If a patient cannot tolerate NMES, which general strategies and specific adjustments are recommended?

• A. General: education/motivation; put patient in control; increase frequency for comfort; Specific: increase ramp time; increase rest time
• B. General: reduce frequency; No rest time; Specific: remove ramp
• C. Increase intensity to maximum
• D. Do not adjust therapy

Answer: (A)

When a patient cannot tolerate NMES, the focus is on making the experience more tolerable through patient engagement and gradual, patient-friendly adjustments. Giving the patient education and motivation helps them understand what to expect and stay engaged with the therapy, which reduces anxiety and increases cooperation. Putting the patient in control—allowing them to participate in decisions about when to start or stop and how to progress—helps them feel empowered and more willing to tolerate the sensations.

For concrete parameter changes, extending the ramp time is a practical way to ease into stimulation. A slower ramp means the intensity builds up gradually rather than jumping to a higher level, which reduces the abruptness of the sensation and helps the patient adapt more comfortably. Increasing rest time between stimulation bursts also supports tolerability by giving the skin and muscles a longer recovery window, reducing fatigue and soreness that can drive intolerance.

The idea that adjusting frequency could help comfort is also used in practice, but it’s more individualized. Some patients find certain frequencies more tolerable than others, so frequency can be tweaked as part of the overall strategy to improve comfort.

Strategies that would cut the therapy short or push the patient to intolerance—such as jumping to higher intensity, removing ramp, eliminating rest, or not adjusting anything—do not address the root issues of discomfort and fatigue and are unlikely to improve tolerability.