Download FES WRITTEN CERTIFICATION SCRIPT 2026 QUESTIONS WITH SOLUTIONS GRADED A+ and more Exams Nursing in PDF only on Docsity!
FES WRITTEN CERTIFICATION SCRIPT 2026
QUESTIONS WITH SOLUTIONS GRADED A+
โ agonist. Answer: spastic muscle "the overactive muscle"- Trying to reduce this โ FES specificallyROM. Answer: Due to spasticity or soft tissue?Ex: Is the muscle hyperactive and preventing joints from moving through ROM? (can change c estim) OR is it because their calf is tight? (cannot actually change c estim) โ post-inspection and education. Answer: When you take them off, ensure again the integrity of their skin is maintained and what they might experience afterwards- They might expect DOMS: especially if they have not contracted the muscle in a long time- Always educate them up front, before, during, after โ What is FES commonly used for?. Answer: Shoulder subluxation, upper extremity function, foot drop, gait training โ sensory level example. Answer: For an individual that is highly sensitive to sensory input which triggers tone and spasticity"Not actually trying to achieve necessarily an activation of the muscle: sub motor sensory level stimulus; but it has potentially functional benefit" โ Where do you place electrodes for a shoulder subluxation?. Answer: On posterior deltoid & supraspinatus โ Studies show that there are improvements in subluxation, but NO changes in function. Answer: Not necessarily changes in function, especially in the more chronic
phase of their rehabTry these interventions as early as possible, because that is when they can get the most out of them due to neural plasticity
โ Considerations for FES: SUMMARY. Answer: External control of an INNERVATED muscle enhance functional controlMultiple components to assess besides normal e-stim considerations
โ FES foot drop & gait treatment time. Answer: determined by muscle fatigue
โ What is the goal for using FES for shoulder subluxation?. Answer: To elevate humeral head without abduction
โ FES. Answer: electrical stimulus to restore or enable mobility and function
โ indications for NMES. Answer: 1. Strengthening2. Edema/swelling
โ FES foot drop & gait pulse duration. Answer: 200-350 microseconds
โ application for ROM. Answer: Apply electrodes set up for antagonist activation โ facilitates strengthElectrodes should be appropriate for muscleDecrease fatigue by decreasing frequency and increasing amplitude
โ FES Pulse rate for upper extrem.. Answer: 10-60 or 30-50 pps
โ When do you use FES for upper extremity function?. Answer: stroke, TBI, CP, SCI
โ FES biking. Answer: Tone modulation (agonist/antagonist)Cardiovascular exercise for general health
โ Depending on the strength of the contraction,.... Answer: 1b fibers in the golgi tendon organs would be activated as well
Answer: SPASTICITY is NOT STRENGTH
โ FES treatment time for upper extrem.. Answer: 20 min to 6 hours
โ FES foot drop & gait pulse intensity. Answer: at least 3-5 muscle contraction
โ FES for Foot drop & gait stimulate what?. Answer: dorsiflexors during swing phases
โ sensory level. Answer: Sub motor stimulationTheory: leads to desensitization and ultimately decreased propagation of a sensory signal
โ considerations for FES. Answer: 1. sensation2. pain3. cognitive status4. FES specifically: ROM, strength, spasticity5. spasticity6. muscle innervation7. function
โ global or remote level*most theoretical. Answer: 1. Afferent information may increase corticospinal excitability- May lead to strengthening of these pathways2. Increased hemodynamic response in sensorimotor region3. Immediate (within 4 sessions) neuromuscular adaptation to increase MVC
โ indications for FES. Answer: 1. Standing balance/control2. Gait trainingEx. Foot drop3. UE training
โ What is the goal of FES. Answer: to restore or improve function, not just contraction
โ cognitive status. Answer: Esp for functional estim; can they understand what it is they should be feeling/expecting AND what you want from them?
โ FES foot drop & gait on:off ratio. Answer: none; is timed with activity (uses trigger)
โ FES is .... Answer: the use of NMES during functional activities or tasks
โ FES ramp up: down for upper extrem. Answer: 3 sec each
โ function. Answer: You will not do this with a functional task they cannot do or is not meaningful to themImportant, salient to them- if they have no goal of being able to return to running, will not do FES while trying to run
โ What does FES stand for?. Answer: Functional electrical stimulation
โ agonist stimulation may have what as well?. Answer: fatigue- it will contract less frequently and less strongly
โ application for hemiplegic shoulder. Answer: Attempts to bring humerus superiorly and suck it back into the GHJElectrodes on supraspinatus and posterior deltoidTry to avoid contraction of the upper trap- can lead to impingement
โ Where do you place electrodes for FES for gait/foot drop. Answer: tibialis anterior over muscle belly and motor point and fibularis longus (under fibular head)
โ FES Pulse duration for upper extrem. Answer: 200-350 microseconds
โ global level stimulation. Answer: increased corticospinal tract excitation that leads to ultimate fatiguing of spastic muscle
โ FES foot drop & gait ramp up:down. Answer: 0-1 sec each
โ FES On:Off for upper extrem.. Answer: 1:1 - 15:1 ; the goal is to increase on time and decrease off time
inhibition that would turn the biceps off
โ Improved results acute > chronic. Answer: Chronic: he thinks 6 mo or so out- Prognosis is not as good, but does not mean neural plasticity is not there at all
โ 5 main ways to set up FES decrease tone, facilitating function:. Answer: 1. Agonist stimulation2. Reciprocal inhibition3. Combined agonist/antagonist stimulation4. Sensory level5. Global or remote Level
โ Theory: leads to desensitization and ultimately decreased propagation of a sensory signal. Answer: Habituation to stimulusEnd result โ less sensitive to stimuli in that limb, making it more difficult to cause reflexive spasticity
โ hand open/closespasticity. Answer: must be able to open hand- Then, must be able to close and hold
โ common uses. Answer: Application for ROMStrength
โ Apply electrodes set up for antagonist activation โ facilitates strength. Answer: If my biceps are spastic and have been this way for a while, and shortened, doing this reflexive inhibition application (on triceps)--if it is moving me into extension, getting stretching of the biceps tooTricep contraction will probably not cause a very strong stretch, will still need manual/self-stretch, but can get some
โ increase activation to what?. Answer: high enough levels it causes the body to reflexively inhibit the agonist (high tone) muscle
โ UMN injury affecting CNS. Answer: PNS is intact; should be able to trigger an appropriate response in the muscle when using estim- Its ok if CNS has problems because we are stimulating the PNS!- Does not mean there will not be other issues: swelling in leg or arm, etc
โ considerations for FES: defining spasticity. Answer: Is spasticity present?Ex: UE flexor toneIncreased biceps tone: biceps have spasticityFunctional effect: loss of UE extensionDoes not mean they do not have the ROM to get there
โ hand open/closemust have what?. Answer: SOME volitional degree of opening and closing- without this, hard to achieve a meaningful functional task
โ sensation. Answer: Do they have some type of affect to their sensation because of x? Can they feel the Estim? Are they going to be able to tell if it is on?
โ Decrease fatigue by decreasing frequency and increasing amplitude. Answer: "Higher intensity of a stimulus in less pulses per second"Motor goal = 3+/5 contraction
โ SPASTICITY is NOT STRENGTHcaution and goal. Answer: Caution when MMTGoal of FES: 3+/5 activation- You want some muscle activation present with FES to get its full, potential benefit- Still benefits to applying FES even without this degree of strength; Esp with foot drop device: can be used as an AFO
โ other uses for FES. Answer: 1. Reciprocating Gait Orthosis (RGO)2. Cerebral palsy3. Hip or knee extension in gait4. Stimulate hip abductors
โ LMN injury affecting PNS. Answer: potential for benefit with FES is limited- Not going to get consistent or adequate contraction of that muscle because PNS impaired
โ hand open/close flaccidity. Answer: must be able to close and hold*Not exclusive to LMN issue although it is a big typical differenceEx: First week after a stroke you will see this
โ Cerebral palsy:.
โ FES specificallystrength. Answer: Intensity of stimCaution when muscle testingGoal of FES: 3+/5Will almost always be affected by velocityIf moving a joint through quick ROM and coming across resistance
โ strengthcommon trt focuses. Answer: 1. hemiplegic shoulder2. foot drop3. hand open/close4. FES biking
โ hemiplegic shoulder. Answer: Occurs in 80% of people post-stokeStudies show that there are improvements in subluxation, but NO changes in functionMay assist with pain controlImproved results acute > chronic
โ remote level stimulation. Answer: shown that it can cause a reduction in tone in overactive muscle
โ muscle innervation. Answer: Is the peripheral nerve innervation affected?NEED this to be intact*Very important for estim to activate a muscle
โ pain. Answer: Will alter ability to tolerate; it can be uncomfortable
โ General considerations: application and monitoring. Answer: 1. Instruct the patient2. Inspect the area3. Electrode placement4. Monitor the treatment5. Post-inspection and education*always think "how is this improving function?"
โ CNS mediated response. Answer: 1. Skeletal muscle spasticity is a clinical phenomenon associated with damage to CNS2. This disorder of muscle movement or motor skills affects that person's dexterity and strength as they attempt to perform an action-often "set off" tone with effort
โ Dr Morgan analogy of spasticity. Answer: If you imagine that a lower motor neuron is the hose and the brain is the faucet, when you have an upper motor neuron lesion, there's no
control at the faucet so the hose will spray everywhere, and you have very little control over the output (muscle motion)Although the exact mechanism is unknown, there's either too much activation, not enough inhibition, or a combination of the two causing poor functional use of that limb
โ agonist stimulationinhibition increased via what?. Answer: increased activity 1a afferents which leads to activation of Renshaw's cell once it passes a certain threshold
โ Hip or knee extension in gait:. Answer: Stimulate quads for knee stability
