DPT - Virginia Commonwealth University - Agents
Exam Study Guide and Practice Questions
1. Direct bene�ts of -facilitation of muscle contraction for enhancement of force production/hyper-
NMES trophy
2. NMES re-educa- it takes several weeks for actual hypertrophy but early strength changes are
tion of muscle documented are thought to be due to neural changes in recruitment
3. Indirect bene�ts of -increase blood �ow
NMES -improved venous and lymphatic drainage for swelling
4. Evidence on NMES - Found statistically signi cant treatment e ect in quad strength, self-reported
post ACL function but not with functional outcomes
- Found that NMES in addition to exercise may speed up quad strength recov-
ery
- However, there are inconsistencies with dosage
-Maximum intensity the patient can tolerate as well as starting NMES early in
rehabilitation produces greater gains
5. Evidence of NMES groups with high intensity NMES and high low intensity NMES showed signi -
for strengthening cantly greater gains in strength (Russian for 15 contractions 3 days a week for
of the Quads post 6 weeks 75bbs at max intensity tolerated)
ACL Repair
6. Evidence on - Found that NMES statistically improves quad strength
NMES post - Some studies also reported improvements in functional outcomes such as
knee arthroscopy squats, lateral step ups and ADL scores
surgery
7. Evidence on NMES - Initiated NMES 3-4 weeks post surgery and found that strength in the quad
for strengthening on the surgical side surpassed the strength of the uninvolved leg at six months
post TKA (statistically signi cant increase at 3, 6, and 12 months post op)
- However, other research studies found no statistical di erence between treat-
ment and control
, -Change in strength was related to the amount of intensity tolerated by the
patient
8. Evidence summa- - Can produce greater strength gains if treated with adequate dosage and
ry for NMES use started early
with ACL and TKA - Intensity needs to be as high as patient can tolerate
- Found that functional gains to be less conclusive
9. Evidence for Estim - Looking at grip and pinch strength and hand muscle function and endurance
to improve mus- - Found signi cant increase in muscle strength and fatigue resistance, but
cle function in pa- evidence had many limitation (need for more research)
tients with RA
10. Evidence on FES - Found no di erence between treatment and control gorup
for motor training - However, research recommended increasing dosage (at least double) to see
of UE post CVA if there is a di erence
11. Evidence on NMES - Used parastep system that stimulates the quad and glut max in paraplegics
for stimulation of patients to allow them to stand and walk
Paralyzed Muscles - Some suggest that NMES does increase voluntary strength in partially para-
(not de-nervated lyzed muscles following SCI (need more research to see how it compares to
muscles) traditional strengthening)
12. Bene�t for NMES -osteoporosis prevention
for Patients with -kidney function
SCI -psychological
-ROM/Contractures
13. Ways to use NMES - Stimulated directly over the spastic muscle
for spasticity - Stimulate over the antagonist muscle
14. NMES to gain -reciprocal or alternate channels over the agnoist and antagonist muscle
AROM groups
, -may provide more normal arthrokinematics than PROM
-ask the patients to voluntarily contact with the simulation
15. Evidence on - May need to take more slowly when starting (may take several sessions to
NMEW is Pediatric introduce and build up to muscle contraction)
Population - Can be used in gait and during functional activities
- Need to monitor more closely than typical patients
16. Evidence on NMES - Looked at 3D gait analysis: step width, velocity, step length and stride length
of Glut Med dur- - They found signi cant di erence between groups with velocity, step length
ing gait in children and stride length
with cerebral palsy
17. Evidence on NMES - Found signi cant improvement in peak DF in swimg and foot �oor angle
to Dorsi exors and - No change in more functional outcomes, but there were variations in treatment
Quads for children (limitation)
with cerebral palsy
18. General evidence - Found that in a systematic review most found improvements in function and
on NMES for chil- gait (range from stimulating tib ant, quads, wrist ext, nger �exors, erector
dren with cerebral spinae and other)
palsy
19. What is TES? And - TES: low-level sub threshold contraction stimulation applied at night, theorized
evidence on TES to increase blood �ow to increase muscle bulk
for children with - Some showed improvements, others didn't - need more research
Cerebral Palsy?
20. Use of FES as a - Can use this in early stages (typically after stroke) to prevent stretching of soft
sling in shoulder tissue structures
subluxation - Want to place over posterior delt and supraspinatus
- Why? - Need to gradually increase the endurance of the patient so that they can
tolerate wearing for several hours a day
Exam Study Guide and Practice Questions
1. Direct bene�ts of -facilitation of muscle contraction for enhancement of force production/hyper-
NMES trophy
2. NMES re-educa- it takes several weeks for actual hypertrophy but early strength changes are
tion of muscle documented are thought to be due to neural changes in recruitment
3. Indirect bene�ts of -increase blood �ow
NMES -improved venous and lymphatic drainage for swelling
4. Evidence on NMES - Found statistically signi cant treatment e ect in quad strength, self-reported
post ACL function but not with functional outcomes
- Found that NMES in addition to exercise may speed up quad strength recov-
ery
- However, there are inconsistencies with dosage
-Maximum intensity the patient can tolerate as well as starting NMES early in
rehabilitation produces greater gains
5. Evidence of NMES groups with high intensity NMES and high low intensity NMES showed signi -
for strengthening cantly greater gains in strength (Russian for 15 contractions 3 days a week for
of the Quads post 6 weeks 75bbs at max intensity tolerated)
ACL Repair
6. Evidence on - Found that NMES statistically improves quad strength
NMES post - Some studies also reported improvements in functional outcomes such as
knee arthroscopy squats, lateral step ups and ADL scores
surgery
7. Evidence on NMES - Initiated NMES 3-4 weeks post surgery and found that strength in the quad
for strengthening on the surgical side surpassed the strength of the uninvolved leg at six months
post TKA (statistically signi cant increase at 3, 6, and 12 months post op)
- However, other research studies found no statistical di erence between treat-
ment and control
, -Change in strength was related to the amount of intensity tolerated by the
patient
8. Evidence summa- - Can produce greater strength gains if treated with adequate dosage and
ry for NMES use started early
with ACL and TKA - Intensity needs to be as high as patient can tolerate
- Found that functional gains to be less conclusive
9. Evidence for Estim - Looking at grip and pinch strength and hand muscle function and endurance
to improve mus- - Found signi cant increase in muscle strength and fatigue resistance, but
cle function in pa- evidence had many limitation (need for more research)
tients with RA
10. Evidence on FES - Found no di erence between treatment and control gorup
for motor training - However, research recommended increasing dosage (at least double) to see
of UE post CVA if there is a di erence
11. Evidence on NMES - Used parastep system that stimulates the quad and glut max in paraplegics
for stimulation of patients to allow them to stand and walk
Paralyzed Muscles - Some suggest that NMES does increase voluntary strength in partially para-
(not de-nervated lyzed muscles following SCI (need more research to see how it compares to
muscles) traditional strengthening)
12. Bene�t for NMES -osteoporosis prevention
for Patients with -kidney function
SCI -psychological
-ROM/Contractures
13. Ways to use NMES - Stimulated directly over the spastic muscle
for spasticity - Stimulate over the antagonist muscle
14. NMES to gain -reciprocal or alternate channels over the agnoist and antagonist muscle
AROM groups
, -may provide more normal arthrokinematics than PROM
-ask the patients to voluntarily contact with the simulation
15. Evidence on - May need to take more slowly when starting (may take several sessions to
NMEW is Pediatric introduce and build up to muscle contraction)
Population - Can be used in gait and during functional activities
- Need to monitor more closely than typical patients
16. Evidence on NMES - Looked at 3D gait analysis: step width, velocity, step length and stride length
of Glut Med dur- - They found signi cant di erence between groups with velocity, step length
ing gait in children and stride length
with cerebral palsy
17. Evidence on NMES - Found signi cant improvement in peak DF in swimg and foot �oor angle
to Dorsi exors and - No change in more functional outcomes, but there were variations in treatment
Quads for children (limitation)
with cerebral palsy
18. General evidence - Found that in a systematic review most found improvements in function and
on NMES for chil- gait (range from stimulating tib ant, quads, wrist ext, nger �exors, erector
dren with cerebral spinae and other)
palsy
19. What is TES? And - TES: low-level sub threshold contraction stimulation applied at night, theorized
evidence on TES to increase blood �ow to increase muscle bulk
for children with - Some showed improvements, others didn't - need more research
Cerebral Palsy?
20. Use of FES as a - Can use this in early stages (typically after stroke) to prevent stretching of soft
sling in shoulder tissue structures
subluxation - Want to place over posterior delt and supraspinatus
- Why? - Need to gradually increase the endurance of the patient so that they can
tolerate wearing for several hours a day
