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(2) Physical Modalities > S2_L4: Electrophysiologic Examination and Evaluation > Flashcards

S2_L4: Electrophysiologic Examination and Evaluation Flashcards

1
Q

TRUE OR FALSE:

Electrophysiologic examinations and
evaluations as practiced by physical
therapists encompass both the professional and technical components of the observation, recording, analysis, and interpretation of bioelectric muscle and nerve potentials, detected by means of surface or needle electrodes, for the purpose of evaluating the integrity of the neuromuscular system.

Electrophysiologic evaluations include, but are not limited to: Clinical electromyography [EMG], Motor and sensory nerve conduction studies
[NCV], Electrodiagnostic procedures, Other evoked potential procedures.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A

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2
Q

TRUE OR FALSE on Nerve conduction velocity (NCV):

Tests peripheral motor & sensory neurons on both orthodromic & antidromic responses.

Estimates the rate of movement of the induced impulse along the course of the nerve.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A

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3
Q

The following statements are true, EXCEPT:

A. NCV is reduced in compression lesions like CTS, PNI, demyelinating disorders.

B. NEUROMUSCULAR JUNCTION
TRANSMISSION, assesses the function of the neuromuscular junction

C.Repetitive Nerve Stimulation Test (RNS) a.k.a. “Jolly Test” is a test for myasthenia gravis

D. Examples of CENTRALLY-EVOKED POTENTIALS are Somatosensory Evoked Potential (SSEP), Visual Evoked Potential (VEP), Brainstem Auditory Evoked Potential (BAEP)

E. None of the above

A

E

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4
Q

The following statements are true about NCV stimulating electrodes, EXCEPT:

A. there are 2 small electrodes applied to the nerve fixed on the skin about 2cm apart

B. Have handheld electrodes

C. Uses rectangular monophasic PC

D. Anode is distal to the Cathode, closest to the most proximal recording electrode

E. None of the above

A

D, Cathode is distal to the anode

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5
Q

TRUE OR FALSE on NCV:

Distance (Measured in mm) is a linear distance between two points along the
course of a nerve.

  • Latency (Measured in msec) is the conduction time between stimulus and the start of muscle contraction or activation of the nerve.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A,
* Formula
NCV = Distance/Latency

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6
Q

The following statements are true about NCV other electrodes, EXCEPT:

A. Active/Recording electrode is placed over the stimulated muscle/nerve

B. Reference electrode is proximally placed

C. Ground electrode is placed on other areas usually on a bony area

D. None of the above

A

B, Reference electrode is distally placed

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7
Q

The following statements are factors to consider about NCV, EXCEPT:

A. Body Temperature: Inc. temperature → Inc. conduction velocity / Dec.
distal latency

B. LE is 7-10 m/s faster vs UE

C. More proximal segments are faster vs distal

D. Age:
▪ <3-5 y/o = lower by 50% vs normal adults
▪ >40 = gradual slowing vs middle-aged
▪ 6th & 7th decade = 10 m/sec less than
middle-aged

E. None of the above

A

B, UE is 7-10 m/s faster vs LE

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8
Q

TRUE OR FALSE:

Sensory Orthodromic = proximal to distal

Motor Orthodromic = distal to proximal

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

B,

Sensory Orthodromic = distal to proximal

Motor Orthodromic = proximal to distal because it send action potential to the efferent organs/muscles

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9
Q

TRUE OR FALSE:

Sensory Antidromic = distal to proximal

Motor Antidromic = proximal to distal

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

B,
Sensory Antidromic = proximal to distal

Motor Antidromic = distal to proximal

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10
Q

The following statements are true on the use & limitations of RD test, EXCEPT:

A. A quick screening test for differentiating a muscle with normal peripheral innervation vs a muscle with peripheral denervation

B. Not done at least 10 days after onset of the problem

C. May be indicated in conditions of unexplained paralysis

D. None of the above

A

D

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11
Q

TRUE OR FALSE:

Sensory Nerve Action Potential (SNAP), provides information on the sensory nerve axon and its pathway from the distal cutaneous receptors to the dorsal root ganglia

Compound Muscle Action Potential (CMAP), give assessment of motor nerve fibers from their origins in the anterior horn cells to the neuromuscular junction of the muscle that the nerve innervates

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A

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12
Q

The following statements are true about biofeedback, EXCEPT:

A. Monitoring and transforming physiologic data into understandable feedback

B. A training technique that enables an individual to gain some element of voluntary control over muscular or autonomic nervous system functions using a device that produces auditory or visual stimuli

C. An adjunct tool and not a treatment in itself

D. None of the above

A

D

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13
Q

Match the following current to its REACTION OF DEGENERATION (RD) TEST.

  1. Short pulse duration (<1msec) with >20-50 Hz frequency
  2. Monophasic or asymmetrical biphasic PC using cathode as the active electrode
  3. Monophasic or Interrupted DC
    using cathode as the active electrode
  4. Long pulse duration (>/=100msec)
  5. Produces smooth tetanic or sustained contraction
  6. Produces brisk muscle twitches

A. Faradic Current
B. Galvanic Current

A
  1. A
  2. A
  3. B
  4. B
  5. A
  6. B
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14
Q

Match the following status of muscle innervation to its current.
(Can have multiple answers)

Faradic current
1. Partial or diminished tetanic contraction

  1. Smooth tetanic or sustained contraction
  2. No contraction

Galvanic current
4. Partial or diminished, sluggish twitches

  1. Brisk muscle twitches
  2. Very slow, sluggish twitches
  3. No contraction

A. Normal peripheral nerve
B. Partial RD
C. Complete RD
D. Absolute RD

A
  1. B
  2. A
  3. C,D
  4. B
  5. A
  6. C
  7. D
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15
Q

TRUE OR FALSE:

REACTION OF DEGENERATION
(RD) TEST Aka Faradic and Galvanic Test is the assessment of lower motor neuron lesions wherein a motor point is stimulated.

A

T

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16
Q

modified TRUE OR FALSE on STRENGTH-DURATION CURVE AND CHRONAXIE TEST:

It uses the electrodiagnosis of peripheral nervous system disorders.

It is used to assess the location, severity, and progress of peripheral motor nerve degeneration.

A

TT

17
Q

The following statements are true about the status of muscle innervation, EXCEPT:

A. Partial RD: degeneration of part
of nerve fibers

B. Complete RD: degeneration of all nerve fibers; muscle tissue retains
contractile elements

C. Absolute RD: degeneration of all
nerve fibers; muscle tissue severely
atrophic, fibrotic or non-contractile

D. None of the above

A

D

18
Q

The following statements are true about STRENGTH-DURATION CURVE
AND CHRONAXIE TEST, EXCEPT:

A. Obtained by joining points that graphically represent the threshold values of stimulation (intensity) along the y-axis for various duration of
stimulus (pulse duration) displayed along the x-axis

B. Uses square, monophasic PC (sawtooth, triangular)

C. Anode as stimulating electrode

D. May use 8-10 pulse durations but sually uses these pulse durations (in msec): 100, 30, 10, 3, 1, 0.3, 0.1, 0.03, 0.01 while the longest pulse duration must be at least 100ms

E. None of the above

A

C, Cathode as stimulating electrode

19
Q

modified TRUE OR FALSE on BIOFEEDBACK:

A training technique that enables an individual to gain some element of voluntary control over muscular or autonomic nervous system functions using a device that produces auditory or visual stimuli.

A tool and not a treatment in itself.

A

TT

20
Q

TRUE OR FALSE:

Rheobase is the least amount of intensity needed to elicit visible
muscle contraction for an indefinite duration (5-35volts/ 2-18mA)

Chronaxie is the minimum time required to produce a muscle contraction with an intensity set at twice the rheobase (0.05 - 0.5 msec or <1 msec)

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A

21
Q

TRUE OR FALSE:

Advantages of SD curve & CHRONAXIE TEST are that it’s quick and easy to
perform, requires minimal training, & more economical (vs other tests)

Disadvantages of SD curve & CHRONAXIE TEST is that it only provides qualitative data in relation to
degree of denervation, cannot locate site of lesion, & only few fibers can be
assessed in large muscles

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A

22
Q

The following statements are Factors affecting the SD Curve, EXCEPT:

A. Skin resistance & temperature
B. Subcutaneous tissues (eg. fats)
C. Electrode size & placement
D. Age & Fatigue
E. None of the above

A

E

23
Q

The following statements are true about Electromyographic (EMG) Biofeedback EXCEPT:

A. Monitoring, detection, or assessment of skeletal muscle activity so that the information gained can be used by the patient and clinician to influence future activity of the skeletal muscle, whether for increasing or decreasing activity

B. It is the study of muscle activity

C. No current is delivered to the patient & electrical activities of the neuromuscular system is detected for therapeutic use

D. Recorded upon voluntary contraction of the muscle & not a therapeutic agent, but part of the therapeutic process

E. None of the above

A

E

24
Q

Match the following EMG biofeedback to its uses

  1. Orthopedic, surgery, functional neurology, gait & posture analysis
  2. Analysis of demand, risk prevention, ergonomics design, product certification
  3. post surgery/accident, neurological rehabilitation, physical therapy, active training therapy
  4. biomechanics, movement analysis, athletes strength training, sports rehabilitation

A. Medical research
B. Rehabilitation
C. Ergonomics
D. Sports science

A
  1. A
  2. C
  3. B
  4. D
25
Q

Match the following EMG biofeedback

  1. Inc. muscle activity (post-injury
    or post-operatively)
  2. Normalize muscle functions
  3. Improve volitional motor
    control following CNS
    dysfunction
  4. Dec. muscle activity (spasticity
    in CNS dysfunctions)
  5. Dec. muscle activity (due to
    postural stress)
  6. Dec. muscle activity / guarding
    (due to chronic pain)

A. Facilitatory biofeedback
B. Inhibitory biofeedback

A
  1. A
  2. A
  3. A
  4. B
  5. B
  6. B
26
Q

Match the following EMG biofeedback

Normal
1. (+) insertion activity with miniature endplate action potentials & no muscle action potentials

  1. Usually biphasic or triphasic muscle AP with Motor unit potentials (MUP) from small-amplitude potentials → progressively large-amplitude potentials
  2. Inc. frequency with (N) stepwise & inc. interference patterns

Abnormal
4. (+) fibrillations/fasciculations with complex discharges & inc./dec. insertional activity

  1. Polyphasic, amplitude either inc./dec. & altered recruitment patterns
  2. dec. interference pattern with early full interference pattern

A. EMG at rest
B. EMG with mild contraction
C. EMG with maximal contraction

A
  1. A
  2. B
  3. C
  4. A
  5. B
  6. C
27
Q

modified TRUE OR FALSE on electrodes:

Recording Electrodes are the “Sensor & considerations include Electrode Spacing & Crosstalk.

Ground Electrode is used over bony surface & also used to minimize extraneous electrical activity
(noise).

A

TT
* electrode spacing which depends on the size of muscle
* crosstalk- contamination of input from a neighboring/antagonistic muscle

28
Q

modified TRUE OR FALSE on RECORDING ELECTRODES:

Surface EMG (sEMG) are non-invasive

Needle EMG (nEMG) are invasive

A

TT

29
Q

The following statements are true about CLINICAL ELECTROMYOGRAM (EMG), EXCEPT:

A. Measurement of the electricity produced by the movement in muscle

B. Involves the evaluation and recording of muscle activity

C. Used for identifying neuromuscular diseases and disorders of motor control

D. Instrument: electrogram

E. None of the above

A

D, Instrument: electromyograph

30
Q

TRUE OR FALSE on SIGNAL AMPLIFICATION & FILTRATION:

To minimize the signal-to-noise ratio.

To maximize the distortion of signal.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

B,

To maximize the signal-to-noise ratio.

To minimize the distortion of signal.

31
Q

TRUE OR FALSE on BAND-PASS FILTERING:

High-pass filter: attenuates contents below a cut-off frequency; 5 Hz/10-20 Hz cut-off.

Low-pass filter: attenuates contents above a cut-off frequency; 500 Hz cut-off.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A

32
Q

The following statements are true on Noise sources during EMG, EXCEPT:

A. Inherent noise of electrical parts inside the signal detection and recording instrument

B. Ambient noise from the environment

C. Motion artefacts (electrodes-skin interface)

D. Inherent instability of EMG signal (random firing of motor units)

E. None of the above

A

E

33
Q

TRUE OR FALSE on Amplification and filtering circuitry sequence:

Electrodes capture signal -> 1st stage amplification -> High-pass filter -> Low-pass filter -> 2nd stage amplification -> Low-pass filter -> Analog digital converter

A

T

34
Q

modified TRUE OR FALSE on signal smoothing:

Moving Average (Movag) is the certain amount of data are averaged using the
sliding window technique

Root Mean Square (RMS) is based on square root calculation; reflects the
mean power of the signal; preferred method

A

TT

35
Q

The following statements are true on SIGNAL RECTIFICATION, EXCEPT:

A. Taking the absolute value of the signal

B. Also known as Full-wave Rectification

C. Rectification + Low-pass Filter = “Linear Envelop”

D. Traditional low-pass filter of rectified signal = Butterworth or Chebyshev

E. None of the above

A

E. None of the above

36
Q

TRUE OR FALSE on Muscle Fatigue Index:

It is used to identify weak muscles.

It is used to prove efficiency of
strength training exercise.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A

37
Q

The following statements are true on GENERAL GUIDELINES FOR ALL
ELECTROPHYSIOLOGIC TESTING, EXCEPT:

A. Patient should be comfortable & use latex gloves, goggles and gown for needle EMG

B. Ensure correct electrode placement & secure properly

C. Perform first a detailed physical examination of strength, sensation, coordination, reflexes and other neuromuscular function

D. When applying electrical stimulation, check for contraindications and precautions

E. None of the above

A

E

(2) Physical Modalities (12 decks)

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