Non-Invasive Spinal Electrical Stimulation in Pediatrics 

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 11
Time: 8:00 a.m.- 6.00 p.m. (9 contact hours)

Date: Sunday April 12
Time: 7:30 a.m. – 3:30 p.m. (7 contact hours)

Course Location: SMILE Therapy for Kids Vancouver

Address: 507, 233 Nelson's Crescent, BC V3L 0E4, Canada

Sponsor: EZ Steps Physiotherapy Inc. (DBA: SMILE Therapy For Kids Vancouver)

Course coordinator details: Chelsea Ezzy (Owner, Physiotherapist), email: info@smiletherapyforkidsvancouver.com, phone: +1(604) 351- 2720

Cost:                                                           
Early Bird Discount until March 11, 2026         US$660   
Group Discount (3+)                                     US$660                             
Regular after March 11, 2026                         US$690                     
Registration: Through this Jotform
 

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 trunk stability and upper/ lower 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.

 

CEUs: 16 contact hours

This course has CEU approval in many startes in the USA

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. Define the required stimulation parameters, protocols, and procedures used in pediatrics for electrical stimulation. 
2. Analyze the advantages, limitations, contraindications, and indications for electrical stimulation in managing pediatric patients. 
3. Explain the mechanisms by which functional electrical stimulation (FES) and NISE-Stim impact the peripheral neuromuscular, vascular, skeletal, and central nervous systems. 
4. Demonstrate nerve conduction testing procedures and the application of lower spinal stimulation protocols effectively. 
5. Develop functional electrical stimulation protocols for gait training and illustrate electrode placement for upper spinal stimulation in plexus paralysis. 
6. Evaluate patient suitability for NISE-Stim for neuromotor impairments such as spina bifida and implement treatment effectively. 
7. Train caregivers on how to properly use electrical stimulation at home to optimize outcomes. 
8. Explain the advantages, limitations, contra-indications, and indications for the use of Turtle Bracing for pediatric patients.
9. Fabricate a Turtle Brace and assess the Turtle Brace for good alignment and fit.

                          

 

 

Class Schedule (subject to change)

Day 1

7:30 AM: Start

8:00–8:30 AM: Registration

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

9:30–10:30 AM: Hands–on laboratory I: Sensory vs. muscle activation, twitch vs. tetanic contraction

10:30–11:00 AM: Research

11:00–11:15 AM: Break

11:15 AM–12:00 PM: Electrical excitability testing for peripheral nerve damage, upper and lower extremity, and trunk

12:00–1:00 PM: Introducing surface non-invasive spinal cord stimulation

1:00–1:30 PM: Lunch

1:30–2:30 PM: Demo patient: nerve conduction testing and spinal stimulation treatment

2:30–3:00 PM: Discussion of the evaluation findings and treatment approach

3:00–3:30 PM: Spinal Stimulation for club foot, nerve pain, CP, scoliosis, plexus paralysis, bowel, and bladder

3:30–3:45 PM: Break

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

5:00–6:00 PM: Hands-on Laboratory III: Spinal Electrical Stimulation for upper extremity and trunk for various impairments, spinal stimulation on the sensory level

6:00–6:30 PM: Questions

Day 2 Schedule 

7:30–8:00 AM (30 min): Review of key points

8:00–9:00 AM (60 min): Hands-On Laboratory: NISE-Stim for various impairments

9:00–10:00 AM (60 min): Functional Electrical Stimulation

10:00–10:15 AM (15 min): Break

10:15–11:15 AM (60 min): Hands-On Laboratory: FES for sit-to-stand transitions, bilateral reaching, gait, transitions, crawling, and unilateral reaching

11:15 AM–12:15 PM (60 min): Demonstration patient: assessment and treatment. Discussion of findings and treatment approach

12:15–12:45 PM (30 min): Lunch

12:45–1:45 PM (60 min): Five demonstration patients for class treatment

1:45–2:00 PM (15 min): Feedback on treatment

2:00–2:15 PM (15 min): Break

2:15–3:30 PM (75 min): Turtle Bracing lecture and hands-on fabrication of 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.

 

Please note that in the event of unforeseen circumstances, such as sudden severe illness or canceled flights, that prevent me from attending the course, I will refund the course fee in full. However, I cannot be held responsible for any additional expenses that participants may incur, such as travel or accommodation costs.