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Can I use electrical stimulation for people with SMA (spinal muscle atrophy)?

What type of stimulation I can use?


2 years ago

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Dear Reda and dear Professors

Firstly - sorry for my simple english, never studiyed. Secondly- since over 20 years i help patients with different neurological causes of muscle paresis or paralysis. The cited investigations are not responsible for the answer and in my opinion the protocols were not properly designed. Muscle stimulation for near all patients with paresis or paralysis and certainly for SMA patients as well, should be realised daily, minimum 90 minutes or more if possible. Very important are the stimulation parameters which should be individually designed according to noninvasive surface electromyography (sEMG) investigation. sEMG is the only method that allow for scientific comparison of influence of NMES or FES on muscle and nervous system function or saying more accurately : influence of NMES or FES on nervous system responsibility to manage muscle tension (contraction and relaxation on demand). I never order any stimulation parameters for home use if i do not check the influence of this kind of stimulation on nervous system using sEMG. Usually in neurological patients with CNS damage due accident or illness, the firing freuency and amplitude of motor nerves strong increases, if compared with healthy persons. One can observe it easily in sEMG (unfortunately near never prescribed or executed in those patients). Each volitional movement in this patiens, including those with SMA, will be realised according to the false firing frequency. Fast muscle fibers are activated firstly, slowtwich fibers are very weak due poor vascularisation. Unproper muscle activation can't lead to proper muscle function. Please consider it when doying therapy. Both methods: physical therapy and functional electrostimulation should be obligatory combined! No one stim unit moves patients extremities according to actually functional status and no one PT specialist may deliver to patients nervous system stable firing frequency that allow for stable muscle contraction ! Those stable firing frequency and relaxation time may deliver only programmed stim unit. We should not discuss about how to make muscles stronger but firstly how to achive proper muscle activation pattern in patients brain and spine. It's more about reeducation of nervous system, neuronal plasicity and repair and not about muscle mass. If we create good pattern the other functional properties of muscles are much more easy to achive. Only long time (sometimes over years) consequently, daily administered muscle stimulation with mild, tollerable intensity and low frequency (range 10 - 25 Hz) may lead to increase of muscle vascularisation and "teach" the nervous system to concentrate mostly on S fibers and activate them in the first order. The best way is to execute the volitional movement during active stimulation or, if the patient is able to cooperate, use ETS therapy (electromyographic triggered stimulation). Both methods activate strong the patients brain - the strongest tool which is designed to control an repair the body. The change of art of thinking, concentration on goal and not on disease and change of firing frequency in nervous system using NMES and FES, are in my opinion the milestones on the way to functional improvement. There are thousands of basic research published how the NMES and FES influence on muscle tissue, nerve conductivity, myelination etc.etc. I have read them and just do it in practice with very good results. Wish you the same. Regards Jan

Prof Tim Watson
Prof Tim Watson

Reda. Ther was a fairly recent paper (2013) [Gorgey, A. S., et al. (2013). "Neuromuscular electrical stimulation attenuates thigh skeletal muscles atrophy but not trunk muscles after spinal cord injury." J Electromyogr Kinesiol 23(4): 977-984.] which tested surface NMES stimulation and demonstrated slowing of the muscle atrophy in the thigh (but not trunk) which might be worth a look at - but as Prof Laakso says, it depends on whether you are looking for effect on pain, function, muscle atrophy retardation etc - so this might not be the kind of paper that you are looking for. Any help??? Tim


Dear Reda, Are you proposing to use eStim for pain, or muscle weakness, or something else? Regards, Liisa Laakso

Prof Gad Alon
Prof Gad Alon

The only study I could find was published in 2002 and found that sensory stimulation at night for 6-12 months had no benefit: The study aimed to evaluate the effect of low-intensity night-time therapeutic electrical stimulation (TES) on arm strength and function in children with intermediate type spinal muscular atrophy (SMA). The design was a randomized controlled trial with a 6-month baseline control period. Children were evaluated at baseline, 6, and 12 months. TES was applied from 6 to 12 months to the deltoid and biceps muscle, of a randomly selected arm with the opposite arm receiving a placebo stimulator. Thirteen individuals with SMA between 5 to 19 years of age were recruited into the study and eight completed the 12-month assessment. No statistically significant differences between the treatment and control arm were found at baseline, 6, and 12 months for elbow flexors, or shoulder abductors on quantitative myometry or manual muscle testing. There was no significant change in excitable muscle mass assessed by M-wave amplitudes, nor function on the Pediatric Evaluation of Disability Inventory (self-care domain). Therefore, in this study there was no evidence that TES improved strength in children with SMA.

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