TherEx Final Study

To improve upper extremtiy strength, stability, and proprioception, during which of the following variations of push-ups does body weight provide the greatest resistance?

Bilateral push-ups in a prone position, head down and feet elevated and weighted vest.

To teach a patient how to manage painful symptoms related to poor posture, which of the following is important?

* Awareness of the relationship between the faulty posture and pain. Provide patient education of the importance of establishing and maintaining correct posture to reduce painful symptoms.

To stretch the Right Levator Scapulae muscle the PTA uses the hand on the back of patient's head to gently push the patient's head into flexion...

* cervical flexion, left lateral flexion and left rotation

Which of the following ligaments of the ankle is most commonly stressed during an inversion sprain?

*Anterior talofibular

Hip flexor weakness or functional impairment will result in a change in the normal gait cycle. The therapist should suspect hip flexor dysfunction when observing gait and noting a:

*Forward flexion of the trunk during the weight bearing.

Treating the soft tissue of the back:

*In prinicple is no different from treating soft tissues in the extremities. You would treat soft tissue in the back just as you would in the extremities.

A posterior glide of the head of the femur on the surface of the acetabulum increases which of the following hip motions?

Flexion and internal rotation

The difference between a lordotic posture and a slouched posture is:

Flexion in the upper lumbar and lower thoracic spine occurs with the slouched posture

Which of the following best defines muscle strength?

Force generated during a single maximum effort

In a patient's chart you see "knee flexion contracture". What does it mean?

Full, passive knee extension is not possible. Contractures develop from shortening of the tissues acrossed a joint and can be permanent. (ie knee, elbow,hip)

Following recovery of a posterolateral disk protusion, your patient returns to a job that requires prolonged forward bending and stooping. Your instruction to the patient must include:

Interruption of the flexed posture at intervals by standing upright and bending backward. Try and educate to have the patient stand and reverse the motion frequently throughout the day.

Your patient has nerve root symptoms and has been diagnosed as having degenerative joint disease of the spine. The approach for treating the cause of the symptoms should be:

Interventions that temporarily increase the size of the intervertebral foramina. Interventions should include the space of the foramina to reduce the stress on the nerve exiting the vertebral structure.

Which of the following is true of flat low-back posture?

It decreases the shock-absorbing function of the spinal curves

What is the best method for determining the progression of exercise during the subacute stage of healing?

Let patient's response guide the progression of exercise. Progress as the patient tolerates.

In order to gain full ROM of the ankle for dorsi-flexion, you would perform which of the following:

Place the patient in supine with the knee flexed or short sitting, then dorsiflex the foot. Begin with the foot in plantarflexion. (A and C answer).

A 40 year old teacher has pain in plantar aspect of the heel and is noticeable when getting out of bed, sitting for over an hour, and playing raquetball. Pain is during walking in terminal stance/pre-swing phase. He most likely has this disorder:

Plantar fasciitis

Which of the following terms best describes impaired extensibility of a muscle-tendon unit as the result of spasticity or rigidity from a lesion of the central nervous system?

Pseudomyostatic contracture

An isometric contraction has no change in muscle length or joint angle? T or F?

True Muscle contracts with no lengthening or shortening to produce movement.

PROM is used to prevent atrophy of the muslces? T or F?

True * - no muscle contraction occurs.

A flexion approach, stabilization and hip flexor stretches are used as an intervention with spondylolisthesis? T or F?

True - Anterior slippage of the vertebra.

HEP compliance can be assisted by:

clear and simple written instructions The HEP fits into patient's schedule Retest HEP at next therapy session Correct! All of the above

Isometrics:

contraction of muscle without movement

A contusion is caused by:

direct blow

As a PTA you assess the functional strength of the hip extensors while observing the patient move from stand to sit. What type of contraction does hip extensors produce during this activity?

eccentric

Force production of the deltoid with elbow extended and slight shoulder flexion is ________ shoulder flexion at 50 degrees with elbow flexed.

equal to The force output would be equal to each other because you are shortening the lever arm producing less tension.

pronator terres :

forearm pronation

long head of biceps brachii:

forearm supination

Recovery time from fatique with total rest is ___________ recovery time from fatigue with light exercise during recovery.

greater than. Light active exercise in between sets will decrease muscle fatigue and soreness.

Match the muscle to the action: gluteus medius:

hip abduction

Match the muscle to the action: Iliopsoas:

hip flexion

A patient uses a foam roller to roll up and down the lateral aspect of the thigh. This therapeutic technique is MOST beneficial for a patient diagnosed with:

iliotibial band syndrome

A PTA is seeing a post-op TKR 4 weeks post, outpatient. The pt. did have a DVT following surgery and WB is limited to WBAT. Pain is 3/10 and the patient is feeling well. The POC asks for an upgrade of the HEP from LAQ (long arc quads) to light resistance for quads, 3+/5. Which of the following would be the best choice?

short sitting with a light theraband around both legs, perform knee extension

Patients with osteoporosis are at a high risk for compression fracture of the vertebral bodies. The primary segments of the spine at risk are at the thoracolumbar region. When planning a treatment program for this high risk population include all of the following EXCEPT:

*Strengthen the abdominals without adding weight bearing stress on the vertebrae by teaching sit-up exercises. A sit up or trunk flexion puts great stress on the anterior body of the vertebrae.

An effective exercise program for a patient with a knee flexion contracture would include these exercises:

*Stretching

Disk lesions are more common in the 30 to 45 age span because:

*The annulus of the disk begins degenerating, losing tensile strength, and begins to wear with excessive forces.

Anterior to posterior to anterior pelvic tilt exercises are used:

*To perform ROM of the lumbar spine.

To maintain gains in ROM achieved as the result of a stretching program, it is recommended to :

*Use the stretch induced gains in ROM during the functional activities as soon as able on a regular basis. Incorporate the newly attained ROM in to everyday activities.

A PTA moves a patient from sidelying to supine after the patient was unable to maintain hip abduction for manual muscle test. The patient is able to perform full ROM in gravity eliminated position. What muscle grade would you give this patient?

2/5

Assuming your patient is pain free and improving with strength. What grade do they at least need to achieve for you to start integrating resistance to your patient's exercise regimen?

3+/5

Each of the following is an indication that muscle fatigue is occurring when a patient is exercising against resistance except:

A mild warmth is noticeable during exercise The gradual warmth is a "normal" response to muscle working.

To effectively stretch the scalene muscles on the left, the patient:

Axially extend the neck, side bend to the right, and rotate to the left.

Your uncle is a 42 year old weekend warrior that felt a sudden sharp pain in his calf and an audible "pop" while running bases. He is having difficulty walking and uses a flat foot walking pattern if he "takes it slow". With this information, what injury do you suspect your uncle has sustained:

Achilles tendon rupture. He would not be able to toe off due to the inability to plantar flex the ankle from the ruptured Achilles tendon.

Which of the following is a contraindication to implementing resistance exercises?

Acute pain and inflammation

During the subacute stage of soft tissue healing after injury and repair of the flexor tendons of the hand or forearm, each of the following is an important intervention except:

Aggressive resistance exercises to improve strength quicker. Progressive resistance exercises are not appropriate at the subacute stage of soft tissue healing.

What is the importance of a prioritized problem list (PPL)? How will it help?

As a place to start, drives treatment and to create a plan and goals for the patient. Helps to evaluate progress, to formulate a tx plan, and documentation after tx. Also helps communicate with pt. and other medical professionals.

Overuse sydromes occur:

As the result of repetitive, submaximal stress of a muscle or a tendon.

The best way to correct substitution is:

Assess the reason or cause provide visual cues provide tactile cues Correct! all of the above

An elastic property of stretching is that "sarcomeres give" and muscle returns to original resting length? T or F?

False*

Which of the following is categorized as an extrinsic factor contributing to limited ROM?

Cast immobilization after a fracture

Collegen modeling occurs and return to function:

Chronic stage

Subacute stage

Collegen tissue formation, pain at end range, fragile tissue.

You are treating a patient with osteoarthritis of the left knee. This morning after performing the exercise program you prescribed for him, he reports experiencing stiffness of the involved knee and joint pain during weight bearing lasting about 30 minutes. What should you do?

Decrease the intensity of the exercise program The patient might be over performing the exercise or not performing it correctly.

All are true for eccentric contractions except:

Decreased delayed onset muscle soreness (DOMS) Eccentric contraction will produce increased delayed onset muscle soreness (DOMS) compared to concentric.

All of the following can cause impaired range of motion (ROM) except:

Early movement after surgery

Which of the following is true of resistance training for the patient with known osteoporosis?

Evidence has shown that resistance exercise is an essential and beneficial part of rehabilitation.

To acheive maximum elongation of the long head of the biceps brachii during passive stretching:

Extend the elbow with the forearm in pronation and then extend the shoulder.

Stretching is another term used for PROM? T or F?

False

The main reason for adding stretching into the plan of care is purely loss of range of motion? T or F?

False

The vasalva manuever is recommended during resistive exercise? T or F?

False Always encouraging controlled breathing during resistive exercises.

A person should use substitution to move the limb through the resisted ROM?

False Target the muslce and quality before quantity.

The less tension on the theraband the increased resistance you will feel? T or F?

False The more slack in the theraband will decrease its resistance.

Open chain exercise consists of distal end of extremity being fixed during exercise? T or F?

False - Open chain has distal end of extremity free to move.

During a concentric contraction, the muscle is producing tension while the muscle is lengthening? T or F?

False - The concentric contraction produces tension in the muscle while to muscle is shortening.

A properly applied and progressed therapeutic exercise program should:

Grade the exercise to the stage of recovery to stress the tissues safely.

A patient with COPD is ambulating and experiencing shortness of breath (SOB), which of the following would you do to help relieve the difficult breathing? Select the BEST answer.

Have the patient rest and perform pursed lip breathing

Your goal is to improve lower extremity proprioception, balance, and strength. Which of the following closed-chain exercises is the most challenging?

Have the patient stand on one foot on a piece of foam and maintain his balance. The foam creates an unstable platform, therefore, increasing difficulty of maintaining balance on one foot.

Of the following, which is the most effective way to improve muscle endurance?

Have the patient train using dynamic exercises against submaximal loads over progressively longer time periods

You place your patient's wrist in a splint because he is experiencing an acute period of lateral epicondylitis (Tennis elbow). Which of the following is the least appropriate intervention while the inflamed soft tissue healing? (Think like a therapist)

Have the patient wear a splint to immobilize the wrist continuously for at least 2 weeks or until there is no pain.

A therapist is treating a patient three days status post total hip replacement who has a posterolateral incision. Which exercises would be contraindicated for the patient assuming an uncomplicated postoperative course?

Hip adduction on the powder board past neutral

If a patient stands in a fencer's stretch posture but with the back leg externally rotated and lunges forward, this self-stretching maneuver primarily stretches which muscle groups of the back leg?

Hip adductors and internal rotators

The goal of the exercise is to increase the flexibility (extensibility) of the pectoralis major muscle. You teach the patient to stand facing a corner with the shoulders abducted 90 degrees, elbows flexed to 90 degrees, and hands and forearms placed on the walls. You tell the patient to relax into the stretch (by leaning into the corner) for 30 seconds; push his forearms into the walls for a count of six; then relax and lean forward toward the corner again and hold for 30 seconds. the self-stretching technique the patient is using is:

Hold-relax (contract-relax)

Your patient is recovering from a back injury that occured 3 weeks ago. You decide it is time to place him on a progressive walking program and integrate with other functional stabilization intervention in order to:

Improve control of the spine while performing a basic functional activity and to improve cardiopulmonary endurance.

ROM (passive, active-assist, active, resistive) techniques are performed?

In the anatomical planes of motion, frontal, sagittal...and In functional patterns if the patient is able

Within 1 week of beginning resistance exercise of the shoulder external rotators as a component of a rehabilitation program after a shoulder injury, your patient, Mr K., is able to increase the level of resistance by using a heavier grade of elastic tubing. This improvement in muscle performance is due primarily to which of the following adaptive changes? Correct!

Increased recruitment of motor units The more motor unit recruitment the more increased strength achieved.

Acute stage

Inflammatory, cellular activity with pain before resistance.

Which of the following is an incorrect statement about hypomobility?

It is usually associated with joint instability. A joint instability would result in hypermobility.

The primary value of a patient performing quad sets when the knee is immobilized in a long cast in extended position for a long time is:

Maintain mobility of the patella.

To increase terminal knee extension, you position the patient prone so the lower leg is not supported on the table. The patient relaxes while the lower leg and foot "hang" off the end of the table. The therapist adds a cuff weight around the ankle. What type of stretching procedure is being applied?

Mechanical

Each of the following is a characteristic of osteoarthritis except:

Onset typically is very sudden in patients older than 40 years of age.

Which of the following is an indication for joint mobilization?

Pain

Which of the following best describes ROM exercises?

Passive, assisted, or active movement of a body segment through the available range of motion

A quadriceps lag may be described as:

Patient cannot actively extend the knee to full extension even though there is full passive knee extension.

Your patient has regained normal strength (5/5) and ROM with rehabilitation. He continues to have difficulty walking on uneven surfaces and gravel. To address this problem, your exercise program should focus on:

Perform progressive balance training with wobble/rocker board in closed chain activity. Increase the neuromuscular and strength within closed chain position to improve reaction and control of the ankle muscle structures instantaneously.

For effective shoulder function, each of the following is necessary except:

Provide substitution during movement if fatigue happens. No substitution should be necessary for pure shoulder function.

Awareness of safety measures during exercise protects the patient and the therapist. All of the the following measures should be routinely taken to prevent injury to the patient and/or therapist except:

Recommend that the patient discontinue taking any medications that might impair balance tolerance for physical activity. With exercise, you take into consideration of the specific medications that could impair balance but we cannot tell a patient to stop taking a prescribed medication.

Each of the following is an expected outcome of conservative management of osteoarthritis of the knees except:

Regenerating worn articulating cartilage. Articulating cartilage does not usually regenerate.

You have a patient assume a prone-lying position and prop symmetrically on his forearms. You apply manual resistance in several directions at the shoulder girdles as you ask the patient to hold (maintain) the symmetrical position. This technique is know as:

Rhythmic stabilization

Movement during the acute stage of healing following soft tissue injury:

Should be passive or assisted and should begin as soon as tolerated with the pain-free range

A normal accessory joint movement that occurs with roll is:

Sliding/gliding

Mrs. B is an 87 year old resident of the skilled nursing facility. She sustained a compression fracture of the T12 vertebra several weeks ago when she sat down too hard into a chair. Incorporating resistance training that focuses on eccentric exercises of her quadriceps and gluteal muscles in weight bearing position (e.g. controlled squats and partial lunges) represents what principle of therapeutic exercise?

Specificity of training

Occasional or intermittent pain that occurs in the chronic stage of soft tissue healing is best relieved by:

Stretching and strengthening the healing tissues. Progress the patient to normal function at this stage.

Your patient describes having upper cervical and upper thoracic pain progressing throughout the day at work by reaching forward and overhead on an assembly line. On evaluation you determine she is experiencing "stretch weakness" from prolonged postural positioning. The treatment program you design should primarily include all of the following execpt:

Stretching for the involved postural muscles. You would want to increase the strength of the postural muscles to decrease the stretch weakness of the upper back muscle groups.

Which of the following are true of the gleno-humeral joint during internal rotation?

The internal rotators are shortening The humeral head is rolling The external rotators are lengthening Correct! all of the above

You are to perform shoulder PROM to a patient, which of the following would be the best position?

Supine

Which one of the terms refers to the degeneration of a tendon due to repetitive microtrauma?

Tendinosis

A patient has limited wrist flexion, to increase the motion which of the following are true?

To perform agonist contraction: contract the wrist flexors, hold for 6 sec, relax and stretch into wrist flexion for 20 sec.

Active-assist exercises provide sensory feedback from contracting muscles? T or F?

True

An terrible triad in the knee consists of an injury to the medial collateral ligament, medial meniscus and anterior cruciate ligament? T or F?

True

Education should be given to the RA (rheumatoid artrthritis) patient to pace activities for energy conservation? T or F?

True

Immobilization, surgery and athlete performance are indications for stretching? T or F?

True

Multi angle isometrics can be performed if movement is too painful to move the joint? T or F?

True

Overwork of a muscle can have a decline in muscle perfomance? T or F?

True

Selective stretching is used in spinal cord patients to provide stability in certain muscle groups and not others? T or F?

True

The glenohumeral joint is a ball and socket triaxial joint? T or F?

True

To reduce muscle soreness, a cool down should be incorporated in the training? T or F?

True

With a grade 2 tissue injury, you might have an antalgic gait and require an assistive device? T or F?

True

Ballistic stretching:

Uses quick bouncing movements during the stretching manuever, resulting in an increased chance for tissue trauma and muscle soreness. Ballistic stretching can lead to injury and increased muscle soreness.

Each of the following signs or symptoms is a characteristic of rheumatoid arthritis except:

Usually asymmetrical joint involvement. RA can affect all joints symmetrically.

Each of the following is a contraindication to stretching except:

When ROM is limited because scar tissue has reduced the tissue's extensibility.

Which of the following is a contraindication to PROM exercises?

When movement of a body segment is disruptive to the healing process

Using a handheld weight as the source of resistance, which of the following positions to strengthen elbow extensors begins with the long head of the triceps brachii fully lengthened?

With the patient standing or sitting in a chair, begin with the elbow fully flexed and the arm elevated overhead and stabilized to maintain the shoulder in as much flexion as possible. The triceps brachii is a 2 jt muscle and the you have to incorporate the should flexion with elbow flexion to lengthen it fully.

serratus anterior:

scapular upward rotation, protraction

Referencing the previous scenario; The patient returns to the clinic 3 days later and pain is now 5/10 and the knee is a bit swollen and warm. What will you do? Best option.

advise the PT and discuss altering today's treatment

Match the muscle to the action: tibialis anterior:

ankle dorsiflexion

Weak abdominal muscles can lead to what structural deformity?

increased lumbar lordosis

Which of the following are true of muscle function, or the muscular system?

inhibition may be caused by the central nervous system (CNS) force output of a muscle decreases with pain (a and b)

Match the muscle to the action: biceps femoris:

kne flexion

Match the muscle to the action: quadriceps:

knee extension

To isolate the gluteus maximus muscle, which of the following would be the best method?

lay prone, knee flexed and perform hip extension

A direct relationship exists between force output of a muscle and which of the following?

motor unit recruitment cross sectional area of muscle contraction type Correct! all of the above

Resistive ROM:

movement against thera-band

Active ROM:

movement produced by muscle contraction

Passive ROM:

movement produced entirely by external force

In order to produce muscle hypertrophy, a muscle must be loaded appropriately during exercise. This statement best refers to which of the following principles?

overload principle

According to the definition of therpapeutic exercise and the the goal of designing an individualized program of therapeutic exercise, the physical therapist might develop a therapeutic exercise for the following:

physical impairments that interfere with activity improvement for an athlete to get better optimal symptom free movement

middle deltoid:

prime mover of shoulder abduction

Active Assist:

prime movers need assistance to complete ROM

A complete tear of soft tissue is:

rupture

subscapularis:

shoulder internal rotation

Which of the following may occur following six weeks of endurance training?

strength gains. Strength gains are possible with prolonged endurance training.

A sustained faulty posture that stresses the ligaments or joint structures usually continue until:

the mechanical stress is stopped You must correct the posture for the mechanical stress to cease.

A PTA is working with a patient who has a tight right Vastus Medialis, which of the following instructions are correct:

to stretch your right vastus medialis from a standing position use your right hand to pull your right ankle posteriorly and away from midline, flexing your knee slightly and abducting your thigh

All are included in the objective portion of the assessment except:

when does the pain bother them