A physical therapist assistant uses neuromuscular electrical stimulation on the wrist extensors. After setup, the contraction yields excessive radial deviation and insufficient wrist extension. What is the MOST appropriate action?

• A. Increase the current intensity
• B. Reposition the electrodes
• C. Alter the waveform of the current
• D. Discuss the situation with the supervising physical therapist

Answer: (B)

When NMES is used, the muscles that contract are determined largely by where the current enters and travels through the tissues. Placing the electrodes over the wrist extensors to target them specifically should produce wrist extension with minimal unwanted movements. If the result is excessive radial deviation, it indicates the current is activating muscles on the radial (thumb) side more than the intended extensors, pulling the hand toward the radius. Repositioning the electrodes alters the path of current so that the motor points of the wrist extensors are more effectively stimulated while reducing stimulation of the radial deviators. This improves wrist extension accuracy and steadiness.

Increasing current intensity would likely amplify both the desired contraction and the unwanted radial deviation. Changing the waveform doesn’t directly address selective recruitment of the correct muscles. Discussing the situation with the supervising PT is valuable if there are safety or protocol concerns, but the immediate corrective step is to reposition the electrodes to better target the wrist extensors.