Newest Treatments in Pediatrics Using Surface Spinal and Functional Electrical Stimulation 

NISE-Stim Certification Part1

by Gerti Motavalli

For PTs, PTAs, OTs

“This course content is not intended for use by any participants outside the scope of their license or regulation.”

Presented by: Gerti Motavalli, MPT
Date: Saturday April 5, 2025
Time: 8:30 a.m.- 6.30 p.m. (9 contact hours)

Date: Sunday April 6, 2025
Time: 8:00 a.m. – 4:00 p.m. (7 contact hours)

Course Location: Shriners Hospitals for Children Chicago:

2211 N Oak Park Ave., Chicago, IL, 60707.

 

CEUs: 16 contact hours

 “The Illinois Chapter Continuing Education Committee has approved this course according to the Criteria for Approval of Continuing Education offerings established by the Illinois Physical Therapy Association.”                                                                
Early Bird Discount until March 5, 2025         $460   
Group Discount (3+)                                   $460                             
Regular after March 5, 2025                         $490                     
Registration: Through this Jotform
 
Hosted by: Shriners Hospitals for Children Chicago

Course Coordinator: Elena Zumbuleva, 773-385-5873, Elena.Zumbuleva@shrinenet.org

 

Course Description:This 16-hour course is designed for physical therapists and other clinicians interested in the most advanced application of non-invasive electrical spinal stimulation to maximize clinical outcomes in children with spinal bifida, spinal cord injuries, plexus paralysis, CP and other neuromotor impairments. A portion of the course will focus on implementing the most effective treatment plans for improving gait, trunk control and upper extremity control through functional electrical stimulation. There will be instructions on testing muscle-nerve functioning, finding the best parameters for treatment and advancing treatment. “Hand’s On” sessions and videos of actual clinical cases will also be presented. It is the first course in the 3-part series to achieve certification in NISE-Stim (Non-Invasive Spinal Electrical Stimulation).

The Turtle Bracing concept will be presented as well. It allows the therapist to fabricate quick, custom molded, inexpensive bracing to UE, LE and trunk which can be remolded and adjusted to growth and fit many times.

NO PREVIOUS KNOWLEDGE OF ELECTRICAL STIMULATION IS NEEDED, BUT CLINICAL KNOWLEDGE IS NECESSARY!

A Chattanooga Continuum or EMPI Continuum e-stim unit will be used for the course. The presenter will bring enough units and electrodes for up to 30 participants.

Biography:
Gerti Motavalli, MPT has worked for 40 years as a pediatric PT in Germany, India, and the USA. Together with Dr Gad Alon, PhD. PT, a world renowned researcher in the field of electrical stimulation, she developed the first surface spinal electrical stimulation protocol for children with Spina Bifida. The findings have been published in the research journal, Child Neurology Open and presented as a poster at the Pediatric Physical Therapy Conference (CSM) in the USA. Gerti Motavalli presented at the Spina Bifida World Conference in March, 2023 in Tucson, AZ. She is now treating children with Spina Bifida and other imaprments in person and via online platforms across the world. Many of her previous course participants are successfully expanding the use of spinal electrical stimulation for patients with various central and peripheral impairments.

Program Objectives:
1. Explain the required stimulation parameters and appropriate protocols/procedures used in pediatrics.

2. Describe the advantages, limitations, contra-indications, and indications for the use of electrical stimulation in the management of pediatric patients.

3. Discuss the various mechanisms by which functional electrical stimulation and spinal electrical stimulation can affect the peripheral neuromuscular, peripheral vascular, skeletal as well as central nervous systems.

4. Describe the procedures for nerve conduction testing.

5. Explain the application of lower spinal stimulation protocols and procedures.

6. Describe how to implement functional electrical stimulation in gait.

7. Explain electrode placement for plexus paralysis using upper spinal stimulation.

8. Select appropriate patients and implement surface spinal electrical stimulation in children with spina bifida or other neuromotor impairments.

9. Advise caregivers how to properly use the stimulation at home in to achieve more effective and efficient outcome.   

10. Explain the advantages, limitations, contra-indications, and indications for the use of Turtle Bracing for pediatric patients.

11. Fabricate a Turtle Brace and assess the Turtle Brace for good alignment and fit.                                                            

 

 

Class Schedule (subject to change)

 

Sat April 5:

8.00-8.30 Registration 

8:30-9:30     (60 min) Electrical stimulation technology (electrical parameters, electrodes,). What we must know about the stimulation systems

9:30-10:30   (60 min) Hands–on laboratory I: Sensory vs. muscle activation, twitch vs. tetanic contraction

10:30-11:00 (30 min) Research

11:00-11:15       Break               

11:15-12:00  (45 min) Electrical excitability testing for peripheral nerve damage, upper and lower extremity and trunk

12:000-1:00 (60 min) Introducing surface non-invasive spinal cord stimulation

1:00-1:30   (30 min) Lunch

1:30-2:30     (60 min) Demo patient: nerve conduction testing and spinal stimulation treatment

2:30-3:00     (30 min) Discussion of the evaluation findings, and treatment approach

3:00-3:30     (30 min) Spinal Stimulation for club foot, nerve pain, CP, scoliosis, plexus paralysis, bowel, and bladder   

3:30-3:45     (15 min) Break   

3:45-5:00     (75 min) Hands–on laboratory II: Various placements and settings for surface non-invasive spinal cord stimulation lower extremity, spinal stimulation on sensory level

5:00-6:00    (60 min) Hands-on Laboratory: Spinal Electrical Stimulation for UE and trunk for various impairments, spinal stimulation on the sensory level

6:00-6:30     (30min) Questions 

 

Day 2 Schedule 

8:00-8:30     (30) Review of key points

9:30-10:30   (60) Functional Electrical Stimulation

10:30-10:45  Break

10:45-11:45.  (60 min) Hands-On Laboratory: FES for sit to stand transitions, or bilat reaching , gait, transitions, crawling, unilateral reaching

11:45-12:45.  (60 min) Demonstration patient, assessment and treatment. Discussions of findings and treatment approach

12:45-1:15  Lunch

1:15-2:15     (60 min) Five demonstration patients for class treatment

2:15-2:30    (15 min) Feedback of treatment

2:30-2:45   Break

2:45-4:00  (75 min)Turtle Bracing lecture and hands on fabrication od Turtle Braces

 

 

Research:
Motavalli, Gerti, Jan J. McElroy, and Gad Alon. "An exploratory electrical stimulation protocol in the management of an infant with spina bifida: a case report." Child Neurology Open 6 (2019): 2329048X19835656.

Goutam Singh, PT, PhD; Anastasia Keller, PhD; et al.
Safety and Feasibility of Cervical and Thoracic Transcutaneous Spinal Cord Stimulation to Improve Hand Motor Function in Children With Chronic Spinal Cord Injury. Neuromodulation 4/2023, https://doi.org/10.1016/j.neurom.2023.04.475

Kristin Girshin 1,2, Rahul Sachdeva, et al. Spinal Cord Neuromodulation to treat Cerebral Palsy in Pediatrics: POUNCE Multiside Randomized Clinical Trial 6/2023 Frontiers in Neuroscience, 10.3389/fnins.2023.1221809

James J. Laskin, Zeina Waheed,et al. Spinal Cord Stimulation Research in the Restoration of Motor, Sensory, and Autonomic Function for Individuals Living With Spinal Cord Injuries: A Scoping Review, Archives of Physical Medicine and Rehabilitation 2022;103: 1387-97, http://www.archives-pmr.org/

Parag N. Gad, Evgeniy Kreydin, Non-invasive Neuromodulation of Spinal Cord Restores Lower Urinary Tract Function After Paralysis, Frontiers in Neuroscience, doi: 10.3389/fnins.2018.00432

Samejima, S. Caskey, C. D. Inanici, F. Multisite Transcutaneous Spinal Stimulation for Walking and        Autonomic Recovery in Motor-Incomplete Tetraplegia: A Single-Subject Design. Phys Ther 2022;102: DOI10.1093/ptj/pzab228.

Anastasia Keller1,2, Goutam Singh 1,2, et al. Noninvasive spinal stimulation safely enables upright posture in children with spinal cord injury NATURE COMMUNICATIONS https://doi.org/10.1038/s41467-021-26026-z

Solopova IA, Sukhotina IA, Zhvansky DS, et al. Effects of spinal cord stimulation on motor functions in children with cerebral palsy. Neurosci Lett. 2017;639:192-198.

Krucoff MO, Rahimpour S, Slutzky MW, Edgerton VR, Turner DA. Enhancing Nervous System Recovery through Neurobiologics, Neural Interface Training, and Neurorehabilitation. Front Neurosci. 2016;10:584.

Gerasimenko Y, Gad P, Sayenko D, et al. Integration of sensory, spinal, and volitional descending inputs in regulation of human locomotion. J Neurophysiol. 2016;116(1):98-105.

Lee NG, Andrews E, Rosoklija I, et al. The effect of spinal cord level on sexual function in the spina bifida population. J Pediatr Urol. 2015;11(3):142 e141-146.

Sayenko DG, Atkinson DA, Floyd TC, et al. Effects of paired transcutaneous electrical stimulation delivered at single and dual sites over lumbosacral spinal cord. Neurosci Lett.2015;609:229-234.

Shideler, B.L., et al., Toward a hybrid exoskeleton for crouch gait in children with cerebral palsy: neuromuscular electrical stimulation for improved knee extension. J Neuroeng Rehabil, 2020.