Practical 2

Question 1

What are the different Purposes NMES is used for?

Answer 1

• Muscle Weakness
• Shoulder Subluxation
• Tendon Excursion (tendon gliding)
• Spasticity/Muscle Spasm

Question 2

What is the appropriate pulse rates/frequency with NMES for Muscle Weakness?

Answer 2

25-35pps (Hz)

Question 3

What is the appropriate pulse rate/frequency with NMES for Shoulder Subluxation?

Answer 3

25-50pps (Hz)

Question 4

What is the appropriate pulse rate/frequency with NMES for Tendon Excursions?

Answer 4

25-50pps (Hz)

Question 5

What is the appropriate pulse rate/frequency with NMES for Spasticity?

Answer 5

30-60pps (Hz)

Question 6

What is the appropriate pulse rate/frequency with NMES for Muscle Spasms?

Answer 6

30-60pps (Hz)

Question 7

What is the appropriate pulse duration with NMES for Muscle Weakness?

Answer 7

300 us

Question 8

What is the appropriate pulse duration with NMES for Shoulder Subluxation?

Answer 8

200-300 us

Question 9

What is the appropriate pulse duration with NMES for Tendon Excursion?

Answer 9

200-300 us

Question 10

What is the appropriate pulse duration with NMES for Muscle Spasms?

Answer 10

300 us

Question 11

What is the appropriate pulse duration with NMES for Spasticity?

Answer 11

300 us

Question 12

What is the On/Off Ratio for Muscle Weakness?

Answer 12

1:2

Question 13

What is the On/Off Ratio for Shoulder Subluxation?

Answer 13

1:3

Question 14

What is the On/Off Ratio for Tendon Excursion?

Answer 14

1:3

Question 15

What is the On/Off Ratio for Muscle Spams?

Answer 15

1:1

Question 16

What is the appropriate On/Off Ratio for Spasticity?

Answer 16

1:1

Question 17

For TENS, what is the appropriate Pulse Rate/Frequency for the Sensory Level?

Answer 17

80-100pps (Hz)

Question 18

For TENS, what is the appropriate Pulse Rate/Frequency for the Motor Level?

Answer 18

2-10pps (Hz)

Question 19

For TENS, what is the appropriate Pulse Duration for the Sensory Level?

Answer 19

50-100 us

Question 20

For TENS, what is the appropriate Pulse Duration for the Motor Level?

Answer 20

150-200 us

Question 21

For TENS, what type of Pain is experienced at the Sensory Level?

Answer 21

Acute pain

Question 22

For TENS, what type of Pain is experienced at the Motor Level?

Answer 22

Chronic pain

Question 23

Client comes in with a Shoulder Subluxation. What do you do? Why? Settings? Placement?

Answer 23

NMES: Reduce shoulder pain & facilitate neuromuscular reeducation (thereby reducing the subluxation).

Waveform: Asymmetrical
Pulse Rate: 25–50pps
Pulse Duration: 200–300 us
On/off Ratio: 1:3

Place negative cathode over Rear-deltoid & positive anode over Supraspinatus.

Question 24

Client comes in with Wrist Extensor Weakness s/p CVA. What do you do? Why? Settings? Placement?

Answer 24

NMES: Increase muscle strength; neuromuscular reeducation.

Waveform: Asymmetrical
Pulse Rate: 25–35pps
Pulse Duration: 300 us
On/off Ratio: 1:2

Placed over extensors & posterior wrist.

Question 25

Client comes in with Radial Nerve Palsy. What do you do? Why? Settings? Placement?

Answer 25

NMES: Neuromuscular reeducation (treating muscle weakness) Waveform: Asymmetrical Pulse Rate: 25-35pps Pulse Duration: 300 us On/off Ratio: 1:2 Placed over extensors & posterior wrist.

Question 26

Client comes in with Shoulder Subluxation–what do you do? Why? Settings? Placement?

Answer 26

NMES: Reduce shoulder pain; facilitate neuromuscular reeducation (reducing subluxation). Waveform: Asymmetrical Pulse Rate: 25–50pps Pulse Duration: 200-300 us On/off Ratio: 1:3 Placement: Negative cathode over Rear-deltoid & positive anode over Supraspinatus.

Question 27

Client comes in with L RF zone II flexor tendon injury 7 weeks post-op (difficulty with 4th DIP). What do you do? Why? Settings? Placement?

Answer 27

NMES: Neuromuscular reeducation & tendon gliding/excursion (after 5wks). Waveform: Asymmetrical Pulse Rate: 25–50pps Pulse Duration: 200–300 us On/off Ratio: 1:3 Placement: Pinky-side extensors.

Question 28

Client comes in with complaints of pain in her Volar forearm s/p MVA. What do you do? Why? Settings?

Answer 28

TENS: Pain reduction–temporary relief (via distraction). If Acute pain–Sensory Level: Pulse Rate: 80–100pps Pulse Duration 50–100 us If Chronic pain–Motor Level: Pulse Rate: 2–10pps Pulse Duration: 150–200 us

Question 29

Interventions for Shoulder Subluxation?

Answer 29

Intention: Promote movement of shoulder joint, bringing the head of the humerus closer to correct placement. Intervention: * Towel Slides/Wall Walks * Occupation-based: Meal prepping: reaching to grab cans, Tupperware, dishes, etc.

Question 30

Contraindications of E-Stem?

Answer 30

* Pregnancy (pelvis, trunk, lower back). * Pacemaker or other cardiac implants. * Peripheral vascular disease * Hyper/hypotensive patients * Heart abnormalities * Cancer, infection, hemorrhage

Question 31

Precautions of using E-Stem?

Answer 31

* Metal * Osteoporosis * Cognitive impairments * SCI-Autonomic Dysreflexia * Seizures

Question 32

Interventions for Left Wrist Extensor Weakness s/p CVA?

Answer 32

Intention: Increase muscle weakness & ROM * Occupation-based: Folding laundry * Wrist maze

Question 33

Interventions for Radial Nerve Palsy?

Answer 33

Intention: Neuromuscular reeducation of wrist extension. * Occupation-based: Brushing hair/teeth * Spilling the cup (Oops, I did it again) * AAROM * Mirror therapy

Question 34

Interventions for L RF zone II flexor tendon injury 7 wks post-op?

Answer 34

Intention: Neuromuscular reeducation. * Occupation-based: Picking up cotton balls, paper, socks, pens, etc. * Making a fist while using NMES

Question 35

Intervention for Pain management in volar forearm s/p MVA?

Answer 35

Intention: Pain management, proprioceptive input; *ask how long ago injury was, pain has been present. * Ball rolls on table * Towel slides on table

Question 35

Intervention for Pain management in volar forearm s/p MVA?

Answer 35

Intention: Pain management, proprioceptive input; *ask how long ago injury was, pain has been present. * Ball rolls on table * Towel slides on table

Question 36

Where would you place electrodes for Thumb IP flexion difficulties?

Answer 36

Volar mid-forearm radial side

Question 37

How would you describe Gate Control Theory to a client?

Answer 37

Think about very hot water being poured on you. What we're doing is adding cold water to the hot water, diluting the hot temperature of the water, lessening the pain.

Question 38

How would you describe the feeling of TENS to the pt?

Answer 38

Prickling & tingling

Question 39

How would you describe the feeling of NMES to the pt?

Answer 39

Tingling with a muscle contraction