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OUR EXPERIENCE WITH SLOW PULSE STIMULATION IN PATIENTS |
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Terzis,
J. K. and Liberson, W. T. [deceased] |
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Eastern |
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Objective: To share our experience with slow purse stimulation of denervated skeletal muscle in patients that underwent microsurgical repair following devastating lesions of the brachial plexus, in obstetrical paralysis and facial paralysis.
Methodology: A “slow pulse stimulator” was developed by one of the authors [W. L. Liberson] that permits a rational technique for treating denervated muscle. First, slow pulses are calibrated as to their duration so that the latter may be chosen for each individual patient according to his needs. The pulses are delivered automatically at a rate that may be harmless. We are now satisfied with the fact that stimuli succeeding each other at a rate of one during each 10 seconds do not harm the skin if applied for a period of 20 to 30 seconds. The stimulator has a timer limiting sessions to 20 minutes.
In areas where denervated fibers may be mixed with normal muscle fibers, to avoid stimulation of the normal muscles, the use of progressive onset of the stimulating pulses has been successfully employed. A time of onset on the order of 100 or 200 msec indeed suppresses the contraction of the innervated muscles. We limit the total time of stimulation to 5 hours for adults and 3 hours for children. The treatment sessions are 20 minutes each, with an interval of 1 hour in between. The patient is warned never to restimulate an area that remains red following the previous session of stimulation.
We have used this type of “slow pulse stimulation” for the past 15 years in all our patients that have undergone microsurgical reconstruction of the injured brachial plexus, in cases of obstetrical brachial plexus palsy and in selected cases of facial paralysis.
Results: Outcomes of microreconstruction all combined with this form of “slow pulse” electrotherapy will be presented and benefits outlined.
Conclusion: Our technique allows simultaneous stimulation of practically all upper extremity muscles by placing one electrode on the shoulder and the other on the palmar aspect of the fingers.
Although the wisdom of stimulation of denervated muscles has often been challenged, we believe strongly that this does not apply to human denervated muscle. Until new therapeutic procedures are developed to compensate for the loss of the nutrient axon, “slow pulse” electrotherapy is an effective alternative for the treatment of denervated muscle.
Dr. Julia K.
Terzis, MRC
Eastern