FORTINBERRY CH5

Question 1

Which of the following is a contraindication to ultrasound at 1.5 watts/cm with a 1-MHz sound head?
A. Over a recent fracture site
B. Over noncemented metal implant
C. Over a recently surgically repaired tendon
D. Over the quadriceps muscle belly

Answer 1

C.
A therapist can use ultrasound with all of the other choices. Performing an ultrasound over a cemented metal implant is also a contraindication. However, with any ultrasound technique, treatment should be stopped if the patient feels pain.

Question 2

While obtaining the history from a 62-year-old woman weighing 147 pounds, the therapist discovers that the patient has a history of rheumatoid arthritis. The order for outpatient physical therapy includes continuous traction due to an L2 disc protrusion. What is the best course of action for the therapist?
A. Follow the order.
B. Consult with the phsician because rheumatoid arthritis is a contraindication.
C. Apply intermittent traction instead of continuous traction.
D. Use continuous traction with the weight setting at 110 pounds.

Answer 2

B.
Choices A and C are incorrect because rheumatoid arthritis is a contraindication for continuous or intermittent traction. Choice Dis incorrect for the same reason as well as the fact that a 110-pound setting is too great for a 147-pound patient.

Question 3

A 25-year-oldwoman has been referred to a physical therapist by an orthopedist because of low back pain. The therapist is performing an ultrasound at the L3 level of the posterior back when the patient suddenly informs the therapist that she is looking forward to having her third child. On further investigation, the therapist discovers that the patient is in the first trimester of pregnancy. Which of the following is the best course of action for the therapist?
A. Change the settings of the ultrasound from continuous to pulsed.
B. Continue with the continuous setting because first-trimester pregnancy is not a contraindication.
C. Cease treatment, notify the patient’s orthopedic physician, and document the mistake.
D. Send the patient to the gynecologist for an immediate sonogram.

Answer 3

C.
The therapist should notify the referring physician. The mistake should be documented and the patient informed. The referring physician can determine the need for a consultation with him or her or an obstetrician.

Question 4

The therapist routinely places ice on the ankle of a patient with an acute ankle sprain. Ice application has many therapeutic benefits.
Which of the following is the body’s first response to application of ice?
A. Vasoconstriction of local vessels
B. Decreased nerve condition velocity
C. Decreasedlocal sensitivity
D. Complaints of pain

Answer 4

A.
Local vasoconstriction is the first response. Nerve conduction velocity decreases after approximately 5 minutes of ice application.

Question 5

Which of the following theories supports the use of a transcutaneous electrical nerve stimulation (TENS) unit for sensory level pain control?
A. Gate control theory
B. Sensory interaction theory
C. Central summation theory
D. Sensory integration theory

Answer 5

A.
This theory supports the use of a TENS unit for sensory level pain control. The activation of the larger fibers decreases the amount of sensory information traveling to the brain.

Question 6

Which of the following tissues absorbs the least amount of an ultrasound beam at 1 MHz?
A. Bone
B. Skin
C. Muscle
D. Blood

Answer 6

D.
Tissue with a high collagen content absorbs more ultrasound. Bone absorbs the most ultrasound.

Question 7

The therapist decides to use electrical stimulation to increase a patient’s quadriceps strength. Which of the following is the best protocol?
A. Electrodes placed over the superior/lateral quadriceps and the vastus medialis obliquus; stimulation on for 15 seconds, then off for 15 seconds
B. Electrodes over the femoral nerve in the proximal quadriceps and the vastus medialis obliquus; stimulation on for 50 seconds, then off for 10 seconds
C. Electrodes over the vastus medialis obliquus and superior/lateral quadriceps; stimulation frequency set between 50 and 80 hertz, pps
D. Electrodes over the femoral nerve in the proximal quadriceps and the vastus medialis obliquus; stimulation frequency set between 50 and 80 hertz, pps

Answer 7

C.
Correct electrode placement is over the motor points of the involved muscle. On /off ccle time is usually between 1:3 and 1:5. Fused tetany of a muscle usually occurs between 50 and 80 hertz or pps (sources vary).

Question 8

A therapist should consider using a form of treatment other than moist heat application on the posterior lumbar region of all of the following patients except
A. Patient with a history of hemophilia
B. Patient with a history of malignant cancer under the site of heat application
C. Patient with a history of Raynaud’s phenomenon
D. Patient with a history including many years of steroid therapy

Answer 8

C.
Raynaud’s phenomenon is a vasospastic disorder of the vessels of the distal parts of the extremities. Patients with Raynaud’s phenomenon do not respond well to cold treatment. Choice B is incorrect because it is believed that moist heat may encourage more rapid growth of cancer. Choice D is incorrect because prolonged use of steroids may cause capillaries to lose their integrity, which compromises the body’s ability to dissipate heat.
Choice A is incorrect because moist heat mav encourage hemorrhaging in patients with hemophilia by causing vasodilation.

Question 9

A 50-year-old woman has been receiving treatment in the hospital for increased edema in the right upper extremity. The therapist has treated the patient for the past 3 weeks with an intermittent compression pump equipped with a multicompartment compression sleeve. The patient’s average blood pressure is 135/80 mm Hg. The daily sessions are 3 hours in duration.
The pump is set at 50 mm Hg, 40 mm Hg, and 30 mm Hg (distal to proximal) for 30 seconds, on and off for 15 seconds. The therapist decides to change the parameters. Of the following changes, which is the most likelv to increase the efficiency of treatment?
A. Place the patient in a seated position with the right upper extremity in a dependent position versus supine and elevated.
B. Increase the maximal pressure from 50 mm Hg to 60 mm Hg.
C. Change the on/off time to 15 seconds on and 45 seconds off.
D. Equalize the sleeve compartments versus having greater pressure distally.

Answer 9

B.
Although the change may be minimal, increasing the maximal pressure to 60 mm Hg is the most likely choice to have a positive effect on edema reduction. The pressure, however, should not exceed the diastolic pressure of the patient. Choice A is not the right choice because placing the extremity in a dependent position causes the pump to work against gravity. Choice C is an incorrect choice because decreasing the on time means that the extremity receives compression for a shorter period. Choice Dis an incorrect choice because greater pressure distally is more likely to move fluid than equal pressure throughout the sleeve.

Question 10

A therapist chose to work with her patient using fluidotherapy rather than paraffin wax. The patient has a lack of range of motion and also needs to decrease hypersensitivity. There are no open wounds on the hand to be treated. Which of the following would not be an advantage of using fluidotherapy versus paraffin wax in the above scenario?
A. The therapist can assist range of motion manually while the patient has his hand in the fluidotherapy and not while in the paraffin wax.
B. The fluidotherapy can be used to assist in desensitization by adjusting air intensity.
C. The fluidotherapy can be provided at the same time as dynamic splinting, and this cannot be done while in paraffin wax.
D. The fingers can be bound, to assist gaining finger flexion, with tape while in fluidotherapy and not in paraffin wax.

Answer 10

D.
The fingers can be bound in paraffin wax as well as in fluidotherapy. When using this technique, the hand remains stationary throughout the heating process, which is necessary for paraffin to be most effective (when using the standard method of dipping the hand and wrapping with plastic wrap and a towel).

Question 11

A therapist is treating a 35-year-old man who has suffered loss of motor control in the right lower extremity due to peripheral neuropathy. The therapist applies biofeedback electrodes to the right quadricep in an effort to increase control and strength of this muscle group. The biofeedback can help achieve this goal in all of the following ways except
A. Providing visual input for the patient to know how hard he is contracting the right quadricep
B. Assisting the patient in recruitment of more motor units in the right quadricep
C. Providing a measure of torque in the right quadricep
D. Providing the therapist input on the patient’s ability and effort in contracting the right quadricep

Answer 11

C.
The EMG does not record torque. It
assists by showing a linear relationship between the EMG and the force produced by the muscle during an isometric contraction.

Question 12

A patient is receiving electrical stimulation for muscle strengthening of the left quadricep. One electrode from one lead wire, 4 x 4 inches in size, is placed on the anterior proximal portion of the left quadricep. Each of two other electrodes from one lead wire are 2 x 2 inches in size. One of the electrodes is placed on the inferior medial side of the left quadricep and one on the inferior lateral side of the left quadricep. This is an example of what type of electrode configuration?
A. Monopolar
B. Bipolar
C. Tripolar
D. Quadripolar

Answer 12

B.
This is an example of a bipolar configuration. Another form of bipolar configuration is to have two electrodes of equal size, each from a different lead wire. In a monopolar configuration, one smaller electrode is placed over the intended site and a larger electrode is placed some distance awav. The stimulation is perceived by the patient, in this case, only under the smaller electrode. In a quadripolar configuration, two electrodes coming from two different lead wires are placed over the intended area.

Question 13

In comparing the use of cold pack and hot pack treatments, which of the following statements is false?
A. Cold packs penetrate more deeply than hot packs.
B. Cold increases the viscosity of fluid and heat decreases the viscosity of fluid.
C. Cold decreases spasm by decreasing sensitivity to muscle spindles and heat decreases spasm by decreasing nerve conduction velocity.
D. Cold decreases the rate of oxygen uptake, and heat increases the rate of oxvgen uptake.

Answer 13

C.
Choice C is correct. Heat decreases spasm by causing the vessels to dilate, which brings more blood (containing oxygen) to the area. Cold decreases spasm by decreasing sensitivity of the muscle spindles.

Question 14

A patient is being treated with iontophoresis, driving dexamethasone, for inflammation around the lateral epicondyle of the left elbow. The therapist is careful when setting the parameters and with cleaning the site of electrode application to prevent a possible blister. This possibility is not as strong with some other forms of electrical stimulation, but with iontophoresis using a form of ______ precautions must be taken to ensure that the patient does not receive a mild burn or blister during the treatment session.
A. Alternating current
B. Direct current
C. Pulsed current
D. Transcutaneous electrical nerve stimulation

Answer 14

B
Iontophoresis uses direct current to drive medication through the skin by repelling ions. For example, if a medication is positively charged, it can be driven by the anode (the positive electrode); if a medication is negatively charged, it can be driven by the cathode (the negative electrode.

Question 15

A physician has ordered a specific type of electrical stimulation that utilizes a frequency of
2500 Hz with a base frequency at 50 Hz to achieve fused tetanv. What tvpe of electrical stimulation has the physician ordered?
A. Iontophoresis
B. Transcutaneous electrical nerve stimulation
C. Intermittent flow configuration
D. Russian stimulation

Answer 15

D.
This is an example of Russian stimulation.

Question 16

A physical therapist who is pregnant has been studying the use of transcutaneous electrical nerve stimulation during labor and birth to decrease pain perception. Which of the following is the most effective technique in this situation?
A. Place the electrodes over the upper abdominals during the first stages of labor and over the lower abdominals during the later stages.
B. Place the electrodes over the paraspinals at the L5 level and S1 level throughout labor and delivery.
C. Place the electrodes in a V pattern above the pubic region during labor and delivery.
D. Place electrodes over the paraspinals at the L1 and S1 level initially during labor, and over the pubic region during the latter stages

Answer 16

D.
This is the most common placement suggested by sources used in preparation of this book. Spinallevel varies, but the overall consensus is that the electrodes are placed higher and on the back initially. Then they are moved lower and to the anterior pubic region as labor progresses.

Question 17

A patient with chronic back pain is referred to physical therapy for application of a transcutaneous electrical nerve stimulation unit.
The parameters chosen by the therapist are set to provide a noxious stimulus described as an acupuncture type of stimulus. Which of the following lists of parameters produces this type of stimulation?
A. Low intensity, duration of 60 μsec, and a frequency of 50 Hz
B. High intensity, duration of 150 μsec, and a frequency of 100 Hz
C. Low intensity, duration of 150 μsec, and a frequency of 100 Hz
D. High intensity, duration of 150 μsec, and a frequency of 2 Hz

Answer 17

D.
This tvpe of stimulation is usually not well tolerated by patients with acute conditions.
Acute conditions are usually treated by TENS with a high frequency, and chronic conditions can be treated with a low frequency (if tolerated by the patient). Treatments providing a noxious stimulus usually have a longer lasting effect.

Question 18

A 63-year-old woman presents to physical therapy with a diagnosis of herpes zoster. The physician informs the physical therapist that the L5 dorsal root is involved and that a transcutaneous electrical neuromuscular stimulation (TENS) unit should be used to help control the pain. Where should the TENS unit electrodes be placed?
A. Posterior thigh
B. Lateral hip/greater trochanter area
C. Anterior thigh
D. Anterior lateral tibia

Answer 18

D.
Herpes zoster involves a particular
dorsal root and its ganglia. TENS unit electrodes should be placed over the involved dermatome (L5 in this case).

Question 19

Use of functional electrical stimulation in patients with longstanding spinal cord injury does not improve
A. Aerobic capacity
B. Muscle strength
C. Osteopenia
D. Muscle mass

Answer 19

C.
Because functional electrical
stimulation involves stimulating the paralyzed muscle groups, the same gains that one can expect from the “well” population can be carried over into the spinal cord injured patient.
There has been no research to prove that osteopenia is reversed with electrical stimulation.

Question 20

A physician has ordered electrical stimulation to a
43-year-old male with complaints of sternocleidomastoid spasms. What is the appropriate course of action by the physical therapist?
A. Begin intervention with low frequency, high phase duration electrical stimulation.
B. Electrical stimulation in this areas a contraindication. Contact the physician to discuss alternative interventions.
C. Begin intervention with high frequency, low phase duration electrical stimulation.
D. Use ultrasound only and do not contact the physician.

Answer 20

B.
The use of electrical stimulation near the carotid sinus is contraindication. The physical therapist should always contact the physician if there is a change in an order as in choice D.

Question 21

The physical therapist has decided to use functional electrical stimulation (FES) in order to help a spinal cord injured patient ambulate. What is the lowest spinal injury level that FES would be considered?
A. T3-T4
B. T8-T9
C. T11-T12
D. L3-L4

Answer 21

C.
A prerequisite for FES is an upper motor neuron lesion. Patients with flaccid paralysis are not suitable candidates for FES. The cauda equina begins below T11-T12.

Question 22

A physical therapist is using a cold pack to decrease inflammation after a therapeutic exercise session. Which of the following areas needs to be monitored most closely during the ice pack application?
A. Lateral knee
B. Lumbararea
C. Quadriceps area
D. Acromioclavicular joint

Answer 22

A.
The lateral knee would cause the most concern because the common peroneal nerve is superficial in this area. The medial elbow near the ulnar nerve would be another area that would need extra care during ice application.

Question 23

In which of the following patient conditions would it be safe to apply spinal traction to help decompress a spinal nerve root?
A. Acute rheumatoid arthritis
B. Degenerative joint disease
C. Osteoporosis
D. Spinal tumor

Answer 23

B.
Spinal traction is contraindicated for patients with conditions that may cause spinal instability or fracture such as tumors, acute infections, osteoporosis, and rheumatoid arthritis.

Question 24

Which of the following best describes the patient’s position when administering positional traction?
A. Hanging upside down on an inversion table (or with inversion boots)
B. Hanging by the hands (right side up)
from an overhead bar
C. Side-lying with a pillow placed under one side of the lumbar spine
D. Sitting with head in a halter that is attached to an over-the-door traction svstem

Answer 24

C.
Positional traction is used to alleviate pressure on an entrapped spinal nerve, which is usually a unilateral occurrence; thus, the side-lying position (nonpainful side) is most commonly used.

Question 25

You plan to administer lumbar traction to a patient who has back pain and nerve root impingement. You determine from your history that this patient has no contraindications to the use of traction. What other piece of information do you need to obtain from this patient in order to determine the appropriate intensity for your traction treatment?
A. Age
B. Body weight
C. Medications currently taken
D. Pain rating

Answer 25

B.
Although all pieces of information are important, the body weight is needed to help determine the maximum intensity for a lumbar traction treatment.

Question 26

Before a lumbartraction treatment, your patient tells you that his pain is localized in his low back and right buttock Your examination indicates a medium-sized herniated disk. The dav after the traction treatment, he tells you that his back pain has diminished, but he now has deep aching and numbness down the posterior aspect of his right lower extremitv. In addition, you are no longer able to elicit his Achilles tendon reflex. Based on these responses, you should
A. Increase the intensity of the traction during the next treatment session
B. Reduce the intensity of the traction during the next treatment session
C. Switch from a static to an intermittent mode of traction application
D. Discontinue the traction treatments

Answer 26

D.
The patient is experiencing
peripheralization of his pain, which indicates that his condition has worsened, so the traction treatment should be stopped.

Question 27

You administer cervical traction to a patient in your clinic to help stretch the tight soft tissues along the posterior aspect of her neck. She responds well to the initial treatment so vou arrange for her to lease a home cervical traction unit to continue this treatment on a daily basis. In what position would you instruct her to place the traction unit to produce the optimal effect?
A. At a downward angle that pulls her neck into slight extension
B. At an upward angle that slightly flexes her neck
C. At an upward angle that fully flexes her neck
D. Lying flat with no angle (no extension or flexion)

Answer 27

B.
Pulling the cervical spine into slight flexion is the best way to target your stretch to the posterior cervical musculature. It also reduces tension on the facet joint capsules.

Question 28

When the goal of alumbar traction treatment is to cause distraction of the vertebrae, the magnitude of the traction force should approximate what percent of the patient’s body weight?
A. 10%
B. 25%
C. 50%
D. 75%

Answer 28

C.
A force that equals up to 50 of the patient’s body weight mav be needed to cause distraction of the lumbar vertebra. Much lower forces (≈7) are needed to distract the cervical vertebrae.

Question 29

Which of the following is not a physiologic benefit associated with the use of continuous passive motion (CPM)?
A. Prevents muscle atrophy by simulating a normal concentric contraction
B. Prevents adhesions by orienting collagen fibers as they heal
C. Reduces edema by facilitating the movement of fluid in and out of the joint
D. Reduces pain via the stimulation of joint mechanoreceptors

Answer 29

A.
Because this is passive movement onlv,
CPM can neither cause a muscle contraction nor prevent atrophy.

Question 30

A patient with venous insufficiency in his lower extremities is referred for instruction on the use of a pneumatic compression pump at home. What inflation pressure and treatment time will you use to initiate this compression treatment?
A. Continuous pressure equal to the patient’s diastolic blood pressure for 20 to 30 minutes
B. Continuous pressure between 30 and
50 mm Hg for 20 to 30 minutes
C. Intermittent pressure no higher than 30 mm Hg for one hour
D. Intermittent pressure between 40 and
80 mm Hg for 2 hours

Answer 30

D.
The pressure setting should never exceed the patient’s diastolic blood pressure.
Because venous pressure is usually higher in the lower extremities than in the upper extremities, guidelines suggest a range of 30 to 60 mm Hg for the upper extremity and 40 to 80 mm Hg for the lower extremity. Intermittent compression is usually tolerated better, and recommended treatment times are 2 to 3 hours a day, depending on the severity of the condition.

Question 31

Which of the following conditions would contraindicate the use of an intermittent pneumatic compression pump?
A. Congestive heart failure
B. Lymphedema
C. Recent joint arthroplasty
D. Venous stasis ulcers

Answer 31

A.
Congestive heart failure and pulmonary edema are both contraindications for pneumatic compression because the heart and lungs are already overloaded and compression will just further increase that fluid load. This could result in more breathing difficulties or complete heart failure.

Question 32

You are treating a patient with acute bicipital tendinitis, so your goal is to reduce inflammation.
Two of vour treatment choices are iontophoresis and phonophoresis. Which of the following comparative statements regarding these two modalities is true?
A. Both procedures can be performed at home by the patient.
B. Both procedures require medications to be suspended in a solution.
C. Iontophoresis can deliver medication to deeper tissues than phonophoresis.
D. Iontophoresis is more likely to cause skin irritation than phonophoresis.

Answer 32

D.
Because iontophoresis is administered with a continuous monophasic (i.e., direct current), it can cause an acidicor alkaline reaction under the electrode, depending on the polarity used. This can be very irritating to the skin. Home units are available for iontophoresis, but not phonophoresis. Iontophoresis requires medications to be suspended in a solution, whereas phonophoresis requires the medication to be mixed in with a lotion, gel, or cream. Deeper penetration is usually possible with phonophoresis because ultrasound can target tissues several centimeters deep, while iontophoresis only penetrates a few millimeters.

Question 33

If you are using iontophoresis to deliver dexamethasone (−) to an inflamed tissue, which of the following would be the most appropriate treatment parameters?
A. Active electrode: intensity = 1.5
mAmps; treatment time = 30 min
B. Active electrode; intensity = 2 mAmps;
treatment time = 20 min
C. Active electrode; intensity = 4 mAmps;
treatment time = 10 min
D. Active electrode; intensity = 8 mAmps;
treatmenttime = 5 min

Answer 33

B.
The active electrode should be the same
polarity as the medication. The optimal current dosage (intensity x treatment time) is 40 to 80 mAmp minutes.

Question 34

If you want move ions into the tissue, as in the application of iontophoresis, what type of electrical current will you need to use?
A. Continuous biphasic
B. Continuous monophasic
C. Pulsed biphasic
D. Pulsed monophasic

Answer 34

B.
In order to move ions continuousiv into
the tissue, a continuous monophasic current (i.e., direct current) is needed.

Question 35

You have a patient with a diabeticulcer that has not responded well to conventional treatment, so you think he might be a good candidate for electrical stimulation. Which tvpe of electrical current would most likely facilitate wound healing?
A. High-volt using a pulsed monophasic waveform
B. Interferential (medium-frequency)
C. Iontophoresis using a continuous monophasic waveform
D. TENS using a pulsed biphasic waveform

Answer 35

A.
High-volt stimulation would be the best option because it is a monophasic waveform and can produce polarity effects. These polarity effects have been shown to help stimulate tissue repair and destroy bacteria that may contaminate the wound. Iontophoresis also produces polarity effects but cannot be applied to an open wound because the continuous current will irritate the tissue too much.

Question 36

You are treating a patient who is recovering from a muscle strain and you want to help increase the blood flow to that muscle as well as enhance its extensibility. Which thermal agent is most likely to produce these effects in muscle tissue?
A. Hot pack
B. Infrared radiation
C. Pulsed ultrasound
D. Shortwave diathermy

Answer 36

D.
Shortwave diathermy produces deep heat and is best absorbed by muscle tissue. Hot packs and infrared radiation are too superficial to adequately heat the target tissue. Pulsed ultrasound produces little or no thermal effect.

Question 37

You are treating an athlete who strained his hamstring muscle. Which of the following modalities would be contraindicated if this patient had a cardiac pacemaker?
A. Ice massage
B. Hydrotherapy
C. Shortwave diathermy
D. Ultrasound

Answer 37

C.
Diathermy is alwavs contraindicated in patients with pacemakers. Ultrasound is only contraindicated when used to treat a body part in close proximity to the pacemaker. In this case, the patient’s thigh is sufficiently distant from the pacemaker.

Question 38

You decide to use sensory-level (i.e., conventional)
TENS to provide some relief for incisional pain in your patient who recently underwent knee surgery. The physiological mechanism by which this form of TENS is thought to provide immediate pain relief is known as
A. Autogenicinhibition
B. Descending inhibition
C. Presvnaptic inhibition
D. Reciprocal inhibition

Answer 38

C.
Sensory-level TENS is believed to selectively activate the large-diameter A-beta fibers that block (i.e., “close the gait”) the slower conduction nociceptive fibers in the dorsal horn of the spinal cord before these neurons can synapse with the second-order neurons in the spinal tracts. Thus, this mechanism is referred to as presvnaptic inhibition.

Question 39

When you apply cryotherapy to a patient, you can expect it to _______ that patient’s sensory and
motor nerve conduction velocity.
A. Decrease
B. Increase
C. Initially increase, then decrease
D. Not change

Answer 39

A.
The application of cold modalities has been shown to reduce nerve conduction velocity.

Question 40

You want to use neuromuscular electrical stimulation (NMES) to facilitate active range of motion in a patient who is recovering from a fractured wrist. The patient has bony union but is limited by soft tissue tightness in her wrist flexors and extensors because of her immobilization.
Which of the following stimulation parameters would vou recommend?
A. Reciprocal stimulation mode using a frequency of 40 Hz and high enough intensity to elicit a full muscle contraction
B. Reciprocal stimulation mode using a frequency of 2 Hz and high enough intensity to elicit an observable muscle twitch
C. Synchronous stimulation mode using a frequency of 100 Hz with high enough intensity to elicit a comfortable sensory response
D. Synchronous stimulation mode using a frequency of Hz with intensity as high as the patient can tolerate

Answer 40

A.
A reciprocal mode is used because vou
want to provide contraction and elongation to both muscle groups (flexors and extensors). In order to simulate a functional muscle contraction, vou need to use a frequency in the tetanizing range and enough amplitude to produce a strong muscle contraction that can overcome the force of gravity and move the joint through its full range of motion.

Question 41

You have a patient with subacute rheumatoid arthritis in her hands who also has a history of Raynaud’s disease. Which of the following modalities would be contraindicated for this patient?
A. Cold pack
B. Fluidotherapy
C. Paraffin wax bath
D. Ultraviolet light

Answer 41

A.
Raynaud’s disease or phenomenon is induced by exposure to a cold stimulus, so the cold pack should be avoided with this patient.

Question 42

You plan to administer a combination of ultrasound and electrical stimulation to a patient who is experiencing muscle spasm in her upper trapezius and posterior neck muscles following a recent whiplash injury. To perform this type of treatment, what type of electrode setup would vou use?
A. Bipolartechnique using a dispersive pad that is equal to the size of the soundhead
B. Monopolar technique using a dispersive pad that is much larger than the soundhead
C. Monopolar technique using a dispersive pad that is much smaller than the soundhead
D. Quadripolar technique using 2 soundheads and 2 equal-sized dispersive pads

Answer 42

B.
Because the soundhead is the active electrode in a combination treatment such as this, you want the dispersive pad to be relatively inactive. Thus, a monopolar technique in which a larger dispersive pad is attached adjacent to the targeted treatment area would be most appropriate.

Question 43

You are treating a 12-vear-old patient with
Osgood Schlatter’s disease and want to apply a modality treatment over his tibial tuberosity to help relieve his pain. Which of the following modalities should you probably avoid using in a patient this age?
A. Ice massage
B. Iontophoresis
C. TENS
D. Ultrasound

Answer 43

D.
Although no evidence has supported prior concerns that ultrasound may damage a growing epiphysis, treating over these bony sites with ultrasound is still not generally recommended, particularly when other treatment options exist.

Question 44

You have an older patient with balance problems who you think would benefit from walking in a therapeutic pool. However, this patient also has some lower extremity edema associated with venous insufficiency. What effect might the pool therapy have on her edema?
A. The hydrostatic pressure exerted by the water should reduce her edema.
B. The relaxing effect of the water is likely to slow her circulation and diminish her edema.
C. Her edemawill probably worsen because therapeutic pools are usually heated to at least 100° F.
D. It should have no effect on her edema because walking in water is not that strenuous.

Answer 44

A.
The hydrostatic pressure exerted by the water at deeper depths (near this patient’s legs and feet) will help push fluid up and out of the lower extremities and back into the central circulation.

Question 45

You are treating a patient who is recovering from Guillain Barré syndrome and is still experiencing considerable weakness and fatigue in herlower extremity muscles. You want to use some electrical stimulation to help facilitate the strength of her muscle contractions. What type of duty cycle would be most appropriate for a patient like this?
A. 10 seconds ON, 50 seconds OFF
B. 10 seconds ON, 30 seconds OFF
C. 15 seconds ON. 15 seconds OFF
D. 15 seconds ON, 5 seconds OFF

Answer 45

A.
Because you are dealing with a very weak, partially innervated muscle, you will need to select a duty cycle that causes the least amount of fatigue. A 1:5 ratio of on/off time is recommended in those cases.

Question 46

You have placed equal-sized electrodes over the dorsal aspect of a patient’s proximal and distal forearm as shown in Figure 5-1 in order to stimulate his wrist and finger extensor muscles.
However, when you first turn the electrical stimulator on, the response you are getting is finger flexion, rather than extension. How would you correct this problem to get the desired motor response?
A. Increase the pulse duration to maximize the intensity
B. Move the electrodes closer together over the muscle belly
C. Switch from a biphasic current to a monophasic current
D. Use a smaller electrode over the distal forearm

Answer 46

B.
The illustration shows that these electrodes are spaced pretty far apart. The further apart two electrodes are, the deeper the current will run. Thus, the current is probably running too deep and actually stimulating the flexors, instead of the extensors. Moving both electrodes over the muscle belly should remedy this problem.

Question 47

You are using electrical stimulation to facilitate the contraction of a muscle that is recovering from a peripheral nerve injury. Because the patient only shows signs of partial innervation at this time, an electrical stimulation treatment will require the use of a stimulator that can produce a
A. High amplitude and long pulse duration
B. Highfrequency (i.e., &gt: 5000 Hz)
C. Monophasic waveform of positive polarity
D. Very low intensity in the microamperage range

Answer 47

A.
The stimulus threshold for a muscle that is enervated or only partially innervated is much higher thanit is for a normal. innervated muscle. The stimulus threshold is reached through a combination of increasing pulse amplitude and duration. Most small stimulators have limited amplitude range and a fixed pulse duration of 150-300 microseconds.
This may not be sufficient to reach the stimulus threshold for this patient’s muscle.

Question 48

You are treating a patient with adhesive capsulitis of the glenohumeral joint. You decide to administer some ultrasound in order to increase the extensibility of the patient’s joint capsule before you begin joint mobilization procedures.
Which ultrasound parameters are most likely to produce the desired results in this particular tissue?
A. 1 MHz continuous ultrasound
B. 1 MHz pulsed ultrasound
C. 3 MHz continuous ultrasound
D. 3 MHz pulsed ultrasound

Answer 48

A.
To increase the extensibility of collagen tissue, you want some thermal effects from the ultrasound treatment; thus, you need to use the continuous mode. To penetrate to the depth of the shoulder joint capsule, you should use the 1
MHz frequency because ultrasound delivered with higher frequencies tends to be absorbed more in the superficial tissues.

Question 49

Which of the following patient conditions would contraindicate the use of most thermal, mechanical, and electrical modalities?
A. Diabeticneuropathy
B. Hypertension
C. Metastaticcancer
D. Urinary incontinence

Answer 49

C.
Most heating, compression, and electrical modalities cause some increase in circulation, which can aggravate a metastatic condition. In addition, the presence of an active cancer in local tissue such as bone can weaken the tissue and cause injury, so traction would also be contraindicated. All of the other conditions are either indications or potential precautions for the use of these modalities

Question 50

Which of the following patients would not be an appropriate candidate for EMG biofeedback. training?
A. Individual with tension headaches
B. Olderadult with Alzheimer’s dementia
C. Poststroke patient who needs balance training
D. Quadriplegic patient who has had a recenttendon transfer

Answer 50

B.
EMG biofeedback requires the patient to consciously attend and respond to a visual or auditory stimulus in order to have a learning effect. An individual with dementia is unlikely to have the attention focus or retention needed to benefit from this type of intervention. All of the other conditions are indicated for either facilitating strength or relaxation of the targeted muscle groups.

Question 51

Which of the following physiologic changes would not be associated with the application of superficial heat?
A. Decreased interstitial fluid
B. Decreased pain perception
C. Increased extensibility of collagen tissue
D. Increased metabolic activity

Answer 51

A.
Heat tends to cause local vasodilation,
so it is more likely to increase the accumulation of fluid in the interstitial spaces than decrease it.

Question 52

You are preparing to apply cryotherapy to a patient who has never had it before. In your history, which question would help you determine whether your patient might be hypersensitive to cold?
A. Do your fingers ever go numb when exposed to cold, damp weather?
B. Have you ever had an allergic response to a cold stimulus (i.e., itchy rash or hives)?
C. Have you ever been frostbitten?
D. How often do you wear gloves when you are outside in cold weather?

Answer 52

B.
An allergic response to cold is most likely to present itself as a skin reaction in the form of itching, rash, or hives. Choice A relates to the occurrence of Raynaud’s phenomenon.
The other two choices are irrelevant.

Question 53

Which of the following modalities produces its thermal effects via evaporation?
A. Hot pack
B. Ice massage
C. Paraffin wax
D. Vapocoolant spray

Answer 53

D.
Vapocoolant sprays cause a surface cooling when the liquid spray evaporates.

Question 54

If you apply a cold pack or ice massage over a patient’s biceps muscle for 5 to 10 minutes before a session of resistive exercise, what change would you expect to see in that muscle?
A. An immediate increase in isometric strength
B. An immediate decrease in muscle tone and tendon reflex
C. Elimination of any exercise-induced muscle soreness
D. Faster recruitment of type II muscle fibers

Answer 54

A.
Studies have shown an increase in
muscle strength following a 5-minute application of a cold modality. Long-term cooling may reduce muscle strength as well as muscle tone. Although cold therapy may reduce the amount of delayed onset muscle soreness, the modality would need to be applied immediately after the exercise session, not before it.

Question 55

Heat modalities are generally contraindicated in the presence of an infectious lesion because they mav
A. Increase circulation, which can spread the organism to other parts of the body
B. Increase the rate of cellular mitosis and cause the organism to mutate
C. Mask the pain associated with the lesion, which may cause further tissue damage
D. Reduce the effectiveness of the body’s immune system

Answer 55

A.
Because heat tends to increase
circulation, the greatest danger is that heat applied over an infectious lesion will cause the organism to spread to adjacent tissues or get into the central circulation where it can cause a systemicinfection.

Question 56

In most cases, it is considered safe to apply ultrasound over or near
A. Cemented and plastic implants
B. Metal screws, plates, implants
C. A pacemaker
D. Reproductive organs

Answer 56

B.
Cement and plastic are rapidly heated
by ultrasound, so it should be avoided over tissues with these tvpes of implants. Ultrasound can interfere with a cardiac pacemaker when applied over the chest or upper back. The effects of ultrasound on reproductive organs is not known; thus, it should be avoided over these anatomic areas. Metal tends to reflect ultrasound, so metal implants are not a contraindication.

Question 57

When examining an ultrasound machine, you note that it operates at a frequency of 1 MHz and has a Beam Nonuniformity Ratio (BR) of 8:1. Which of the following statements regarding this machine is true?
A. Most energy will be absorbed in superficial tissues, and it may produce uneven heating.
B. Most energy will be absorbed in superficial tissues, and it should produce even heating.
C. Most energy will be absorbed in deep tissues, and it may produce uneven heating.
D. Most energy will be absorbed in deep tissues, and it should produce even heating,

Answer 57

C.
A 1MHz ultrasound unit is a relativelv low frequency that allows the sound waves to be absorbed deeper into the tissue (higher frequency energy is absorbed more superficially). BNR is the ratio between the spatial peak intensity and the spatial average intensity of the ultrasound beam. The higher the BNR, the less uniform the heating effect will be and the more likely to produce “hot spots” during the treatment. Most units produce a BNR of 5:1 or 6:1 and some are as low as 2:1.

Question 58

The most common clinical use of phonophoresis is to
A. Apply an anti-inflammatory medication to a localized musculoskeletal tissue
B. Deliver antibiotics to an infected wound
C. Provide a mechanical stimulus to accelerate repair in bone and cartilage
D. Slow the conduction velocity of sensory nerves to relieve pain

Answer 58

A.
Phonophoresis is most commonly used to deliver anti-inflammatory medication to soft tissues such as muscles, tendons, and joint capsules.

Question 59

You are administering ultrasound to a localized area around a patient’s patellar tendon when she begins to complain of intense pain over her tibial tuberosity. What is the most likely cause of this response?
A. You are using an ineffective or insufficient amount of coupling medium.
B. There is a very low attenuation of ultrasound in bony tissue.
C. You are using an ultrasound unit with a high BNR and/or are moving it too slowly.
D. The crystal in the soundhead has been damaged.

Answer 59

C.
Bony tissue has a high attenuation for ultrasound due to both absorption and reflection. Thus, if you are moving the soundhead too slowly or using a unit with a high BNR. the heating effect may be more concentrated over the bone tissue and cause discomfort (i.e., deep aching).

Question 60

A patient with diabetes is admitted for care of a venous stasis ulcer on the medial aspect of his ankle. You decide to include pulsed ultrasound as part of your treatment plan to take advantage of its nonthermal effects on wound healing. Which of the following is an example of a nonthermal effect produced by ultrasound?
A. Decreased cell membrane permeability, which reduces edema
B. Decreased histamine release and macrophage activity
C. Destruction of surface bacteria and stimulation of antibodies in the wound bed
D. Increased intracellular calcium and protein svnthesis

Answer 60

D.
Nonthermal effects of ultrasound include an increase in intracellular calcium levels, skin and cell membrane permeability, histamine release, rate of protein svnthesis, rate of mast cell degeneration, and nitric oxide synthesis, all of which promote wound healing.

Question 61

You plan to give a short wave diathermy treatment to a 42-year-old female patient who has low back pain. Which of the following questions would not be necessary or appropriate to ask this patient before giving her this treatment?
A. Are you currently menstruating?
B. Could you possibly be pregnant?
C. Do you know if you might have a urinary infection or a pelvic tumor?
D. Do you take birth control pills?

Answer 61

D.
The use of birth control pills does not contraindicate or add precautions to the use of short wave diathermy, so it is an unnecessary question. All of the other questions may have some relevance to the use of this modality over this particular part of the body.

Question 62

A college student injures his ankle in an intramural volleyball game. X-rays reveal no evidence of fracture, so he is referred to PT for treatment of an acute ankle sprain. Which of the following modalities would be most appropriate to apply at this time?
A. Air-activated heat wrap
B. Cold compression cuff
C. Fluidotherapy
D. Short wave diathermy

Answer 62

B.
The combination of cryotherapy and compression is best for reducing edema because the cold will cause vasoconstriction and the compression will prevent the build-up of fluid in the interstitial spaces. The other choices are all heat modalities, which can aggravate the edema formation.

Question 63

You receive a referral to treat a decubitus ulcer over a patient’s sacrum. Following hydrotherapy to clean and debride the ulcer, you decide to irradiate the wound with ultraviolet light. Before administering a UV treatment, you need to ask your patient if he/she
A. Has a cardiac pacemaker
B. Has any food allergies
C. Has ever been severely sunburned
D. Is currently taking any medications that cause sensitivity to sunlight

Answer 63

D.
The use of photosensitive medications can affect the choice of treatment intensity when using ultraviolet treatment. The rest of the questions are not particularly relevant to the use of this modality in terms of precautions or treatment parameters.

Question 64

The intensity of an infrared or ultraviolet lamp is greatest when the lamp is
A. Positioned closer to the patient at a 45 degree angle
B. Positioned closer to the patient at a 90 degree angle (perpendicular to skin)
C. Positioned further from the patient at a
90 degree angle (perpendicular to skin)
D. Radiating the skin through a sheet or thin towel

Answer 64

B.
According to the Inverse Square and
Cosine Laws, the intensity of the radiation will be most intense when the light source is positioned closer to the obiect and perpendicular to its surface.

Question 65

How does low-powered (“cold*) laser light differ from other tvpes of phototherapy?
A. Laserlight has greater divergence from its source.
B. Laserlight is monochromatic (i.e., one wavelength).
C. Lightwaves from lasers are transmitted in an asynchronous, noncoherent manner.
D. Laserlightis classified as a form of ionizing radiation.

Answer 65

B.
By definition, a laser emits light of a specific wavelength; thus, it is monochromatic.
Cluster diodes used in newer therapeutic lasers usually contain several lasers of differing wavelengths. The other unique characteristics of laser light are that it does not diverge much from its source (ie., less “scatter” of the light), and the waves travel in a synchronous pattern Low-powered lasers are nondestructive because they are not in the ionizing range of the electromagnetic spectrum.

Question 66

A young woman is referred to you with severe muscle spasm in her back that began shortly after she started working as a ticket agent at the local airport. You think that some deep heat will really help calm down her spasm. When you ask about her past history of back problems she tells you that she had scoliosis as a child but underwent a surgical fusion (with metal rods) to stop the progression of her curve. She thinks her limited spinal mobility may be what triggered her spasm.
Based on this history and her current symptoms, which thermal modality would you select?
A. Diathermy because it selectively heats muscle tissue the best
B. Ultrasound because diathermy is contraindicated in this patient
C. Hot pack because both diathermy and ultrasound are contraindicated
D. None of the above because heat will only make her muscle spasm worse

Answer 66

B.
Heat should help reduce this patient’s muscle spasm. However, the target tissue in this case is too deep to be effectively heated with superficial modalities such as hot packs.
Because she had metal rods in her back. diathermy is contraindicated even though it tends to heat muscle tissue better than ultrasound.

Question 67

Why must a patient’s skin be cleaned and debrided before applying electrodes?
A. To avoid contaminating your electrodes
B. To determine whether his or her sensation is intact
C. To help decrease skin resistance
D. To reduce current density at the electrode-tissue interface

Answer 67

C.
Rubbing the skin surface with soap or alcohol will remove any dirt, lotions, or skin oils that mav create impedance to the electrical current and ensure better conductivity using the least amount of intensity.

Question 68

In Figure 5-2, which stimulation parameter is being modulated?
A. Pulse amplitude
B. Pulse duration/width
C. Pulse frequency
D. Pulse waveform

Answer 68

A.
In the illustration provided, the height of each pulse (ie. amplitude) progressively increases then decreases again. The shape of the pulses, width (i.e., duration) of the pulses, and the space between pulses remain the same.

Question 69

For which of the following patient conditions would electrotherapy be an inappropriate treatment modality?
A. An infected wound
B. Prior history of seizures
C. Muscle spasticity
D. Urinary incontinence

Answer 69

B.
Electrotherapy may be used to treat all infected wounds, spasticity, and urinary incontinence (via strengthening of the pelvic floor muscles). However, it is contraindicated in patients with a history of seizures because of the possibility that the stimulus might provoke a seizure.

Question 70

A high frequency sinusoidal (i.e., biphasic) waveform that is tvpically delivered in bursts of approximately 50 per second and used for muscle strengthening is usually referred to as
A. High-volt galvanic stimulation
B. Interferential current
C. Microcurrent
D. Russian current

Answer 70

D.
This tvpe of current is known as
Russian current. The other currents listed have different waveforms and are usually intended for other clinical indications besides muscle strengthening.

Question 71

Why do most neuromuscular electrical stimulation (NMES) protocols recommend frequency settings between 30 and 50 pulses per second?
A. Frequencies lower than this range cannot produce a muscle contraction.
B. Higher frequencies usually stimulate the nociceptors and make the patient uncomfortable.
C. Itproduces a smooth, tetanic muscle contraction without excessive fatigue.
D. Most muscle stimulators cannot produce frequencies above or below this range.

Answer 71

C.
Muscle tetany is usually achieved at a pulse rate between 30 and 50 pulses per second (Hz). Because a smooth contraction is desired for muscle strengthening or range of motion, most NMES protocols include frequency settings in this range. A muscle contraction can be elicited atlower frequency settings (will present as a twitch response), and higher frequency settings may be used, particularly when the treatment goal is to fatigue a muscle thatis in spasm.

Question 72

In which of the following situations would it be appropriate to use a low frequency (i.e., 1 to 5 Hz) to stimulate a muscle?
A. When the muscle is only partially innervated and very weak
B. When stimulating the intrinsic muscles of the hand or foot
C. When you are trying to relax a muscle that is in spasm
D. When you are trying to stretch a joint contracture

Answer 72

A.
A very weak or partially innervated muscle is easily prone to fatigue, so a lower frequency setting is indicated for these patients.

Question 73

When using NMES, when would you want to use a long rise/ramp time (i.e., 2 to 3 seconds)?
A. When stimulating a completely denervated muscle
B. When stimulating a hypotonic (i.e..
flaccid) muscle
C. When stimulating a hypertonic (i.e.
spastic) muscle
D. When stimulating the antagonist of a hypertonic (i.e., spastic) muscle

Answer 73

D.
When using electrical stimulation to help reduce spasticity, many protocols stimulate the antagonist of the spastic muscle because it is usually in a weakened state.
However, if the stimulus is brought on too quickly byusing a fast rise/ramp time, it may cause a quick stretch to the spastic muscle, thus exacerbating the problem.

Question 74

Which muscles would you stimulate if you were using NMES to help correct a subluxed glenohumeral joint in a patient who has had a stroke?
A. Anterior and posterior deltoid
B. Rhomboids and serratus anterior
C. Supraspinatus andlatissimus dorsi/teres maior
D. Supraspinatus and posterior deltoid

Answer 74

D.
Because the subluxedhumerus is displaced anteriorly and inferiorly, the supraspinatus and posterior deltoid muscles are usually stimulated simultaneously to help reverse the subluxed position.

Question 75

The concept of current dosage in iontophoresis refers to the
A. Current amplitude (intensity)
multiplied by treatment time
B. Current density as determined by the size of the delivery electrode
C. Current polarity in relation to the medication’s polarity
D. Difference between the phase charge and the treatment time

Answer 75

A.
The important aspect of iontophoresis
is to deliver a sufficient amount of medication to the tissues. Thus, it takes a combination of current intensity and treatment time to achieve the desired results. A current dosage of 40 mAmp minutes is usually required for effective results. Thus, if a patient only tolerates 1 mAmp of current, the treatment time would be 40 minutes. Ifthey tolerate more intensity, the treatment time can be reduced accordingly.

Question 76

If you are using electrical stimulation to limit edema formation in an acutely injured joint, the amplitude should be adjusted to produce a
A. Mild muscle contraction (tapping)
B. Strong muscle contraction (beating)
C. Sensory response only
D. Subsensory response

Answer 76

C
When the injury is acute and edema is still forming, stimulation should be kept at the sensory level to avoid further injury to the tissues. Sensorv-level stimulation is all thatis needed to affect the cell permeability changes that help reduce the edema formation.

Question 77

Why is a modulated current recommended when using conventional TENS for pain control?
A. Itprovides combined effects of sensory and motor level TENS.
B. Ithelps prevent sensory adaptation/habituation.
C. Itreduces the placebo effect of TENS.
D. Itselectively activates A-beta fibers.

Answer 77

B.
With sensory-level TENS, the body can quickly adapt, or habituate, to the sensation which diminishes its effects. By modulating the pulse amplitude, frequency, and /or duration, the body does not have the opportunity to get used to the sensation and should continue to respond to it.

Question 78

Nerves cannot achieve a continuous state of excitation due to
A. Threshold
B. Depolarization Period
C. Repolarization Period
D. Refractory Period

Answer 78

D.
Refractory period is the amount of time it takes for an excitable membrane to be ready for a second stimulus once it returns to its resting state following excitation. In the generation of an action potential, as the membrane potential is increased, both the sodium and potassium on channels begin to open. This increases both the inward sodium current (which is called depolarization) and the balancing outward potassium current (which is called repolarization). Threshold is the amount of current required for voltage to increase past a critical limit, typically 15 mV higher than the resting value. This results in initiating a process whereby the positive feedback from the sodium current activates even more sodium channels, and this eventually leads to the generation of an action potential.

Question 79

When utilizing electrical stimulation, what is the pulse frequency range for tetany?
A. 25 to 50 pps
B. 0to 10 pps
C. 10 to 20 pps
D. 75 to 100 pps

Answer 79

A.
Pulse frequency determines the rate of action potential activation. In addition, frequency influences the strength and motor response of a single motor unit. Increasing frequency changes muscle response from twitch to tetany. Tetany is required for most stimulation programs. Twenty five to 50 pulses per second is the frequency range to achieve tetany in most muscles. Anything less will result in twitch muscle responses. Increases in frequency past 50 ps deplete neurotransmitter supply in neuromuscular junction and depletes muscles energy supplies (ATP).

Question 80

What is the duty cycle for an electrical stimulation program with 6 seconds on time and 18 seconds off time?
A. 25%
B. 15%
C. 33%
D. 50%

Answer 80

A.
Duty cycle is the percentage of time that
stimulation is on or active. Duty cycle = {on
time/(on + off time)]x 100%;. In this case, 6
sec on/(6 on + 18 sec off) = 25%; duty cycle
(1:3 ratio).

Question 81

When stimulating the wrist extensors, the best current type/electrode configuration is
A. Symmetric biphasic/monopolar
B. Symmetric biphasic/bipolar
C. Asvmmetric biphasic/monopolar
D. Asymmetric biphasic/bipolar

Answer 81

C.
Electrode placement or electrode configuration is dependent on several factors, including the size of electrodes, orientation of electrodes, distance between electrodes, distance from motor points, polarity of electrodes, and type of waveform utilized. A monopolar electrode configuration occurs when one electrode is located over target tissue (active) and a second electrode over a distant site (inactive). A bipolar configuration occurs when both electrodes are over the target area and both electrodes are usually active.
Monopolar configurations are often used when current must be kept in a small area. Bipolar is utilized when current is desired in a larger target area. Asymmetrical or monophase configurations referto type of electrical waveform. It is utilized when current is desired in greater dosages at a specific electrode site.
One active electrode is placed close to the motor point while the other electrode is placed at another point to disperse current. Symmetric or biphasic waveforms are utilized when both electrodes need to be equally active. This is utilized in muscles that are larger or require more current. Wrist extensors are a small muscle mass that requires specific current to a small region. The asymmetric biphasic waveform with monopolar electrode configuration will provide the configuration for this muscle mass.

Question 82

When utilizing electrical stimulation, the key element of pulsed current is
A. A period of electrical silence
B. The duration of the current
C. The frequency of the current
D. The amplitude of the current

Answer 82

A.
There are three classes of electrical current. Direct current (DC) is characterized by a continuous or uninterrupted unidirectional flow of charged particles. Alternating current (AC) refers to a continuous or uninterrupted bidirectional flow of charged particles. Pulsed current is a unidirectional or bidirectional flow of charged particles that periodically ceases for a finite period of time. A period of electrical silence is a hallmark characteristic of pulsed current.

Question 83

A 29-year-old woman fractured her right midtibia in a skiing accident 3 months ago. After cast removal, a severe foot drop was noted. The patient wants to try electrical stimulation orthotic substitution. You would set up the functional electrical stimulation to contract the appropriate muscles during
A. Toe off
B. Push off
C. Foot flat
D. Swing phase

Answer 83

D.
While foot drop itself can be the result of numerous pathologies (both neurologic and orthopedic), weakness of the tibialis anterior muscle results in an impaired ability to dorsiflex the foot. This deficit is most apparent during the swing phase of gait in which the foot is required to dorsiflex in order to clear the toes as the foot progresses forward in the air.

Question 84

A patient has been referred to you following a fracture of the femur six months ago. The cast was removed, but the patient was unable to volitionally contract the quadriceps. You decide to apply electrical stimulation to the quadriceps muscle. Your choice of electrode placement and electrical stimulation duty cycle (on/off) would consist of
A. Large electrodes, closely spaced (10:10)
B. Large electrodes, widely spaced (10:30
C. Small electrodes, closely spaced (10:30)
D. Small electrodes, widely spaced (10:10)

Answer 84

B. Large electrodes should be utilized because the quadriceps are a large muscle group and a wider electrical field will allow for the recruitment of a greater number of motor units. Widely spaced electrodes are needed because electricity will travel the path of least resistance. If the electrodes are placed closely, that pathway will be superficial. By spreading the electrodes out wider, the current will flow deeper to the muscles motor points. The 10:30 duty cycle will provide the muscle with adequate recovery time between contractions as opposed to the 10 second rest cycle of the
10:10 duty cycle.

Question 85

A 31-year-old patient complains of patellar tendonitis as a result of a mountain climbing accident 3 weeks ago. The patient complains of pain with resisted knee extension, stair climbing, and sit-to-stand movements. You choose to apply iontophoresis using a pain medication with a positive charge. The correct type, polarity, and active electrode placement is
A. Monophasic current with anode placed on the tendon
B. Monophasic current with the cathode placed on the tendon
C. Biphasic current with the cathode placed proximal on the tendon
D. Low-volt, continuous current with the anode placed distal on the tendon

Answer 85

A.
When ionizable substances such as
acids, basis, salts or alkaloids are dissolved in water, the substances dissolve and dissociate into their polar components (ionization).
Resulting solutions (electrolytes) can carry an electrical current by virtue of the migration of the dissociated ions. When a direct current (DC) is passed between two electrodes in an electrolytic solution, positive ions will be repelled from the anode () and negative ions repelled from the cathode (−). The anode will repel the positively charged ion from the electrode and into the body. Electrostatic repulsion of like charges is the driving force for iontophoresis. Direct current is the continuous or uninterrupted unidirectional flow of charged particles. It allows for continuous transmission of the medication and assures maximum ion transfer per unit of applied current. Pulsed, AC. and interferential currents are less effective in meeting the need of causing a local medication effect.

Question 86

A 28-year-old actor/singer is complaining of TM] pain. He also complains of headaches and neck tightness. He has been under a lot of stress lately and has noticed an increase in the frequency and magnitude of symptoms. His doctor suggested and you concur that biofeedback might help him relax the neck and shoulder muscles and therefore decrease his svmptoms. Initially, the EMG biofeedback protocol should consist of
A. High detection sensitivity with recording electrodes placed far apart
B. Low detection sensitivity with recording electrodes placed closely together
C. Low detection sensitivity with recording electrodes placed far apart
D. High detection sensitivity with recording electrodes placed closely together

Answer 86

B.
Biofeedback operates on the theory that we have the innate ability to influence the functions of our bodies through volitional control mechanisms. Biofeedback is the use of electronic instrumentation to provide objective information (feedback) to an individual about physiologic function or response so that the individual becomes aware of his or her response. The individual attempts to alter the feedback signal in order to modify the physiologic response. Biofeedback EMG is the recording of the electrical activity of the muscle membrane in response to the physiologic activation of skeletal muscle. The amplitude of EMG reflects the size and number of active motor units as well as the distance of the active muscle fibers from the recording electrodes.
Therefore, distance between the electrodes is critical in determining the activity of a muscle group. Electrodes placed close together will require the patient to contract the muscle hard in order to register a response in the biofeedback unit. Electrodes placed far apart will make it easier to register a response.
Progression of the use of biofeedback to decrease muscle recruitment would involve placing electrodes close together initially and progressing to moving them farther apart as the patient is able to recruit the muscle more effectively. Detection sensitivity is utilized to monitor how much muscle recruitment is being generated. High detection sensitivity refers to the biofeedback unit’s ability to detect small muscle contractions. The setting allows for a high ability to detect muscle contractions. Low detection sensitivity will require a larger muscle contraction for the biofeedback unit to detect the muscle activation. In this patient case, the activity of the masseter muscle is high and you wish to decrease that activity. Placing the electrodes close with a low detection sensitivity is the best arrangement.

Question 87

A 26-year-old presents with weakness of the knee resulting from an anterior cruciate ligament injury. Your examination reveals moderate pain (5/10) and excessive translation of the tibia during active knee extension. You determine functional stability of the knee should consist of stimulation of the
A. Hamstrings immediately before the quadriceps to produce co-contraction
B. Quadriceps only
C. Hamstrings only
D. Quadriceps immediately before the hamstrings to produce co-contraction

Answer 87

A.
The hamstring muscles function to
reduce or prevent anterior translation of the tibia during terminal knee extension. The ACL plays a similar role. In an ACL deficient knee, rehabilitation should be geared towards recruiting the hamstring during functional activities. The hamstring should be recruited before the quadriceps to provide for joint stability.

Question 88

A patient presents with partial- and full-thickness burns on the chest and neck region. You are applying TENS during your debriding procedure to modulate pain. Your TENS treatment of choice would be
A. Modulated TENS
B. Conventional (high rate) TENS
C. Acupuncture-like (low rate) TENS
D. Briefintense TENS

Answer 88

D.
Briefintense pain TENS is also known as Motor Level TENS or Counter Irritation TENS.
Physiologically, it utilizes the concept that if someone’s hand hurts, causing pain in the leg will result in the person feeling less pain in the hand. Physiologically, the mechanism is still unclear, but it is hypothesized that changes occur cortically as the CNS shifts its focus awav from the painful area to the new area of pain.
Because of the nature of the pain involved with wound debridement, a very noxious stimulant should be utilized to counter the pain generated from the procedure. Brief intense TENS is the best setting to achieve the noxious stimulant.

Question 89

A 73-year-old patient presents with a stage III decubitus ulcer on the plantar surface of the right foot. After a series of conservative treatments with limited success, the therapist chooses to apply electrical stimulation for tissue repair. The electrical current best suited in this case is
A. Russian current
B. Asymmetric biphasic pulsed current
C. Symmetric biphasic pulsed current
D. Interferential current

Answer 89

B.
Results from animal and human studies
support electrical stimulation as a means of promoting faster healing rate (epithelization) and enhanced wound (dermal) strength. The proposed physiologic effects include improved epidermal cell proliferation and migration, increased dermal fibroblastic activity, diminished edema, improved blood flow, increased oxygen, increased nutrients, decreased waste products, inhibited bacterial growth, enhanced phagocytosis, and changes in the “skin batter.” The skin, like cell membranes, separates charge across its membrane. This separation of charge creates an electrical potential difference across the membrane. With wounds, electrical charge escapes the wound and the potential difference decreases. With healing wounds, there is a current flow across the wound and with nonhealing wounds there is no current flow. This is called the skin battery.
Electrical stimulation has been postulated to create this current flow and therefore promote wound healing. The current has been hypothesized to promote epithelial cell migration, increased capillary permeability, and increased macrophages. Asymmetric waveforms have been shown to be more effective then symmetric waveforms indicating that polarity may play a role in healing. Biphasic waveforms appear to be more effective than monophasic.

Question 90

You are applying pulsed current to the quadriceps to improve patellar tracking during knee extension. Your patient complains that the current is uncomfortable. To make the current more tolerable to the patient, yet maintain a good therapeutic effect, you should consider adjusting the
A. Current intensity
B. Pulse rate
C. Pulse duration
D. Current polarity

Answer 90

A.
The quadriceps are a large muscle group and as a result require a relatively significant amount of current to effectively recruit enough motor units to strengthen the muscle. Studies on the quadriceps indicate that it is difficult to selectively recruit one of the quadricep muscles individually during functional activities. The focus of treatment is not to improve strength of the muscle but rather to improve the muscle’s motor control.
Maximal muscle recruitment is not required to improve muscle motor control. Therefore, the clinician could decrease the amount of current (current intensity). This would make the treatment more comfortable for the patient, but the patient should be encouraged to actively recruit the muscle in conjunction with the stimulation. Modifying the pulse rate and pulse duration would affect the ability to recruit muscle fibers and therefore should not be changed. With a muscle group as large as the quadriceps, a biphasic waveform is probably preferable to monophasic; therefore, changing polarity will not affect the comfort of the intervention because a biphasic waveform will have equal current at each electrode.

Question 91

Your patient has moderate spasticity of the biceps brachii on the left as a result of a stroke. You choose to use electrical stimulation to temporarily decrease the effects of hypertonicity in order to work on ADL activities. Your objective in applying the current is to
A. Fatigue the ipsilateral biceps brachii
B. Stimulate the contralateral biceps brachii
C. Stimulate the ipsilateral triceps
D. Stimulate the contralateral triceps

Answer 91

C.
While stimulation of any of the mentioned muscles could potentiallead to an inhibition of the biceps muscle, the best results would be accomplished through stimulation of the ipsilateral triceps. Physiologically, the stimulation of the ipsilateral triceps would result in reciprocal inhibition of the biceps muscle via the la inhibitory pathway.

Question 92

A 66-year-old patient with spastic hemiplegia was referred to you for ambulation training. The patient is having difficulty with standing up from a seated position due to co-contraction of the quadriceps and hamstrings during the knee and hip extension phase. You choose EMG biofeedback to assist you in progressively decreasing the motor activity of the hamstrings. You wish to use biofeedback beginning with simple knee extension exercise in the seated position and progressing to sit to stand training. Initially, the biofeedback protocol should consist of
A. Low detection sensitivity with recording electrodes placed far apart
B. High detection sensitivity with recording electrodes placed closely together
C. Low detection sensitivity with recording electrodes placed closely together
D. High detection sensitivity with recording electrodes placed far apart

Answer 92

C.
Biofeedback operates on the theory that we have the innate ability to influence the functions of our bodies through volitional control mechanisms. Biofeedback is the use of electronic instrumentation to provide objective information (feedback) to an individual about a physiologic function or response so that the individual becomes aware of his or her response. The individual attempts to alter the feedback signal in order to modify the physiologic response. Biofeedback EMG is the recording of the electrical activity of the muscle membrane in response to the physiologic activation of skeletal muscle. The amplitude of EMG reflects the size and number of active motor units as well as the distance of the active muscle fibers from the recording electrodes.
Therefore, distance between the electrodes is critical in determining the activity of a muscle group. Electrodes placed close together will require the patient to contract the muscle hard in orderto register a response in the biofeedback unit. Electrodes placed far apart will make it easier to register a response.
Progression of the use of biofeedback to decrease muscle recruitment would involve placing electrodes close together initially and progressing to moving them farther apart as the patient is able to recruit the muscle more effectively. Detection sensitivity is utilized to monitor how much muscle recruitment is being generated. High detection sensitivity refers to the biofeedback unit’s ability to detect small muscle contractions. The setting allows for a high ability to detect muscle contractions. Low detection sensitivity will require a larger muscle contraction for the biofeedback unitto detect the muscle activation. In this patient case, the activity of the hamstring muscle is high and you wish to decrease that activity. Placing the electrodes close with a low detection sensitivitv is the best arrangement.

Question 93

A physical therapist is providing intervention for an 11-year-old boy diagnosed with Sever’s disease. All are appropriate therapeutic interventions for this patient except
A. Gastrocnemius/soleus stretches
B. Tibialis anterior strengthening
C. Ultrasound
D. Ice

Answer 93

C.
All are appropriate interventions except
ultrasound. Itis contraindicated to apply ultrasound directly over active epiphyseal regions (growth plates) in children.

Question 94

The physical therapist makes recommendations to a patient after hip replacement surgery for positioning in a wheelchair. Which set of instructions would adhere to safety precautions?
A. Keep the legs abducted with abductor pillow and affected leg in neutral.
B. Keep the legs together by using an adductor strap to prevent external rotation of legs.
C. Sit in a regular wheelchair with the feet supported on a footrest.
D. Sit in regular wheelchair with the affected leg in full extension.

Answer 94

A.
Following hip precautions, it is essential to avoid hyperextension or flexion of the hip past 90 degrees. In a wheelchair, a cushion or pillow should be placed in the seat to reduce the angle of the hip while seated, and the legs should be positioned in neutral to prevent internal or external rotation with the use of an abductor pillow.

Question 95

The therapist is ambulating a patient with an above-knee amputation. The new prosthesis causes the heel on the involved foot to move laterally at toe-off. Which of the following is the most likely cause of this deviation?
A. Too much internal rotation of the prosthetic knee
B. Too much external rotation of the prosthetic knee
C. Too much outset of prosthetic foot
D. The prosthetic foot is set in excessive dorsiflexion

Answer 95

A.
This deviation is commonly referred to
as a lateral heel whip. Excessive internal rotation of the prosthetic knee is one of the causes of this deviation. Excessive external rotation of the knee causes a medial heel whip.

Question 96

The therapist in an outpatient physical therapy clinic receives an order to obtain a shoe orthotic for a patient. After examining the patient, the therapist finds a stage I pressure ulcer on the first metatarsal head. Weight-bearing surfaces need to be transferred posteriorly. Which orthotic is the most appropriate for this patient?
A. Scaphoid pad
B. Thomas heel
C. Metatarsal pad
D. Cushion heel

Answer 96

C.
Metatarsal pads successfully transfer weight onto the metatarsal shafts of this patient.
A Thomas heel and a scaphoid pad are for patients with excessive pronation. A cushion heel absorbs shock at contact.

Question 97

When ordering a customized wheelchair for a patient, the therapist determines that the pelvic beltneeds to be positioned so that it allows active anterior pelvic tilt. What is the best position for the pelvic belt in relation to the sitting surface?
A. 30 degrees
B. 45 degrees
C. 60 degrees
D. 90 degrees

Answer 97

D.
A belt that is angled at 90 degrees with the sitting surface limits the patient’s involuntary efforts to extend the trunk because of increased tone. This angle also allows the patient to actively tilt the pelvis anteriorly, which is a functional movement that does not need to be restricted.

Question 98

The therapist is treating a patient who has suffered a recent stroke. There is a significant lack of dorsiflexion in the involved lower extremity and a significant amount of medial/lateral ankle instability. The therapist believes that an ankle foot orthosis (AFO) would be beneficial. Which of the following is an in appropriate AFO?
A. Solid AFO
B. Posterior leaf spring AFO
C. Hinged solid AFO
D. Electrical stimulation aided AFO

Answer 98

B.
Choices A and C provide the most
medial/lateral ankle support. A posterior leaf-spring ankle-foot orthosis only provides assistance with dorsiflexion. Electrical stimulation aided AFOs also only assist with dorsiflexion and do not address the ankle instability.

Question 99

The use of compression stockings on the feet and ankles is contraindicated in which patient population?
A. Chronic venous disease
B. Recenttotal knee replacement
C. Burnpatients
D. Chronic arterial disease

Answer 99

D.
Compression stockings (e.g. Jobst, TED hose) are used in patients with poor venous return. A patient with chronic arterial disease already has difficulty with getting blood to the lower extremities; there is no need to further inhibit the flow.

Question 100

The therapist is examining a 36-year-old woman to fit her with the appropriate wheelchair.
Recent injury caused C6 quadriplegia. What is the correct way to measure length of the footrests for the patient’s permanent wheelchair?
A. From the patient’s popliteal fossa to the heel and add 1 inch
B. From the patient’s popliteal fossa to the heel and subtract 1 inch
C. Fromthe patient’s popliteal fossa to the first metatarsal head and add 1 inch
D. From the patient’s popliteal fossa to the first metatarsal head and subtract 1 inch

Answer 100

B.
The correct procedure is choice
B. Subtracting 1 inch allows correct pressure distribution over the patient’s buttocks and thighs.

Question 101

The therapist is ambulating a 42-year-old man who has just received an above-knee prosthesis for the left leg. The therapist notices pistoning of the prosthesis as the patient ambulates. Which of the following is the most probable cause of this deviation?
A. The socket is too small.
B. The socket is too large.
C. The foot bumper is too soft.
D. The foot bumper is too hard.

Answer 101

B.
A socket that is too large may cause the prosthetic limb to “drop” during ambulation.

Question 102

While examining a patient who has just received a new left below-knee prosthesis, the therapist notes that the toe of the prosthesis stays off the floor after heel strike. Which of the following is an unlikely cause of this deviation?
A. The prosthetic foot is set too far anterior.
B. The prosthetic foot is set in too much dorsiflexion.
C. The heel wedge is too stiff.
D. The prosthetic foot is outset too much.

Answer 102

D.
If the foot is outset too much, it
is likely to cause the prosthetic knee to bow inward during standing.

Question 103

Which of the following is the most appropriate orthotic for a patient with excessive foot pronation during static standing?
A. Scaphoid pad
B. Metatarsal pad
C. Metatarsal bar
D. Rocker bar

Answer 103

A.
Metatarsal pads, metatarsal
bars, and rocker bars transfer weight onto the metatarsal shaft. A scaphoid pad is for patients with excessive pronation.

Question 104

A therapistis instructing a patient in the use of a wrist-driven prehension orthotic. What must be done to achieve opening of the involved hand?
A. Activelvextend the wrist
B. Passively extend the wrist
C. Actively flex the wrist
D. Passively flex the wrist

Answer 104

D.
This tve of orthotic uses
tenodesis to achieve opening and closing of the hand. To close the hand, the patient actively extends the wrist. To open the hand, the patient passively flexes the wrist.

Question 105

The therapist is treating a patient who received an above-elbow amputation 2 years ago. The prosthesis has a split cable that controls the elbow and the terminal device. With this type of prosthesis, the patient must first lock the elbow to allow the cable to activate the terminal device.
This is accomplished with what movements?
A. Extending the humerus and elevating the scapula
B. Extending the humerus and retracting the scapula
C. Extending the humerus and protracting the scapula
D. Extending the humerus and depressing the scapula

Answer 105

D.
To lock the elbow with this type
of prosthesis, the patient must extend the humerus and depress the scapula.

Question 106

A 30-year-old man is referred to physical therapy after a recent motor vehicle accident that resulted in total loss of motor control of both legs.
Trunk and bilateral upper extremity control allows independent sitting at bedside. The patient is to be discharged from the hospital and will return home a few hours after the physical therapy session. The therapist notices, from the history in the chart, that the patient lives alone and has little or no outside support from family members. The patient also suffers from severe obesity. The therapist decides to practice a transfer from the bed to the wheelchair. Which assistive device should the therapist use for this transfer attempt?
A. Hoyer lift (pneumatic lift)
B. Sliding board
C. Geriatric chair (using a slide sheet transfer)
D. Trapeze bar

Answer 106

B.
Use of a sliding board is the
most functional transfer for this patient. The pneumaticlift requires assistance from another person, on which this patient cannot rely because he lives alone and has poor outside family support. A fully reclined geriatric chair is often used to transfer obese patients with a slide sheet transfer, which requires two or more people. A trapeze bar may be useful, but transferring wheelchair to bed with a sliding board teaches the patient the skill needed to transfer from the wheelchair to many other surfaces (that may not have a trapeze barto assist).

Question 107

The physical therapist has just given the patient a custom wheelchair. The patient has a longstanding history of hamstring contractures resulting in fixation of the knees into 60 degrees of flexion. The patient is also prone to develop decubitus ulcers. Which of the following is incorrect advice to give the family and patient?
A. Keepthe patient’s buttocks cleanand dIv.
B. Make sure that the wheelchair cushion is always in the wheelchair seat.
C. Keep the legrests of the wheelchair full elevated.
D. Nevertransferusing a sliding board from one surface to another.

Answer 107

C.
Fully elevating the leg rests of
the patient’s chair increases hip flexion. The already tight hamstrings (secondary to contracture) would tilt the pelvis posterior.
This maneuver would increase weight on the ischial tuberosity, risking a decubitus ulcer.
Choice D is correct advice because sliding board transfers can lead to abrasions. Choices A and B are also correct measures to decrease the chance of developing ulcers.

Question 108

A 27-year-old man with a diagnosis of incomplete spinal cord injury at the L4level is being examined by a physical therapist. The patient is nearing discharge from the rehabilitation unit. Manual muscle testing reveals the following. right hip flexion = 4/5, right hip adduction = 5/5, right knee flexion = 2/5, right knee extension = 38#43;/5, right ankle plantar flexion = 1/5, and right ankle dorsiflexion = 2-/5; left hip flexion = 4/5, left hip adduction = 48#43:/5, left knee flexion = 2/5, left knee extension = 3/5, left ankle plantar flexion = 2-/5, and left ankle dorsiflexion = 2-/5. What is the appropriate orthotic for this patient? What is his most likelv functional outcome?
A. Hip-knee-ankle-foot orthosis (HKAFO)
with forearm crutches, household ambulator.
B. Knee-ankle-foot orthosis (KAFO) with forearm crutches, household ambulator.
C. KAFO with forearm crutches, functional ambulator.
D. HKAFO with forearm crutches, functional ambulator.

Answer 108

C.
Because the hip flexors are
strong, there is no need for the hip component of an orthotic.

Question 109

A physical therapist is ordered to provide gait training for an 18-year-old girl who received a partial medial meniscectomy of the right knee one dav earlier. The patient was independent in ambulation without an assistive device before surgery and has no cognitive deficits. The patient’s weight-bearing status is currently partial weight bearing on the involved lower extremity. Which of the following is the most appropriate assistive device and gait pattern?
A. Crutches, three-point gait pattern
B. Standard walker, three-point gait pattern
C. Standard walker, four-point gait pattern
D. Crutches, swing-to gait pattern

Answer 109

A. A patient of this age usually can begin with crutches instead of a standard walker. If the patient has no cognitive deficits and was independent in ambulation without an assistive device before surgery, she most likely will have the balance and coordination necessary to ambulate with crutches. A three-point gait pattern is necessary because of the current partial weight-bearing status. A swing-to pattern also can be used, but a three-point pattern assists more quickly in returning a more normal gait pattern.

Question 110

A physical therapist is ordered to provide gait training to a 78-year-old man who received a right cemented total knee replacement 24 hours earlier. The patient also had a traumatic amputation of the left upper extremity 3 inches above the elbow 40 years ago. If the patient lives at home alone, which of the following is an appropriate assistive device?
A. Rollingwalker
B. Standard walker
C. Hemi-walker
D. Wheelchair for 2 weeks

Answer 110

C.
Although the patient will have
to use the hemi-walker with the right upper extremity, answer C is still the best choice for this patient. Choices A and B are unsafe with one upper extremity. Choice D does not encourage weight-bearing and is not the most functional choice. A person with a cemented prosthesis can bear weight as tolerated on the involved lower extremity in early rehabilitation.

Question 111

Which of the following statements about below-knee amputations is false?
A. Gel socket inserts should be left in the prosthesis overnight.
B. The therapist should puncture any blisters that appear on the stump.
C. Areas of skin irritation on the stump can be covered with a dressing, then a nylon sock, before donningthe prosthesis.
D. When not in use, the prosthesis should be laid on the floor.

Answer 111

B.
Blisters should be allowed to
subside naturally. Gel inserts lose their shape if not left in the prosthesis overnight. The prosthesis should be propped up in a corner or laid on the floor to prevent it from falling and cracking.

Question 112

A therapist is assisting a patient with pre-gait activities who has been fitted with a hip disarticulation prosthesis. To ambulate with the most correct gait pattern, what must be mastered first?
A. Forward weight shift on to the prosthesis
B. Swing-through of the prosthesis
C. Maintain stability while in single limb support on the prosthesis
D. Posterior pelvic tilt to advance the prosthesis

Answer 112

D.
All of the above are important
skills for a patient with a hip disarticulation prosthesis to master, but posterior pelvic tilt should be mastered first to advance the prosthesis.

Question 113

A 68-year-old man is being treated by a physical therapist after a right below-knee amputation.
The patient is beginning ambulation with a preparatory prosthesis. In the early stance phase of the involved lower extremity, the therapist notes an increase in knee flexion. Which of the following are possible causes of this gait deviation?
A. The heelis too stiff.
B. The foot is set too far anterior in relation to the knee.
C. The foot is set in too much plantar flexion.
D. The heel is too soft.

Answer 113

A.
A heel that is too stiff causes
excessive knee flexion. Choices B and C cause excessive knee extension during this stage of the gait cycle.

Question 114

Orthotic intervention is usually recommended at ________ for a child with idiopathic scoliosis.
A. 15 degrees
B. 25 degrees
C. 40 degrees
D. 60 degrees

Answer 114

B.
The type of orthosis used
depends on the degree of curve, location, and curve tvpe. Skeletallv immature patients with a curve of 25 to 45 degrees have shown good results with orthotics.

Question 115

An advantage for use of an externally-powered
UE prosthetic device over a body-powered prosthetic device is
A. Cost
B. Ease of use
C. Improved fit
D. Weight

Answer 115

A.
An externally powered
prosthesis uses muscle contractions by the child that activates an electrode in the prosthesis. A body-powered prosthesis uses a cable and harness system.

Question 116

A patient begins ambulation with axillary crutches for the first time. The gait required will be non-weight bearing for the right foot. What is the best advice to give them in regard to crutch placement during static standing?
A. Stand with the crutches and weight-bearing foot in a parallel line.
B. Stand with both crutches under the right arm.
C. Stand with both crutches under the left arm.
D. Stand with both crutches approximately
4 inches to the front and side of the shoulders.

Answer 116

D.
Choice A provides a very small
base of support, while choice Dwidens the base of support. Crutches should never be placed under the same arm.

Question 117

Of the walkers listed, which is the least stable?
A. Foldingwalker
B. Reciprocal walker
C. Rollingwalker
D. Nonfolding standard walker

Answer 117

B.
The reciprocal walker has
hinges that allow each side of the walker to move with the lower extremity being advanced.
This walker is unsafe. The order of most to least stable is nonfolding standard walker, folding, rolling, and reciprocal.

Question 118

The physical therapist is providing intervention for a patient with a recent stroke. Gait training with a new ankle foot orthosis (AFO) will begin today. What is the most important aspect of the fit of the AFO?
A. The ankle should be flexed to 90 degrees.
B. The top of the AFO should be 4 inches
below the knee joint.
C. Any complaints of pain or discomfort are important to AFO fit.
D. The bottom of the AFO should stop at the metatarsal heads.

Answer 118

C.
Any complaints should be
investigated immediately. Pain could be a sign of possible pressure areas or a compartment syndrome. The fit of the brace should be examined after there are no complaints.

Question 119

Which of the following is the most important factor when considering using restraints on a patient?
A. Comfort of application
B. Consent to apply restraints from patient/family
C. Current knowledge of staff in securing restraints
D. Mental status of patient

Answer 119

B.
Without legal consent for
restraints, none of the other choices are a concern. Legal documentation is imperative with any medical procedure.

Question 120

A physician orders gait training for a 16-year-old male with recent open reduction internal fixation of the left femur. The patient is non-weight bearing on the affected leg. Which of the following assistive devices is most appropriate for this patient?
A. Forearm crutches
B. Front-wheel walker
C. Axillary crutches
D. Quad cane

Answer 120

C.
Axillary crutches are the most
appropriate device based on the patient’s age and diagnosis.