Integrating EMG-Triggered-Stimulation, Surface Biofeedback and
Current Exercise Protocols into a Pediatric Practice Model
Karen Pape, MD and Pia Stampe, PT, DPT

May 16 & 17, 2009

Ithaca College Rochester Campus
1100 South Goodman Street
Rochester, NY 14620

Course Description
This new course introduces an integrated approach to disuse muscle atrophy in the pediatric population. The focus is on children and adults with cerebral palsy and brachial plexus injury. However, the core principles are easily transferred to other populations, including generalized hypotonia in children, other nerve injuries, head injury and stroke.

Day 1 - Habit Hides Recovery
In the majority of children with neurological problems, there is significant recovery of the brain and peripheral nerves after injury. The emerging field of neuroplasticity offers new hope and treatment opportunities for both children and adults.

Day 1 explores the key difference between the adult and child models of recovery. After an event, such as a mild stroke, the adult re-learns their normal function. The child, with mild hemiplegia or diplegia, has an abnormal gait for life. The difference is that the child has no concept of our definition of a normal gait. Their gait feels normal to them. There are many therapies and technologies that can produce a short-lived improvement, but the habitual pattern recurs.

When a therapist can achieve normal or near normal movement, the “therapy walk” or the occasional good pincer grasp, that therapist is demonstrating Recovery. When the old walking patterns re-emerge or the child reverts to an ulnar grasp, the Habit Hides Recovery.

Day 1, Lecture 1
All children with a neurological problem have some degree of muscle weakness. The key components of strengthening muscle are Activation, Recruitment, Balance and Muscle Fiber Development. Surface biofeedback can quickly demonstrate Improvements in activation and neural recruitment, documenting the extent of “hidden” recovery. To convert this potential into function we address the issues of muscle balance and fiber development. The array of neuroplastic interventions that address these factors include Kinesiotape, serial casting, splints, Botulinum Toxin injections, Threshold Electrical Stimulation, and prolonged nighttime constraint.

Day 1, Lecture 2
This hands-on lab will teach the use of a simple, single channel surface EMG unit to improve muscle activation and neural recruitment. Studies have demonstrated that children with BPI often have sufficient neural recovery for normal function, but do not know how to turn the muscle ON. Children with CP have similar difficulty turning muscles ON and OFF in sequence. Activation of the correct muscle is easily achieved with this closed loop training method.

Day 1, Lecture 3
Case studies will demonstrate how to use surface EMG Biofeedback in a pediatric practice model. It is a powerful technique to improve motivation and compliance by reliably demonstrating “hidden” potential to parents and teenagers who are tired of therapy. Surface EMG units may also be used to chart the rate and extent of nerve regeneration in children with BPI and adults with other nerve injuries or transfers. Protocols for improving sensory awareness and muscle activation will be demonstrated with case studies.

Day 1, Lecture 4
This lab will familiarize the participants with the dual channel MyoTrac Infiniti NeuroPD and provide protocols for equipment set-up, training ON:OFF, determining activation thresholds and the entry assessment for EMG-STIM training and strengthening.

Day 2 - Creating New Habits
Changing habits is difficult at any age. It is particularly difficult in children who lack the understanding or motivation to change established movement patterns, even though they are capable of better function.

The exercise sciences teach us that humans learn best with short-term, focused interventions or intensives. Whether it is a period of forced use constraint therapy, a post-Botulinum mobilization or a three month strength training protocol, the key to success is preparation. Permanent change takes time, but it is achievable. The evidence for the intensive model is strong with results that are better than the traditional 1-2 times per week therapy model.

Day 2, Lecture 1
The Pediatric Practice Model for Intensive Strength Training starts with a needs assessment. Kinesio taping, TheraTogs, splints and braces can be used during training to improve alignment. The various techniques for tissue release will be discussed as part of the plan prior to training and as part of tissue recovery during the intensive periods. The goals of the intensive program must address the key complaints of the patient and family. The most common complaint is that the children are tired and have poor task endurance. With increasing fatigue, balance and function deteriorates. Protocols addressing the issues of CVS fitness and endurance muscle training with low weight, high repetition closed loop training will be provided.

Day 2, Lecture 2
Lab comparing NMES and EMG-Triggered Stimulation in the pediatric neurological patient. Participants will practice the equipment set-up and use with the MyoTrac Infiniti NeuroPD unit. Patient demonstrations of set-up for use with common placements will be done in the group setting.

Day 2 Lunch – Payment Issues

Day 2, Lecture 3
Not all muscle is the same, even within a diagnostic category. The instructors will lead an interactive discussion of treatment models for Normal, Low Tone and Spastic Muscle with suggested best sequence of treatment. Learn to do the Right Thing, at the Right Time and in the Right Order. Preparation for sessions of Forced use with Constraint Therapy, the Euro-Peds Program, the Thera Suit, Robotics, FES, and/or Brain Training with Visualization and Virtual Reality improves the therapeutic benefit of each technique. In some cases, strengthening intensives are all that is needed to gain the desired goals.

Not sure this course is for you?
Call or email either of the instructors with your questions.
1-877-827-2242
info@tascnetwork.net

Course participants will be eligible for a 10% discount on all products purchased at the course. For more information call or write.

Phone: (585) 427-2580
Toll-free: (877) 427-2580
Fax: (585) 427-7410
Email: sales@advancedmusclestimulators.com

To register, please contact info@tascnetwork.net or call 1-877-827-2242 or
Download the brochure