Industrial Rehab Flashcards
Which finding is a relative contraindication to cryotherapy?
(a) Acute inflammation
(b) Pain
(c) Acute hematoma
(d) Impaired sensation
Answer: (d)
Commentary: Cryotherapy, that is, the therapeutic use of cold by means such as ice, cold packs, or cold water immersion is commonly used to decrease pain, muscle soreness, fatigue and acute inflammation. Relative contraindications include cold intolerance, cryoglobulinemia, impaired sensation or cognitive defects. Cold intolerance can lead to decreased compliance and increased muscle guarding. Cryoglobulinemia results in immune complex precipitation at lower temperatures. Impaired sensation or cognitive defects may lead to tissue injury. Cryotherapy can be effective in decreasing the swelling or bleeding that commonly accompany tissue injuries.
Reference: Lane E, Latham T. Managing pain using heat and cold therapy. Paediatr Nurs
2009;21:14-18
2013
Which ergonomic recommendation for computer stations is NOT appropriate for an injured
worker with upper extremity cumulative trauma disorder?
(a) Neutral position of the wrists
(b) Forearm position horizontal to the floor
(c) Elevated positioning of the mouse
(d) Mid-line positioning of the keyboard
Answer: (c)
Commentary: Ergonomic evaluation of the computer workstation is important for both the
prevention and the treatment of cumulative trauma disorders. All the listed ergonomic
recommendations are appropriate, with the exception of elevated placement of the mouse. More
midline and level mouse placement is recommended, especially in cases of de Quervain
tenosynovitis.
Reference: Foye PM, Cianca JC, Prather H. Industrial medicine and acute musculoskeletal
rehabilitation. 3. Cumulative trauma disorders of the upper limb in computer users. Arch Phys
Med Rehabil 2002;83(3 Suppl):S14-5
2013
Repetitive transcranial magnetic stimulation (rTMS) of the motor cortex appears to have
therapeutic value in the treatment of
(a) fatigue.
(b) hypertension.
(c) stroke.
(d) seizure
Answer: (c)
Commentary: With demonstrated facilitation of motor recovery after stroke, rTMS has been used
in 2 ways: (1) frequency stimulation less than 1 Hz to the unaffected hemisphere, reducing its
inhibitory effects on the affected hemisphere and (2) frequency stimulation greater than 1Hz to
the affected hemisphere, increasing its excitability. Studies suggest possible greater benefit when
the lesion is subcortical rather than cortical. Frequencies greater than 20 Hz, especially when
intensity is higher, theoretically may increase the risk of seizure. Benefits of rTMS have been
shown in preliminary studies of those with both chronic and acute stroke.
Possible adverse or undesirable effects of rTMS include seizure (with treatment frequencies
greater than 20 Hz) and increasing blood pressure (with higher treatment frequencies after
chronic stroke.) Transcranial magnetic stimulation can be used to evaluate central fatigue, but has
not been used for treatment of fatigue.
Reference: Corti M, Patten C, Triggs W; Repetitive transcranial magnetic stimulation of motor
cortex after stroke; Am J Phys Med Rehabil 2012 ;91:254-70.
2013
Which deep heat method recommends the use of protective eyewear to prevent the formation of
cataracts?
(a) Ultrasound
(b) Short wave diathermy
(c) Fluidotherapy
(d) Microwave diathermy
Answer:(d)
Commentary: Microwave diathermy is another form of electromagnetic energy that uses
conversion as its primary form of heat production.Temperature distribution in a particular tissue is affected largely by its water content. In general, tissues with high water content absorb greater amounts of energy and are selectively heated. General heat precautions should be observed with microwave procedures. Metal implants, pacemakers, sites of skeletal immaturity, reproductive organs and brain, and fluid-filled cavities (eye, bullae, effusions, etc.) should be avoided. Microwaves can cause cataracts and protective eye wear should be worn by both patient and therapist to reduce risk.
2012
Which non-surgical treatment for carpal tunnel syndrome is shown to provide significant short-term benefit?
(a) Magnet therapy
(b) Laser therapy
(c) Therapeutic exercise
(d) Therapeutic ultrasound
Answer: (d)
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Commentary: Patients suffering from carpal tunnel syndrome are often offered nonsurgical treatments. Current evidence shows significant benefit from therapeutic ultrasound treatments, splinting, yoga, and carpal bone mobilization. However, trials involving the use of magnet therapy, laser therapy, therapeutic exercise, and chiropractics have not produced significant benefits compared to placebo or control treatments.
2013
Repetitive transcranial magnetic stimulation (rTMS) of the motor cortex appears to have therapeutic value in the treatment of
(a) fatigue.
(b) hypertension.
(c) stroke.
(d) seizure
Answer: (c)
Commentary: With demonstrated facilitation of motor recovery after stroke, rTMS has been used in 2 ways: (1) frequency stimulation less than 1 Hz to the unaffected hemisphere, reducing its inhibitory effects on the affected hemisphere and (2) frequency stimulation greater than 1Hz to the affected hemisphere, increasing its excitability. Studies suggest possible greater benefit when the lesion is subcortical rather than cortical. Frequencies greater than 20 Hz, especially when intensity is higher, theoretically may increase the risk of seizure. Benefits of rTMS have been shown in preliminary studies of those with both chronic and acute stroke.
Possible adverse or undesirable effects of rTMS include seizure (with treatment frequencies greater than 20 Hz) and increasing blood pressure (with higher treatment frequencies after chronic stroke.) Transcranial magnetic stimulation can be used to evaluate central fatigue, but has not been used for treatment of fatigue.
2013
Which ergonomic recommendation for computer stations is NOT appropriate for an injured worker with upper extremity cumulative trauma disorder?
(a) Neutral position of the wrists
(b) Forearm position horizontal to the floor
(c) Elevated positioning of the mouse
(d) Mid-line positioning of the keyboard
Answer: (c)
Commentary: Ergonomic evaluation of the computer workstation is important for both the prevention and the treatment of cumulative trauma disorders. All the listed ergonomic recommendations are appropriate, with the exception of elevated placement of the mouse. More midline and level mouse placement is recommended, especially in cases of de Quervain tenosynovitis.
2013
Which therapeutic modality delivers medication to the site of pathology by promoting the
movement of charged particles through the skin under an imposed electrical field?
(a) Phonophoresis
(b) Low energy laser
(c) Ultraviolet radiation
(d) Iontophoresis
Answer: (d)
Commentary: Iontophoresis is a physical medicine modality that delivers topical medicine, such
as corticosteroids, through the skin and into soft tissues. A current is created to direct a particular
solution away from the electrode and into the surrounding tissue. Phonophoresis utilizes
ultrasound rather than current to deliver the topical medication. Low energy laser and ultraviolet
radiation are not used to deliver topical medications.
2010
Which phenomenon is an effect of functional electrical stimulation (FES) as it pertains to gait?
(a) Decrease in muscle spasticity
(b) Increase in physiologic cost of gait
(c) Decrease in voluntary muscle strength
(d) Decrease in stride length
Answer: (a)
Commentary: In addition to a decrease in muscle spasticity, FES decreases the physiologic cost
of gait, increases voluntary muscle strength, and increases stride length.
2010
The use of a magnetic knee wraps in patients suffering with mild to moderate knee osteoarthritis
has been shown to
(a) decrease edema.
(b) increase walking distance.
(c) increase isokinetic strength.
(d) increase range of motion.
Answer: (c)
Commentary: The application of magnetic knee wraps has been shown to increase isokinetic
strength and improve pain scales. Edema, walking distance and range of motion were not
outcome measures.
2010
When applying cryotherapy in the treatment of musculoskeletal disorders, which of the following
events is NOT a contraindication to its use?
(a) Paroxysmal cold hemoglobinuria
(b) Impaired sensation
(c) Arterial insufficiency
(d) Spasticity
Answer : (d)
Commentary: Contraindications for the use of cryotherapy include paroxysmal cold
hemoglobinuria, impaired sensation and arterial insufficiency. Other contraindications are cold
hypersensitivity, cryopathies, cold intolerance, cryotherapy-induced neurapraxia, and Raynaud
disease. Spasticity is one of the general uses of cryotherapy in addition to musculoskeletal
injuries and pain syndromes, postoperative conditions and emergency treatment of minor burns.
2012
Which deep heat method recommends the use of protective eyewear to prevent the formation of cataracts? (a) Ultrasound (b) Short wave diathermy (c) Fluidotherapy (d) Microwave diathermy
Answer:(d)
Commentary: Microwave diathermy is another form of electromagnetic energy that uses
conversion as its primary form of heat production. Temperature distribution in a particular tissue
is affected largely by its water content. In general, tissues with high water content absorb greater
amounts of energy and are selectively heated. General heat precautions should be observed with
microwave procedures. Metal implants, pacemakers, sites of skeletal immaturity, reproductive
organs and brain, and fluid-filled cavities (eye, bullae, effusions, etc.) should be avoided.
Microwaves can cause cataracts and protective eye wear should be worn by both patient and
therapist to reduce risk.
2012
Answer: D
Commentary:Functional restoration programs produce a greater improvement in endurance, but
no differences are noted between functional restoration programs and active individual therapy
programs.
Answer: C
Commentary:The physician should be concerned if there is a time gap between the ultrasound
application and the stretching activity. In order to be effective, the deep heating that is
accomplished with the ultrasound application should be combined with a period of prolonged
passive stretching, both during and immediately after the ultrasound application. This can be
achieved by having the patient stand during the ultrasound application and after it. An
appropriate treatment time with ultrasound is 8 to 12 minutes and the patient may experience a
transient deep ache in the treatment application area.
2009
Which factor is a contraindication for phonophoresis?
A. Contractures
B. Neuromas
C. Tendonitis
D Skeletal immaturity
Option d is correct.
In phonophoresis ultrasound is used to facilitate transdermal migration of topically applied medications. Corticosteroids are the most frequently used agents and the anti-inflammatory effects of the medication and ultrasound may be synergistic. Indications for phonophoresis are osteoarthritis, bursitis, capsulitis, tendonitis, strains, fasciitis, epicondylitis, tenosynovitis, contracture, scar tissue, neuromas, and adhesions. Contraindications for use of phonophoresis (or ultrasound) include general heat precautions, skeletal immaturity, and locations near the eyes, brain, reproductive organs, a pacemaker, a menstruating or gravid uterus, laminectomy sites, or malignancy.
2014
A journalist is interested in writing an article about work options for the chronically disabled population. When discussing vocational rehabilitation, you inform him that
A governmental rehabilitation agencies are mostly funded by state resources.
B the emphasis is to provide services for patients with mild disabilities.
C tax incentives cannot be offered to employers who offer job training.
D after completion of training and placement in a job for 60 days, a file is usually closed.
Option d is correct.
The Rehabilitation Act of 1973 authorized federal funding for state rehabilitation agencies to provide a variety of services to qualified persons with disabilities. The federal government supplies 80% of the funding for state vocational rehabilitation agencies, whereas the states must provide the remaining 20%. State agencies administer the programs under the Rehabilitation Services Administration in the Department of Education. The intent of the Rehabilitation Act was to provide services to persons with disabilities, with emphasis placed on serving those with more severe disabilities. Tax incentives for potential employers can help convince industry to offer training. Once an individual has completed training and has been placed for 60 days, the state vocational rehabilitation agency considers the case a “success” and closes its file. No follow-up evaluation is typically provided.
2014
The manager of a call center solicits your advice about ergonomics for computer work stations. Which ergonomic recommendation is correct to reduce cervical strain?
A The distance of the monitor should be no more than two-thirds the length of the employee’s arm.
B The bottom third of the computer screen should be situated at eye level.
C Headsets reduce sustained contralateral and forward flexion of the cervical spine.
D Individuals who use bifocals should position materials to reduce sustained cervical extension.
D is correct
Instruction in proper positioning at the work station represents an important component in the rehabilitation of patients with cervical disorders. Sustained spinal posturing out of the neutral zone can lead to further aggravation of the affected tissues and a perpetuation of symptoms. Individuals who require bifocal eyeglasses should be instructed to position reading materials in such a fashion as to avoid sustained cervical extension postures. Proper distance from the computer monitor is an arm’s length measurement, which is unique to each individual. The upper third of the computer screen should be situated at eye level. Headsets can reduce ipsilateral, lateral flexion of the cervical spine.
2014
What finding is a relative contraindication to therapeutic ultrasound?
A. Acute inflammation
B. Pain
C. Malignancy
D. Contracture
Option c is correct.
Therapeutic ultrasound is commonly used to decrease pain and muscle soreness through thermal effects. Malignancy is a relative contraindication secondary to concerns of increased tumor growth or hyperemia and hematogenous spread. Relative contraindications also include use near the brain, eyes, or reproductive organs, as well as near pacemakers and laminectomy sites.
2014
A physical therapist tells you that he just took a refresher course on therapeutic ultrasound, and you would like to refer a patient to him. The patient most likely to benefit from this therapy is a
a. 56-year-old woman with an acute lateral
epicondylitis.
b. morbidly obese woman with a snapping hip, or tight iliopsoas.
c. elderly man whose chronic shoulder pain is associated with calcific tendonitis.
d. young man who wants to hasten recovery from a quadriceps contusion.
Option c is correct.
The effect of ultrasound on the treatment of calcific rotator cuff tendonitis has been supported in literature to be associated with more rapid symptom improvement and greater resolution of calcium deposits. Although ultrasound may be an effective therapeutic modality in subacute and chronic inflammation, ultrasound use during acute inflammation may be detrimental to healing. Of the heating modalities (ultrasound, phonophoresis, shortwave diathermy, microwave diathermy), ultrasound provides the deepest penetration, but only up to 5 centimeters below the skin surface. There is little evidence to support efficacy of ultrasound in the treatment of musculoskeletal disorders, but ultrasound may improve tendon and bone healing and reduce calcium deposits in calcific tendonitis.
2014
Ultrasound utilizes the physiologic mechanism of
(a) conduction.
(b) evaporation.
(c) convection.
(d) conversion.
Answer: D
Commentary:Conversion is a process of transforming energy to heat; for example, sound
transformation with ultrasound. Conduction is a transfer of thermal energy through direct
contact; for example, hot packs. Convection is a process of using a medium to transfer energy;
for example, fluidotherapy. Evaporation is a process of transforming a liquid to a gas; for
example, vapocoolant sprays.
2009
. In contrast to cryotherapy, heat may
(a) be used safely over insensate areas.
(b) increase edema in the treated area.
(c) be used over areas with decreased vascular supply.
(d) decrease pain while cold will not
Answer: B
Commentary:Cryotherapy and heating modalities share several therapeutic benefits and
therapeutic contraindications. Both heat and cold modalities have some analgesic properties and
can be used as adjuvant treatments for pain management. Neither cold nor heat modalities should
be used over insensate areas or over areas with decreased vascular supply. Heat modalities may
increase edema in the area treated, whereas cold therapy will not lead to increased edema
2009
Which massage technique has as it goal the breakup of tissue and muscle adhesions?
(a) Acupressure
(b) Petrissage
(c) Friction Massage
(d) Effleurage
Answer: B
Commentary:Petrissage is a method of compression massage that is used to break up tissue and
muscle adhesions. In effleurage massage the practitioner uses a stroking motion that is beneficial
for vascular and lymphatic drainage. Friction massage is a method of massage that uses circular
motions to small areas of tissue to help with tendonitis and fasciitis. Acupressure is a massage
method in which pressure is applied on specific body points to help reduce pain.
2009
Which type of cryotherapy uses conduction for energy transfer?
(a) Cold packs
(b) Fluidotherapy
(c) Vapocoolant spray
(d) Whirlpool baths
Answer: A
Commentary:Conduction is a process of transferring thermal energy between 2 entities placed in direct contact with each other, for example cold packs on skin. Convection is a process of using a
medium to transfer energy: Examples of convection include the use of husks with fluidotherapy, and the use of water with whirlpool therapy. Vapocoolant sprays are an example of evaporation,
not conduction
2009
. You recommend work hardening for a worker recovering from a shoulder injury. You explain to
the worker to expect a therapy program that
(a) builds aerobic conditioning and will be performed 2 hours daily.
(b) simulates work duties and will be performed approximately 4 hours daily.
(c) simulates a heavy manual labor job and will be performed 6 hours daily.
(d) improves aerobic conditioning while simulating a light duty job and will be performed 8
hours daily
Answer: B
Commentary:Work hardening is a rehabilitation program designed to simulate the individual
worker’s job. It can be performed at a center or at the worker’s jobsite. These programs are often
recommended to be done 5 days a week. The worker performs an individualized program based on his/her specific job requirements. Physician follow-up is needed to determine if goals have
been achieved. Work conditioning is a program used to enhance aerobic conditioning but does
not attempt to replicate the tasks of a specific job
2009
What is the primary disadvantage of moving the rear axle of a wheelchair forward?
(a) Ascending curbs becomes more difficult.
(b) It takes more muscle effort to propel the wheelchair.
(c) More strokes are required to push the wheelchair.
(d) Ascending a ramp becomes more difficult.
Answer: D
Commentary:Moving a wheelchair’s rear axle forward enables the user to propel the chair with
less muscle effort and fewer strokes. Because the modification causes more weight to be centered
over the rear wheels, it is easier to pop a wheelie, negotiate obstacles and ascend or descend
curbs. However, moving the axle forward can also make the wheelchair more “tippy” (likely to
tip backwards) and that tendency to tip backwards makes it more difficult to push the chair up a
ramp.
2009
