 |
|
 |
|
|
|
| |
Changing Habits with EMG+STIM
(email a question)
|
| |
|
Q: I have read the information about the new MyoTrac Infiniti Neuro PD and am excited to try the EMG triggered stimulation. I think it will be appropriate for many of the children seen in our clinic. I use NMES on a regular basis in therapy sessions to teach improved motor control. I find the trigger helpful in both gait and upper limb work. Can I use an external trigger with this machine?
Response: The short answer is NO. The longer answer is that you do not have to use an external trigger because the child is triggering the stimulation with its own brain. The child attempts the movement and the unit sensors pick up the resulting EMG signal. When the child reaches a threshold, the stimulation comes on and helps complete the movement. It is closed loop training and is far more effective than an externally applied zap. If you read the book, The Brain that Changes Itself by Dr. Norman Doidge, you will understand that modern neuroscience teaches an improved approach to changing established movement patterns. Book Review of The Brain that Changes Itself.
Using gait as an example, the child learns their own movement pattern that is established in their brain as a movement map. As they practice it, all the neural connections become facilitated. I call this Habit. Dr. Doidge says, “Neurons that fire together, wire together”. It is very hard to change this movement map. Focusing on the walking movement actually strengthens the abnormal pattern. Standing and walking activates the habitual walk. Using an external trigger to modify the gait will have some changes in the clinic, but it is unlikely to have much carryover. You see the same type of reinforcement when children are taught to use a treadmill for cardiovascular fitness. The speed is turned up…to make them work…and the gait deteriorates. In fact, they are now learning how to “do bad better”.
The neuroplastic way would be to create a new movement map by practicing the components of movement in a different environment.
The EMG+STIM treatment paradigm has the child developing new movement habits by teaching awareness and then strengthening. These movements, such as dorsiflexion to allow heel strike, are wired into the brain by multiple repetitions. It is important that these training sessions are done out of gravity, seated or lying, not standing and walking. The children find this type of training engaging and fun. They see and feel their bodies moving the right way. This focus is part of what consolidates the new neural pathway. Once the child’s brain has the normal patterns wired and strengthened, then they will put them together into a new movement map. To quote Dr. Doidge again, “This new circuit can eventually compete with the older one, and according to use it or lose it, the pathological networks will weaken. With this treatment we don’t so much “break” bad habits as replace bad behaviors with better ones.”
Dr. Doidge is talking about changing mental behaviors. When we try to change body movements, the child has a big advantage. The human body is designed to work in a “best possible” manner. Children with neural problems do not normally experience what we think of as normal. With the power of EMG+STIM, they experience our normal and learn to use it. In some children, just one session is enough to make a measurable change.
|
|
|
|
