Neuromuscular electrical stimulation was applied to the quad…
Neuromuscular electrical stimulation was applied to the quadriceps muscle. The stimulation was done at 60° of knee flexion and the intensity was increased to at least 30% of the patient’s daily maximum voluntary isometric contraction, as described previously. This patient was also progressed to a cane to facilitate more symmetrical weight bearing and greater functional use of the left lower extremity. By week 2 she had full active knee extension. During gait, she continued to ambulate with a flexed knee during stance since she was not functionally using her extension. Standing terminal knee extension with resistance band (Figure) was added to her program. Cues to increase knee extension during stance were reinforced during gait training. By week 3, the patient’s main complaint was difficulty descending and ascending stairs. Upon reevaluation, she had 0° to 130° of active knee range of motion. She had a 3.5-cm girth difference left to right measured at midpatella. She continued to ambulate with a single-point cane in a symmetrical step pattern. Maximum volitional isometric contraction testing showed the right quadriceps produced 440 N and the left produced 297 N of force; the quadriceps force production of the left was 68% of the right. The Timed Get Up and Go Test was completed in 9.1 seconds; the Stair-climbing test was finished in 18.45 seconds. Her Knee Outcome Survey was 77%. The patient’s main impairment at this time is: