Deck 13: Neuromuscular Electrical Stimulation

Question 1

What is meant by the term "balanced movement"?

A)When both the right and left sides have the same strength
B)When both the agonist and the antagonist have the same strength
C)When movement of a joint most closely approximates functional movement
D)When the patient is unsupported and able to provide joint movement

Answer 1

C

Question 2

Which of the following terms is used to describe the use of electrical stimulation for pain management with portable stimulators?

A)Electrical stimulation
B)Transcutaneous electrical nerve stimulation
C)Functional electrical stimulation
D)Neuromuscular electrical stimulation

Answer 2

B

Question 3

What would be the rationale behind using NMES to reduce muscle guarding?

A)NMES is so uncomfortable that it should not be used to reduce muscle guarding.
B)NMES stimulates sensory nerve fibers to reduce muscle guarding.
C)NMES causes muscle strengthening, which promotes fatigue.
D)NMES causes a rapid rate of muscle fatigue.

Answer 3

D

Question 4

Which of the following statements is most accurate regarding electrically induced muscle contraction?

A)The use of higher frequencies leads to more rapid fatigue.
B)The use of higher frequencies leads to slower fatigue.
C)The use of lower frequencies leads to more rapid fatigue.
D)There is no relationship between the frequency used and the rate of fatigue with an electrically induced muscle contraction.

Question 5

What is the relationship between frequency and the quality of a motor response?

A)When the frequency is higher than 50 Hz, the quality of the motor response is less than optimal.
B)When the frequency is lower than 50 Hz, the quality of the motor response is optimal for most large muscles.
C)When the frequency is 50 Hz, the quality of the motor response is optimal for most large muscles.
D)Frequency and the quality of motor response are not related to each other.

Question 6

Which of the following statements is most accurate regarding the use of NMES for edema reduction?

A)NMES has been shown to enhance edema reduction.
B)NMES can be an effective adjunct to standard interventions to reduce edema.
C)NMES is contraindicated in the presence of edema.
D)NMES is a precaution in the presence of edema.

Question 7

What is the minimum requirement from a patient for NMES?

A)A willingness to have NMES applied to elicit a response
B)A partially intact peripheral nerve to respond
C)A muscle to respond
D)All of the above

Question 8

Which of the following statements is most accurate regarding NMES and isometric muscle contraction?

A)There was no difference between volitional isometric strength gains and NMES isometric strength gains.
B)Superior isometric strength has been accomplished with NMES in comparison to volitional isometric contraction strength gains.
C)Simultaneous stimulation of the agonists and antagonists is discouraged with the use of NMES for muscle contraction.
D)Patients receiving NMES should be permitted to move through the entire available range of motion for the therapeutic exercise that is augmented by the NMES.

Question 9

When comparing a motor nerve to a sensory nerve on a strength duration curve, how long would the pulse duration need to be to elicit a response from a motor nerve as compared to the duration needed to elicit a response from a sensory nerve?

A)Longer
B)Shorter
C)Both types of nerves have the same requirements for pulse duration.
D)The pulse duration is irrelevant if the amplitude is increased.

Question 10

Appropriate timing modulation for electrically elicited muscle contractions can facilitate the accomplishment of therapeutic treatment goals. Which of the following would be considered a more appropriate form of documentation for the on-off ratio of electrical stimulation, and why?

A)1:5 for 15 minutes since both the ratio and treatment time are included.
B)10 contractions in 15 minutes since both the number of contractions and treatment time are included.
C)2 seconds on, 10 seconds off or 1:5 for 15 minutes since contraction times, relaxation times, and the treatment times are all included.
D)20% duty factor for 15 minutes since the percentage of overall on time and the treatment time is included.

Question 11

A patient was evaluated several months ago for a denervating injury as a result of a stabbing incident. When the strength duration (SD) curve from today is compared with the first SD curve, there is a marked migration of all of the fibers from the upper right hand corner down toward the lower left. What does this imply?

A)The patient is regressing.
B)The patient is progressing, but the nerves are not recovering.
C)The patient is a malingerer or symptom magnifier.
D)The patient is progressing nicely, and the nerves are recovering.

Question 12

For patients who are obese, it may not be possible to achieve the desired muscle response with NMES. Why?

A)Patients who are obese do not have enough muscle mass to be stimulated with electrical stimulation.
B)The statement is false.
C)The motor nerve may be too "insulated" by the intervening layer of adipose to allow sufficient stimulation without painful stimulation of the sensory nerves in the skin.
D)The depth of the myoneural junction in patients with significant adipose is prohibitively deeper than in patients who are not obese, making stimulation of the motor nerve virtually impossible.

Question 13

When stimulating weakened muscles, careful attention to limb position can take advantage of the length-tension relationship to enhance muscular performance. Which of the following positions would be best to enhance the contraction of weakened quadriceps, while also enabling stabilization so that an isometric contraction is elicited?

A)Supine with the hip and knee flexed to 90 degrees
B)Semi-reclined with a bolster under the knee
C)Sitting with the hip and knee flexed to 90 degrees
D)Semi-reclined with the knee in 0 degrees of extension

Question 14

Which of the following terms is used to describe the use of electrical stimulation to facilitate muscle contractions for the purpose of performing an activity?

A)Electrical stimulation
B)Transcutaneous electrical nerve stimulation
C)Functional electrical stimulation
D)Neuromuscular electrical stimulation

Question 15

Which of the following terms is used to describe the use of electrical stimulation for activation of muscle through stimulation of the intact peripheral nerve?

A)Electrical stimulation
B)Transcutaneous electrical nerve stimulation
C)Functional electrical stimulation
D)Neuromuscular electrical stimulation

Question 16

Conventional exercise programs to increase strength are based on the overload principle of eliciting a small number of high-intensity contractions in an intervention session performed several times a week for a couple of weeks. How does NMES for the augmentation of strength differ from this?

A)NMES cannot be used to augment strength.
B)NMES uses electrical stimulation to help elicit the muscle contractions to augment muscle strength.
C)NMES is not capable of eliciting enough of a muscle contraction to augment muscle strength.
D)NMES needs to be performed for only 10 contractions to augment muscle strength.

Question 17

According to a normal strength duration (SD) curve, what would be the first sensation that a patient would perceive as the intensity was slowly increased and if the pulse duration of the stimulator was set at 250 $\mu$ sec (250 microseconds)?

A)Pain
B)A muscle twitch or contraction
C)An achy sensation
D)Pins and needles or tingling

Question 18

Which of the following would be considered a contraindication to the use of NMES?

A)Pregnancy
B)Presence of a cardiac pacemaker
C)Superficial metal implants
D)Impaired or absent skin sensation

Question 19

Which statement is most accurate regarding the difference between an electrically elicited muscle contraction and a voluntarily elicited muscle contraction?

A)Electrically elicited contractions recruit large superficial motor units first.
B)Electrically elicited contractions recruit small superficial motor units first.
C)Electrically elicited contractions recruit large deep motor units first.
D)Electrically elicited contractions recruit small deep motor units first.

Question 20

Following a neurological injury or surgical procedure, a patient may have difficulty initiating movement in a muscle group. Of what potential benefit is NMES, and why?

A)NMES will potentially elicit an isometric contraction but has not been shown to be of benefit for motor learning.
B)NMES will only initiate a contraction but has not shown carryover to voluntary contraction or motor learning.
C)NMES can enhance the voluntary contraction and increase CNS feedback and motor learning.
D)NMES provides no potential benefit.