Which of the following is NOT a SAM precaution?

• A. Diabetes mellitus
• B. Near growth plates
• C. Pacemaker
• D. Spinal cord stimulator

Answer: (D)

SAM precautions are safety flags used in rehab to identify situations where standard therapies could pose risk. Diabetes mellitus is a SAM precaution because neuropathy and impaired wound healing can make tissues more vulnerable during treatment, so we monitor skin integrity, sensation, and healing more closely and adjust activities as needed. Near growth plates is a precaution in children, since applying stress or high loads near open growth plates can risk physeal injury; therapy is modified to protect these areas. Pacemaker is a SAM precaution because external modalities that involve electrical currents or strong fields can interfere with the device; this requires avoiding or modifying certain therapies and coordinating with the patient’s medical team.

Spinal cord stimulator, while an implanted device, is not typically listed as a SAM precaution. Device-specific guidelines govern its safety, and clinicians rely on the manufacturer’s recommendations and the prescribing physician for safe use, rather than a general SAM category. Always verify current device-specific precautions and consult the medical team when an implant is present.