Therapeutic Modalities & Non-Systems review for NPTE

______ mV is the threshold for activation of an action potential (AP); anything below (more negative) than this value with fail to generate an AP

-55 (mV) (Point at which enough Na+ channels open to change the net current flow from outward [mostly K+, Cl-] to inward [Na+])

ULTRASOUND: ___ MHz = *greater heat production* in *deeper* layers - Used for tissues up to ______ cm deep - _____ W/cm^2 intensity for thermal effects

1, 6 (cm), 1.5-2.0 (intensity)

Patients should change positions every ____-____ *minutes* for pressure relief. For full blood profusion/reprofusion, a body area requires 3 minutes of pressure relief, but should be done at a *minimum for 30-60 seconds at a time.* - additionally, an excellent seat cushion (i.e. Roho) is necessary - For ROM, therapists should pay close attention to 2-joint muscles (i.e. hammies, gastroc, rectus femoris, biceps, etc.) - For *bed pressure relief* - individuals should be on a regular turning schedule that involves change position every _______ *hours* (an alternative to this is investing in a quality water bed or air mattress)

15, 20, 2 (examples include wheelchair push-ups [most ideal but requires most strength], lateral or forward leaning; can also use tilt-in-space or reclining WC to change position)

ADA Community requirements - - Ramps: __________ ratio of slope to rise, min 36 inches wide, nonslip surface, handrail waist high for ambulators, level landing and top - Doorways: _________ inches wide *minimum* for WC clearance - Stairs: recommended height is *___________ inches*

1:12 (for every inch of vertical rise, 12 inches of ramp is required), 32 (36 inch wide doorways are ideal), 7-9

ULTRASOUND: ___ MHz = *greater heat production* in *superficial* layers - Used for tissues ______ cm deep - _____ W/cm^2 intensity for thermal effects

3, 1-2.5 (cm), 0.5-1.0 (intensity)

A PT is conducting an initial examination of a client that sustained a direct blow to the knee 2 days ago. The x-ray in the ER was negative for a fracture. The pt is concerned about increased swelling over their "kneecap." The PT's initial assessment is consistent with traumatic patellar bursitis. Which of the following would be of MOST BENEFIT to treat this condition? a. 20 min cryotherapy, every 2-3 hours, for 3 continuous days b. 30 min of cryotherapy, 2x/day, for 3 continuous days c. 1 MHz 20% pulsed US for 8 min, 3x/week d. 3 MHz 20% pulsed US for 8 min, 3x/week

A (20 min cryotherapy, every 2-3 hours, for 3 continuous days)

the change in electrical potential associated with the passage of an impulse along the membrane of a muscle cell or nerve cell - the way neurons communicate with each other - efficiently conveys info over long distance - also called: spike, nerve impulse, discharge - *all or nothing phenomenon* - typical length: ~ 2 millisec

AP (action potential)

A PT is putting on an educational workshop about the proper utilization of low-dose ultrasound in clinical practice. Which of the following conditions is low-dose US considered contraindicated? A. Over the distal femur in a 16 y/o with quadricep tendonitis B. Over the site of a healing proximal humedal Fx in a 34 y/o F C. Over the lower back in a 31 y/o F who is 2 weeks postpartum D. Over the hip in a 60 y/o F who had a THA using methyl-methacrylate

D (Low dose US = 0.5 W/cm^2 intensity; shouldn't use any type US with plastic THA or THA with acrylic adhesive that can rapidly heat and lose its properties leading to instability in the THA)

Kelli presents with plantarflexor spasticity of 2 Modified Ashworth Scale. The patient is active and demonstrates fair+ medial/lateral ankle stability. The therapist would like to provide the most effective and least restrictive orthotic to assist with gait. Which of the following orthotics is the MOST appropriate for this patient? A. Solid Ankle-Foot Orthotic (AFO) B. Ground Reaction Ankle Foot Orthotic (AFO) C. Posterior Leaf Spring Ankle-Foot Orthotic (AFO) D. Articulated Ankle-Foot Orthotic (AFO) with a posterior stop

D (articulated AFO with posterior stop) (Modified Ashworth score of 2 = more marked increase in muscle tone throughout most of the ROM, but affected part/limb is still easily moved Solid AFO = protects the ankle from instability, pretty much prevents any ankle movement at all / is pretty restrictive GR AFO = typically used with patients who have knee buckling due to inability to control ankle DF; if a pt DF their ankle in CLOSED chain this causes knee flexion/buckling Posterior leaf = used to help patients who have drop foot, stores energy, helps with patients who have WEAK DF, NOT GOOD for a patient who doesn't have medial/lateral ankle stability Articulated/hinge with posterior stop = will prevent excessive PF as well as supports ankle/provides stability medially and laterally; allows for free DF motion)

A PT is looking to facilitate scar healing with iontophoresis. Which of the following should the therapist utilize during treatment? A. Acetate B. Copper C. Dexamethasone phosphate D. Iodine

D (iodine) (Iontophoresis is used with inflammation, scar healing, fungal infections, etc. Typically used with a form of medication. What ion source is used to facilitate scar tissue healing? Acetate is used to treat Ca2+ deposits Copper is used with fungal infections Dexamethasone phosphate is used to reduce inflammation Iodine is used for facilitating scar healing when used with iontophoresis)

A PT is working with a child with CP in the school setting. The therapist would like to ensure that the child is being provided all necessary care according to IDEA. Which of the following is NOT covered under IDEA? A. Therapist-directed interventions to be performed by the child's teacher B. Monthly reassessments to monitor the child's progress C. A standing frame to facilitate learning in the classroom D. A position in any given extra-curricular activity or sport

D (they should have an equal opportunity to join extra-curricular activities, but they are not GUARANTEED a spot)

In pain regulation, the _________ ________ of pain asserts that non-painful input closes the nerve "gates" to painful input, which prevents pain sensation from traveling to the central nervous system. - Afferent regulation of by low threshold mechanorecptors (A-beta fibers) - feels good to rub skin around a bruised shin

Gate theory

*(Sensitivity/Specificity)* is a test's ability to correctly identify the proportion of those that truly have the condition, impairment, or disease.

Sensitivity (true positive rate)

When using continuous US in treating the hip of an obese patient, the GREATEST benefit might occur if the US frequency and dosage/intensity are set at which parameters? a. 1 MHz and 1.5 watts/cm^2 b. 1 MHz and 0.5 watts/cm^2 c. 3 MHz and 1.5 watts/cm^2 d. 3 MHz and 0.5 watts/cm^2

a (1 MHz and 1.5 watts/cm^2) (1 MHz can penetrate *deeper* than 3 MHz which would be needed with a patient who is obese/has more tissue to go through)

A patient walks with excessive foot pronation during midstance through toe off (preswing). What is the MOST likely cause of the patient's gait deviation? a. Compensated rearfoot varus deformity b. Compensated forefoot valgus deformity c. Uncompensated lateral (external) rotation of the tibia d. Uncompensated pes cavus

a (Excessive foot pronation during midstance to toe off is the result of a compensated rearfoot [or forefoot] varus deformity.)

A physical therapist reads about a clinically based study in which electrical stimulation was used for subjects with acute disc herniation. The author gives details about the parameters used and reports that the intervention had a statistically significant effect. External validity is LEAST threatened if the study findings are applied to which of the following groups? a. Patients from the same population, when the same parameters are used, even if the stimulation device is not the same model b. Patients from a similar population, when the same stimulation device model and the same parameters are used c. Patients with a variety of diagnoses as long as they have low back pain d. Patients with a similar physical therapy problem list as long as the same stimulation device model is used

a (External validity is the degree to which the results of a study can be generalized to another situation. In this option, the only change in the procedure is the model of the electrical stimulation machine. External validity should be maximized in this situation.)

A patient who has a transfemoral amputation reports buckling of the prosthetic knee while walking. Which of the following conditions is the MOST likely cause? a. Knee with axis anterior to the trochanteric-knee-ankle line b. Prosthesis that is too long c. Mechanical knee with too much friction d. Socket with a medial wall that is too high

a (Knee with axis anterior to the trochanteric-knee-ankle line) (A knee axis anterior to the trochanteric-knee-ankle [TKA] line creates a flexion moment at the knee, causing knee instability and possibly buckling)

A PT is considering the use of E-stim on a chronic wound. Which of the following sets of parameters is the MOST appropriate? a. Monophasic, direct current b. Biphasic, direct current c. Monophasic, alternating current d. Biphasic, alternating current

a (Monophasic, direct current) (high-voltage pulsed current, HVPC, e-stim has been shown to enhance healing in numerous types of wounds including chronic ulcers, burns, and donor and graft sites. The application of monophasic direct current stimulates angiogenesis and epithelial migration, decreases bacterial activity and wound pain, and increases O2 perfusion and tensile strength.

Where on the forearm should a physical therapist place electrodes for biofeedback therapy in order to facilitate hook grasp? a. Proximal anteromedial b. Proximal posterolateral c. Distal anteromedial d. Distal posterolateral

a (Proximal anteromedial; For best biofeedback results, electrode placement should be as close to the muscle as possible. Hook grasp requires finger flexion)

Which of the following definitions BEST describes a systematic literature review? a. Secondary analysis of individual studies with similar characteristics b. Secondary analysis of individual studies with divergent characteristics c. Aggregation of raw data from multiple studies to increase the sample size d. Aggregation of raw data from multiple studies to generate new hypotheses

a (Secondary analysis of individual studies with similar characteristics)

Iontophoresis using dexamethasone would be MOST appropriate for a patient who has which of the following conditions? a. Supraspinatus tendinitis b. Patellar tendon calcium deposits c. Skin lesion over the lateral epicondyle d. Lumbar paraspinal muscle spasm

a (Supraspinatus tendinitis)

A patient who has hemiparesis is learning to propel a manual wheelchair. Which of the following interventions is MOST appropriate for the cognitive stage of learning this task? a. The physical therapist guides the patient with hand-over-hand cues and demonstrates the propulsion technique. b. The patient propels the wheelchair with variable speed through an obstacle course with supervision from the physical therapist. c. The physical therapist allows the patient to problem-solve when steering errors occur and does not provide feedback. d. The physical therapist allows the patient to independently explore strategies for propulsion and steering during a specific propulsion task.

a (The cognitive stage is the beginning of the learning process. Cues, instructions, and guidance are provided by the therapist, and demonstration is used.)

A PT is treating a patient with active infectious Hepatitis B. In addition to wearing a protective gown when in the pt's room, what precautions should be taken to avoid transmission of the disease? a. avoid direct contact with the patient's blood or blood-contaminated equipment by wearing gloves b. avoid direct contact with any part of the patient c. have the patient wear a mask to minimize droplet spread of the organisms from coughing d. provide tissues and no-touch receptacles for disposal of tissues

a (avoid direct contact with the patient's blood or blood-contaminated equipment by wearing gloves Hep B is transmitted via blood, body fluids, or body tissues)

A PT considers an AFO for a patient who has difficulty with toe clearance during ambulation due to left DF weakness. Which objective finding would make a posterior leaf spring orthosis an *inappropriate* orthotic selection? a. poor PF strength b. mild spasticity c. good knee stability and strength d. right leg 1 cm longer

a (poor PF strength) (Posterior leaf spring - most common AFO, *resists PF* at heel strike and during swing, thus preventing foot slap and toe drag. Indicated for weakness of the ankle DF)

A PT has decided to use mechanical lumbar traction on a patient with posterior herniated nucleus pulposus at L4-L5 and S&S of nerve root compression. If tolerated by the pt, what is the BEST positioning for this treatment? a. prone, with no pillow under the hips or abdomen b. prone, with a pillow under the hips and abdomen c. supine, with the hips and knees flexed to 45 deg d. supine, with the hips and knees flexed to 90 deg

a (prone, with no pillow under the hips or abdomen) (neutral or extended position of the spine allows for separation of the vertebral bodies while preventing excessive stress on the posterior structures)

A physical therapist is educating a patient on the use of a moist hot pack for home treatment. For the patient to prevent burns and still receive the benefits of superficial heat, which of the following heat application time frames is MOST appropriate? a. 5-10 minutes b. 20-30 minutes c. 45-60 minutes d. 70-90 minutes

b (20-30 minutes)

A physical therapist is assisting with bed mobility for a patient who is receiving antibiotics for vancomycin-resistant Enterococcus (VRE). Which of the following precautions and personal protective equipment are indicated for physical therapy intervention? a. Contact precautions; the therapist should wear a mask. b. Contact precautions; the therapist should wear a gown. c. Droplet precautions; the therapist should wear a mask. d. Droplet precautions; the therapist should wear a gown.

b (Contact precautions; the therapist should wear a gown.)

When using electrical stimulation to cause a contraction of innervated muscles, which of the following nerve fibers are activated FIRST? a. Small diameter nerve fibers b. Large diameter nerve fibers c. Nerve fibers that innervate the slow-twitch muscle fibers d. Nerve fibers that innervate the type I muscle fibers

b (Large diameter nerve fibers)

A physical therapist is instructing a patient in the proper technique for ascending stairs without a handrail using bilateral axillary crutches. The patient is restricted to 75% weight-bearing status on the right lower extremity. Which of the following procedures is appropriate? a. Position both crutches on the next higher step, and follow first with the left lower extremity, then the right lower extremity. b. Place the left lower extremity on the next higher step, and follow with both the right lower extremity and crutches together. c. Place the right lower extremity on the next higher step, and follow with both the left lower extremity and crutches together. d. Place the right lower extremity on the next higher step with both crutches, then follow with the left lower extremity.

b (Place the left lower extremity on the next higher step, and follow with both the right lower extremity and crutches together.)

A patient with low back pain has L4 nerve root impingement. The patient will MOST likely demonstrate which of the following gait deviations? a. Trendelenburg gait b. Foot slap c. Posterior thrust of the trunk at heel strike (initial contact) d. Toe walking

b (The L4 nerve root is the main segmental innervation to the tibialis anterior. The L4 nerve root is also the myotome for ankle dorsiflexion. Impingement of the L4 nerve root would result in foot slap.)

A patient has sustained a moderate ankle sprain with significant swelling greater than 1 inch (2.5 cm) throughout the ankle and into the foot. Which of the following wrapping techniques is MOST appropriate to control the edema? a. Figure-8 compression wrap with consistent pressure on the limb distally and proximally b. Spiral compression wrap with more pressure on the limb distally than proximally c. Figure-8 compression wrap with more pressure on the limb proximally than distally d. Spiral compression wrap with consistent pressure on the limb distally and proximally

b (When applying compression wraps to control edema, a spiral wrap is used with more pressure applied distally than proximally.)

When donning personal protective equipment prior to working with a patient who has tuberculosis, which of the following items should be applied LAST? a. Gown b. Gloves c. Goggles d. N-95 respirator

b (gloves)

A 21 y/o male presents to PT with c/o severe HA that typically occur only on the left side. The pt describes the pain as throbbing or pulsating and is concentrated around or behind the left eye. Which of the following types of HA is the pt most likely experiencing? A. Acute whiplash injury B. Migraine C. Tension HA D. Cervicogenic HA

b (migraine)

PTSD FROM EBP: -___: the extent to which two or more individuals agree or can obtain the same rating for a given variable; the consistency of multiple raters -___: the degree to which a test measures an intended hypothetical abstract concept (nonobservable behaviors or ideas) -___: the degree of agreement among multiple repetitions of a diagnostic test performed by the same individual -___: the degree to which a test, instrument, or procedure accurately measure what it is supposed to or intended to measure -___: the degree to which an instrument measures an intended content area; determined by expert judgement; requires both item validity and sampling validity a. intra-rater reliability b. inter-rater reliability c. internal validity d. content validity e. construct validity

b, e, a, c, d

this gait deviation is also called a compensated *GLUTE MAX LIMP* since it often signified *weakness* in that muscle group - Problem during loading and can persist through midstance and terminal stance - difficulty with going up stairs or ramps

backward trunk lean

What is the MINIMUM width of a doorway that allows clearance for a standard wheelchair? a. 28 inches (71 cm) b. 30 inches (76 cm) c. 32 inches (81 cm) d. 36 inches (91 cm)

c (32 inches)

A patient exhibits a steppage gait pattern. Which of the following muscles is MOST likely weak? a. Quadriceps b. Gluteus medius c. Tibialis anterior d. Gluteus maximus

c (A patient who has weakness of the tibialis anterior muscle would have a steppage gait due to the decrease in ankle dorsiflexion. The patient would exhibit high steppage to allow clearing of the ankle and foot during gait and to avoid tripping over the foot.) (think stroke patients with LE hemiplegia learning to walk again - generally lack DF strength, use their hip ADD/flexors to throw their involved leg forward)

Which of the following research designs is LEAST valid and generalizable? a. Small case series b. Clinical case report c. Clinical observation d. Randomized controlled trial

c (Clinical observation)

A patient ambulates with an absent heel strike (initial contact) on the left. Range of motion assessment reveals a loss of left ankle dorsiflexion. Which of the following modality and treatment interventions would be MOST appropriate? a. Moist heat application followed by stretching into dorsiflexion b. Cryotherapy application while stretching into dorsiflexion c. Continuous ultrasound while stretching into dorsiflexion d. Continuous ultrasound followed by stretching into dorsiflexion

c (Continuous ultrasound while stretching into dorsiflexion)

A PT sets the parameters of a iontophoresis unit in preparation for treatment on a patient diagnosed with lateral epicondylitis. Which of the following treatment parameters would represent the highest iontophoresis dose? a. Current amplitude of 1.0 milliamps; duration of 20 minutes b. Current amplitude of 2.0 milliamps; duration of 10 minutes c. Current amplitude of 3.0 milliamps; duration of 20 minutes d. Current amplitude of 4.0 milliamps; duration of 10 minutes

c (Current amplitude of 3.0 milliamps; duration of 20 minutes)

A patient has Fair (3/5) quadriceps strength, intact sensation in the lower extremity, and 0/10 pain. Which of the following electrical stimulation parameters would be MOST appropriate for the patient? a. Frequency of 35 pps, duration of 50 microseconds b. Frequency of 35 pps, duration of 150 microseconds c. Frequency of 50 pps, duration of 250 microseconds d. Frequency of 150 pps, duration of 50 microseconds

c (Frequency of 50 pps, duration of 250 microseconds) (For a large muscle group with intact innervation, the most effective parameters for promoting increased muscle strength are a frequency of 35-80 pps and a pulse duration of 200-350 microseconds. Frequency of 150 pps and duration of 50 microseconds would be more appropriate for influencing pain and not as effective for promoting muscle strength)

A physical therapist is conducting a research project that synthesizes the results of several studies in a quantitative process. This process represents which of the following research methods? a. Cross-sectional b. Correlational c. Meta-analytical d. Methodological

c (Meta-analytical)

A patient reports decreased levels of low back pain after receiving physical therapy interventions over a 3-week period. The patient then cancels the last three scheduled appointments. Which of the following actions is MOST appropriate for the physical therapist to take? a. Leave a message on the patient's answering machine discussing the patient's noncompliance. b. Document that the patient has discharged self from physical therapy. c. Talk with the patient to find out the reason for the cancellations. d. Speak to the referring physician concerning the patient's nonadherence to the plan of care.

c (Talk with the patient to find out the reason for the cancellations.)

During an exam, the limitations of US imaging include which of the following? a. inability to clearly see cartilage in infants b. disruption of cardiac pacemakers c. difficulty penetrating bone and therefor visualizing internal structure of bones d. inability to give a clear picture of tendons and therefor diagnose tendon tears

c (difficulty penetrating bone and therefor visualizing internal structure of bones)

Tammy underwent a right transtibial amputation several weeks ago and is participating in therapy for balance and gait training. During initial contact to loading response, the patient has excessive knee extension. Which of the following is the MOST likely cause of the deviation? A. Gluteus medius weakness B. Knee flexion contracture C. Inadequate socket flexion D. Hip flexion contracture

c (inadequate socket flexion) (glute med weakness = lateral trunk lean/Trendelenburg gait deviation; FRONTAL plane, occurs mostly during MIDSTANCE knee flexion contracture = excessive knee extension not possible the more socket flexion present, the more the knee will be flexed, and vice versa)

Which of the following is NOT a goal or indication for the use of therapeutic ultrasound? a. increase connective tissue extensibility b. reduce or eliminate soft tissue inflammation c. increase healing rate of tissue over recent joint replacement d. reduce muscle spasm

c (increase healing rate of tissue over recent joint replacement)

An 18 month old child presents to you with a PMH of significant developmental delay. Parents report that the child is unable to sit unsupported for self-feeding. Which of the following sections should this information be documented in? A. Objective section B. Assessments section C. Subjective section D. Planning section

c (subjective section) (6 months = normal milestone for Unsupported sitting 10-15 months = normal milestone for self-feeding)

Match the following electrical stimulation *wave forms* with the correct description: -___: 3+ phases in a single pulse; Russian current or Interferential Current (IFC) -___: unidirectional flow of charged particles; can be (+) or (-) charged -___: bidirectional flow of charged particles; half of the cycle is above the baseline (+), the other half is below the baseline (-) (doesn't have to be symmetrical) a. Monophasic b. Biphasic c. Polyphasic

c, a, b

(Continuous/Pulsed) ultrasound is applied when thermal effects are desired. A duty cycle of _______ is normal with this type of US.

continuous, 100%

What form of validity is measured by comparing results obtained with a test to results obtained using an already well-established and validated tool? a. Face b. Construct c. Content d. Criterion-related

d (Criterion-related validity of a new tool is tested by using practical and objective comparisons to a reliable/valid [gold] standard measure already in use.) (concurrent validity = a type of criterion-related validity. Used when comparing two measures at the same time to determine if the experimental measure can be used as a substitute for the reference measure/gold standard)

Yael presents to physical therapy status post right femoral neck fracture with an ORIF. During the gait assessment, the patient demonstrates a diminished backward rotation of the pelvis on the right when compared with the left. Which of the following findings will MOST likely accompany this clinical picture? A. Excessive plantarflexion during midstance on the right B. Lengthened step length on the left C. Shortened step length on the right D. Diminished left trunk rotation

d (Diminished left trunk rotation) (diminished backward rotation of the pelvis on the right = transverse plane, decreased *terminal stance on the right* Excessive PF during midstance = vaulting gait pattern with decreased terminal stance on the right you would expect to see a *decreased step length of the left*, a normal right step length, and diminished left trunk rotation Every time an extremity is in *terminal stance*, the body/trunk is *rotating in the OPPOSITE direction* - if my right leg is going into terminal stance, with my right pelvis rotating posteriorly, my trunk will be rotating to the LEFT to keep facing forward)

A patient who has a transfemoral amputation should perform which of the following movement patterns when being taught to pick up an object from the floor while wearing a prosthesis? a. Place both lower extremities at the same level and weight-bear through both extremities while reaching for the object. b. Place the affected lower extremity forward and weight-bear through the affected lower extremity while bending forward to reach for the object. c. Place the affected lower extremity forward and weight-bear through the unaffected lower extremity while bending forward to reach for the object. d. Place the unaffected lower extremity forward and weight-bear through the unaffected lower extremity while bending forward to reach for the object.

d (Place the unaffected lower extremity forward and weight-bear through the unaffected lower extremity while bending forward to reach for the object.)

Which of the following orthoses would be MOST appropriate for a child who has a history of myelomeningocele at the S1 level and has Poor (2/5) gastrocnemius strength? a. Supramalleolar b. Knee-ankle-foot c. Reciprocating gait d. Solid ankle-foot

d (S1 myelomeningocele would cause weakness in the muscles of the posterior lower leg and tibia, without affecting muscle strength in the hips and knees. Solid ankle-foot orthoses would provide the appropriate support at the foot and ankle.)

A physical therapist would be required to wear a surgical face mask when working on transfer training with a patient who has which of the following conditions? a. Rubeola b. Tuberculosis c. Varicella zoster d. Bacterial pneumonia

d (bacterial pneumonia) (Droplet precautions, including wearing a face mask, should be used when working with patients who have bacterial pneumonia.)

A pt's plan of care includes use of iontophoresis for the management of calcific bursitis of the shoulder. To administer this treatment using the *acetate ion*, what current characteristics and polarity should be used? a. monophasic, twin-peaked pulses using the positive pole b. monophasic, twin-peaked pulses using the negative pole c. direct current using the positive pole d. direct current using the negative pole

d (direct current using the negative pole acetate ion has a negative charge and thus a negative pole will be needed to repel the drug into the tissue. Direct current will continuously drive the acetate into the tissue during the treatment time)

A patient has normal quads strength but unilateral weakness (3/5) of the hamstrings on the right side. What might the therapist observe during swing phase of gait? a. excessive compensatory hip extension on the sound side b. decreased hip flexion followed by increased knee flexion on the weak side c. excessive hip extension followed by abrupt knee extension on the weak side d. excessive hip flexion followed by abrupt knee extension on the weak side

d (excessive hip flexion followed by abrupt knee extension on the weak side) (hamstrings primarily control the forward swing of the leg during terminal swing; loss of function may result in abrupt knee extension and increased hip flexion)

While using continuous ultrasound on a patient who has an upper trapezius muscle spasm, a physical therapist adjusts the intensity from 1.5 W/cm2 to 2.0 W/cm2. Which of the following changes will MOST likely occur? a. Decrease in the depth of tissue penetration b. Decrease in the amount of heating energy delivered c. Increase in the depth of tissue penetration d. Increase in the amount of heating energy delivered

d (increase the amount of heating energy delivered)

A therapist is examining the gait of a person with a transfemoral prosthesis. The pt circumducts the prosthetic limb during swing. The therapist needs to ID the cause of the gait deviation. What is the MOST likely prosthetic cause? a. unstable knee unit b. inadequate socket flexion c. high medial wall or abducted hip joint d. increased knee flexion resistance

d (increased knee flexion resistance) (prosthetic causes of circumduction: prosthesis that is *too long*, locked knee unit, inadequate knee flexion, inadequate suspension, small or loose socket, and PF foot)

Which of the following is NOT a precaution for the use of therapeutic ultrasound? a. acute inflammation b. over breast implants c. over a healing fracture d. over closed epiphyseal plates

d (over closed epiphyseal plates = fully matured adult bones, no problemo over OPEN epiphyseal plates [aka in a growing adolescent] = CONTRAINDICATION)

Match the following electrical stimulation *currents* with the correct description: -___: time period with a gradual rise of the current intensity, which is maintained at a selected level for a given period of time, followed by a gradual or abrupt decline in intensity -___: intermittent cessation of current flow for >/= 1 sec -___: uninterrupted flow -___: gradual increase and decrease in the current intensity over a finite period of time a. Continuous b. Interrupted c. Surge d. Ramped

d, b, a, c

The *strength* of an AP is *always the same*, the only thing to be manipulated is the _________ and ________ of the APs

frequency, speed (Weak stimulus tends to trigger less frequent APs and vice versa)

The *action potential* (AP) is generated at the axon __________, where the density of voltage-gated Na+ channels is greatest. The AP begins when signals from the dendrites and cell body reach this area and cause the membrane potential there to become more (negative/positive), in a process called _________

hillock, positive, depolarization

The gait deviation of *circumduction* (swinging the leg out to the side for clearance during swing) is generally due to weakness in what muscle group(s)

hip flexors, knee flexors (circumduction = ABD + ER initially followed by ADD + IR)

In an *antalgic gait* pattern, stance time is *decreased* on the (involved/uninvolved) LE, resulting in an *asymmetric* gait pattern.

involved (painful limb) (Uninvolved/nonpainful LE: shortened step length as WB occurs sooner than normal)

this gait deviation is also called a *GLUTE MED LIMP* since it can signify *weakness* in that muscle group - Problem during loading, midstance, and terminal stance

lateral trunk lean (bend)

__________________ is the use of *ultrasound* (US) to drive medications through the skin into the deeper tissues. Local analgesics (lidocaine) and anti-inflammatory drugs (dexamethasone, salicylates) often used

phonophoresis (Application method: Mode = pulsed 20% Tx time = 5-10 min Intensity = 0.5-0.75 w/cm^2 gel medium or transdermal patch [don't use pastes/creams] Goals/indications: modulate pain, decrease inflammation in subacute and chronic MSK conditions)

When a neuron is resting it is said to be ____________. If membrane potential moves more *towards zero* it is ______________ if membrane potential moves *more negative* it is ______________

polarized, depolarized (inward current of Na+), hyperpolarized (outward current of K+)

(Continuous/Pulsed) ultrasound is applied when NON-THERMAL effects are desired. A duty cycle of ________ is normal with this type of US.

pulsed, 2-50%

What is the main potentially cause for a *forward trunk lean* gait pattern

quad weakness (or pain) (= MOVES GRFV forward aka decreases the flexion moment at the knee) (From PHM gait notes: 3 potential causes of forward trunk lean gait pattern = weak hip extensors [glute max/hamstrings], weakness/pain in the quads, limited dorsiflexion ROM at ankle / plantar flexor weakness [likely the case when forward trunk lean is only during MIDSTANCE])

What are the 5 most common causes of* knee hyperextension* during gait

quad weakness, PF tightness (or extensor spasticity or contracture), glute max weakness, forefoot first contact, proprioceptive deficits

6 key measurements of WC fitting

seat width (widest part of pt's hip + 2 inches), seat depth (posterior buttocks to popliteal fossa - 2 to 3 inches), seat to footplate length (bottom of shoe to below the thigh in sitting + seat cushion height), seat height (min clearance b/w floor and footplate = 2 inches), armrest height (seat platform to just below pt's elbow held at 90 deg flexion + 1 inch), back height (varies depending on support needed)

*(Sensitivity/Specificity)* is a test's ability to correctly identify the proportion of those who do NOT have the condition, impairment, or disease.

specificity

T/F: Positioning to avoid contracture in patients with a *transtibial* or *transfemoral* amputation include prolonged hip / knee *flexion* and hip external rotation

true (important to maintain knee and hip EXTENSION in amputee patients; use a posterior board to keep knee straight while in WC, regularly schedule time in PRONE LYING)

Rejecting null hypothesis when it is true (false positive) = what type of error (concluding there is a difference between groups, when in fact, there is no difference)

type I error

failing to reject the null hypothesis when there really is a difference between groups (false negative) = what type of error - can happen if you conclude that the difference between groups is so small that it doesn't matter much or is very hard to detect, OR concluding that the difference is big enough to care about but your sample size was just too small to tell you much (uninformative null finding)

type II error

With Cane usage, the proper fit is for the cane height to go up to the patient's ___________ of their hanging UE, to allow for ________ degrees of elbow flexion. Cane should be held on the '_________' side! 2-point gait pattern (ideal) = cane and *(involved/uninvolved)* LE advance *together*

wrist crease, 20-30, strong (uninvolved), involved (*crutches and walkers should also have handgrips be at the height of 20-30 deg elbow flexion*)