Chapter 15. Rehabilitation Flashcards
1
Q
- The Henneman size principle of therapeutic
exercise says motor units are recruited in order of
(A) increasing size, decreasing contraction
strength, and diminishing fatigue
(B) increasing size, increasing contraction
strength, and diminishing fatigue
(C) increasing size, increasing contraction
strength, and escalating fatigue
(D) decreasing size, increasing contraction
strength, and diminishing fatigue
(E) none of the above
A
- (C) Smaller, less powerful, fatigue resistant motor
units, which contain slow-twitch muscle fibers,
have the lowest firing threshold and are recruited
first. Demands for larger forces are met by the
recruitment of increasingly larger, more powerful,
fatigable motor units. The largest motor units
that contain the fast-twitch B fibers have the
highest threshold and are recruited last.
2
Q
950. What is an example of an open kinetic chain exercise? (A) Leg press (B) Knee extensions (C) Push up (D) Treadmill (E) Bench press
A
- (B) Open kinetic chain exercises are typically
performed where the foot/leg or hand/arm is
free to move, and non-weight bearing, with the
movement occurring at the peripheral joint.
Examples of these exercises would be knee
extensions, straight leg raises, and biceps curl. In
closed kinetic chain (CKC) exercise, the distal
part of the limb-upper or lower, is fixed to the
ground or to the wall or plate. Examples include
leg press, push up, and running exercises. In
bench press, the foot is on the floor so this too is
a CKC exercise. CKC exercises are felt to be more
“functional”, since these exercises may mimic
what patients do throughout the day or in an
employment setting and thus are often favored.
However, a mix of both types of exercises typically
recommended.
3
Q
951. Which type of therapy has been found to reduce the risk of falls in the elderly? (A) Tai chi (B) Pilates (C) Yoga (D) Strength training (E) None of the above
A
- (A)
A. Tai chi is an internal Chinese martial art often
practiced with the aim of promoting health
and longevity. Training consists of slow
motion routines that groups of people
practice together every morning in parks
around the world, particularly in China.
Many medical studies support its effectiveness
as an alternative exercise and a form of
martial arts therapy. Tai chi improves balance
in persons of all ages.
B. Pilates is a physical fitness system developed
in the early 20th century by Joseph
Pilates. Pilates called his method “contrology,”
because he believed his method uses the
mind to control the muscles. The program
focuses on the core postural muscles which
helps keep the body balanced and which are
essential for providing support for the spine.
C. Yoga is a group of ancient spiritual practices
originating in India. Yoga involves flexibility
exercise combined with strength training,
but also traditional chants and relaxation
techniques that relax the mind and the body.
D. Strength training has been found to be
effective in elderly patients but does not
specifically reduce falls.
4
Q
952. Direct participants in interdisciplinary comprehensive pain management include all of the following, EXCEPT (A) vocational counselor (B) physical therapist (C) psychologist (D) general internal medicine physician (E) occupational therapist
A
- (D) While a family physician is important to provide
medical information to the team, the team
leader is most often a physician with sub-specialty
qualifications in pain management. The team
consists of professionals from a variety of therapeutic
groups that work together with the patient
to help them improve their function and manage
their chronic pain. All of the above except the primary
care physician can readily be found among
the interdisciplinary team.
5
Q
- Which of the following is true regarding aerobic
training?
(A) Persons placed on bedrest will experience
a decrease in resting heart rate
(B) Oxygen consumption (VO2) increases in
proportion to the intensity of the exercise
(C) For training to be effective, the duration
of aerobic training must be at least
10 minutes at a stretch
(D) Intensity of training must be within 40%
to 85% of maximal VO2 (VO2 max) to be
considered aerobic training
(E) Patients placed at bedrest will experience
an increase of VO2 max after 3 weeks
A
- (D) When placed at bedrest, many detrimental
changes occur to the cardiovascular system.
People placed on bedrest will experience an
increase in resting heart rate. Oxygen consumption
(VO2) decreases in proportion to the
intensity of the exercise. Patients will experience
a 25% decrease in VO2 max after 3 weeks of
bedrest. Additionally, during bedrest muscle
breakdown occurs, osteoporosis occurs, and
joint contractures can set in. Therefore, during acute pain episodes, it is imperative that patients
are encouraged not to lie in bed for 24 hours.
6
Q
954. All of the following are examples of core strengthening programs for spine rehabilitation, EXCEPT (A) lumbar stabilization (B) pilates training (C) yoga (D) abdominal exercises (E) all of the above
A
- (C)
A. Lumbar stabilization is a type of exercise
that attempts to strengthen muscles in the
abdomen and posterior spine (multifidus)
by cocontracting the muscles in a position of
“neutral spine.” Neutral spine is a position
where the spine hurts the least so exercise
can take place.
B. Pilates is an exercise designed by Joseph
Pilates to use machines to assist with
strengthening of muscles of the abdomen
and spine—the core muscles.
C. Yoga is an exercise of the mind and body.
Positions are attempted that achieve maximum
body stretch and relaxation. Strengthening
is not a part of the program.
D. Abdominal muscles are part of the core.
The core defined as muscles between the
chest (nipple line) and the waist.
7
Q
- Atypical exercise precaution that should be followed
with a patient who has chronic osteoarthritis
would be
(A) no exercise in patients with osteoarthritis
of three or more joints
(B) no weight bearing on a limb with knee
pain of 2 years’ duration
(C) no ice when knee effusion occurs after
exercise
(D) only low-impact exercises in a patient
with severe osteoarthritis of both knees
awaiting joint replacement surgery
(E) no stretching of a lower limb in a
patient with osteoarthritis of the ankle
who has a tight calf muscle
A
- (D) The exercise program in patients with
osteoarthritis must be adjusted to their tolerance
level. Many patients are functionally
impaired, obese, and are at high risk for developing
medical complications such as type-2
diabetes or cardiovascular disease because of
their inactivity. Thus, even if a patient is awaiting
joint replacement because of chronic pain
from osteoarthritis a period of physical activity
before their surgery is warranted. Often protected
weight-bearing, low-impact exercises, or
exclusively aquatic exercises can allow the
patient to tolerate sessions of physical therapy
they otherwise could not tolerate.
8
Q
- A patient presents to your office with T6 paraplegia.
He was living independently until severity
of neuropathic pain in his legs increased to
10/10. Now he can no longer go to work because
the pain is so severe that he cannot concentrate
at work. The fact that this patient cannot work is
considered as
(A) impairment
(B) disability
(C) handicap
(D) physical capacity
(E) none of the above
A
- (C)
A. The American Medical Association Guides
to the Evaluation of Permanent Impairment
define impairment as “a loss, loss of use, or
derangement of any body part, organ system,
or organ function.” Thus in this case,
the impairment would be the T6 injury.
B. The American Medical Association Guides
to the Evaluation of Permanent Impairment
define disability as “an alteration of an individual’s
capacity to meet personal, social,
or occupational demands or statutory or
regulatory requirements because of an
impairment.” Thus, the inability to walk
would be a disability. Another example
might be a finger injury. A lawyer might
have no vocational disability but a pianist
might have 100% disability from the same
impairment.
C. Impairment is the functional consequence
of the disability. Thus the inability to
work, play a sport, or pay the rent would
all be disabled.
D. Physical capacity is just the capacity of the
body to operate.
9
Q
- A patient presents to the office with 2-week
history of leg pain consistent with S1 radiculopathy.
Magnetic resonance imaging (MRI)
reveals a paracentral L5-S1 disc herniation. The
pain is worsened with bending forward, driving,
and lifting objects. Aproper type of physical
therapy exercise would be
(A) McKenzie method of physical therapy
with extension exercises
(B) yoga
(C) Williams method of physical therapy
with flexion exercises
(D) stationary bike
(E) no therapy
A
- (A)
A. Although individualized exercises also are
performed, McKenzie exercises are most
well known as a set of spinal extension exercises.
The goal is to off-load the disk compression
on the spinal nerve and reduce the
pain in the leg. Often the pain “centralizes”
to the lower back where is can be improved
by other therapy methods. Although often
practiced, little is written and even fewer
studies have been performed to prove the
effectiveness of the therapy. The study referenced
above found improvement in leg
pain in the short term (0-3 months) compared
to other treatments but after 3 month,
the benefit was no longer seen.
B. Yoga is a form of exercise where bending forward
often occurs. This might worsen the
symptoms. For chronic back pain, yoga has
been found to be effective in a recent study.
C. Williams exercises are a set of flexion based
exercises. Persons with acute paracentral
disc herniations might get worse leg pain
with flexion-type exercises. Flexion spine
exercises can be beneficial in cases of stenosis
or lateral disc herniations where flexion
can result in offloading of neural structures.
D. Stationary bike is a flexion exercise. This can
result in more pressure on the disc increasing
the leg pain.
Although some studies suggest that physical
therapy has no effect on painful disc herniations,
many other studies find that therapy
has a significant beneficial effect.
10
Q
- Which of the following is false regarding
muscle tightness in the lower extremity?
(A) Gluteus maximus inflexibility may
decrease lumbar lordosis causing
increased forces on the lumbar spine
(B) The Ely test evaluates rectus femoris
tightness
(C) Lumbar lordosis can be increased in
iliopsoas tightness
(D) Anterior pelvic tilt may cause stress on
the lumbar spine and can be caused by
rectus femoris or hamstring tightness
(E) The Thomas test assesses tightness of
the iliopsoas muscle
A
- (D)
A. Gluteus medius and hamstring inflexibility
can lead to posterior pelvic tilt, decreasing
lumbar lordosis.
B. The Ely test evaluates the rectus femoris.
C. Rectus femoris and iliopsoas tightness can
cause anterior pelvic tilt, increasing lumbar
lordosis.
D. Increasing or decreasing lumbar lordosis
can put stress on the lumbar spine.
E. The Thomas test evaluates for iliopsoas
muscle tightness while the Ely test evaluates
the rectus femoris.
11
Q
- Which of the following statements regarding
central pain is not correct?
(A) Patients with central pain are usually
affected by a change in temperature
(B) More than 10% of patients with a stroke
report significant central pain within the
first year
(C) Central pain caused by a thalamic
infarction is often a burning pain that
may be described as agonizing and is on
the side contralateral to the lesion
(D) Almost 90% of all central pain is caused
by cerebral vascular accidents
(E) No singular pharmacologic, surgical or
other treatment has been proven to be
helpful in the long term
A
- (B) Ninety percent of all cases of central pain
are caused by cerebral vascular accidents but
only 8% of all stroke patients will report central
pain within the first year. The pain may be constant
(85%) or intermittent (15%) and is primarily
burning, prickling, aching, and lancinating.
Thalamic strokes cause agonizing burning pain
contralateral to the side of the lesion. Central
pain is almost always affected by change in
temperature and no one treatment has been
found to be efficacious in the long term.
12
Q
- Achilles tendinosis is a chronic source of pain
in many active adults. Which of the following
interventions has been found to be helpful in
the treatment of pain for this disease process?
(A) Nonsteriodal anti-inflammatory drugs
(B) Corticosteroid injections of the tendon
(C) Heel pads
(D) Topical laser therapy
(E) Ultrasonography
A
- (A) Despite the controversy over the presence
or lack of inflammation in Achilles tendonosis,
there is weak evidence to support the use of
oral nonsteroidal drugs for pain control. On
the other hand there is weak evidence of lack
of effect for heel pads, topical laser, heparin
injections, and peritendinous corticosteroid
injections. There is no well-designed study
confirming the efficacy of ultrasound in treatment
of this disease. Eccentric loading has
been shown to be helpful.
13
Q
- Chronic pain from fibromyalgia is characterized
by the following statements, EXCEPT
(A) fibromyalgia affects women more often
than men
(B) there is a suggestion that genetic factors
contribute to the etiology of fibromyalgia
(C) mood and anxiety disorders are significant
comorbidities in fibromyalgia
(D) patients with fibromyalgia may experience
a range of other symptoms including
irritable bowel or bladder
syndromes
(E) cognitive disturbances are never part of
fibromyalgia and suggest that there is
an organic cause for the problem
A
- (E) Fibromyalgia affects about 2% of the general
population, affecting 3.4% of women and 0.5%
of men. The symptoms include sleep disturbances,
stiffness, anxiety, depression, cognitive
disturbances, irritable bowel and bladder syndromes,
headaches, paresthesias, and other less
common symptoms. Fibromyalgia aggregates
in families and congregates with major mood
disorders in families, suggesting genetic factors
may be involved in the etiology of fibromyalgia.
14
Q
- The use of physical therapy that includes
“directional preference” in the treatment of low back pain has not been shown to
(A) decrease the need for surgery
(B) decrease the use of medications
(C) be associated with greater improvements
in pain control
(D) be as good as intensive dynamic
strengthening
(E) be better than nondirectional exercises
A
- (A) McKenzie based exercises are often called
directionally based exercises and have been
thought to be better than regular physical therapy
in the treatment of low back pain. Not all studies
have agreed. Several large studies have evaluated
this paradigm. In one case, intensive
dynamic strengthening was found to be as good
as the McKenzie method for treatment of subacute
and chronic low back pain. Another large
study showed directional preference exercises
can decrease medication consumption by threefolds
and give rapid significant pain control when
compared to nondirectional therapy and opposite
directional therapy. No study has evaluated the
use of directional therapy in avoiding surgery.
15
Q
- Evaluation and treatment of anterior knee pain
that is insidious in onset, bilateral, peripatellar,
and most often problematic in repetitive loadbearing
movements includes all the following,
EXCEPT
(A) hamstring strengthening
(B) activity modification
(C) closed chain kinetic exercises
(D) patellar taping
(E) evaluation for apophysitis at the tibial
tuberosity in adolescents
A
- (A) Patellofemoral pain syndrome (PFPS) is usually
insidious in onset and often bilateral. It is
most often associated with load-bearing exercises
and repetition of the exercise. It is relatively
benign, but in adolescents, one must consider
the presence of a traction apophysitis of the tibial
tuberosity. Closed kinetic chain exercises, patellar
taping, and activity modification along with
nonsteroidal anti-inflammatory drugs are the
mainstays of treatment. Strengthening of the
vastus medialis obliquus and other quadriceps
muscles are important in the treatment and not
strengthening of the hamstrings.
