A patient with a traumatic brain injury presents with hemiparesis and slight spasticity. What is the best timing sequence for applying functional electrical stimulation (FES) to facilitate active elbow extension?

The best timing sequence for applying functional electrical stimulation (FES) to facilitate active elbow extension in a patient with hemiparesis and slight spasticity involves a gradual and sustained approach to allow for both muscle activation and the necessary adaptation of the neuromuscular system. The chosen timing sequence of a 5-second ramp up, 5-second stimulation, and a 5-second ramp down provides several advantages.

The ramp-up phase is critical as it ensures a gradual increase in electrical stimulation, which can help prevent discomfort and allow the muscles to respond in a more controlled manner. A 5-second duration is sufficient to allow the motor units to recruit effectively while giving the patient time to prepare for the muscle contraction.

Following the ramp-up, the 5-second stimulation period is designed to maintain muscle contraction for a duration that is long enough to facilitate an adequate response in muscle tone and function without being excessively fatiguing. This balance is important, especially in patients with spasticity, where prolonged contractions may result in unwanted muscle tightness or distress.

Lastly, the ramp down phase, also lasting 5 seconds, is essential for gradually decreasing stimulation. This gradual reduction allows the muscle to relax in a controlled manner, reducing the potential for abrupt cessation of