Patient Cases for treating impairments using NMES
Electrotherapy Lab Practice Problems
1. OUTPATIENT SETTING: Patient is 55 yr old female with L CVA 3 weeks ago with persistent symptoms of difficulty
performing voluntary wrist & finger extension on the R. with some mild spasticity in the wrist/finger flexors.
Rx: NMES program to improve voluntary extension motion in the wrist AND fingers via muscle re-education.
Note: What approach could you take to Rx the spasticity more directly, or in combination with the extensors?
1. Patient position 2. electrode placement (target area) 3. # of channels & electrodes 4. NMES mode / Type of contraction 5. Rx Time 6. Options -
2. OUTPATIENT SETTING: Patient is 30 yr old male with healed fx of the radial head (required ORIF) on the L; there
was a long period of immobilization. Therapy for the last 10 days has focused on regaining full elbow extension
ROM via joint mobilization and AAROM/PROM stretching, but the patient still have a 20° loss of full extension.
Pain with treatment is tolerable thus far and has to be pushed through. You decide to add the use of NMES to
do some PROM stretching of elbow extension, perhaps even with weighted gravity asstd stretching - - first in the
clinic and then will consider home use.
Rx: NMES program to stretch the elbow into extension ROM.
1. Patient position 2. electrode placement (target area) 3. # of channels & electrodes 4. NMES mode / Type of contraction 5. Rx Time 6. Options -
3. OUTPATIENT SETTING: Patient is 45 yr old female who is 3.5 wks post-injury of the L shoulder due to lifting a
heavy object; specifically a middle deltoid strain. Overprotection during the most painful period of recovery has
resulted in weak shoulder abduction (3-/5 MMT); however, passive ROM is close to normal and pain is minimal
(1/10).
Rx: NMES program, combined with voluntary exercise, to strengthen the middle deltoid.
1. Patient position 2. electrode placement (target area) 3. # of channels & electrodes 4. NMES mode / Type of contraction 5. Rx Time 6. Options -
4. CONTRACT PT IN INDUSTRIAL SETTING: Patient is 56 yr old male who is 4 wks post-injury of the R knee due to a
twisting injury (sprain) at work, RICE self-Rx was performed acutely and patient was placed on light duty; patient
was largely non-compliant with therapeutic strengthening exercise. Now pt is unable to return to regular duties
b/c of weak knee extension (MMT grade is 3+/5) & a lot of difficulty achieving terminal knee extension vs gravity
(due to weakness). Passive ROM is WNL. Atrophy is present but motor control of quads is satisfactory.
Rx: NMES program to strengthen knee extension.
Why emphasize strengthening & not re-education?
1. Patient position 2. electrode placement (target area) 3. # of channels & electrodes 4. NMES mode / Type of contraction 5. Rx Time 6. Options -
5. OUTPATIENT SETTING: Patient is 70 yr old male who suffered a stroke 10 days ago. Chief problem is impaired L
UE function. Examination reveals difficulty with voluntary finger, wrist & elbow extension with mild spasticity in
the finger, wrist & elbow flexors. Slow PROM of the elbow, wrist, & fingers is WNL.
Rx: NMES program to facilitate and re-educate the elbow, wrist, and finger extensors. Also refer to approach
taken in case #1.
1. Patient position 2. electrode placement (target area) 3. # of channels & electrodes 4. NMES mode / Type of contraction 5. Rx Time 6. Options -
6. OUTPATIENT SETTING: Patient is 48 year old female with mild L hemiparesis 2° to a stroke one week ago.
Examination reveals very weak and incomplete voluntary dorsi-flexion at the ankle. There is very mild spasticity
in the plantarflexors. The patient sometimes exhibits a footslap, and sometimes a forefoot-first initial contact with
gait. No pain is present and passive ROM is WNL.
Rx: NMES program to re-educate/strengthen the ankle dorsiflexors.
Why emphasize re-education first?
1. Patient position 2. electrode placement (target area) 3. # of channels & electrodes 4. NMES mode / Type of contraction 5. Rx Time 6. Options Alternate Rx: Fit the patient with a heel switch in the shoe to stimulate the weak dorsiflexors during ambulation.
This treatment uses NMES as a substitute for an AFO (ankle-foot orthosis). This is an example of functional
electrical stimulation (FES).
7. OUTPATIENT SETTING: Patient is 15 yr old female who had patellar dislocation at the R knee 2.5 weeks ago.
Splint, crutches, and WBAT gait was prescribed at the ER. Additional appropriate follow-up care was not
received. Examination reveals active extension of the knee lacking 25°; however, passive extension is 0
degrees. Pt. also exhibits poor motor control of the quadriceps with quad sets.
Rx: NMES muscle re-education program to regain the final 20 degrees of knee extension.
Why emphasize re-education & not strengthening?
1. Patient position 2. electrode placement (target area) 3. # of channels & electrodes 4. NMES mode / Type of contraction 5. Rx Time 6. Options -
8. OUTPATIENT SETTING: Patient is 16 yr old male with 2nd degree strain of the R triceps which occurred during
weight training 3 weeks ago. An arm sling was self-prescribed and used for 1 week but the patient did very little
to mprove arm function and strength since then. Examination reveals a MMT grade of 3+/5 with mild pain.
Passive elbow ROM is overall WNL.
Rx: NMES program to increase strength in elbow extension.
Why emphasize strengthening & not re-education?
1. Patient position 2. electrode placement (target area) 3. # of channels & electrodes 4. NMES mode / Type of contraction 5. Rx Time 6. Options -
9. INDUSTRIAL / WORK SETTING: Patient is 35 yr old male with lumbar muscle strain which occurred when lifting a
heavy object 2 days ago. Examination reveals muscle spasms in the lumbar paraspinals bilaterally which are
painful to palpation. Forward and lateral bending and rotation of the spine is very limited due to the spasms and
pain.
Rx: NMES program to decrease the muscle spasms.
1. Patient position 2. electrode placement (target area) 3. # of channels & electrodes 4. NMES mode / Type of contraction 5. Rx Time 6. Options -
10. OUTREACH / PRO BONO SETTING: Patient is 22 yr old female with subacute whiplash injury from a rear-end MVA.
Examination reveals limited neck ROM in all planes with pain. Bilateral muscle spasms in the posterior cervical
region are tender to palpation.
Rx: NMES program to decrease the muscle spasms.
1. Patient position 2. electrode placement (target area) 3. # of channels & electrodes 4. NMES mode / Type of contraction 5. Rx Time 6. Options -
11. HOME/PRO BONO: Patient is 32 yr old female in her 7th month of pregnancy with lower leg and foot edema
(worse on the R). The foot and ankle are swollen sufficiently to cause limited ankle motion.
Rx: NMES program to increase vascular flow in the lower leg and foot, combined with proper positioning,
relative to gravity, and edema massage.
1. Patient position 2. electrode placement (target area) 3. # of channels & electrodes 4. NMES mode / Type of contraction 5. Rx Time 6. Options -
12. OUTREACH / PRO BONO SETTING: Patient with 1+° strain of the R gastrocnemius muscle and a R knee sprain which
occurred 8 days ago during basketball play. Both plantarflexion and dorsiflexion AROM (causing contraction and
stretching of ms.) cause mild pain in the gastroc muscle (2/10). Chief complaint is spasm of the gastroc even
with light walking activities. Muscle spasms in both heads of the gastrocnemius are tender to palpation. You
suspect that the patient may have some posterior meniscal damage in the knee which can cause persistent
guarding and spasm in the gastroc.
Rx: NMES program to decrease the muscle spasms.
1. Patient position 2. electrode placement (target area) 3. # of channels & electrodes 4. NMES mode / Type of contraction 5. Rx Time 6. Options -