What considerations are there when using NMES with a patient who has a cast or joint immobilization?

• A. Stimulate across immobilized joints to promote movement
• B. Place electrodes to target the muscle without interfering with the cast or splint
• C. Use high amplitude to ensure contraction through the cast
• D. NMES is contraindicated in immobilization

Answer: (B)

When using NMES with a cast or immobilization, the goal is to stimulate the underlying muscle without disrupting the immobilized limb and without letting the cast block or heat up. The best approach is to place electrodes on the skin around the cast so the current can reach the target muscle without having to pass through the cast itself. The cast acts as an insulator and can impede current flow, so trying to drive a contraction across the cast or through it is inefficient at best and risky at worst.

Keep the stimulation comfortable and safe by using appropriate amplitude and pulse duration, and ensure the skin under and around the electrodes is clean, dry, and intact. Avoid placing electrodes directly under the cast or trying to force a contraction through the cast, as this can cause skin irritation, overheating of the cast, or unpredictable current paths. NMES can still be useful during immobilization to help preserve muscle bulk and circulation, as long as electrode placement respects the cast and safety considerations.