TEST BANK for Therapeutic Exercise Foundations and Techniques 7th Edition Kisner by StudyGuide

Chapter 1: Therapeutic Exercise: Foundational Concepts

Multiple Choice

1. According to the definition of therapeutic exercise and the goal of designing an individualized program of therapeutic exercise, the physical therapist might develop a therapeutic exercise program in order to: A. Restore function through the elimination of body structure impairments. B. Improve function but not to remediate or reduce disability. C. Optimize overall health status, fitness, or sense of well-being. D. Remediate activity limitations but not to reduce health-related risk factors. ANS: C KEY: Book Part: Part I: General Concepts DIF: Intermediate

2. Awareness of safety measures during exercise protects the patient and the therapist. All of the following measures should be routinely taken to prevent injury to the patient and/or therapist except: A. Recommend that the patient discontinue taking any medication that might impair balance or tolerance for physical activity. B. Maintain proper body mechanics while applying manual resistance, stretching, or jointmobilization techniques. C. Assess the physical environment for adequate space and equipment. D. Provide the necessary feedback and education for proper performance of therapeutic exercise. ANS: A KEY: Book Part: Part I: General Concepts DIF: Basic

3. Which of the following terms associated with aspects of physical function is used to describe the ability of the neuromuscular system to statically or dynamically hold proximal or distal body segments in appropriate positions using synergistic muscle action? A. Muscle strength B. Muscle power C. Coordination D. Stability

ANS: D KEY: Book Part: Part I: General Concepts DIF: Basic

4. Which of the following terms is synonymous with cardiopulmonary fitness and is associated with the aspects of physical function that can be modified by therapeutic exercise? A. Cardiopulmonary resistance B. Cardiopulmonary endurance C. Cardiopulmonary stability D. Cardiopulmonary strength ANS: B KEY: Book Part: Part I: General Concepts DIF: Basic

5. Each of the following is a step in the process of evidence-based practice except: A. Convert the patient problem to an answerable clinical question. B. Spend many hours gathering any and all information that might be used to answer the question. C. Integrate relevant evidence with clinical experience and expertise to make decisions about the management and care of a patient. D. Assess the outcomes of interventions based on evidence. ANS: B KEY: Book Part: Part I: General Concepts DIF: Basic

6. According to the International Classification of Functioning, Disability and Health (ICF) endorsed by the American Physical Therapy Association (APTA), a rotator cuff tear is considered a(n): A. Health condition. B. Impairment. C. Functional limitation. D. Disability. ANS: A KEY: Book Part: Part I: General Concepts DIF: Basic

7. Which of the following components of the ICF model is defined by the individual’s life-style, education, and social and environmental backgrounds? A. Risk factors for health conditions B. Impairments in body function C. Participation restrictions D. Contextual factors ANS: D KEY: Book Part: Part I: General Concepts DIF: Basic

8. Ms. C is an 18-year-old who is 3 days post-ACL reconstruction. She must wear a knee immobilizer during ambulation with axillary crutches and must remain partial weight bearing on the involved side. She has limited passive and active range of motion of the operated knee. According to the ICF model of functioning and disability, her limited knee ROM is classified as a: A. Secondary impairment of body structure. B. Primary impairment of body function. C. Primary impairment of body structure. D. Secondary impairment of body function. ANS: B KEY: Book Part: Part I: General Concepts DIF: Basic

9. Ms. L is a 78-year-old who underwent surgery for internal fixation of an intertrochanteric fracture of the (L) hip 3 days ago. For the next few weeks she must remain nonweight-bearing on the operated side and has begun to use a walker for ambulation. She is able to walk for short distances around her hospital bed but is not yet able to rise from a chair to standing. According to the ICF model, the inability to stand from a sitting position is classified as a(n): A. Health condition. B. Impairment. C. Activity limitation. D. Participation restriction. ANS: C KEY: Book Part: Part I: General Concepts DIF: Basic

10. Part of a preseason screening program for high school athletes includes testing the stability of the glenohumeral and scapulothoracic joints. If you identify an athlete with signs of shoulder instability but has no activity limitations or participation restrictions, you might suggest an exercise program designed to prevent or reduce the risk of injury during the season. This is an example of what type of prevention? A. Primary B. Secondary C. Tertiary D. Indirect ANS: B KEY: Book Part: Part I: General Concepts DIF: Basic

11. Which of the following is a true statement about the components of the patient management model described in the Guide to Physical Therapist Practice? A. Patient education is the one intervention that should be included for every patient throughout the entire episode of care. B. Goals and outcomes are synonymous terms. C. A primary focus of the diagnostic process performed by physical therapists is the identification of pathology. D. It is appropriate to discontinue a patient from an exercise program only when the patient has attained the goals stated in the initial plan of care. ANS: A KEY: Book Part: Part I: General Concepts DIF: Basic

12. According to the patient management model described in the Guide to Physical Therapist Practice, each of the following is a component of the examination performed by the physical therapist except: A. Selecting and performing appropriate tests and measures. B. Taking a patient’s history either verbally or from the medical record. C. Interpreting information derived from specific measurement tools to form a diagnosis and prognosis. D. Performing a systems review. ANS: C KEY: Book Part: Part I: General Concepts DIF: Basic

13. As a result of supraspinatus impingement syndrome, Mrs. J is unable to lift her arm fully overhead without pain. You plan to design an exercise program consisting of both discrete and serial tasks. You do not want to include continuous tasks at this time. Which of the following should not be included? A. ROM exercises using a cloth to wipe down the wall B. Active reaching exercises to place small objects in a cabinet C. Active assisted stretching by lifting a cane overhead in supine D. Warming up on the upper extremity (UE) ergometer (UE cycling) ANS: D KEY: Book Part: Part I: General Concepts DIF: Intermediate

14. Your patient is performing pelvic tilt exercises for the first time and needs verbal and tactile cues (feedback) to perform the exercises correctly. This represents which stage of motor learning? A. Cognitive B. Contemplative C. Associative D. Autonomous ANS: A KEY: Book Part: Part I: General Concepts DIF: Basic

15. During several physical therapy sessions, a patient you have been treating for low back pain learned how to perform pelvic tilt exercises in several positions (supine, sitting, quadruped, standing). With continued practice at home, your patient is now able to perform extremity movements while maintaining a stable pelvic position. This represents which stage of motor learning? A. Cognitive B. Continuous C. Associative D. Autonomous ANS: D KEY: Book Part: Part I: General Concepts DIF: Intermediate

16. You are helping a patient learn a motor skill. You set up several variations of the same task (walking on several types of surfaces). You have the patient perform one variation of the task and have him identify his own errors after the first repetition (or point out errors to him after the first repetition). Next, allow him to repeat the same variation of the task one or two more times before moving on to another variation of the task. What term best describes this type of practice? A. Blocked B. Random-blocked C. Random D. Augmented ANS: B KEY: Book Part: Part I: General Concepts DIF: Difficult

17. In which of the following stages of motor learning does augmented/extrinsic feedback have the most positive impact on acquisition of a motor skill? A. Cognitive stage B. Associative stage C. Autonomous stage D. External feedback is equally effective in any stage of motor learning. ANS: A KEY: Book Part: Part I: General Concepts DIF: Basic

18. Helping a patient acquire the ability to shift his weight from side to side in a standing position by means of manual guidance by the therapist is called: A. Summary feedback. B. Delayed feedback. C. Concurrent feedback. D. Instantaneous postresponse feedback. ANS: C KEY: Book Part: Part I: General Concepts DIF: Intermediate

19. For which of the following tasks will teaching components (parts) of the motor task be most effective? A. Swinging a golf club B. Riding a stationary bicycle Copyright © 2018 by F. A. Davis Company

C. Grasping an object D. Performing a standing-pivot transfer from bed to wheelchair ANS: D KEY: Book Part: Part I: General Concepts DIF: Basic

20. Consistent with the taxonomy of motor tasks, which of the following activities is the best example of body stability in an open environment with intertrial variability without manipulation? A. Maintaining sitting balance while riding a bus from school to home B. Maintaining standing balance while on an escalator C. Maintaining balance on a sidewalk or on the grass D. Maintaining sitting balance in chairs of different heights in your family room when you are home alone ANS: A KEY: Book Part: Part I: General Concepts DIF: Difficult

21. Which of the following is not a prerequisite for motor skill acquisition and retention? A. Augmented feedback B. Understanding the task or goal C. Being able to activate the motor system D. Being able to retrieve motor memories over time ANS: A KEY: Book Part: Part I: General Concepts DIF: Intermediate

22. As a therapist, you can be relatively confident that motor learning has taken place when your patient demonstrates which of the following? A. Consecutive repetitions of a task without error during the treatment session B. Decreased need for manual guidance during the treatment sessions C. The ability to perform a slight variation of the task in a new context during the treatment session D. Increased speed demonstrated when carrying out the task ANS: C KEY: Book Part: Part I: General Concepts Copyright © 2018 by F. A. Davis Company

DIF: Intermediate

23. Patient satisfaction is an important area for outcome assessment in physical therapy when following the patient management model described in the Guide to Physical Therapist Practice. There are several determinants of patient satisfaction that, if included in the gathering and analysis of data, may help clinics to improve the quality of care being provided. Each of these has been shown in the literature to be determinant of patient satisfaction except: A. Professionalism, empathy, and helpfulness of the therapist. B. Patient participation in goal setting in the plan of care. C. The chronicity of the patient’s condition (higher satisfaction with patients having chronic conditions). D. Convenience of access and flexibility for scheduling appointments. ANS: C KEY: Book Part: Part I: General Concepts DIF: Basic

24. The body systems react, adapt, and develop in response to forces and physical stresses placed on them. All of the following stresses help the body to develop and maintain a functional level of strength except: A. Gravity. B. Weight-bearing. C. Therapeutic exercise. D. Bed rest. ANS: D KEY: Book Part: Part I: General Concepts DIF: Basic

Chapter 2: Prevention, Health, and Wellness

Multiple Choice

1. Each of the following is a prescreening question that should be addressed before participation in a health promotion program, except: A. Have you ever been diagnosed with a heart condition? B. What are your blood pressure and heart rate normally? C. Do you experience chest pain when you engage in physical activity? D. Do you ever lose your balance or lose consciousness? ANS: B KEY: Book Part: Part I: General Concepts DIF: Basic

2. An individual who perceives a threat of contracting a disease decides to follow specific health recommendations because he believes that he can prevent or reduce the risk of contracting the disease. These behaviors are aligned with what behavioral change theory or model? A. Social cognitive theory B. Health belief model C. Transtheoretical model D. Risk assessment theory ANS: B KEY: Book Part: Part I: General Concepts DIF: Intermediate

3. The goals of Healthy People 2020 are based on the nation’s vision to: A. Eliminate HIV and develop an immunization for prevention of AIDS. B. Develop a cure for the common cold. C. Promote smoking cessation, eliminate tobacco use, and pass legislation in all states banning smoking in public places. D. Foster a society in which all people live long and healthy lives. ANS: D KEY: Book Part: Part I: General Concepts DIF: Basic

4. Mr. K has had chronic low back pain for several years. He has a sedentary life-style that includes office work and being a self-reported “TV junkie.” His physician suggests physical therapy for exercise and management of his pain. Even though Mr. K schedules physical therapy, initially he does not think that exercises will help his pain. He does not associate his life-style with his low back pain and therefore does not consider making changes. After his first session with the physical therapist, Mr. K realizes that changes in his life-style and adding regular exercise may help decrease his low back pain. So he decides to continue physical therapy two times a week for 1 month as suggested. Following the first physical therapy session, Mr. K shows he is in which of the following stages of change associated with the transtheoretical model of behavioral change? A. Contemplation B. Preparation C. Action D. Maintenance ANS: B KEY: Book Part: Part I: General Concepts DIF: Intermediate

5. Which of the following sequences represents the correct order for developing and implementing a health promotion program? A. Assess the need; set goals and objectives; develop the intervention; implement the program; evaluate the program. B. Develop goals and objectives for a program; assess the need; design an intervention; implement the program; evaluate the outcomes. C. Develop a broad-based intervention; set goals and objectives that could be met; assess the community’s needs; implement the program; evaluate the program’s effectiveness. D. Evaluate the goals, objectives, and effectiveness of a previously implemented program; modify or update the program based on the evaluation; assess the current needs of a community; implement the new program. ANS: A KEY: Book Part: Part I: General Concepts DIF: Basic

6. The purpose of performing pre-participation screenings and risk assessments when developing health, wellness, and fitness programs includes all of the following except: A. To provide the therapist with baseline information for monitoring the individuals’ response to program progression. B. To determine the motivational readiness of the individual to make life-style changes. Copyright © 2018 by F. A. Davis Company

C. To assist the therapist in developing an appropriate level of exercise for the individuals. D. To identify if an individual should be referred to a physician prior to participation in the program. ANS: B KEY: Book Part: Part I: General Concepts DIF: Basic

7. The Perceived Wellness Survey (PWS) and the Model of Healthy Living Assessment Wheel were developed from models of wellness and various initiatives to improve the health and wellness of society as advocated by the Healthy People 2020 program. Which of the following best describes these tools? A. They are complex and require special training to administer and interpret. B. They have no clinical relevance to the role of physical therapy and are intended to be anecdotal for the public. C. If used as part of the examination and history taking during the initial visit, they could provide a baseline to establish goals and report outcomes when incorporating wellness into physical therapy practice. D. They were program assessments that were used to evaluate the success of the Healthy People 2010 program and to improve the subsequent initiative, Healthy People 2020. ANS: C KEY: Book Part: Part I: General Concepts DIF: Difficult

8. You have designed and are directing an exercise class for individuals who have been diagnosed with high blood pressure. This type of program falls within the definition of which type of prevention? A. Multifactorial prevention B. Primary prevention C. Secondary prevention D. Tertiary prevention ANS: C KEY: Book Part: Part I: General Concepts DIF: Basic

B. Smoking C. Sedentary life-style D. Family history ANS: A KEY: Book Part: Part I: General Concepts DIF: Intermediate

10. Which of the following best describes the target audience for a program of physical activity designed for primary prevention of childhood obesity? A. A group of morbidly obese children who have been diagnosed with type 2 diabetes B. A group of mildly obese children who are identified as being “at risk” for type 2 diabetes C. A group of mildly obese children D. A group of sedentary children whose weight is within normal limits ANS: D KEY: Book Part: Part I: General Concepts DIF: Intermediate

11. Non-communicable chronic diseases are the primary cause of death and illness in the United States (US). The top four chronic conditions in the US in terms of mortality include all of the following except: A. Cardiovascular disease B. Diabetes C. Obesity D. Chronic respiratory disease ANS: C KEY: Book Part: Part I: General Concepts DIF: Basic

12. People with disabilities should be included in wellness and prevention programs, as described by Healthy People 2020’s goal of health equity and elimination of disparity. Each of the following are resources for providing health and wellness programs to people with disabilities except: A. Individual Education Plans (IEPs) for school-aged children with disabilities. B. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF). C. The National Center on Health, Physical Activity and Disability (NCHPAD). D. Physical Activity Guidelines for Americans (US Department of Health & Human Services). Copyright © 2018 by F. A. Davis Company

ANS: B KEY: Book Part: Part I: General Concepts DIF: Intermediate

13. Which of the following descriptions is true about mindfulness and its implications for health and wellness? A. Mindfulness encourages focus on pain, increasing the pain response, anxiety, and blood pressure. B. Mindful meditation is a spiritual exercise that should not be associated with human movement interventions. C. Mindful breathing can be easily incorporated into physical therapy exercise instructions to assist the patient to avoid holding the breath during difficult or painful activities. D. Mindfulness invites one to be in another place or time and experience peace and well-being while focusing on a past time or event. ANS: C KEY: Book Part: Part I: General Concepts DIF: Intermediate

Chapter 3: Range of Motion

Multiple Choice

1. Which of the following is a goal of passive range of motion (PROM) exercises? A. Prevent muscle atrophy B. Enhance movement of synovial fluid for articular cartilage nutrition C. Increase joint range of motion (ROM) and muscle length D. Improve muscle performance ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

2. Which of the following is a contraindication to PROM exercises? A. When movement of a body segment is disruptive to the healing process B. Presence of muscle weakness or paralysis C. Presence of chronically impaired circulation D. When a patient is in a coma ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

3. All of the following can cause impaired range of motion (ROM) except: A. Early movement after surgery. B. Muscle imbalance and disuse. C. Neurological injury. D. Systemic inflammatory disease. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

B. Passive or active stretching exercise beyond the available range of movement C. Active muscle insufficiency D. Passive, assisted, or active movement of a body segment through the available range of motion ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

5. During active ROM exercises, which of the following structures is most elongated with full active extension and ulnar deviation of the wrist if the fingers remain relaxed? A. Flexor carpi ulnaris B. Flexor carpi radialis C. Flexor digitorum profundus D. Flexor digitorum superficialis ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

6. You are treating a patient with weak hip abductors (muscle grade is 2/5). Which of the following ROM exercises is most appropriate to prevent tightness of the hip adductors and maintain the current level of strength of the hip abductors? A. Perform passive abduction of the hip with the patient positioned in the supine position B. Have the patient perform active hip abduction through the available ROM while positioned in the side-lying position C. Have the patient perform active hip abduction through the available ROM while positioned in the supine position as you support the weight of the leg D. Perform passive abduction of the hip with the patient positioned in the side-lying position ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

7. The most effective results of continuous passive motion (CPM) can be expected: A. If the device is applied for at least 5 hours per day but its use is delayed for at least 5 days postoperatively. B. If the device is applied as early as possible after surgery for at least 4 to 8 hours per day. C. If the device is applied immediately after surgery for 1 hour, then on alternate days for 1 hour each time. Copyright © 2018 by F. A. Davis Company

D. If the rate of motion is at least 5 cycles per minute, no matter how many hours per day the device is used. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

8. Which of the following PROM exercises provides the most flexion of the lumbar spine? A. Single knee to chest B. Posterior pelvic tilt with the patient lying supine with hips/knees at 45°/90° C. Posterior pelvic tilt with patient lying supine D. Double knees to chest ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

9. Mr. J underwent a repair of a torn biceps brachii 2 days ago. During PROM exercises, which combination of motions should you avoid at end range to protect (not disrupt) the healing tissue? A. Elbow extension, shoulder extension, forearm supination B. Elbow extension, shoulder flexion, forearm pronation C. Elbow extension, shoulder flexion, forearm supination D. Elbow extension, shoulder extension, forearm pronation ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

10. Which of the following is a true statement about ROM exercises? A. Passive ROM is synonymous with stretching. B. If a joint is hypermobile, PROM exercises are contraindicated. C. Passive ROM can be carried out manually or mechanically. D. Whenever possible, active-assistive ROM should be performed in positions that eliminate the effect of gravity on the weak muscle that is actively contracting. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

11. During ROM of the cervical spine: A. Avoid grasping the jaw. B. Avoid extension past neutral (i.e., hyperextension). C. Perform ROM while the patient is in an upright position (seated or standing). D. Never combine flexion with rotation. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

12. During your examination of a patient’s lower extremity, you have identified tightness of the gastrocnemius muscle. You are teaching a patient to perform self-ROM exercises of the ankle. In order to maintain the gastrocnemius in a relaxed position while moving the ankle into full range of dorsiflexion available, the patient should: A. Actively extend the toes. B. Keep the knee extended. C. Actively flex the toes. D. Keep the knee flexed. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

13. In order to maintain the web space of the hand, it is important to maintain which of the following motions of the carpometacarpal joint of the thumb? A. Adduction and flexion B. Abduction and extension C. Adduction and extension D. Abduction and flexion ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

14. The most effective and safe way to perform passive pronation and supination of the forearm is to: A. Grasp the patient’s hand around the metacarpals and perform ROM while maintaining the elbow in extension. B. Grasp the patient’s forearm just proximal of the wrist and perform ROM while maintaining Copyright © 2018 by F. A. Davis Company

the elbow in extension. C. Grasp the patient’s forearm just proximal of the wrist and perform ROM while maintaining the elbow in flexion. D. Grasp the patient’s hand around the metacarpals and perform ROM while maintaining the elbow in flexion. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

15. You are treating a patient who sustained an anterior dislocation of the glenohumeral joint. When it is permissible for the patient to begin self-assisted or active ROM of the involved shoulder within pain-free ranges, which of the following exercises places the most stress on the anterior aspect of the capsule at the end range of external rotation, therefore posing the greatest risk of re-dislocating the involved shoulder? A. Wand exercises while lying in the supine position with both shoulders abducted to 90° (upper arms supported on the treatment table) and both elbows flexed to 90° B. Wand exercises while sitting in a chair or standing, both arms at the patient’s sides and elbows flexed to 90° C. Self-assisted shoulder ROM guided manually by the sound hand while lying on the sound side and the involved upper arm resting on a pillow placed alongside the chest and the elbow flexed to 90° D. Self-assisted shoulder ROM guided manually by the sound hand while the patient is lying in the supine position on a treatment table and the involved arm is at the patient’s side, resting on a pillow in slight abduction and flexion and the elbow is flexed to 90° ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

16. When incorporating functional patterns into ROM interventions, which of the following guidelines is correct? A. PROM should always be performed in anatomical planes of motion to reinforce motor learning. B. Mechanical assistance should not be used for assisted ROM because it will reduce motor learning. C. Incorporate the functional movement into the patient’s daily activities once the pattern can be performed safely and correctly, without assistance or compensation. D. Patients with visual impairments should always perform ROM in anatomical planes, avoiding functional patterns, so that joint alignment is maintained. ANS: C Copyright © 2018 by F. A. Davis Company

KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

Chapter 4: Stretching for Improved Mobility

Multiple Choice

1. Which of the following is an incorrect statement about hypomobility? A. It may be associated with loss of passive or dynamic flexibility. B. It may be caused by muscle imbalance or weakness. C. It is usually associated with joint instability. D. It may occur with or without tissue trauma. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

2. In a patient’s medical record you see “knee flexion contracture.” What does it mean? A. The patient is unable to actively extend the knee through the full range of motion (ROM) despite full passive knee extension. B. The quadriceps muscle group is tight and limits full, passive knee flexion. C. Full, passive knee extension is not possible. D. The patient cannot actively contract the hamstrings to flex the knee. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

3. Which of the following descriptions of stretching procedures performed for several repetitions during a single treatment session and repeated over a series of stretching sessions represents the safest and most comfortable process to achieve soft tissue lengthening? A. In an end-range position, apply several high-intensity, rapid-velocity stretch forces. B. Slowly apply a low-load force; maintain the end-range position for an extended time period and release the stretch force slowly. C. Apply an end-range, high-load force slowly, maintain the end-range stretch for an extended time period, and release the stretch quickly. D. In an end-range position, apply several low-intensity, rapid-velocity stretch forces. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

4. Which of the following is categorized as an extrinsic factor contributing to limited ROM? A. Bony block B. Inflammation of soft tissue C. Paralysis D. Cast immobilization after a fracture ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

5. To maintain gains in ROM achieved as the result of a stretching program, it is recommended to: A. Use the stretch-induced gains in ROM during functional activities as soon as able on a regular basis. B. Perform daily resistance training of the muscle group opposite the stretched muscle. C. Apply heat on a daily basis to the lengthened muscle groups. D. Perform daily resistance training of the stretched muscle. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

6. 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? A. Myostatic contracture B. Fibrotic contracture C. Pseudomyostatic contracture D. Hypotonic contracture ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

7. Each of the following is a contraindication to stretching adaptively shortened tissues except: A. Sharp, acute pain during ROM. B. When ROM is limited because scar tissue has reduced soft tissue extensibility. C. A bony block. Copyright © 2018 by F. A. Davis Company

D. When tight (shortened) soft tissues provide functional stability of a body segment affected by paralysis. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

8. Which of the following is a true statement about a muscle’s response to stretch? A. The muscle spindle is the motor receptor that protects the sarcomeres when a stretch is applied. B. “Sarcomere give” is best described as a plastic change in muscle that occurs as the result of stretch force that is applied quickly. C. A quick stretch of a muscle is believed to facilitate contraction of muscle fibers by means of the Golgi tendon organ (GTO). D. The primary source of a muscle’s resistance to passive stretch is the connective tissue in and around muscle. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

9. To achieve maximum elongation of the long head of the biceps brachii during passive stretching: A. Extend the elbow with the forearm in pronation and then extend the shoulder. B. Flex the shoulder overhead after extending the elbow with the forearm in supination. C. Extend the elbow with the forearm in supination and then extend the shoulder. D. Flex the shoulder overhead after extending the elbow with the forearm in pronation. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

10. To increase terminal knee extension, you position the patient prone so the lower leg is not supported on the treatment 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? A. Ballistic B. Mechanical C. Dynamic D. Cyclic Copyright © 2018 by F. A. Davis Company

ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

11. Multiple potential benefits and outcomes are speculated to result from stretching programs. Which of the following is strongly supported by evidence and research? A. Reduction in the risk of soft tissue injury by participating in a stretching warm-up routine B. Improved flexibility and increased ROM by restoring extensibility of the muscle-tendon unit with specific stretching techniques C. Reduction in muscle soreness after rigorous exercise by participating in a warm-up and cool-down stretching routine D. Enhanced physical performance (strength and endurance) in athletics when participating in pre-event (acute) stretching ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

12. Based on the neurophysiological properties of the contractile components of muscle, a high-intensity, quick stretch of a muscle-tendon unit is believed to create phasic elevation of tension in the stretched muscle by: A. Facilitating the muscle spindle via the Ib fibers. B. Facilitating the GTO. C. Facilitating the primary (Ia) afferents, which in turn stimulate the extrafusal fibers of the muscle. D. Inhibiting the secondary (II) afferents, which in turn stimulate the extrafusal fibers of the muscle. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

13. Ballistic stretching: A. Should be used with elderly patients or patients with long-standing contractures. B. Utilizes quick bouncing movements during the stretching maneuver, resulting in an increased chance for tissue trauma and muscle soreness. C. Is effective only if done concurrently with joint-mobilization techniques. D. Can be very effective because the rapid force has greater chance of reaching the plastic range, leading to tissue remodeling. Copyright © 2018 by F. A. Davis Company

ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

14. Each of the following is a true statement about self-stretching procedures except: A. A portion of body weight is often the source of the stretch force when the distal segment is fixed. B. Self-stretching is effective only when the distal segment is stabilized and the proximal segment moves. C. Proper stabilization of one segment sometimes can be achieved intrinsically (i.e., by an isometric or active muscle contraction). D. A stationary object or surface can be used to stabilize one body segment as the other segment is moved. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

15. During a stretching maneuver, you apply a 30-second stretch of a shortened muscle group just up to the point of tissue resistance. After this maneuver, rather than relaxing with the patient and returning the body segment to a neutral position, you move the body segment into the newly gained range to apply another stretch of the same muscle group and hold the stretch for an additional 30 seconds. What term best describes this type of stretching? A. Static B. Cyclic C. Ballistic D. Static-progressive ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

16. You are teaching a client total-body relaxation techniques as part of a pain management program. Each of the following is an indicator of relaxation except: A. Flat facial expression. B. Lowered heart and respiratory rates. C. Decreased skin temperature in the extremities. D. Decreased muscle tension evidenced by relaxed jaw and hands.

ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

17. The goal of this 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 to 90°, elbows flexed to 90°, 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: A. Hold–relax (contract–relax). B. Contract–relax–contract (hold–relax–agonist contraction). C. Agonist contraction. D. Static-progressive stretching. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

18. Which is the safest (for protection of the long arch of the foot) and most effective way to apply a long-duration self-stretch of the gastrocnemius-soleus muscle group? A. Stand facing a wall; lean into the wall while keeping both heels on the floor. Sustain that position for as long as possible. B. Assume a long-sitting position on the floor; loop a towel or strap under one foot (strap should be at the heads of the metatarsals) and pull on the towel or strap. C. Stand on a solid wedge (5°, 10°, or 15° angle) for an extended period of time. D. Stand on a step with your heels hanging over the edge and let your heels drop slightly below step level and maintain that position as long as tolerated. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

19. The most effective means of stretching the latissimus dorsi in order to increase flexion of the shoulder is to: A. Place the patient in a prone position; stabilize the scapula and hyperextend the shoulder. B. Place the patient in a supine position; stabilize the lateral border of the scapula as you flex the shoulder. C. Place the patient in the supine position with hips and knees flexed; stabilize the pelvis at the iliac crest and flex the shoulder. Copyright © 2018 by F. A. Davis Company

D. Place the patient in a supine position; hyperextend the shoulder and move the arm over the side of the table as you stabilize the anterior aspect of the shoulder. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

20. What is the safest and most effective way of stretching the multijoint flexor digitorum profundus? A. Stabilize the wrist, metacarpophalangeal, and proximal interphalangeal (PIP) joints in full extension; then passively extend the distal interphalangeal (DIP) joint. B. With the wrist in neutral, stabilize the metacarpophalangeal and DIP joints in full extension; then passively extend the PIP joint. C. First flex the wrist; then fully extend the DIP joint to the point of tissue resistance; then extend the PIP joint and then the metacarpophalangeal joint. D. With the wrist stabilized in a neutral position, first extend the DIP joint, then the PIP joint, and then the metacarpophalangeal joint of each finger. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

21. Of the following choices, which is the most appropriate application of the hold–relax (contract–relax) method of muscle inhibition and elongation of the gastrocnemius muscle? Extend the patient’s knee, stabilize the lower leg, and: A. Place the patient’s ankle in as much dorsiflexion as is comfortable; have the patient isometrically contract the plantar flexors against resistance for 6 to 10 seconds. Then have the patient relax as you passively dorsiflex the ankle. B. Place the patient’s ankle in a fully plantar flexed position. Have the patient concentrically contract the dorsiflexors against your manual resistance through as much ROM as possible. C. Place the patient’s ankle in as much dorsiflexion as possible; have the patient isometrically contract the dorsiflexors against resistance for 6 to 10 seconds. Then have the patient relax as you passively dorsiflex the ankle. D. Place the patient’s ankle in a comfortably dorsiflexed position; have the patient concentrically contract the plantar flexors against your resistance through the available ROM. Then have the patient dorsiflex the ankle as far as possible. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

22. Which of the following statements about stretching is true? A. To effectively stretch the tensor fascia latae, you first flex the hip to 30° and then adduct the hip. B. To maximally lengthen the wrist extensors, you fully flex the wrist and flex the elbow. C. To stretch the posterior tibialis, you dorsiflex and evert the foot and ankle. D. To stretch the long head of the triceps brachii, you fully flex the elbow and then extend the shoulder past neutral. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

23. When a patient is involved in a stretching program, it is recommended that you: A. Strengthen the muscle to be stretched in order to convert nondistensible, noncontractile tissue to easily distensible contractile tissue. B. Avoid strengthening the muscle that has been stretched because it is easier to achieve elongation when the muscle is weak. C. Avoid active exercises for warm-up prior to stretching because it may increase excitability of the muscle tissue and prevent relaxation during stretching. D. Warm up the tissues to be stretched by engaging in light-intensity active exercise or using therapeutic heat prior to stretching. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

24. When applying a stretch, you first feel some resistance; as you maintain the stretch, you feel as though you can move into a greater range using the same amount of force. This describes what mechanical property of connective tissue? A. Stress relaxation B. Tissue failure C. Elastic limit D. Creep ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

important for connective tissue health because: A. They bind the collagen fibers together, giving them their crystalline qualities. B. They stimulate the elastic qualities in elastin. C. They reduce friction and transport nutrients and metabolites. D. They provide bulk to add strength to ligaments and tendons. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

26. Stress within the elastic range of tissue deformation may cause all of the following except: A. Straining of bonds (cross-links) between collagen fibers. B. Microfailure between collagen bonds. C. Squeezing water out of the ground substance. D. Grade II ligament injuries. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

27. To achieve permanent lengthening of connective tissue: A. The collagen fibers must line up in a parallel fashion. B. The region of necking, or macrofailure, must be reached. C. Bonds between collagen fibers must be remodeled in the lengthened position. D. The ground substance between the fibers must be reduced. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

28. To most effectively use the phenomenon of creep in a stretching routine: A. The tissues should be warmed and the force (load) maintained as long as tolerated. B. The force should be repeated in a cyclic manner. C. A high-intensity, rapidly applied force should be used. D. The force should be great enough to cause necking. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

29. Connective tissue fatigue occurs: A. When the heart rate is maintained at 80% of the age-adjusted maximum during active exercise. B. When there is a buildup of metabolites in connective tissue as the result of active stretching procedures. C. When a muscle is not allowed adequate time to recover from exhaustion after exercise. D. When a submaximal stress load is applied repeatedly and causes tissue failure as in a stress fracture or overuse syndrome. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

30. Which of the following is a true statement about a muscle’s response to immobilization? A. When a muscle is immobilized for a period of time, atrophy occurs more rapidly and extensively in fast-twitch fibers than in slow-twitch fibers. B. As the immobilized muscle atrophies, an increase in fibrous and fatty tissue in the muscle occurs. C. Atrophy of an immobilized muscle will begin after the first 30 days of inactivity, resulting in contractile weakness. D. A muscle immobilized in a shortened position will have an increased ability to produce maximum tension at its resting length because of sarcomere absorption. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

Chapter 5: Peripheral Joint Mobilization/Manipulation

Multiple Choice

1. Which of the following terms best describes movements that a patient can control actively/voluntarily? A. Joint play B. Accessory movement C. Physiological movement D. Component movement ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

2. Each of the following is true about joint mobilization/manipulation techniques except: A. Techniques can be applied using gliding or oscillation techniques that involve low or high amplitudes and velocities. B. Techniques involve the application of accessory joint movements but not physiological movements. C. They are appropriate to use if a joint is painful or inflamed to decrease or inhibit the perception of pain. D. Techniques can be applied to restore or maintain joint play. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

3. Which of the following techniques combines the application of sustained accessory joint movements by a therapist and active end-range physiological movements performed by the patient? A. Manipulative thrust techniques B. Facilitative mobilization techniques C. Muscle energy techniques D. Mobilization with movement techniques ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques Copyright © 2018 by F. A. Davis Company

DIF: Basic

4. Which of the following is an indication for joint mobilization? A. Pain B. Joint effusion C. Muscle contracture D. Joint hypermobility ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

5. A normal accessory joint movement that occurs with roll is: A. Sliding. B. Swing. C. Distraction. D. Compression. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

6. Which of the following is a false statement about joint arthrokinematics? A. The more congruent the joint surfaces are, the more rolling of one joint surface on the other occurs. B. In normal ovoid joints, rolling and sliding both occur. C. If a moving joint surface is convex, sliding of that surface is opposite that of its swinging bone. D. Movement of the head of the radius against the capitulum during pronation/supination is called spin. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

7. Which of the following is a false statement about joint mobilization? A. When the therapist passively moves the articulating surface in the direction in which the slide of the bone normally occurs, the technique is called glide. Copyright © 2018 by F. A. Davis Company

B. Gliding or traction techniques are used to treat painful symptoms during the acute and early subacute stages when applied at a low, nonstretch dosage. C. Joint mobilization is safer than passive angular stretching through an arc motion because it avoids the compressive forces that occur during passive angular stretching through the range. D. Grade III joint techniques can be used safely and effectively to increase the range of motion (ROM) during an acute flare of arthritis when there is loss of motion. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

8. To determine the point of tissue resistance and how sensitive a joint is, you would use which of the following grades of sustained mobilization? A. Grade I B. Grade II C. Grade III D. Grade IV ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

9. Which of the following mobilization techniques can be used to stretch a joint? A. Sustained grade I B. Sustained grade II C. Oscillation grade II D. Oscillation grade III ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

10. If a patient exhibits signs of joint hypermobility or joint effusion/inflammation, which of the following mobilization techniques is contraindicated? A. Sustained grade I B. Sustained grade II C. Sustained grade III D. Oscillation grade II ANS: C Copyright © 2018 by F. A. Davis Company

KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

11. In what way does mobilization with movement (MWM) differ from passive mobilization techniques? MWM: A. Is appropriate for hypomobile or hypermobile joints. B. Uses only joint distraction techniques to mobilize joints. C. Integrates active movements by the patient during the mobilization procedure to reduce/eliminate the barrier of pain during the technique. D. Is performed only in the midrange of available motion to ensure patient comfort. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

12. Your patient has a painful right wrist from typing a very large report. You find that she has full active and passive ROM and normal strength. Of the following mobilization techniques, which is most appropriate for managing this patient’s signs and symptoms? A. Anterior-posterior grade II oscillations B. Sustained grade III distractions C. Sustained grade III glides D. Joint mobilization using these grades of sustained or oscillation techniques is not appropriate for this patient at this time. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

13. Your patient has a forward shoulder posture with associated joint restrictions throughout the shoulder complex. In which of the following directions should you apply mobilization of the sternoclavicular joint to improve the patient’s posture? A. Anterior B. Inferior C. Posterior D. Superior ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

14. Moving the proximal row of carpals on the radius in a volar direction increases which wrist motion? A. Flexion B. Extension C. Radial deviation D. Ulnar deviation ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

15. A posterior glide of the head of the femur on the surface of the acetabulum increases which of the following hip motions? A. Flexion and external rotation B. Extension and external rotation C. Extension and internal rotation D. Flexion and internal rotation ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

16. Joint mobilization techniques are thought to be safer than passive angular stretching using physiological ROM to increase mobility of capsular and ligamentous structures because: A. A therapist has a better mechanical advantage (leverage) over the tight structures when using mobilization techniques. B. Mobilization techniques replicate the less traumatic rolling motion of the bone surfaces. C. Mobilization techniques direct forces specific to the involved capsular and ligamentous tissues without causing compressive damage to the articular cartilage. D. Mobilization techniques are applied only in the resting positions of joints, not end-range positions. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

A. Combine a grade III distraction with a grade III sustained glide B. Initiate joint mobilization procedures with the joint in the resting position of the joint C. Combine a grade I distraction with a grade III sustained glide D. Stabilize one of the articulating bones while applying the mobilization force close to the joint ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

18. A long-axis distraction of the humerus provides which direction of gliding? A. Anterior B. Inferior C. Posterior D. Superior ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

19. Your patient’s knee was immobilized in a long leg cast for more than a month. To improve knee ROM, you have been treating the knee with a grade III posterior glide of the tibia with the knee in the resting position. To progress the procedure for which this treatment was intended, you could: A. Take the joint to the end of the range of flexion, internally rotate the tibia, and apply a sustained grade III distraction. B. Use a grade IV posterior glide oscillation technique in the resting position. C. Position the tibia in a resting position, then externally rotate the tibia and apply a grade III posterior glide. D. Take the joint to the end of the range of flexion, position the tibia in external rotation, and apply a grade III sustained posterior glide. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

20. Your patient has rheumatoid arthritis and currently is exhibiting acute symptoms in the wrist. This patient will benefit from grade I or II mobilization techniques at this time because these techniques: A. Increase the ROM by stretching restrictions. B. Temporarily relieve pain, thereby allowing freer motion of the wrist. Copyright © 2018 by F. A. Davis Company

C. Retard synovitis and the progression of the disease process, if only temporarily. D. Reduce preexisting deformity. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

21. To increase flexion of the shoulder, position the patient in the supine position, stabilize the scapula, and: A. Place the glenohumeral joint in the resting position and apply a posterior glide of the humeral head. B. Place the shoulder in 90° flexion and apply an inferior glide of the humeral head. C. Place the shoulder in neutral (along the patient’s side) and apply long-axis traction of the humerus. D. Place the glenohumeral joint in the resting position and apply an anterior glide of the humeral head. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

22. Your patient had a cast removed last week following a distal tibiofibular fracture. He now has limited motion of the ankle and foot. Which of the following joint-mobilization techniques would you use to increase ankle dorsiflexion? A. Dorsal glide of calcaneus on talus B. Plantar glide of navicular on talus C. Anterior glide of talus on tibia D. Posterior glide of talus on tibia ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

23. Which of the following joint mobilization procedures matches the desired goal? A. Posterior glide of the tibia on femur—increase knee extension B. Lateral glide of the calcaneus on talus—increase subtalar inversion C. Dorsal glide of the navicular on talus—increase foot supination D. Caudal glide patella—increase knee extension ANS: B Copyright © 2018 by F. A. Davis Company

KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

24. Which of the following joint mobilization procedures at the elbow matches the desired goal? A. Volar glide of the head of the radius on the proximal ulna—increase forearm pronation B. Dorsal glide of the head of the radius on the proximal ulna—increase forearm supination C. Dorsal glide of the head of the radius on the humerus—increase elbow extension D. Volar glide of the head of the radius on the humerus—increase elbow extension ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

25. Your patient has a stiff foot after a long period of immobilization in a cast. Each of the following mobilization techniques will increase supination and the arch of the foot except: A. Stabilize the cuneiforms and plantar glide metatarsals I, II, and III. B. Stabilize the calcaneus and plantar glide the cuboid. C. Stabilize the talus and dorsal glide the navicular. D. Stabilize the talus and laterally glide the calcaneus. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

26. To increase radial adduction of the carpometacarpal joint of the thumb: A. Glide the base of the first metacarpal in an ulnar direction on the trapezium. B. Glide the base of the first metacarpal dorsally on the trapezium. C. Glide the base of the first metacarpal radially on the trapezium. D. Glide the base of the first metacarpal in a volar direction on the trapezium. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

27. To increase palmar abduction of the thumb, stabilize the trapezium and: A. Radial glide the base of the first metacarpal. B. Ulnar glide the base of the first metacarpal. C. Dorsal glide the base of the first metacarpal. Copyright © 2018 by F. A. Davis Company

D. Volar glide the base of the first metacarpal. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

28. Mobilizations to increase extension of the wrist include all the following except: A. Stabilize the trapezium-trapezoid unit and volar glide the scaphoid. B. Stabilize the lunate and volar glide the capitate. C. Stabilize the radius and volar glide the lunate. D. Stabilize the scaphoid and volar glide the radius. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

29. The safest way to progress stretching the glenohumeral joint capsule to increase external rotation is to: A. Position the arm in 90° abduction with the humerus in neutral position and do an anterior glide. B. Position the arm in 90° abduction with the humerus externally rotated as far as possible and do an anterior glide. C. Position the arm in the resting position with the humerus externally rotated as far as possible and do a distraction. D. Position the arm in the resting position with the humerus externally rotated as far as possible and do an anterior glide. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

30. All of the following gliding techniques match except: A. Long axis traction of femur—distracts weight-bearing surface in acetabulum. B. Posterior glide tibia on femur—knee flexion. C. Plantar glide navicular on talus—supination. D. Dorsal glide first phalanx on metatarsal head—metatarsophalangeal flexion. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult Copyright © 2018 by F. A. Davis Company

Chapter 6: Resistance Exercise for Impaired Muscle Performance

Multiple Choice

1. Which of the following best defines muscle strength? A. Ability of muscle to contract repeatedly against a load B. Work produced by a muscle per unit of time C. Produce or control forces imposed during functional activities D. Force generated during a single maximum effort ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

2. Of the following, which is the most effective way to improve muscle endurance? A. Have the patient train on an isokinetic dynamometer at fast speeds only B. Have the patient train using dynamic exercise against submaximal loads over progressively longer time periods C. Have the patient exercise against maximal resistance for a limited number of repetitions D. Have the patient train by using isometric exercises against resistance ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

3. Mrs. B is an 87-year-old resident of Western Hills Skilled Nursing Facility. She sustained a compression fracture of the T12 vertebra several weeks ago when she inadvertently sat down forcefully on a hard chair. Incorporating resistance training that focuses on eccentric exercises of her quadriceps and gluteal muscles in weight-bearing positions (e.g., controlled squatting and partial lunges) represents what principle of therapeutic exercise? A. Specificity of training B. Reversibility of training C. Overflow principle D. Overload principle ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate Copyright © 2018 by F. A. Davis Company

4. Which of the following is a contraindication to implementing resistance exercise? A. Risk of pathological fracture due to osteoporosis B. Joint instability C. Acute pain or inflammation D. Muscle soreness that occurs after a bout of exercise ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

5. 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? A. Increased recruitment of motor units B. Increased oxygen to the muscle C. Hypertrophy of muscle fibers D. Fiber-type transformation from slow twitch to fast twitch ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

6. A patient had surgery and 8 weeks of rehabilitation for carpal tunnel syndrome. You notice that the patient’s thenar eminence is almost the same size as that of the uninvolved hand. This change is due to which of the following adaptive changes? A. Increased recruitment of motor units B. Hyperplasia of muscle fibers C. Hypertrophy of muscle fibers D. Fiber-type transformation ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

A. Muscular tremor occurring during the exercise. B. A gradual increase in temperature (sensation of warmth) in the exercising muscles. C. The patient may not be able to complete the available range of motion (ROM) against the initial level of resistance applied. D. The patient may attempt to use a substitute motion and muscle group to perform the exercise. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

8. It has been shown that after performing resistance exercise to the point of exhaustion, recovery from exercise (recovery from fatigue) occurs most efficiently if: A. The fatigued muscle rests completely during recovery. B. Cold is applied to the fatigued muscle. C. The patient performs low-intensity, active exercise using the fatigued muscle. D. The muscle is passively stretched during recovery. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

9. Each of the following is a true statement about muscle strength and resistance training through the life span except: A. Although muscle strength tends to gradually decrease in middle-aged and older adults, weight training has been shown to be ineffective (does not lead to adaptive strength gains or functional improvement) after the seventh decade of life. B. During the early and middle childhood years prior to puberty, muscle strength increases linearly and is reasonably similar (as little as a 10% difference) in boys and girls. C. During puberty, although greater muscle hypertrophy occurs in boys than girls as the result of resistance training, relative training-induced strength gains are comparable between the sexes. D. During late adulthood, muscle atrophy occurs to a greater extent in type II than type I muscle fibers. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

10. Which of the following forms of resistance training is most appropriate for a 9-year-old child with weakness of the elbow musculature as the result of an elbow sprain, followed by several weeks of elbow immobilization combined with daily active (nonresisted) ROM? Copyright © 2018 by F. A. Davis Company

A. High-load, low-repetition biceps curls on equipment specifically designed to adjust to a child’s body proportions B. Low-load, high-repetition biceps curls on equipment usually used by the adult patient population C. Supervised exercise by unlicensed support personnel D. Underhand bilateral toss of a weighted ball ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

11. All of the following are true of the repetition maximum (RM) except: A. RM can be used to document a baseline for a muscle group’s dynamic strength. B. A 1-RM can be mathematically calculated from a patient’s ability to perform multiple reps at a reduced load. C. Establishing a 1-RM involves trial and error and so has been determined to be invalid for use in research studies for resistance training. D. RM is an effective way to determine an appropriate exercise load to begin and progress strength training. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

12. If the strength of a muscle is “good” (grade 4/5) and active ROM cannot be done, repetitive muscle setting exercises will accomplish each of the following except: A. Maintain mobility between muscle fibers. B. Develop or maintain an awareness of the sensation of a muscle contraction. C. Increase the strength in the muscle. D. Enhance circulation within the muscle. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

13. When an exercise involves using the same muscle group to lift and lower a constant load, such as flexing and extending the elbow while standing and holding a weight, which of the following is correct about the effect of this exercise on the tension generated by the musculature? A. Greater muscle tension develops when the weight is lowered (controlled by an eccentric contraction) than when it is lifted and controlled by a concentric contraction. Copyright © 2018 by F. A. Davis Company

B. When the weight is lowered (controlled by an eccentric contraction), fewer motor units are recruited, and thus less tension is generated, than when the weight is lifted (controlled by a concentric contraction). C. The same tension is generated in the muscle during the lifting and lowering phases of the exercise because the greatest resistance (load) is imposed by the weight at the same point in the ROM. D. Greater energy expenditure is necessary during the eccentric phase of the exercise than during the concentric phase. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

14. To improve upper extremity strength, stability, and proprioception, during which of the following variations of push-ups does body weight provide the greatest resistance? A. Bilateral wall push-ups while in a standing position and leaning into and pushing away from the wall B. Bilateral push-ups in a prone position, head down on an incline board with weight on hands and knees C. Bilateral push-ups while standing and leaning on the hands on a kitchen countertop D. Bilateral push-ups in a prone position with weight on the hands and knees ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

15. A patient has mild joint swelling and pain during active ROM, but resisted tests of the muscles that cross the swollen joints do not cause pain. Your goal is to maintain or possibly increase strength through the available ROM. The most appropriate choice of exercise is: A. Muscle setting exercises at the end of the ROM. B. High-velocity isokinetic exercise. C. Multiple-angle isometric exercise against resistance. D. Eccentric/concentric, closed-chain exercise against body weight throughout the ROM. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

16. If a patient, who is in a prone-lying position with a cuff weight around his ankle, flexes his knee from a fully extended (0°) position to a fully flexed (150°) position, what type(s) of Copyright © 2018 by F. A. Davis Company

contraction will occur in which muscle group(s)? A. The knee flexors contract concentrically through the full ROM. B. The knee flexors contract concentrically from 0° to 90°, and the knee extensors contract eccentrically from 90° to 150° of flexion. C. The knee flexors contract eccentrically from 0° to 90°, and the knee extensors contract concentrically from 90° to 150° of flexion. D. The knee flexors contract eccentrically throughout the full ROM. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

17. Each of the following is a true statement about isokinetic exercise except: A. Current technology provides resistance only to concentric muscle contractions. B. It accommodates for a painful arc. C. It provides maximal resistance throughout the available ROM. D. It accommodates for muscle fatigue. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

18. Which of the following is true regarding isokinetic exercise? A. Joint compressive forces increase with increased velocity of exercise. B. Load is dependent on the velocity of limb movement through the arc of motion. C. Slow-velocity training is more appropriate for carryover to functional activities than medium and fast velocities. D. Depending on the type of isokinetic dynamometer used, the rate of limb movement may range from 0° to 500° per minute. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

19. Which of the following is true regarding closed-chain exercise? A. It is less effective for developing co-activation of muscle groups and dynamic stability than open-chain training. B. Muscles develop strength more quickly than with open-chain exercise. C. It is a better choice than open-chain exercise to isolate and train weak muscle groups. D. Against similar exercise loads, it causes lower levels of shear in the joint than open-chain Copyright © 2018 by F. A. Davis Company

exercise. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

20. Your goal is to improve lower extremity proprioception, balance, and strength. Which of the following closed-chain exercises is the most challenging? A. Have the patient stand on one foot on a piece of foam and maintain his balance. B. Have the patient kneel in an upright position on a piece of foam and shift his weight from side to side. C. Have the patient stand on the floor on one leg and maintain his balance. D. Have the patient stand on the floor with weight equally distributed on both feet and throw and catch a ball. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

21. You test the muscle strength of the middle deltoid and determine it to be 2/5. The goal of an exercise you are having a patient do is to increase muscular endurance of the middle deltoid. Of the exercises described, which is most appropriate to meet the goal at this point in the exercise program? A. Place the patient in a side-lying position and have her actively abduct the arm without assistance as many times as possible. B. Place the patient in a sitting position with the elbow flexed and have her abduct the arm through the full ROM 8 to 10 times against light resistance. C. Place the patient in a supine position on a large mat. As you support the weight of the arm, have the patient abduct the arm through a full ROM as many times as possible against a minimal amount of manual resistance. D. Have the patient assume the supine position. Provide as much assistance as needed to enable the patient to flex the shoulder from 0° to 90° for as many repetitions as possible. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

22. Your patient is lying supine and you are strengthening the iliopsoas on the (R) using manual resistance. The main reason you would want to place the patient’s (L) hip and knee in flexion (foot planted on the table) is to: Copyright © 2018 by F. A. Davis Company

A. Stretch the erector spinae muscles in the lumbar region of the back. B. Improve the mechanical efficiency of the iliopsoas on the (R). C. Stabilize the pelvis in a neutral to posteriorly rotated position to lessen the possibility of an anterior pelvic tilt occurring, placing stress on the low back. D. Place the pelvis in a slight anterior tilt so the trunk is more stable and the iliopsoas can generate greater tension. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

23. Which of the following best describes cross-training or cross-exercise, a phenomenon that has been observed as a result of resistance training? A. When resistance exercise is carried out by a muscle, the antagonist to that muscle also shows an increase in strength. B. When exercise is carried out concentrically against resistance, an increase in eccentric muscle strength in the same leg also occurs. C. When resistance exercise is carried out by a muscle group on the right side of the body, small gains in strength occur in the same unexercised muscle on the opposite side of the body. D. When training is carried out for the purpose of developing strength, muscular endurance also develops in that same muscle. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

24. To selectively strengthen the flexor digitorum superficialis using manual resistance exercise, position the patient’s forearm in supination and wrist in neutral on a table. What should happen next? A. Stabilize the metacarpophalangeal and proximal interphalangeal (PIP) joints in neutral, then apply resistance to the distal phalanx as the patient flexes the distal interphalangeal (DIP) joint. B. Stabilize the metacarpophalangeal and DIP joints in neutral, then apply resistance to the middle phalanx as the patient flexes the PIP joint. C. Stabilize the PIP and DIP joints in neutral, then apply resistance to the proximal phalanx as the patient flexes the metacarpophalangeal joint. D. Without additional stabilization, apply resistance to the distal phalanx and ask the patient to flex the metacarpophalangeal, PIP, and DIP joints simultaneously. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

25. To strengthen the posterior tibialis using manual resistance, have the patient assume a long sitting position on a table or mat. Support and hold the lower leg with one hand and: A. Apply resistance to the plantar and medial surfaces of the foot at the first metatarsal as the patient plantar flexes and inverts the ankle and foot. B. Apply resistance to the plantar and lateral surfaces of the foot at the fifth metatarsal as the patient plantar flexes and everts the ankle and foot. C. Apply resistance to the dorsal and medial surfaces of the foot at the first metatarsal as the patient dorsiflexes and inverts the ankle and foot. D. Apply resistance to the dorsal and lateral surfaces of the foot at the fifth metatarsal as the patient dorsiflexes and everts the ankle and foot. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

26. You are having a patient perform manual resistance exercise of the lower extremity using a proprioceptive neuromuscular facilitation (PNF) diagonal pattern. In which of the following lower extremity patterns is ankle dorsiflexion coupled with eversion resisted? A. D1 flexion B. D1 extension C. D2 flexion D. D2 extension ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

27. 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 known as: A. Agonist-contraction. B. Rhythmic stabilization. C. Recurrent facilitation. D. Repeated contractions. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

28. You are having a patient perform manual resistance exercise in a PNF pattern, specifically the D2 flexion pattern for the upper extremity. As the patient flexes the shoulder and brings the arm overhead against your resistance, what other muscle groups at the shoulder are being strengthened? A. Abductors and external rotators B. Adductors and external rotators C. Abductors and internal rotators D. Adductors and internal rotators ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

29. When applying manual resistance to the upper extremity using the D1 extension pattern (PNF), the muscle groups being facilitated (strengthened) are the shoulder extensors and the: A. Adductors, internal rotators, and wrist and finger flexors. B. Abductors, external rotators, and wrist and finger extensors. C. Adductors, external rotators, and wrist and finger flexors. D. Abductors, internal rotators, and wrist and finger extensors. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

30. Of the following, which is the best definition of an “8 RM”? A. The number of repetitions of a particular exercise a patient can perform in 8 seconds against a specific load (amount of resistance) B. The number of sets (bouts) of a specific exercise a patient can perform for 8 repetitions C. The greatest amount of resistance (load) a patient can lift or lower through the available ROM in 8 seconds D. The greatest amount of resistance (load) a patient can lift or lower through the available ROM for 8 repetitions (no more, no less) ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

31. Mr. Z is a 68-year-old man who underwent abdominal surgery 3 months ago. Since his surgery, he has had difficulty walking. You determine that during the period of bed rest and Copyright © 2018 by F. A. Davis Company

modified activity, his legs have become quite weak, contributing to his difficulty walking. The ROM of his lower extremities is within normal limits. You determine that the 10 RM for the hip extensors and quadriceps bilaterally (measured on a bilateral leg press unit) is only 20 lb. After a brief warm-up on a stationary bicycle, you have Mr. Z perform the following PRE regimen: 10 repetitions of hip and knee extension against 20 lb; 10 repetitions against 15 lb; and 10 repetitions against 10 lb with a rest between each set of 10 repetitions. This approach to PRE is known as: A. Circuit weight training. B. Oxford regimen. C. DeLorme regimen. D. DAPRE regimen. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

32. A patient is holding a piece of elastic tubing with both hands in front of the body. Both elbows are flexed to 90°, and both upper arms are held gently against the sides of the patient’s chest. Instruct the patient to internally and externally rotate both shoulders simultaneously in this position. This activity strengthens the: A. Internal rotators concentrically and eccentrically. B. External rotators concentrically and the internal rotators eccentrically. C. Internal rotators concentrically and the external rotators eccentrically. D. External rotators concentrically and eccentrically. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

33. Which factors affect the amount of resistance provided by elastic resistance bands during exercise? A. Length of the muscle and stretch of the band B. Stretch of the band and speed of movement C. Stretch of the band and angle of the band in relation to the moving bone D. Angle of the band in relation to the moving bone and length of the muscle ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

34. Which of the following is the most efficient way to neutralize the effects of muscle fatigue during an exercise session? A. Perform active exercises during the rest interval between sets B. Stop all exercise and rest completely between sets C. Apply cold to the muscle/muscle groups between sets D. Massage the muscles between sets ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

35. Which of the following describes the research evidence regarding the effective treatment of delayed-onset muscle soreness (DOMS) once it occurs? A. Modalities consisting of electrical stimulation and cold are the only treatments that are consistently effective at reducing muscle soreness experienced with DOMS. B. Postexercise massage reduces both the signs and symptoms of DOMS in the elite athlete but not in the casual athlete. C. Use of compression sleeves on the affected muscles improves the strength deficits that occur as a result of DOMS. D. Continuation of the training program that has induced DOMS does not worsen the muscle damage or slow the process of recovery. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

36. If a patient who has an inflammatory muscle disease such as polymyositis engages in a vigorous resistance training program, it is possible that irreversible progressive deterioration, rather than improvement, in muscle strength can occur. The term that best describes this phenomenon is: A. Overwork weakness. B. Progressive muscle fatigue caused by overtraining. C. Muscle overload. D. Delayed-onset myopathy. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

A. Tends to peak 48 to 72 hours after the conclusion of high-intensity exercise. B. Increased soreness seen during passive lengthening of the involved muscle groups. C. Occurs more frequently after eccentric exercise than isometric exercise. D. Is believed to be caused by postexercise muscle spasm. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

38. Which of the following is true of resistance training for the patient with known osteoporosis? A. Safe resistance training imposes only submaximal loads—no more than the patient encounters during activities of daily living. B. Only isometric exercises should be prescribed in order to eliminate torque on the bones. C. Evidence has shown that resistance exercise is an essential element in the rehabilitation, conditioning, and aerobic programs of patients both at risk for and with known osteoporosis. D. Resistance training is contraindicated for patients with known osteoporosis due to the risk of pathological stress fracture. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

39. You are designing an exercise program for a patient with a history of hypertension. Which of the following types of exercise is associated with the highest risk of causing an increase in blood pressure during exercise? A. Isokinetic exercise at medium to fast velocities B. High-effort isometric exercise C. Muscle setting exercises D. High-effort dynamic resistance exercise ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

40. In addition to an isokinetic dynamometer, which of the following types of resistance equipment can be used safely and effectively to improve muscle strength at fast velocities of limb movement? A. Free weights B. Variable resistance equipment made up of a weight-cable and cam system C. Variable resistance equipment that employs pneumatic or hydraulic resistance Copyright © 2018 by F. A. Davis Company

D. Simple weight-pulley system ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

Chapter 7: Principles of Aerobic Exercise

Multiple Choice

1. The ability of the body to transport and use oxygen during physical and aerobic activities is an indicator of physical fitness and is measured most commonly using which unit of measure? A. Metabolic equivalents (METs) B. Kilocalorie C. Maximum oxygen consumption (VO2 max) D. Blood pressure and heart rate ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

2. Aerobic exercise training (cardiorespiratory endurance) is defined as improvement in the energy utilization of the muscle by means of an exercise program. Which of the following is true of this type of training? A. It is dependent on sufficient intensity, time, and frequency of exercise. B. A person with an initial high level of fitness has more potential to improve than one with a low level of fitness. C. It produces significant crossover effects from one physical activity to another. D. It requires at least 6 months of progressive training for evidence of improvement. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

3. A patient referred to you in your home-health practice needs to spend the next 8 weeks on bed rest because of complications of pregnancy. You design an exercise program to reduce the adverse effects of prolonged bed rest. Which of the following is least likely to occur as the result of deconditioning from prolonged bed rest? A. Loss of muscle mass B. Orthostatic hypotension C. Decreased bone mineral density D. Laxity of ligaments ANS: D Copyright © 2018 by F. A. Davis Company

KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

4. As part of a circuit weight training program, your patient performs 2 sets of 10 repetitions of biceps curls at 70% of a 1 repetition maximum (RM), resting briefly between sets. Which of the following energy systems is primarily being used? A. Phosphagen system B. Anaerobic-glycolytic system C. Aerobic system D. ATP-PC (adenosine triphosphate-phosphocreatine) system ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

5. Your patient has poor upper quarter posture, and you are training the scapular depressors in order to improve thoracic and scapular position for postural control. Against low resistance, the scapular depressors are muscle setting for 60 seconds. What muscle fibers primarily are recruited during this activity? A. Type I B. Type IB C. Type IIA D. Type IIB ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

6. If jogging for 20 minutes requires 50 units of work output and 200 units of work input, what is the exercise efficiency? A. 2% B. 2.5% C. 20% D. 25% ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

7. Your patient is a sedentary 52-year-old man who smokes a pack of cigarettes a day and has a family history of cardiovascular disease. The most appropriate method of determining his cardiovascular fitness is: A. Distance run in 12 minutes. B. Heart rate following 6 minutes of fast walking. C. Sample expired air during multistage treadmill testing to provide a direct measure of VO2 max D. Time required to run 1.5 miles. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

8. Mary is 30 lb overweight and wants to start exercising for fitness and to lose weight before her high school class reunion next year. For motivation, she has set a specific goal to run a 10K race in 6 months. The best method of training for this event would be: A. Bicycling 2 days a week and fast walking 4 days a week. B. Fast walking, progressing to running 5 to 6 days a week. C. Bicycling and running 3 days a week for each activity. D. Swimming 1 day a week, bicycling 2 days a week, and running 3 days a week. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

9. Four methods of training are known to challenge the aerobic system. Which method of training is characterized by a period of exercise followed by a brief period of relief? A. Continuous B. Interval C. Circuit D. Circuit–interval ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

10. Principles of stress testing include each of the following except: A. The workload initially used in the test is low compared with an individual’s anticipated aerobic threshold. B. To increase the workload during treadmill testing, the speed and/or incline are increased. Copyright © 2018 by F. A. Davis Company

C. Each successive workload level is maintained for no more than 30 seconds. D. Testing is terminated at the onset of symptoms, or definable abnormalities are noted on the electrocardiogram. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

11. A stress test should be terminated if: A. There is a significant drop in systolic blood pressure in response to an increasing workload. B. Cheeks become flushed. C. Blood pressure increases 7 to 10 mm Hg per MET of physical activity. D. Respiratory rate and depth increase without shortness of breath. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

12. Which of the following is a correct statement about maximum heart rate and exercise heart rate? A. The most accurate method of determining maximum heart rate is by using the formula 220 minus age. B. Karvonen’s formula (heart rate reserve) is used to determine maximum heart rate. C. If a young or middle-aged individual is carefully screened and has been jogging or running for some time, it is appropriate to use the results of a submaximal field test to determine maximum heart rate. D. Individuals with cardiopulmonary disease should have a target exercise heart rate of at least 70% of their maximum heart rate. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

13. Which of the following is correct about the intensity of exercise and achieving a conditioning response? A. For a young, healthy individual, training at an intensity of 70% maximum heart rate is considered the maximum-level stimulus for a safe training program. B. If an adult is young, healthy, and accustomed to exercise, training at 100% of the maximum heart rate is recommended to achieve a conditioning response. C. For a sedentary, deconditioned individual, an initial training intensity at 70% of the maximum Copyright © 2018 by F. A. Davis Company

heart rate is the level of training typically required to achieve a conditioning response. D. For a sedentary, deconditioned individual, low-intensity exercise at the 40% to 60% level is usually sufficient to induce an initial conditioning response. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

14. Each of the following is true about the inpatient cardiac rehabilitation program for a patient who has had a myocardial infarction except: A. Inpatient phase begins after the patient’s cardiovascular status has been stabilized and while the patient is hospitalized. B. Inpatient cardiac rehabilitation usually lasts at least 7–10 days. C. A purpose of cardiac rehabilitation while the patient is still hospitalized is to initiate patient education about reducing risk factors. D. Inpatient cardiac rehabilitation often involves manually monitoring the heart rate, ventilation, and blood pressure and electrocardiographically monitoring the heart during standing activities and low-intensity supervised ambulation. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

15. Which of the following statements is correct about the use of arm exercises (upper extremity ergometry) versus leg exercises (treadmill walking, bicycling) in a cardiac rehabilitation program? A. There are no differences in responses of the cardiopulmonary system with arm exercises versus leg exercises. B. Myocardial O2 consumption (heart rate ´ systolic blood pressure) is higher with arm exercises than with leg exercises. C. Myocardial efficiency is lower with arm exercises than with leg exercises. D. Patients with coronary artery disease typically are able to complete less work with leg exercises than arm exercises before symptoms occur. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

16. A carefully planned exercise program includes three components: the warm-up, aerobic period, and the cool-down. Which of the following is a true statement about an exercise program Copyright © 2018 by F. A. Davis Company

that is carefully planned? A. It can slow the decrease in functional capacity of the elderly individual. B. The cool-down period is intended to encourage rapid return of blood to the extremities. C. A program of continuous training is the most effective way to improve aerobic conditioning. D. Venous return is reduced during the warm-up period as blood flow is shifted centrally from the periphery. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

Chapter 8: Exercise for Impaired Balance

Multiple Choice

1. The center of gravity in most adult humans is located slightly: A. Posterior to the L2 vertebra. B. Posterior to the S2 vertebra. C. Anterior to the L2 vertebra. D. Anterior to the S2 vertebra. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

2. Which of the following terms is defined as “the sway boundaries in which an individual can maintain equilibrium without changing his/her base of support”? A. Center of mass B. Limits of stability C. Limits of pressure D. Center of gravity ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

3. The vestibular system provides which of the following types of sensory information for balance control? A. Muscle tension and length B. Joint movement and position C. Position of the head and body with respect to inertial forces D. Position of the head relative to the environment ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

4. When a hip strategy is used for balance control in response to a posterior displacement of the support surface, which muscle groups are activated and in what sequence? A. Abdominals followed by the quadriceps B. Quadriceps followed by the abdominals C. Hamstrings followed by the paraspinals D. Paraspinals followed by the hamstrings ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

5. Mrs. S is a 65-year-old woman with a history of falling due to episodic loss of balance. The medical diagnosis is “balance disorder.” Which of the following tests is the best choice to administer to determine whether Mrs. S has a fear of falling? A. Activities-Specific Balance Confidence Scale B. Tinetti Performance-Oriented Mobility Assessment C. Berg Balance Test D. Functional Reach Test ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

6. During an examination of a patient who has a history of episodic falls, you observe the patient performing functional tasks to determine how she loses her balance. You note that the patient becomes unsteady whenever she picks up objects from the floor or reaches for objects in a kitchen cupboard. These findings most likely indicate a control deficit in: A. Anticipatory balance. B. Reactive balance. C. Static balance. D. Sensory organization. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

7. While testing a patient’s balance, you have the patient perform a series of activities, starting with those that require a low level of balance control and progressing to more difficult tasks. Of the following, the task that requires the greatest amount of balance control is: A. Catching and throwing a ball while sitting. Copyright © 2018 by F. A. Davis Company

B. Raising the opposite arm and leg while in the quadruped position. C. Walking with one foot placed in front of the other. D. While standing, balancing on one leg for 10 seconds. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

8. As part of a patient’s balance training program, you have her walk across a balance beam or on a line drawn on the floor. The motor strategy this patient is most likely retraining is the: A. Ankle strategy. B. Suspensory strategy. C. Stepping strategy. D. Hip strategy. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

9. To improve a patient’s dynamic postural control using visual and vestibular inputs, the most appropriate activity for the patient to perform is: A. Standing on a foam surface with feet apart and eyes open. B. Marching in place on a firm surface with eyes open. C. Walking with a narrowed base of support on foam with eyes open. D. Walking with a narrowed base of support on a firm surface with eyes closed. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

10. To prevent falls and maximize safety while lifting heavy objects from the floor, an elderly patient is instructed to: A. Bend at the knees as far as possible, keeping the back straight and placing the load between the legs. B. Keep the knees straight, bend at the hips, keep the back straight, and pick up the load quickly. C. Bend at the knees partially while keeping the back straight and pick up the load slowly. D. Bend the knees partially and rotate and laterally bend the back to lift the load to one side of the hips. ANS: C Copyright © 2018 by F. A. Davis Company

KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

11. As part of the treatment program to improve a patient’s balance, you decide to utilize a balance training program recommended by Nitz and Choy. The components of this program include: A. Group exercises that consist of practicing standing postures and walking and perturbation training. B. Individual and group exercises emphasizing dynamic and multisensory activities delivered in a circuit mode. C. Group exercises consisting of stretching, strengthening, and coordination exercises; body mechanics; survival training; and walking. D. Home program consisting of lower and upper extremity exercises in sitting and standing positions. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

12. The semicircular canals of the vestibular system would contribute the most to balance control during which of the following activities? A. Standing and quickly turning the head to look at a person B. Sitting in a chair reading a newspaper C. Standing on a bus that suddenly accelerates forward D. Standing on an elevator that suddenly accelerates downward ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

13. The typical pattern of muscle activation associated with an ankle strategy to correct forward body sway is: A. Gastrocnemius and hamstrings are activated simultaneously, followed by the paraspinals. B. Gastrocnemius is activated first, then the hamstrings, followed by the paraspinals. C. Paraspinals are activated first, then hamstrings, followed by the gastrocnemius. D. Hamstrings, gastrocnemius, and paraspinals are activated simultaneously. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic Copyright © 2018 by F. A. Davis Company

14. Individuals with somatosensory deficits in the lower extremities, such as peripheral polyneuropathies, tend to use which of the following motor strategies in response to balance disturbances? A. Ankle strategy B. Hip strategy C. Stepping strategy D. Suspensory strategy ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

15. The most important neural structures for the integration and processing of sensory information for balance control are: A. Basal ganglia, primary motor area, and cerebellum. B. Basal ganglia, thalamus, and supplementary motor area. C. Supplementary motor area, cerebellum, and basal ganglia. D. Supplementary motor area, cerebellum, and thalamus. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

16. Individuals who become unstable or fall in condition 5 (standing on foam with eyes closed) and condition 6 (standing on foam wearing a dome) during the Clinical Test of Sensory Integration on Balance Test (Foam and Dome Test) most likely have deficits in: A. Proprioception. B. Somatosensation. C. Vestibular function. D. Vision. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

17. To maintain balance in condition 3 (standing on a firm surface wearing a dome) of the Clinical Test of Sensory Integration on Balance Test, a person must rely solely on: Copyright © 2018 by F. A. Davis Company

A. Somatosensory and vestibular information. B. Vestibular information. C. Visual and somatosensory information. D. Visual and vestibular information. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

18. The Romberg Test measures: A. Anticipatory balance control. B. Reactive balance control. C. Static balance control. D. Dynamic balance control. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

19. The elderly and individuals with diabetes who have peripheral neuropathy in the lower extremities might experience balance deficits and increased risk for falls due to: A. Inability to generate motor output to regain balance. B. Decreased joint position sense in the feet, reducing ability to use ankle or hip strategies to maintain balance. C. Reduced somatosensation in the lower extremities. D. Inability to participate in balance exercise programs or activities. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

20. An 82-year-old woman is referred to physical therapy with a history of two falls in the past month. She shows inadequate anticipatory control on the Functional Reach Test and is now expressing fear of falling. The patient lives alone and relies on her daughter for transportation. The best exercise program for this person is: A. The Otego Home Exercise Program. B. Circuit training as described by Nitz and Choy . C. A Tai Chi exercise program. D. An individualized walking exercise program that she can do with her daughter.

ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

21. A 76-year-old community-dwelling man is referred to physical therapy for balance training. He reports no previous falls. His Timed Up-and-Go score is 15 seconds. The best setting for him to receive training is in: A. An individual or community-based group exercise program. B. A community-based group exercise program with individual supervision provided by trained staff. C. A clinic with physical therapist or physical therapist assistant supervision. D. At home with physical therapist or physical therapist assistant supervision. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

22. The outcome measure developed specifically to measure balance control during gait in people with vestibular disorders is the: A. Timed Up-and-Go Test. B. Tinetti Performance-Oriented Mobility Assessment. C. Functional Gait Assessment. D. Dynamic Gait Index. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

Chapter 9: Aquatic Exercise

Multiple Choice

1. If present, which of the following conditions is a contraindication to having a patient perform an exercise program in an aquatic environment? A. Tracheotomy B. Fear of water C. Influenza D. High blood pressure ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

2. Decreasing the amount of weight bearing by immersing more of a person’s body in water is a result of what property of water? A. Viscosity B. Buoyancy C. Surface tension D. Hydrostatic pressure ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

3. When a person is standing in chest-deep water, the percentage of weight bearing is approximately what percentage of body weight? A. 10% B. 20% C. 33% D. 50% ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

4. If a patient has lower extremity edema, which of the following principles associated with hydrotherapy (an aquatic environment) will assist with decreasing the edema? A. Viscosity B. Buoyancy C. Surface tension D. Hydrostatic pressure ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

5. While playing tennis, Mr. K sustained a grade 3 tear of the Achilles tendon and subsequently underwent a surgical repair of the tendon. His wound is now well healed, and he is permitted to immerse the incision site in water. His goal for therapy is to return to tennis competitively. To challenge his balance on the involved lower extremity, you have him stand in front of a strong, single stream of water (jet) while trying not to use his arms for balance. This activity applies which hydromechanics property of water? A. Drag B. Viscosity C. Laminar flow D. Turbulent flow ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

6. Which of the following statements is true regarding the temperature range of water (26°C–35°C) recommended for aquatic exercise? A. Patients should perform cardiovascular exercise at the low end of this range. B. Patients with multiple sclerosis should exercise in temperatures at the high end of this range. C. Patients should perform intense aerobic exercise at the high end of this range. D. If a patient has an acute, painful injury, perform exercise at the low end of this range. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

7. Which of the following is true regarding aquatic therapy equipment? A. Buoyancy equipment placed anteriorly will facilitate posterior movements of the trunk in the Copyright © 2018 by F. A. Davis Company

vertical position. B. Buoyancy equipment used for supine positioning is ideal to assist with stabilization needed for eccentric manual resistance exercises. C. Nonbuoyant equipment used underwater provides resistance opposite the direction of movement. D. Using equipment to increase the surface area of an extremity underwater decreases resistance. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

8. Meyer and Leblanc provided an algorithm for clinical decision making for aquatic therapy intervention for patients with stable congestive heart failure and/or left ventricular dysfunction. All of the following are true in this algorithm except: A. Patients with decompensated congestive heart failure should participate in aquatic exercise for cardiac rehabilitation. B. Patients with left ventricular dysfunction should not rely on how they feel in the water as an indicator of tolerance for aquatic exercise. C. Patients with congestive heart failure who tolerate sleeping supine may be able to tolerate a half-sitting position if immersion is not above the xiphoid process. D. Patients with Q-wave myocardial infarcts should wait 6 weeks and exercise upright in a water level that does not exceed the xiphoid process. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Difficult

9. Which of the following describes the most effective patient position and use of the buoyancy of water for self-stretching the hamstrings? A. In a buoyancy-supported supine position (flotation devices around the neck and hips), perform a unilateral straight-leg raise, lifting the leg to be stretched out of the water. B. With a buoyancy device secured around the distal thigh of the leg to be stretched, stand on the opposite leg and hold on to the side of the pool for balance. Keep the knee relaxed as the buoyancy device lifts the thigh and flexes the hip. C. Sit on the steps of a pool in waist-deep water, hips flexed to 90°, with a buoyancy device secured around the ankle of the leg to be stretched. D. With a buoyancy device secured around the ankle of the leg to be stretched, stand on the opposite leg and hold on to the side of the pool for balance. Allow the buoyancy device to lift the leg to the surface of the water with the knee extended. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques Copyright © 2018 by F. A. Davis Company

DIF: Intermediate

10. In an aquatic environment, manual resistance exercises of the extremities typically involve which type of muscle contractions? A. Eccentric, closed-chain (distal segment fixed) B. Concentric, closed-chain (distal segment fixed) C. Isometric D. Concentric, open-chain (distal segment moving) ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

11. After a musculoskeletal injury of the lower extremity, you develop an aquatic exercise program for your patient. An aquatic exercise program is the least effective for: A. Transfer of training to land-based functional activities. B. Reducing risk of re-injury during the early stage of rehabilitation. C. Enabling early weight bearing. D. Increasing range of motion. ANS: A KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

12. Your patient had a total hip replacement several weeks ago. Now that her incision is well healed, she has clearance from her orthopedic surgeon to begin an aquatic exercise program to improve lower extremity strength. Which combination of the following patient positions and velocities of limb movement in water is the most appropriate to begin to improve the strength of the hip abductors/adductors at the initiation of the aquatic exercise program? A. Fast repetitions while standing in chest-deep water B. Slow, controlled motions while standing in chest-deep water C. Fast repetitions, buoyancy-supported in a supine position D. Slow, controlled repetitions buoyancy-supported in supine position ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate

13. Which of the following is true of pools used for aquatic therapy? A. Ventilation is not necessary for installation of a self-contained, individual pool in your clinic. B. Therapeutic pools should not have a depth that exceeds 6 feet because of safety requirements in case of a medical emergency. C. One disadvantage of a self-contained individual pool is the inability to incorporate a treadmill. D. Built-in filtration systems are available in both therapeutic pools and self-contained pools. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

14. The ability of the body to regulate temperature must be considered with the prescription of aquatic therapy for both the healthy and the rehabilitating patient. All of the following are true of temperature regulation except: A. The body is not as efficient at dissipating heat in the water as it is on land. B. Patients are unable to maintain adequate core warmth at water temperatures below 25°C. C. The ambient air temperature should be equal to the water temperature to avoid overheating or chilling while in the pool area. D. Water temperatures above 37°C cause increased cardiac demand both at rest and while exercising, especially with prolonged time or deep immersion. ANS: C KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

15. The difficulty of exercises can be controlled with the depth of immersion and the body’s physiological response to hydrostatic pressure. According to Barbosa and colleagues, which of the following best describes a proper progression of a patient’s exercise program in order to increase physiological demands? A. Land exercises to aquatic chest depth to hip depth B. Aquatic hip depth to neck depth to land exercises C. Alternate land exercises with aquatic chest depth exercises D. Aquatic chest depth to hip depth to land exercises ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Intermediate 16. Increasing the amount of resistance to limb movement in water can be achieved by: A. Increasing agitation, moving the limb closer to the surface of the water, moving the limb Copyright © 2018 by F. A. Davis Company

quickly. B. Moving the limb further from the surface of the water, moving the limb quickly, and using a device to increase the effective limb volume. C. Decreasing water temperature, moving the limb further from the surface of the water, slowing limb movement. D. Moving the limb quickly, increasing water temperature, agitating the water. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

17. A 55-year old man with stable congestive heart failure is unable to tolerate land-based exercises for strengthening his back because of chronic low back pain. He has expressed concern with attempting pool therapy because of his inability to swim and his use of pain medications. Which of the following statements is true about his ability to participate in aquatic therapy? A. Pool therapy is contraindicated because of the chronicity of his pain. B. Pool therapy can be used to decrease pain, improve mobility, and strengthen muscles. C. Fear of water and use of pain medications are a contraindication. D. Pool therapy is contraindicated for any individual with congestive heart failure. ANS: B KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

18. The dynamics of circulation may be affected by immersing a body part in deep water because of the effects of: A. Viscosity. B. Laminar flow. C. Buoyancy. D. Hydrostatic pressure. ANS: D KEY: Book Part: Part II: Applied Science of Exercise and Techniques DIF: Basic

Chapter 10: Soft Tissue Injury, Repair, and Management

Multiple Choice

1. Which of the following terms refers to the degeneration of a tendon due to repetitive microtrauma? A. Tendinitis B. Tenosynovitis C. Tenovaginitis D. Tendinosis ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Basic

2. Overuse syndromes occur: A. As the result of repetitive, submaximal stress of a muscle or tendon. B. As the result of a severe blow to a muscle. C. As a result of prolonged immobilization. D. Only if there is impaired circulation to soft tissue. ANS: A KEY: Book Part: Part III: Principles of Intervention DIF: Basic

3. A properly applied and progressed therapeutic exercise program should: A. Follow a pre-established protocol in order to be consistent for all patients with the same diagnosis. B. Push the patient beyond his or her current stage of recovery in order to progress the healing process. C. Grade the exercise to the stage of recovery to stress the tissues safely. D. Begin with passive exercise, progressing to active assistive exercise, active exercise, and then resistive exercise by the third week after injury. ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Basic

4. To effectively manage soft tissue lesions during the subacute stage of tissue healing, the role of the therapist is critical. The objective of treatment during the moderate protection/controlled motion phase of rehabilitation should be to: A. Control the pain and inflammation. B. Encourage the patient to permanently stop doing the activity that caused the injury. C. Maintain passive range of motion (PROM). D. Introduce and progress stretching to increase mobility and alignment of newly forming scar tissue. ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Basic

5. Which of the following stages of soft tissue healing is characterized by remodeling and maturation of collagen in the scar? A. Chronic stage B. Early subacute stage C. Late subacute stage D. Acute stage ANS: A KEY: Book Part: Part III: Principles of Intervention DIF: Basic

6. During the repair process following tissue injury, the newly developing collagen fibrils are: A. Ready to withstand normal stresses by 3 weeks. B. Slow to be deposited. C. Laid down in alignment exactly replicating the fibers that were damaged. D. Thin and unorganized. ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

7. Which of the following types of active exercises are the most appropriate to use first during the acute phase of healing after a muscle injury? A. Submaximal isokinetic concentric exercise at slow velocities B. Active ROM exercises Copyright © 2018 by F. A. Davis Company

C. Multiple-angle isometrics against manual resistance D. Low-intensity muscle setting ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

8. Passive ROM and grade I or II joint-mobilization techniques are appropriate during the acute stage of soft tissue healing. What do these interventions have in common when used during this stage? A. Include movements into tissue resistance B. Affect muscle, ligament, and capsular tissue around the site of injury equally C. Maintain fluid dynamics and nutrition in a joint D. Used to increase ROM ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

9. Movement during the acute stage of healing following soft tissue injury: A. Is contraindicated. B. Should be passive or assisted and should begin as soon as tolerated within the pain-free range. C. Should include the full ROM in order to prevent adhesions. D. Should begin on the fourth day and be tissue-specific. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

10. Your patient reports having had a sudden onset of severe pain in the left posterior thigh yesterday while sprinting. Today he is unable to fully extend his left knee while walking because of pain. Which of the following interventions is most appropriate today? A. Passive knee flexion/extension with the hip flexed to 90° B. Passive knee flexion/extension with the hip positioned in 0° extension C. Active knee flexion but no passive or active extension D. Submaximal resisted knee flexion in the prone-lying position ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Difficult Copyright © 2018 by F. A. Davis Company

11. Progressing resistance and stretching exercises vigorously during the early subacute stage of soft tissue healing: A. Decreases recovery time. B. Prolongs the inflammation and promotes adhesion formation. C. Increases the strength of the healing tissues. D. Helps scar tissue resolve more quickly. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

12. Transient or intermittent pain that occurs during the chronic stage of soft tissue healing is best relieved by: A. Stretching and strengthening the healing tissues. B. Applying cold. C. Applying heat and massage. D. Resting. ANS: A KEY: Book Part: Part III: Principles of Intervention DIF: Basic

13. Your examination of a patient who sustained a soft tissue injury reveals that she experiences pain only at the end of the available ROM when you apply overpressure. Based on this finding, which of the following would be the most appropriate technique to include in the treatment plan to decrease the patient’s pain? A. Immobilize and rest the painful structures B. Grades I and II joint distraction or gliding techniques C. End-range joint or muscle stretching techniques to increase the mobility of the tight structures D. Progressive resistance exercises to work through the pain ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

A. Strengthening exercises are the only intervention that can resolve the patient’s problems. B. Inflammation must be treated before stretching is initiated. C. The pain will decrease after stretching exercises are implemented. D. The scar must be stretched vigorously to regain ROM. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

15. During your evaluation, you identify signs of chronic inflammation of a muscle group. Each of the following techniques is tissue-specific for this condition at this time except: A. Cross-fiber massage. B. Grade II joint mobilization. C. ROM within the limits of pain. D. Muscle setting in pain-free positions. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Basic

16. Muscle guarding is best treated by: A. Applying modalities and then massaging the muscle. B. Identifying and treating the cause of the guarding. C. Gentle muscle setting exercises with the muscle in a shortened position. D. Massaging the muscle. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

17. What is the best method for determining the progression of exercise during the subacute stage of healing? A. Increase range of motion 10° each treatment session B. Increase strength training by 1 lb each treatment session C. Increase endurance exercises by 3 repetitions each treatment session D. Let patient response guide the progression of exercise ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Basic Copyright © 2018 by F. A. Davis Company

18. All of the following are considerations for interventions when establishing a rehabilitation program for a patient diagnosed with chronic inflammation resulting from repetitive trauma except: A. Tissues subjected to repetitive trauma may never completely heal. B. Connective tissue sustains structural weakening as a result of the perpetuated inflammatory tissue response. C. Initiation of resistance exercise should begin with eccentric (muscle lengthening) techniques as soon as pain subsides to avoid tissue contracture. D. Inflammatory response must first be managed by controlling the inflammation with modalities or other conservative measures. ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

Chapter 11: Joint, Connective Tissue, and Bone Disorders and Management

Multiple Choice

1. Each of the following signs or symptoms is a characteristic of rheumatoid arthritis except: A. Inflammatory synovitis. B. Recurring periods of active disease (flare) followed by remission. C. Usually asymmetrical joint involvement. D. Fatigue, general malaise, and possibly fever. ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Basic

2. You are treating a patient with a 5-year history of rheumatoid arthritis who is experiencing an exacerbation of symptoms. Which of the following is an appropriate intervention at this time? A. A low-impact, aerobic exercise program to improve endurance and reduce fatigue B. Grade II oscillation techniques to decrease the pain C. Grade III joint mobilization techniques to increase mobility of involved joints D. Progressive resistance exercise at an intensity of 60% of the maximum voluntary contraction to improve muscle strength ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

3. Each of the following is a characteristic of osteoarthritis except: A. It typically affects only a few joints. B. Onset typically is sudden in patients older than 40 years of age. C. There is no evidence of systemic symptoms. D. It can affect the spine or small or large joints of the extremities. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Basic

4. You are treating a patient with osteoarthritis of the left knee. The 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? A. Refer the patient to his physician B. Reassure the patient that this is an expected and desired response C. Decrease the intensity of the exercise program D. Add early morning jogging to his exercise program ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Basic

5. The articular cartilage of a synovial joint is most susceptible to damage from stress: A. During low-impact exercise performed on a regular basis. B. During early weight-bearing exercises after soft tissue surgery. C. During passive stretching procedures. D. Immediately following a period of prolonged joint immobilization. ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Basic

6. Your patient has osteoarthritis of the left hip and states he experiences hip and thigh pain after walking for more than 20 to 30 minutes. As a therapist, which of the following is the most appropriate intervention for you to recommend? A. A period of complete rest or immobility B. Application of heat and massage after periods of walking C. Measures to decrease the mechanical stresses on the hip joint, such as use of a cane when walking over an extended period of time D. Use of anti-inflammatory medication ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Basic

7. A therapist’s role in diagnosing arthritic conditions is to: A. Identify the underlying pathological process and inform the physician. B. Order laboratory tests or radiological imaging that may confirm or rule out the diagnosis. C. Determine the type of arthritis that is causing the patient’s symptoms. D. Identify impairments, such as the pattern and extent of range of motion (ROM) and joint Copyright © 2018 by F. A. Davis Company

mobility limitations, contributing to a patient’s activity limitations and participation restrictions. ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Basic

8. Each of the following is true regarding principles of joint protection and energy conservation for a patient with rheumatoid arthritis experiencing a flare of the disease except: A. Stop activities for a period of time when pain or fatigue begins to develop. B. Perform stretching exercises once a day to help maintain joint alignment. C. Use adaptive equipment to avoid deforming forces during functional activities. D. Maintain inflamed joints in positions opposite the positions of deformity during periods of rest. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

9. Each of the following is characteristic of fibromyalgia (FM) except: A. Chronic muscle pain experienced in referred patterns. B. Decreased ROM. C. Chronic fatigue and decreased exercise tolerance. D. Eleven of eighteen tender points at specific sites throughout the body. ANS: A KEY: Book Part: Part III: Principles of Intervention DIF: Basic

10. A 43-year-old patient with a diagnosis of FM has been referred to you for an exercise program. As you take her history, she tells you that she rarely exercises. Which of the following types of exercise has been shown to be most appropriate at the beginning of an exercise program for patients with FM? A. Circuit weight training at 60% to 70% of the maximum repetition for each exercise at five or six stations B. Stretching program of trunk and large muscles of the extremities C. Aerobic exercise started at a low intensity that is adjusted based on the individual’s response D. Relaxation and meditation exercises ANS: C KEY: Book Part: Part III: Principles of Intervention Copyright © 2018 by F. A. Davis Company

DIF: Intermediate

11. Which of the following interventions would be appropriate for myofascial pain syndrome but not for fibromyalgia, based on the etiology of the two conditions? A. Providing education with a focus on activity modification B. Eliminating trigger points with techniques such as muscle elongation with contract–relax procedures, spray and stretch techniques, and dry needling C. Reducing postural stresses and improving posture D. Treating muscular pain with low-intensity strengthening and aerobic exercise ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

12. Which of the following are risk factors for secondary osteoporosis? A. Low body weight B. Family history of osteoporosis C. Caucasian or Asian descent D. Long-term use of corticosteroids ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

13. A balance of bone resorption that equals bone replacement occurs normally during growth and development until peak bone mass is reached. This typically occurs: A. At about age 18 for females and 21 for males. B. During the third decade of life. C. At puberty. D. During the sixth decade of life. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

14. A patient with a diagnosis of osteoporosis wishes to participate in a fitness program at her local community center. All of the following describe precautions that she should adhere to during exercise except: Copyright © 2018 by F. A. Davis Company

A. Avoid sitting abdominal machines and supine curl-ups and sit-ups to strengthen the abdominals. B. Avoid high-velocity movements of the spine and extremities. C. Avoid strength training with free weights or the use of a weighted vest during walking or jogging. D. Avoid end-range resisted movements of the spine combining flexion and rotation. ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

15. At what point in the healing process after reduction of a fracture is immobilization usually discontinued and exercise of related areas permissible so long as stress is not placed across or distal to the fracture site? A. When callus formation begins to develop B. When the site is radiographically healed C. When delayed union has been achieved D. At the stage of clinical union ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

16. A person can usually resume normal activity with no limitations when a fracture shows: A. Radiographic union. B. Clinical union. C. Delayed union. D. Callus formation. ANS: A KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

17. Your 80-year-old patient fractured his distal radius and ulna 6 weeks ago. He wore a cast during this period, extending from the mid-humerus to, but not including, the metacarpophalangeal joints. His cast was removed yesterday because of evidence of clinical union, and he has been cleared to begin exercise. ROM is limited (wrist flexion and extension, thumb flexion, forearm supination, and elbow extension). Which type of exercise is contraindicated at this time? A. Grade II distraction of the humeroulnar joint Copyright © 2018 by F. A. Davis Company

B. Active ROM of all limited joints C. Passive stretching to increase wrist, forearm, and elbow ROM D. Grade III joint mobilization (gliding technique) to increase flexion of the thumb ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

18. All of the following are recommendations of the National Osteoporosis Foundation for ways to prevent osteoporosis except: A. Maintain a diet rich in calcium and vitamin D. B. Routinely participate in weight bearing and aerobic exercises. C. Strengthen the core and protect the spine with flexion exercises (curls and sit-ups). D. Stop smoking and decrease excessive alcohol consumption. ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

Chapter 12: Surgical Interventions and Postoperative Management

Multiple Choice

1. You are part of a team presenting a preoperative education program for a group of patients scheduled to undergo total knee or hip replacement during the next month at a large medical center where you are employed. As a therapist, you most likely would be responsible for presenting information on each of the following topics except: A. An explanation and demonstration of exercises a patient is expected to do the day of or after surgery. B. An explanation of early postoperative precautions, such as weight-bearing restrictions or safe and unsafe positioning. C. An explanation of the administration of postoperative pain medication, such as patient-controlled analgesics. D. Use of assistive devices, such as a walker or crutches, for early ambulation. ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Basic

2. Which of the following is a true statement about the phases of postoperative rehabilitation? A. Phases are based on the stages of tissue healing and each patient’s responses to interventions. B. It is important to strictly adhere to a progression of interventions spelled out in a predetermined protocol. C. During the maximum protection phase of postoperative rehabilitation, movement of the operated body segment is contraindicated regardless of the type of surgery. D. Once a patient reaches the minimum to no protection phase of rehabilitation after surgery, there is no value to continuing postoperative exercise. ANS: A KEY: Book Part: Part III: Principles of Intervention DIF: Basic

3. What is the term used to describe a postoperative rehabilitation program in which a patient is progressed from one phase of rehabilitation to the next based on the attainment of predetermined levels of performance? A. Norm-based rehabilitation B. Time-based rehabilitation Copyright © 2018 by F. A. Davis Company

C. Phase-specific rehabilitation D. Criterion-based rehabilitation ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Basic

4. Which of the following postoperative complications is least likely to be prevented by adherence to a carefully progressed postoperative exercise program? A. Formation of adhesions B. Local infection at the wound site C. Subluxation or dislocation of a joint D. Rupture of repaired soft tissue ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Basic

5. In general terms, which of the following surgical procedures is performed primarily to release a contracture and improve range of motion (ROM)? A. Capsulorrhaphy B. Débridement C. Osteotomy D. Tenotomy ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Basic

6. Which of the following surgical procedures typically is performed arthroscopically? A. Minimally invasive joint replacement procedures B. Reduction and internal fixation of a displaced fracture C. Removal of a portion of a meniscus at the knee D. Arthrodesis of the wrist ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Basic

7. There are several types of grafts that can be used to reconstruct a torn knee or ankle ligament. Of the following, which is the best description of an allograft? A. Graft made of synthetic material B. Patient’s own tissue harvested from the identical ligament on the contralateral (noninvolved) extremity C. Patient’s own tissue harvested from one of many possible donor sites D. Tissue graft from a cadaver ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Basic

8. Which of the following is a true statement about the use of autografts and allografts for repair of tissue lesions? A. An autograft can be used to repair soft tissues, such as a torn ligament, but cannot be used for repair of articular cartilage lesions. B. A risk associated with an autograft is potential weakening of a patient’s otherwise healthy tissue at the donor site. C. There is a greater risk of disease transmission with use of an autograft than an allograft. D. There is a greater risk of graft failure with use of an autograft than an allograft. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

9. Which of the following is a correct statement about surgical repair of a torn or ruptured muscle or tendon? A. A surgically repaired muscle or tendon is immobilized in a shortened position for a period of time after surgery. B. After a tear or rupture of a muscle, the best results are achieved if the torn tissue is repaired immediately after injury rather than delaying the repair for 48 to 72 hours after injury. C. During postoperative rehabilitation for a muscle or tendon repair muscle setting exercises are contraindicated during the acute phase until immobilization is removed. D. A longer immobilization period is required for a repaired muscle than for a repaired tendon because the degree of inflammation and edema is greater. ANS: A KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

10. Which of the following is correct about a tendon transfer versus a tendon realignment procedure? A. A tendon realignment procedure, such as realignment of the extensor mechanism of the knee, not only alters the line of pull of the quadriceps, but it also alters the action of the quadriceps. B. A tendon transfer from one bony surface of a joint to the opposite bony surface of the same joint changes the action of the muscle. C. After tendon realignment or transfer, the muscle-tendon unit is immobilized in a lengthened position to prevent contracture. D. Tendon transfer cannot be done to adjacent soft tissue but, rather, must be done to a different bony surface. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

11. Synovectomy, when used, typically is indicated for: A. Long-standing osteoarthritis. B. Tear of a joint capsule as the result of trauma. C. Rheumatoid arthritis. D. Postimmobilization arthritis. ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Basic

12. Which of the following is a correct statement about osteochondral grafts? A. The procedure is indicated for management of advanced (late-stage) arthritis of a joint. B. The term is synonymous with chondrocyte transplantation. C. The procedure involves transplantation of small plugs of intact articular cartilage and some subchondral bone resulting in a bone-to-bone graft. D. Freezing osteochondral grafts from a cadaveric donor for future use makes this procedure cost effective and efficient. ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

13. When arthroplasty involves first débriding and then resurfacing a joint by placing a foreign material—such as fascia, metal, or a silicone spacer—between the articulating surfaces of a joint, Copyright © 2018 by F. A. Davis Company

it is called a(n): A. Abrasion arthroplasty. B. Interposition arthroplasty. C. Excision arthroplasty. D. Hemireplacement arthroplasty. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Basic

14. Each of the following is a relative or absolute contraindication for use of total joint replacement arthroplasty except: A. Severe loss of bone stock. B. Active systemic infection or infection in the joint. C. Significant paralysis of the muscles surrounding the joint. D. Significant joint deformity. ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Basic

15. Active ROM is not possible at a joint that has undergone: A. Arthrodesis. B. Arthroplasty. C. Synovectomy. D. Osteotomy. ANS: A KEY: Book Part: Part III: Principles of Intervention DIF: Basic

16. Which of the following is a true statement about a deep vein thrombosis (DVT)? A. It may occur in the greater saphenous veins. B. It is most common in the deep arterial system of the calf muscles. C. It usually resolves without complication if the patient is active. D. It may result in a pulmonary embolism if undetected. ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate Copyright © 2018 by F. A. Davis Company

17. Ambulation should begin in the early postoperative phase in order to: A. Reduce the risk of a pulmonary embolism after a diagnosis of DVT is confirmed. B. Reduce the risk of a DVT after surgery. C. Provide an alternative circulatory activity for those who do not want to wear compression stockings. D. Reduce the risk of a diagnosed embolism traveling to the lungs. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Difficult

18. Which of the following surgical procedures is also considered to be a diagnostic tool? A. Arthrotomy B. Capsulorrhaphy C. Arthroscopy D. Osteotomy ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Basic

19. Which of the following soft tissue repairs are most commonly immobilized in a relative position of tension (elongation) postsurgically? A. Tendon Z lengthening and ligament tears B. Muscle fasciotomy and tendon realignments C. All repairs of muscles and tendons D. Muscle and ligament complete ruptures ANS: A KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

20. All of the following are signs and symptoms your patient may exhibit that would alert you to a possible pulmonary embolism except: A. Sudden onset of dyspnea. B. Chest pain alleviated with deep breathing and rib compression. C. Rapid, shallow breathing. Copyright © 2018 by F. A. Davis Company

D. Diaphoresis with minimal activity. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

Chapter 13: Peripheral Nerve Disorders and Management

Multiple Choice

1. Your patient describes total numbness in the tips of the index and middle fingers that has been there for 2 months. Four months ago, he sustained a Colles’ fracture. While immobilized in a cast, he had experienced periods of intermittent numbness and pain. You observe atrophy in the thenar eminence and ape hand deformity. This patient most likely sustained: A. Mild compression of the median nerve and has excellent prognosis for full recovery. B. Laceration of the median nerve with complete interruption; there is no chance of neurological recovery. C. Chronic compression of the median nerve; there is a guarded prognosis; may require surgical intervention. D. A stretch injury to the median nerve with adhesions preventing normal mobility; gentle nerve mobilization should alleviate the symptoms. ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

2. Your patient injured her ulnar nerve falling up some steps and catching herself on the medial side of her hand 2 days ago. She currently has constant tingling and decreased sensation to pressure and touch in the little finger and ulnar half of the ring finger. Your intervention during the first week of treatment will be all of the following except: A. Protect the nerve by immobilizing the wrist in a splint. B. Teach active ROM to wrist and fingers. C. Emphasize the importance of resistive exercises to prevent muscle atrophy. D. Inform the patient about ways to protect the hand from further injury. ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

3. Following nerve injury, motor retraining exercises: A. Begin as soon as signs of voluntary muscle action are detected. B. Begin as soon as the patient tolerates electrical stimulation. C. Are used to desensitize the areas of hypersensitivity. D. Cannot be used until the chronic phase of healing in order to avoid further trauma to the Copyright © 2018 by F. A. Davis Company

nerve. ANS: A KEY: Book Part: Part III: Principles of Intervention DIF: Basic

4. The chronic phase of recovery following nerve injury occurs when: A. The patient has significant residual effects from lack of regeneration and must learn to compensate for lost function. B. The nerve is regenerating, and strength and sensory recovery are emphasized in the rehabilitation program. C. Innervation is complete and emphasis is placed on retraining and re-education. D. The surrounding connective tissue can withstand normal tensile stresses, and the patient can return to all functional activities. ANS: A KEY: Book Part: Part III: Principles of Intervention DIF: Basic

5. Your patient experiences a tingling sensation in the upper extremity while in the following position: shoulder girdle depression; slight abduction of the shoulder; elbow extension; medial rotation of the arm; pronation of the forearm, wrist, and finger; thumb flexion; and ulnar deviation of the wrist. Which peripheral nerve is being placed on a stretch? A. Median B. Radial C. Ulnar D. Musculocutaneous ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

6. Nonoperative management of carpal tunnel syndrome emphasizes: A. Vigorous stretching to gain mobility of the structures in the carpal tunnel. B. Activity modification and joint, nerve, and tendon mobilization. C. Strengthening exercises, especially to the muscles of the thenar eminence. D. Immobilization. ANS: B KEY: Book Part: Part III: Principles of Intervention Copyright © 2018 by F. A. Davis Company

DIF: Intermediate

7. Following transverse carpal ligament surgery to release impingement of the median nerve in the carpal tunnel, your patient has increased sensation of tingling when the wrist is extended. The impairment and its intervention should be: A. Joint adhesions: use joint-mobilization techniques. B. Median nerve adhesions: use nerve-mobilization techniques. C. Ligamentous stress from the surgery: use cross-friction massage. D. Scar adhesions: mobilize the skin around the surgical site followed by range of motion (ROM) exercises. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

8. Your patient sustained a traumatic injury to his shoulder 3 weeks ago. You have been treating him because of decreased shoulder ROM and strength and general lack of functional reaching and overhead use of the upper extremity. Today he reports that he has been experiencing increased pain, swelling, and stiffness of his hand. What can you conclude? A. These signs are the result of a thoracic outlet syndrome (TOS); begin treating this region as well. B. The patient is possibly developing complex regional pain syndrome (CRPS); treatment should be initiated to reduce swelling, maintain range, and increase use of the hand. C. These signs are a normal reaction to trauma; it is important to tell the patient he is engaging in too much activity. D. These are signs of a possible clot; immediately send him to the emergency room. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

9. Dominant signs of CRPS that should alert you to the potential of this condition developing are: A. Pain, osteoporosis, swelling, and paresthesias. B. Pain, swelling, stiffness, and discoloration of the hand. C. Pain, muscle atrophy, stiffness, and brittle nails. D. Recent injury, pain, and red, hot, swollen tissue. ANS: B KEY: Book Part: Part III: Principles of Intervention Copyright © 2018 by F. A. Davis Company

DIF: Basic

10. To effectively treat CRPS, a physical therapist: A. Performs a sympathetic block prior to any manual or exercise interventions. B. Utilizes an approach that manages the physical symptoms of pain, edema, stiffness, and muscle changes. C. Bombards the autonomic nervous system with stimuli using desensitization techniques. D. Avoids the “no pain, no gain” philosophy and encourages the patient to minimize activity if it causes discomfort. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Basic

11. Your patient complains of numbness in the hand and forearm whenever working for prolonged periods at the computer; the hand also develops a puffy sensation and occasionally turns blue. Adson’s maneuver reproduces these symptoms. All of the following should directly help your patient with this problem and will be part of your treatment approach for TOS except: A. Stretch the scalene muscles. B. Teach posture correction. C. Teach relaxed diaphragmatic breathing. D. Apply mechanical traction at 20 lb for 20 minutes. ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Intermediate

12. You have been treating a patient with a diagnosis of TOS for 1 week; she describes increased burning pain over the past week. She also has ischemic symptoms in the upper extremity whenever she exercises or while engaging in simple functional activities. This means: A. There could be progressive axonal disruption and compromise of the vascular supply; the physician should be notified. B. The patient has not been compliant with instructions for posture and safe exercises. C. The exercises have been too vigorous and should be decreased in intensity. D. This is a typical reaction to exercises for TOS. ANS: A KEY: Book Part: Part III: Principles of Intervention DIF: Difficult

13. CRPS is defined as an extremely painful multisymptom syndrome involving many systems that is: A. Responsive and easily treated with modalities. B. Primarily psychomotor, resulting in weight changes and depression. C. Easily diagnosed with universal signs and symptoms. D. Accompanied by dystrophic and vascular changes and hyperesthesia. ANS: D KEY: Book Part: Part III: Principles of Intervention DIF: Basic

14. The pain associated with CRPS characteristically is: A. Entirely psychogenic and responsive to antidepressants. B. Intermittent and related to body and head position. C. Out of proportion to the report of history of injury or precipitating event. D. Always responsive to modalities, primarily cold and electrical stimulation. ANS: C KEY: Book Part: Part III: Principles of Intervention DIF: Basic

15. On examination, your patient reports that he is an avid cyclist and over the past 2 months has been experiencing numbness of the little finger and the ulnar side of his ring finger that has become painful over the past week with an inability to effectively grasp the handlebars. One area of possible nerve compression producing these signs and symptoms is: A. Carpal tunnel. B. Tunnel of Guyon. C. Thoracic outlet. D. Tarsal tunnel. ANS: B KEY: Book Part: Part III: Principles of Intervention DIF: Basic

Chapter 14: The Spine: Structure, Function, and Posture

Multiple Choice

1. Postural stability of the spine is provided by: A. Elasticity of passive restraints. B. Interaction of passive restraints and muscle control. C. Interaction of muscle control modulated by the central nervous system and passive restraints. D. Muscle activity maintaining balance in the neutral zone. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

2. Characteristics of the global muscles in the spine include all of the following except: A. Provide dynamic stability to each segment in the spine. B. Prime movers of the spine. C. Multisegmental guy wires. D. Control spinal orientation in response to external loads. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

3. The spinal muscles that are activated first with rapid arm movements are the: A. Erector spinae and rectus abdominis. B. Internal and external obliques. C. Multifidus and internal obliques. D. Transversus abdominis and multifidus. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

4. A sustained faulty posture that stresses the ligamentous or joint structures usually results in: A. Diffuse pain that is relieved when the mechanical stress is stopped. Copyright © 2018 by F. A. Davis Company

B. Diffuse pain that is relieved with pain medication, modalities, and massage C. Sharp pain that cannot be relieved until the tissue heals. D. Sharp pain that changes in intensity as the posture changes. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

5. Which of the following is true of a flat low-back posture? A. It is the best posture for a healthy spine. B. It is typically associated with tight hip flexor muscles. C. It reduces the shock-absorbing function of the spinal curves. D. It should be the goal of all back rehabilitation programs. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

6. To teach a patient how to manage painful symptoms related to poor posture, which of the following is most important? A. Awareness of the relationship between the faulty posture and pain B. Stretching program C. Strengthening program D. High-repetition, low-resistance exercise program ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

7. The difference between a lordotic posture and a slouched posture is: A. Only the lordotic posture has lumbar lordosis. B. Flexion in both the upper lumbar and lower thoracic spine occurs with the slouched posture. C. Extension of the pelvis on the femurs occurs with the lordotic posture. D. There is no difference; both affect the pelvis and lumbar spine the same way. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

8. Your patient complains of cervical pain and headaches. You notice that she has a forward head and round back posture. The complaints could be derived from all of the following except: A. Impingement on the neurovascular bundle from sternocleidomastoid muscle tightness. B. Increased tension in the muscles of mastication with associated temporomandibular joint syndrome. C. Irritation of the facet joints in the upper cervical spine. D. Impingement of the suboccipital nerves. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

9. Your patient describes posterior cervical pain and headaches that get progressively worse throughout each workday. She is a computer programmer, plays tennis on the weekends, and is an aerobic walker in the evenings. Your evaluation reveals a person who is physically fit with well-balanced flexibility and strength. Your treatment emphasis will be: A. Stretching the short suboccipital, levator, and scalene muscles. B. Teaching tension-reducing postures and modification of chair, desk, and computer heights. C. Teaching proper warm-up exercises and progressing her aerobic program to running. D. Changing her sleeping posture and pillow height. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

10. Your patient describes increased pain in the back in the morning before getting out of bed. The patient should be: A. Advised never to sleep prone. B. Evaluated for sleeping posture and advised in mechanically safe adaptations. C. Advised to sleep in a recliner or with a pillow under her knees to accentuate hip flexion. D. Advised to place a board under a soft mattress. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

11. Your patient describes having cervical and upper thoracic pain progressing throughout the day at work where she works by reaching forward and overhead on an assembly line. On evaluation you determine she is experiencing “stretch weakness” from prolonged postural Copyright © 2018 by F. A. Davis Company

positioning. The treatment program you design should primarily include all of the following except: A. Posture training for safe body mechanics. B. Muscular endurance and strengthening. C. Stretching for the involved postural muscles. D. Environmental adaptations for ergonomic relief and protection. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

12. Your patient has a forward head posture. On testing (supine-lying), she cannot isolate capital flexion to lift her head when you ask her to flex her neck. Passively you can move the head about 5° into capital flexion and then feel tissue resistance. Based on these supine tests, what muscles are tight and what muscles are weak? A. Tight suboccipital muscles and weak longus capitis and longus colli muscles B. Tight erector spinae and weak sternocleidomastoid muscles C. Tight splenius capitis and splenius cervicis muscles and weak multifidus muscles D. Tight erector spinae and weak suprahyoid and infrahyoid muscles ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

13. Motion at a functional unit of the spine is defined by what is occurring with the: A. Anterior portion of the body of the superior vertebrae. B. Anterior portion of the body of the inferior vertebrae. C. Spinous process of the superior vertebrae. D. Spinous process of the inferior vertebrae. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

14. The anterior pillar of the spine: A. Consists of the vertebral bodies and the vertebral arches. B. Includes the sternum and the 12 pairs of ribs. C. Is the weight-bearing portion of the spinal column. D. Provides the gliding mechanism for movement.

ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

15. All of the following are generally true of the nucleus pulposus except: A. It is the axis of motion for the functional units of the spine. B. It takes on and/or releases water in response to compressive loads. C. It is centrally aligned within the annulus fibrosis at all levels of the spine to provide uniform shock absorption. D. It is covered superiorly and inferiorly by a cartilaginous end-plate. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

16. Which of the following best describes scoliosis? A. A transverse plane deviation of the vertebrae usually involving the thoracic and lumbar regions B. A lateral curvature of the spine wherein rotation of the vertebral bodies is toward the convexity of the curve C. An irreversible lateral curvature with fixed rotation of the vertebrae caused by lordotic posture D. A collapse of intervertebral space resulting from weakness of the deep segmental muscle of the spine ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

Chapter 15: The Spine: Management Guidelines

Multiple Choice

1. Treating the soft tissue of the back: A. Is more difficult than treating the extremities because of the way it is innervated. B. Is usually not necessary because most back pain results from dysfunction of the facets or disks. C. Involves using heat rather than cold, massage rather than exercise, and principles that in general are different from those used when treating the extremities. D. In principle is no different from treating soft tissues in the extremities. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

2. Disk lesions are more common in the 30 year to 45 year age span because: A. The annulus begins degenerating, loses tensile strength, and begins to tear with excessive forces. B. The nucleus pulposus changes in chemical composition during this time and is capable of imbibing greater than normal amounts of water, causing greater than normal pressure against pain-sensitive structures. C. The facets are wearing out and the entire joint complex is placed under greater stress. D. This is not the most common age span for disk lesions. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

3. One day following onset of pain and muscle guarding in the low back region, your patient stands with lumbar flexion and a sciatic scoliosis. Repeated flexion tests increase pain into the buttock. Repeated extension done after side gliding increases the pain in the midback and decreases the pain in the buttock. You begin treatment by: A. Positioning the patient supine and having him bring both knees to his chest. B. Placing the patient in intermittent traction at less than half his body weight for 20 minutes. C. Having the patient lie prone and attempting passive extension with press-ups or prone propping maneuvers after side gliding the thorax. D. Placing the patient on complete bed rest for at least 4 days, applying modalities and massage Copyright © 2018 by F. A. Davis Company

during that time. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

4. Which of the following sacroiliac impairments will probably not respond to muscle energy techniques? A. Pubic symphysis hypomobility B. Posterior rotated innominate C. Anterior rotated innominate D. Up-slipped innominate ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

5. All resistive flexion and extension activities and exercises are contraindicated when there is an acute disk lesion because: A. They cause increased pain. B. They cause swelling of the nucleus against pain-sensitive structures. C. They increase the intradiscal pressure. D. Resisted extension is all right—but not flexion because it increases the bulge. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

6. Following recovery of a posterolateral disk protrusion, your patient will be returning to a job that requires prolonged forward bending and stooping. Your instructions to the patient must include: A. Interruption of the flexed postures at frequent intervals by standing upright and bending backward. B. Advice to quit that job and find one that is sedentary. C. No advice—forward bending helps maintain mobility in the spine. D. Preparing for the forward bending by posterior tilting of the pelvis before bending and stooping. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region Copyright © 2018 by F. A. Davis Company

DIF: Intermediate

7. Patients with osteoporosis are at high risk for compression fractures of the vertebral bodies. The primary segments of the spine at risk are the thoracolumbar regions. When planning intervention programs for this high-risk population all of the following are appropriate except: A. Instruct in safe lifting techniques that minimize trunk flexion. B. Teach stabilization exercises to develop spinal stability. C. Strengthen the abdominals without adding weight-bearing stress on the vertebrae by initiating sit-up exercises. D. Teach postural awareness and scapular stabilization techniques to decrease the progression of thoracic kyphosis. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

8. Your patient has complaints of increasing low back pain during the day. Her job requires repetitive lifting and reaching overhead (25 lb maximum). On examination, you note that on forward bending she has difficulty moving smoothly midrange and that on side bending to the left there is an acute angle in the midlumbar region. Additional tests lead you to hypothesize that she has clinical instability in the midlumbar region. This could be caused by all of the following except: A. Degeneration of the intervertebral disk. B. Poor neuromuscular control of the deep segmental stabilizing musculature. C. Ligamentous laxity. D. Advanced spondylitis. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

9. Your patient has acute joint trauma to the cervical spinal facets. Every time she attempts neck motions, there is increased pain and muscle guarding. A possible way to maintain integrity in the contractile units of the muscles is to: A. Apply cold. B. Perform passive range of motion to the cervical spine. C. Apply heat. D. Perform reverse muscle action using gentle scapular motions. ANS: D Copyright © 2018 by F. A. Davis Company

KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

10. 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: A. Heat and massage. B. Interventions that temporarily increase the size of the intervertebral foramina. C. Intermittent setting exercises with the extensor muscles in the shortened position. D. Relaxation exercises, including head rolls and conscious tension-release techniques. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

11. Extreme caution should be used when manipulating the spine of patients with rheumatoid arthritis. There is high potential for subluxation of the vertebrae and damage to the spinal cord secondary to: A. Ligamentous necrosis. B. Joint effusion. C. Synovial hypertrophy. D. Pain. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

12. All of the following statements are true about functional position (bias) of the spine except: A. The functional position may change as tissues heal and the individual gains mobility and strength. B. If there is an extension bias, it means there is a disk lesion. C. A person with a nonweight-bearing bias is sensitive to the effects of gravity and feels greatest relief when lying down. D. The functional position is not a static position but a range wherein nontraumatic or safe activity can occur. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

13. Your patient has signs of an acute lumbar intervertebral disk protrusion. On testing, he experiences decreased symptoms when applying manual traction. To use mechanical traction effectively as part of the treatment plan during the early stages: A. Use sustained traction for 20 minutes with a dosage of at least 50% of the body weight. B. Use intermittent traction for 20 minutes with a dosage of at least 50% of the body weight. C. Use sustained traction for less than 10 minutes with a dosage of at least 50% of the body weight. D. Use intermittent traction for less than 15 minutes with a dosage of less than 50% of the body weight. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

14. All of the following are techniques to increase temporomandibular joint (TMJ) motion except: A. Place tongue blades between the front teeth and progressively adding more as tolerated. B. Place your thumb and index finger against the patient’s incisors or molars and press the mandible caudally. C. Teach self-manipulation of the joints by placing dental rolls between the patient’s molars and asking him to bite down while attempting to close the front teeth. D. Instruct the patient to chew gum for at least 10 minutes, three times a day to build endurance. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

15. Your patient complains of facial pain, especially when under tension and when eating. All of the following are appropriate except: A. Jaw relaxation by clicking the tongue and resting the tongue on the hard palate behind the front teeth. B. Stretching and strengthening the muscles of mastication so they can withstand the stress. C. Teaching the patient extra-oral massage in the region of the masseter and/or temporalis muscle. D. Relaxation techniques and controlled breathing. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

16. Which of the following is contraindicated for a patient who has undergone L4/L5 laminectomy? A. Extension exercises of the trunk B. Joint manipulation at the thoracolumbar junction C. Flexion exercises of the trunk D. Strengthening of the transverse abdominals ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

17. Scheuermann’s disease: A. Is a rheumatic disorder. B. Results from weakened vertebral end-plates. C. Begins with radicular signs that diminish over time. D. Requires functionally increasing the lumbar lordosis to prevent development of kyphosis. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

18. The vertebral arteries: A. Are protected in positions of extreme cervical extension. B. Cause tension headaches when they are occluded. C. Are compromised with severe TMJ dysfunction. D. Enter the transverse foramen of C6 bilaterally in their course to C1. ANS: D KEY: Book Part: Part IV: Exercise Intervention by Body Region DIFF: Basic

19. All of these are reasons to assess the thoracic spine during evaluation of patients who present with cervical spine dysfunction except: A. The thoracic spine becomes unstable with pain and soft tissue dysfunction in the cervical spine. B. The thoracic spine is prone to hypomobility. C. There are common muscle attachments between the cervical and thoracic areas. D. Joint manipulation performed along with high-velocity thrust of the thoracic spine often improves outcomes in patients with cervical complaints. Copyright © 2018 by F. A. Davis Company

ANS: A KEY: Book Part: Part IV: Exercise Intervention by Body Region DIFF: Basic

20. Your patient presents with a chief complaint of headaches with unknown etiology, beginning last week. During the course of the initial assessment you determine that the source of the headache most probably is not musculoskeletal (a cervical headache). Which of the following indicates that a referral to the patient’s physician is appropriate? A. Pain or altered sensation in the face or TMJ region B. Unilateral headaches or bilateral headaches with one side predominant C. Report of sharp pain or spikes in intensity D. Pain in the neck or suboccipital region that spreads in the head ANS: C KEY: Book Part: Part IV: Exercise Intervention by Body Region DIFF: Basic

Chapter 16: The Spine: Exercise and Manipulation Interventions

Multiple Choice

1. Fundamental techniques that every patient with spinal impairments should learn before progressing to basic and advanced training exercises include: A. Strengthening exercises for the cervical and trunk stabilizers, including the abdominals, longus colli, quadratus lumborum, and cervical and lumbar multifidus muscles. B. Safe use of weights and elastic resistance while maintaining the spine in a neutral posture. C. Safe stretching techniques prior to any stabilization, strengthening, or power training. D. Kinesthetic awareness of safe spinal positions and movement, activation of deep segmental muscles, and global muscle control of spinal posture when moving the extremities or moving from one position to another. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

2. Anterior-posterior pelvic tilt exercises are used: A. To strengthen the abdominal muscles. B. To strengthen the back extensor muscles. C. To train the transversus abdominis. D. To perform range of motion (ROM) of the lumbar spine. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

3. Your patient is recovering from a back injury that occurred 3 weeks ago. You decide it is time to place him on a progressive walking program and integrate it with the other fundamental stabilization interventions in order to: A. Improve control of the spine while performing a basic functional activity and to improve cardiopulmonary endurance. B. Strengthen the legs while improving cardiopulmonary function. C. Improve cardiopulmonary function and his sense of well-being. D. Develop muscular endurance along with general lower extremity strengthening. ANS: A Copyright © 2018 by F. A. Davis Company

KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

4. All of the following may be indications for using stretching or mobility exercises in acute spinal conditions except: A. When there is an accompanying postural impairment that prevents an alignment that would relieve symptoms. B. When there is decreased mobility in the extremities that restrict postural alignment. C. When an inflamed tissue is the cause of restriction. D. When fluid stasis prevents movement. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

5. To effectively stretch the scalene muscles on the left, the patient: A. Axially extends the neck, side bends to the right, and rotates to the left. B. Places the left hand behind the head, rotates head to the left, and looks down. C. Rotates head to the right, looks down, and places left hand behind the head. D. Tucks in chin and nods the head through 15° of motion. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

6. Positional traction is used to: A. Allow the patient to relax the musculature and therefore get greater separation of the vertebrae. B. Isolate a passive distraction stretch to a specific facet. C. Substitute for mechanical traction when a traction unit is not available. D. Apply traction when the therapist is not strong enough to apply a sufficient amount of manual traction. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

A. In supine, pull both thighs to the chest until the sacrum is lifted off the mat. B. In long sitting, reach both hands toward the feet as far as possible. C. While standing, bend over and touch the toes. D. In prone, perform press-ups. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

8. The first step in training a patient with spinal stabilization techniques should be: A. Performing posterior pelvic tilt followed by alternating arm and leg motions. B. Developing muscular endurance prior to strength. C. Teaching awareness of safe spinal motions and functional position. D. Developing control of extremity motions while in the functional position. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

9. Your patient is recovering from a low back injury that occurred when picking up her 15-lb infant 4 weeks ago. The symptoms are no longer acute. She has learned the basic drawing-in maneuver and neutral spine position and can maintain her neutral spine while rolling, transitioning from supine to sit and from sit to stand. Now you plan to progress her exercises in order to improve her ability to return to managing household responsibilities. How should you progress the exercises to improve the stabilizing function in the abdominals? A. Wall slides, beginning with 10 repetitions; progress to 25, then begin squats B. Maintain neutral spine while walking for 10 minutes two times a day; progress to 5 times a day C. Curl-ups on a mat; progress to doing curl-ups on an unstable surface such as a gym ball D. Supine; maintain neutral spine while alternating arms, then add alternating legs; increase repetitions until she can hold the position for 3 minutes; progress difficulty by increasing the lever arm or adding weights to arms and legs ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

10. Your patient describes frequent headaches, especially when working at her computer, which get progressively worse during the day. The following limitations in motion are noted: capital flexion, lower cervical extension, cervical side bending, and lateral rotation of the shoulders. Use Copyright © 2018 by F. A. Davis Company

of a pressure cuff to test control of capital flexion shows the ability to maintain an increase in pressure of 8 mm Hg for 3 seconds. She is not able to lie prone and perform axial extension by lifting her forehead off the table. All of the following would be appropriate methods for initiating your interventions except: A. Gentle manual traction to the suboccipital region followed by passive capital flexion to increase flexibility. B. Training of deep cervical flexors to maintain capital flexion for 10-second holds, using a pressure cuff for feedback. C. Prone-lying axial extension with the head over the end of the table, holding for 10 seconds at a time. D. Supine lying with a foam roller placed longitudinally under the spine and head, allowing the shoulders to roll outward into external rotation. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

11. Rhythmic stabilization exercises are important in a spinal rehabilitation program because they: A. Develop postural muscle response to external disturbances. B. Make the patient feel good. C. Develop strength using isometric holds. D. Develop awareness of the neutral spinal posture. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

12. The decision to utilize dynamic exercises in the later stages of a spinal rehabilitation program should be based on: A. Strength of the muscles demonstrating antigravity function. B. Patient demonstrating effective deep segmental and global stabilization techniques. C. Patient demonstrating 20 minutes of cardiopulmonary endurance activities without exacerbating symptoms. D. Patient’s ability to maintain an isometric contraction of the trunk musculature for 3 minutes. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

13. Individuals with symptoms from an intervertebral disk lesion and individuals with osteoporosis should not do: A. The drawing-in maneuver. B. Anterior and posterior pelvic tilt motions. C. Dynamic trunk flexion exercises. D. Stabilization exercises in the supine position. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

14. For a patient to be able to learn good body mechanics for lifting: A. The abdominal muscles must be strong enough to maintain a posterior pelvic tilt. B. The patient must be able to maintain a neutral spinal posture against the force being lifted. C. The spine needs to be braced in extension by the trunk muscles. D. Emphasis should be placed on strengthening the lower extremity musculature, not the spinal musculature. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

15. Modified bridging, partial lunges, partial squatting, and upper extremity pushing and pulling exercise are used in spinal exercise programs for the purpose of: A. Using weight-bearing exercises rather than exercising in supine- or prone-lying positions. B. Adding variety to what could be a monotonous program. C. Strengthening the trunk-stabilizing musculature. D. Developing extremity strength in conjunction with trunk stabilization to prepare for functional activities. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

16. The quadratus lumborum is an important stabilizer of the spine in which planes of motion? A. Frontal and sagittal B. Sagittal and coronal C. Transverse and frontal D. Sagittal and transverse

ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

17. Your patient is in the chronic phase of healing with decreased ROM of C4-5 resulting in activity restrictions related to flexion and rotation of her head. You perform a spinal manipulation technique consisting of small amplitude oscillations for 1–2 minutes that go through the restrictive joint barrier with a goal to improve her joint ROM. What grade of manipulation will you document? A. Grade II B. Grade III C. Grade IV D. Grade V ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

18. To effectively apply a manipulation technique to improve cervical flexion, you would: A. Position the patient supine with knees flexed and her arms at her side and use a two-thumb contact on the spinous process while pressing in a caudal direction. B. Stand on one side of the patient with your body facing caudally and contact the cervical pillar on that side with the second metacarpal phalangeal joint and apply a caudally directed force. C. Position the patient prone and use a two-thumb contact on the transverse processes of the superior restricted segment of the three-joint complex and apply a caudally directed force. D. Position the patient prone and apply force through the thumbs to slide the superior vertebra in a cephalad-anterior direction. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

19. Safe and effective use of muscle energy techniques to improve joint mobility requires that the therapist closely follows the procedural guidelines, including: A. Never use muscle energy in the craniocervical region because of the risk of vertebral artery occlusion. B. Perform the technique a minimum of 8–10 repetitions to achieve the outcome. C. Have the patient hold the contraction for 15 seconds against moderate to maximum resistance followed by movement into the new range. D. Use a gentle hold-relax technique to create submaximum, isometric contractions followed by Copyright © 2018 by F. A. Davis Company

movement into the new range. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

20. Manipulation to increase thoracic spinal rotation requires clear communication in the medical record describing the treatment outcome for the segment. When using the V-spread contact, one finger is placed on the superior transverse process and the second finger is placed on the contralateral inferior transverse process. The rule of the lower finger describes the direction of rotation as: A. Rotation of the segment occurs in the direction of the finger on the side of the inferior transverse process. B. Rotation of the segment occurs in the direction of the finger on the side of the superior transverse process. C. There is no rotation with the V-spread because the lower finger equally counteracts the force through the superior finger, creating an anterior glide. D. A distraction occurs with the V-spread as the lower finger creates movement inferiorly through the lever arm of the transverse process as the force is applied. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

21. Spinal manipulation techniques are contraindicated: A. In pregnant women. B. In patients with osteoporosis. C. In patients currently using corticosteroids. D. In the high cervical spine because of risk of vertebral artery compromise. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

Chapter 17: The Shoulder and Shoulder Girdle

Multiple Choice

1. For effective shoulder function, each of the following is necessary except: A. Appropriate movement and stability of the scapula. B. Greater mobility in the external rotators than the internal rotators. C. A balance in strength of the external and internal rotators. D. Thoracic extension and axial extension of the cervical spine. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

2. Your patient exhibits a forward head posture and excessive thoracic kyphosis. Considering the muscles that typically are weak with this faulty posture, which of the following muscles of the shoulder girdle are most important to strengthen? A. Pectoralis minor and levator scapulae B. Serratus anterior and levator scapulae C. Upper and lower trapezius and serratus anterior D. Upper and lower trapezius and pectoralis minor ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

3. Pendulum (Codman’s) exercises are used most effectively: A. As a grade II oscillation technique to inhibit pain and maintain mobility. B. As a strengthening exercise when a weight is held in the hand or placed around the wrist. C. To stretch the shoulder musculature and increase range of motion (ROM) when a patient does not have antigravity control of shoulder movement. D. As a grade III distraction technique to increase ROM when mobility of the scapula is normal but there is chronic stiffness of the glenohumeral joint. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

4. You are developing an exercise program for a patient who has adhesive capsulitis of the right shoulder. You have determined that the signs and symptoms identified during your examination are consistent with stage 2, the “freezing” stage, of this disorder. In addition to maintaining mobility of joints distal to the shoulder, which of the following interventions for the shoulder is most appropriate at this time? A. Low-intensity progressive resistance exercise, mobilization with movement techniques, and manual stretching of the shoulder and scapular stabilization exercises with progressive weight bearing through the upper extremity B. Grade III joint-mobilization techniques, self-stretching, and strengthening exercises C. Gentle weight bearing on the involved upper extremity to develop scapular control and active ROM of the shoulder (e.g., wand and wall-climbing exercises) D. Grades I and II joint distraction and gliding techniques, pendulum exercises, passive or active-assistive ROM within pain-free ranges, and muscle setting exercises for shoulder musculature ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

5. Which of the following is a true statement about glenohumeral arthroplasty? A. Hemiarthroplasty is most often performed using an arthroscopic approach. B. The primary indication for glenohumeral arthroplasty is limited mobility of the shoulder. C. A reverse total shoulder arthroplasty (rTSA) is an appropriate procedure for a patient with marked instability of the glenohumeral joint and a rotator cuff that is not repairable. D. For adequate exposure of the joint during surgery, the muscle that routinely must be released (and reattached prior to closure) is the anterior deltoid. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

6. Which of the following is an inappropriate component of an exercise program 1 to 3 weeks postoperatively for a patient without preoperative rotator cuff deficiency who underwent total shoulder replacement? A. Wand exercises for active-assistive external rotation to neutral with the arm positioned near the side of the chest B. Wand exercises for active-assistive shoulder extension (combined with internal rotation) by placing the wand behind the back and sliding it up the back C. Pendulum exercises D. Wand exercises for active-assistive elevation of the arm in the plane of the scapula to Copyright © 2018 by F. A. Davis Company

approximately 90° while in a supine or sitting position ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

7. Results of numerous outcome studies have demonstrated that the most predictable outcome after shoulder arthroplasty is: A. Increased active shoulder ROM. B. Increased shoulder-joint stability. C. Pain relief. D. Improved function of the rotator cuff mechanism. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

8. According to Neer’s classification of rotator cuff disease, which of the following stages is seen most often in patients 25 to 40 years of age and characterized by tendonitis or bursitis but not a rotator cuff tendon rupture? A. Stage I B. Stage II C. Stage III D. Stage IV ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

9. Rotator cuff disease is multifactorial and is associated with both intrinsic and extrinsic factors affecting the structures in the suprahumeral space. Of the following contributing factors, which is classified as an intrinsic factor? A. Vascular changes in the rotator cuff tendons B. Hypertrophic degenerative changes of the acromioclavicular joint C. The shape of the acromion D. Increased thoracic extension ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic Copyright © 2018 by F. A. Davis Company

10. Muscles that typically are shortened in patients with increased thoracic kyphosis; forward head; and protracted, forward tilted scapula are the: A. Teres major and minor, subscapularis, infraspinatus, and triceps. B. Pectoralis major and minor, latissimus dorsi, infraspinatus, and teres minor. C. Pectoralis major, teres major and minor, and serratus anterior. D. Pectoralis minor, subscapularis, and levator scapulae. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

11. You are treating a patient with a painful shoulder as the result of supraspinatus tendonitis from chronic impingement. There is no evidence of tendon rupture or joint instability. Acute symptoms have subsided. Each of the following is appropriate to improve active elevation of the arm at this stage of rehabilitation except: A. Reinforce the importance of maintaining an erect trunk during elevation of the arm. B. Teach the patient to apply cross-fiber massage to the supraspinatus tendon while it is on a stretch, followed by isometric contractions of the muscle. C. As the patient actively elevates the arm within the pain-free range, apply an anterior glide of the head of the humerus (mobilization with movement technique). D. Strengthen key scapular stabilizers, such as the serratus anterior, middle trapezius, and lower trapezius, in closed-chain and open-chain positions. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

12. Which of the following is a true statement about an arthroscopic subacromial decompression procedure? A. It is indicated for a patient who sustains a full-thickness, traumatic tear of the rotator cuff if coupled with a repair of torn cuff tissues. B. It may or may not involve resection of the anterior acromial protuberance and contouring of the undersurface of the remaining acromion. C. It is indicated for a patient with secondary impingement syndrome due to glenohumeral joint hypermobility/instability. D. During surgery, the deltoid must be detached for adequate exposure of the suprahumeral space. ANS: B Copyright © 2018 by F. A. Davis Company

KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

13. Which of the following is a true statement about surgical repair of the rotator cuff and postoperative management? A. Regardless of the size of the cuff tear, the shoulder is immobilized in an abduction splint for a period of time after surgery. B. If the size and severity of the tears are similar, rehabilitation after repair of an acute, traumatic cuff tear typically progresses more rapidly than after repair of an atraumatic tear associated with chronic impingement. C. Detachment of the deltoid from its proximal insertion is a necessary component of a traditional open repair or an arthroscopically assisted repair (mini-open). D. The quality of the patient’s tissues (tendon and bone) has little to no impact on the progression of rehabilitation. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

14. Each of the following is correct about precautions that should be taken after repair of a fullthickness rotator cuff tear associated with chronic impingement except: A. After a traditional open repair for a massive cuff tear, postpone active ROM exercises until about 2 weeks postoperatively to avoid avulsion of the deltoid that was detached and reattached during the procedure. B. When the patient is lying in the supine position during the early postoperative days, place a folded towel under the humerus to position the arm slightly anterior to the frontal plane of the body to minimize anterior translation of the head of the humerus and the potential for impingement. C. Before initiating active elevation of the arm in the sitting or standing position, restore strength in the rotator cuff muscles, especially the supraspinatus and infraspinatus muscles, to prevent superior translation of the head of the humerus during active elevation of the arm. D. Delay weight-bearing/closed-chain exercises on the operated upper extremity for about 6 weeks. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

A. While in the supine position, have the patient perform repeated concentric contractions of the scapular protractors against manual resistance applied to the anterior aspect of the shoulder. B. While standing, have the patient place the arms in a reverse-T position while holding a piece of elastic tubing between the hands. Then have the patient attempt to “pinch the shoulder blades together” repeatedly against the elastic resistance. C. Have the patient stand, face a wall, place the hands on the wall, and lean into the wall as the therapist applies alternating resistance against the shoulders. D. Have the patient hold the arms in various positions in space (perform isometric contractions) as the therapist applies resistance in various directions. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

16. Each of the following is a true statement about rehabilitation following dislocation of the glenohumeral joint except: A. After an initial dislocation and a course of nonoperative management, recurrence of a dislocation is higher in older patients (greater than 40 years of age) than in younger patients (less than 30 years of age). B. Anterior dislocation is far more common than posterior dislocation. C. A compression fracture of the posterolateral margin of the humeral head is an associated lesion that may occur as the result of a traumatic anterior dislocation. D. A fall on the arm when it is positioned in flexion, adduction, and internal rotation can result in a posterior dislocation. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

17. After closed reduction of an anterior dislocation of the glenohumeral joint, which of the following is the safest and most effective procedure to increase mobility of the joint for external rotation of the shoulder? A. With the shoulder in the resting position, apply a grade II distraction of the humerus. B. With the shoulder in the resting position, apply a grade III anterior glide of the humerus. C. With the shoulder placed at the end of the available range of external rotation, apply a grade III anterior glide of the humerus. D. With the shoulder in the resting position, externally rotate the shoulder and apply a grade III distraction of the humerus. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate Copyright © 2018 by F. A. Davis Company

18. Which of the following surgical procedures is performed for recurrent anterior instability or dislocation of the glenohumeral joint and involves reattachment and repair of the capsulolabral complex to the anterior rim of the glenoid? A. Anterior capsular shift B. Bankart repair C. Hill-Sachs repair D. SLAP lesion repair ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

19. Which of the following is true about postoperative precautions and the rate of progression of rehabilitation after surgery for glenohumeral instability? A. Progress upper extremity weight-bearing exercises more slowly/cautiously after surgery for posterior instability than for anterior instability. B. Progress exercises more slowly/cautiously if the origin of the instability was traumatic versus atraumatic. C. Progress exercises more slowly/cautiously after an arthroscopic capsular shift involving imbrication and suturing the capsule than after an arthroscopic thermally assisted capsular shift. D. Progress ROM into internal rotation more slowly/cautiously after surgery for anterior instability than for posterior instability. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

20. Which of the following functional activities should a patient avoid for the longest period of time after rTSA? A. Reaching overhead B. Hugging with both arms C. Reaching into abduction in the plane of the scapula at a drive-through window D. Fastening a bra behind the back ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

Chapter 18: The Elbow and Forearm Complex

Multiple Choice

1. Your patient, a 19-year-old college student, sustained a nondisplaced fracture of the distal humerus, which was managed by closed reduction and 6 weeks of immobilization in a cast. Yesterday the cast was removed and the patient is to begin exercises to improve range of motion (ROM) and strength of the elbow. Your examination reveals significant limitation of elbow flexion/extension and forearm pronation/supination as well as reduced joint play at the elbow. The patient describes her elbow as feeling “very stiff,” but pain occurs only when overpressure is applied at the end of the available ranges. One of the goals in this patient’s treatment plan is to increase elbow ROM. With which of the following techniques should you begin to increase ROM? A. Cross-fiber massage of the tendons inserting at the elbow B. Joint-mobilization techniques to stretch the restricted joints (grade III sustained glide or grade IV oscillation techniques) after evaluating the reactivity of the elbow joints with grade II sustained glides C. Manual passive stretching to lengthen muscles that cross the elbow D. Passive ROM within pain-free ranges ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

2. When a period of continuous immobilization of the elbow is required after trauma or surgery, the elbow often is positioned in only a moderate amount of flexion (20° to 30°) rather than 90° of flexion. This position is selected to: A. Decrease the risk of ulnar neuropathy from compression of the ulnar nerve in the cubital tunnel. B. Decrease the risk of radial neuropathy from compression of the radial nerve in the cubital tunnel. C. Decrease the risk of median nerve neuropathy from compression in the cubital tunnel. D. Decrease the risk of overstretching the lateral collateral ligament complex of the elbow that could cause posterior translation of the radial head. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

3. The most common fracture in the elbow region is a fracture of the head and neck of the radius. All of the following are true about medical management of this injury except: A. Improved ROM is the primary indication for surgery and the primary goal of postoperative rehabilitation following a radial head fracture. B. Open reduction and internal fixation is the preferred technique if stable fixation can be achieved and the patient is a young, active adult. C. Closed reduction is preferred for radial head fractures in children. D. Biomechanical studies demonstrate that implant arthroplasty after a severely comminuted fracture restores stability and kinematics similar to the native radial head. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

4. A person with a long history of polyarticular rheumatoid arthritis is experiencing severe, dominant-side elbow pain that is interfering with personal grooming, light housework, and work-related responsibilities as a computer programmer. In addition to pain, physical findings include persistent synovitis despite ongoing medical management, limited elbow ROM, and complete loss of the joint space of the humeroulnar and humeroradial joints. Given these findings, this person is most likely a candidate for which of the following surgical procedures to relieve pain and improve daily function? A. Synovectomy B. Excision of the radial head coupled with prosthetic implant C. Total elbow arthroplasty D. Arthrodesis of the elbow ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

5. Which of the following is true about total elbow arthroplasty (TEA)? A. A semiconstrained, linked prosthesis allows flexion and extension of the elbow but not varus, valgus, or rotational motions. B. The typical method of fixation of the implants is all-cementless (all-biological) fixation. C. The surgical approach most often used leaves the triceps tendon intact. D. One of the more common, long-term complications after TEA is joint instability, particularly with unlinked implants or in patients who previously underwent excision of the radial head. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate Copyright © 2018 by F. A. Davis Company

6. Each of the following is a precaution that should be taken after TEA involving a triceps-reflecting or triceps-splitting approach except: A. Limit assisted elbow flexion to about 90° to 100° for the first 3 to 4 weeks postoperatively. B. For about the first 3 to 4 weeks, perform active elbow flexion/extension only while lying in the supine position. C. Postpone elbow extension against manual resistance or light weights for 6 weeks or longer. D. Avoid pushing motions with the operated upper extremity during functional activities, such as pushing up from a chair, for at least 6 weeks. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

7. Which of the following is true about myositis ossificans (heterotopic bone formation) in the elbow region? A. The muscle most often affected in the elbow region is the biceps brachii. B. It is distinguished from traumatic arthritis of the humeroulnar joint in that passive extension is more limited than flexion. C. After the acute inflammatory period, heterotopic bone is laid down within muscle fibers and within the joint. D. Before the bony mass in the muscle has matured, the muscle should be stretched and massaged regularly to prevent a contracture. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

8. You place your patient’s wrist in a splint because he is experiencing an acute episode of lateral epicondylitis. Which of the following is the least appropriate intervention while the inflamed soft tissue is healing? A. Have the patient wear a splint to immobilize the wrist continuously for at least 2 weeks or until there is no pain. B. Have the patient remove the splint several times each day and perform active or self-assisted ROM of the wrist within pain-free ranges. C. Have the patient remove the splint several times a day and perform gentle muscle-setting exercises, elongating the involved muscle-tendon unit slightly after each contraction but not beyond the pain-free ranges. D. Apply cross-fiber massage at the site of the lesion.

ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

9. You are modifying a home exercise program for a patient recovering from an episode of medial epicondylitis. Although pain has subsided, there is evidence of mild limitation of motion and pain when the involved muscle-tendon unit is placed on a stretch and overpressure is applied at the end of the available ROM. To fully lengthen the muscle-tendon unit typically involved in medial epicondylitis, have the patient perform a self-stretch by using the opposite hand to: A. Flex and ulnarly deviate the wrist and flex the fingers while the elbow is extended and the forearm is pronated. B. Flex and radially deviate the wrist and flex the fingers while the elbow is extended and the forearm is supinated. C. Extend and ulnarly deviate the wrist and extend the fingers while the elbow is extended and the forearm is pronated. D. Extend and radially deviate the wrist and extend the fingers while the elbow is extended and the forearm is supinated. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

10. To strengthen the elbow extensors in a closed chain, you have the patient perform push-ups, using body weight as the source of resistance. Which of the following variations of push-ups provides the greatest amount of resistance to the elbow extensors? A. Bilateral push-ups while in a fully prone position on the floor with weight on the hands and toes B. Bilateral wall push-ups while in a standing position and leaning into and pushing away from the wall C. Bilateral push-ups while standing and leaning on the hands on a kitchen countertop D. Bilateral push-ups in a prone position with weight on the hands and knees ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

11. Using a handheld weight as the source of resistance, which of the following positions to strengthen the elbow extensors begins with the long head of the triceps brachii fully lengthened? A. Have the patient assume a prone-lying position with the shoulder in 90° abduction, the upper arm supported on the table, and the elbow flexed to 90°. Copyright © 2018 by F. A. Davis Company

B. Have the patient assume the supine position with the shoulder flexed to 90° and the elbow flexed so the handheld weight touches the opposite shoulder. C. 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. D. While the patient is in a standing position and the hips are flexed to 90°, begin with the shoulder in hyperextension. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

12. Your goal is to increase end-range elbow flexion using joint-mobilization techniques. Which of the following techniques is appropriate? A. Stabilize the distal humerus and apply a proximal glide of the ulna B. Apply a valgus stress at the elbow C. Stabilize the humerus and apply a dorsal glide to the head of the radius D. Stabilize the distal humerus and apply an ulnar (lateral) glide of the ulna ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

13. You are educating your patient about returning to functional activities following a radial head resection with an implant. What should you tell her about returning to high-demand, high-impact activities? A. Avoid these activities on a permanent basis. B. Because she had a radial head implant, she may return to these activities after 6 months. C. She may return to heavy lifting after 6 months, but not high-impact (tennis or golf) activities because of the ballistic force these activities create. D. She should have had a TEA if she wanted to return to these activities. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

14. Tennis elbow may involve all of the following structures except the: A. Extensor carpi radialis brevis. B. Extensor communis. C. Pronator teres. D. Annular ligament. Copyright © 2018 by F. A. Davis Company

ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

15. Current research shows that the “survival rate” for TEA is: A. 30% over a 10-year period. B. Greater for patients with rheumatoid arthritis than for those with traumatic arthritis or osteoarthritis. C. Highly correlated with the type of implant (prosthesis). D. Greater for young, active adults who provide consistent stress to the fixation, encouraging increased bone formation and less loosening of the implant. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

Chapter 19: The Wrist and Hand

Multiple Choice

1. You are evaluating a patient with rheumatoid arthritis (RA) of the hand and wrist. You notice several deformities, including hyperextension of the proximal interphalangeal (PIP) joints and flexion of the distal interphalangeal (DIP) joints of digits 2, 3, and 4. This deformity is called: A. Swan-neck deformity. B. Heberden’s deformity. C. Boutonnière deformity. D. Saddleback deformity. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

2. What is the biomechanical cause of a Boutonnière deformity? A. Overstretching of the volar plate (palmar plate) and bowstringing of the lateral bands of the extensor hood mechanism B. Volar displacement of the extensor carpi ulnaris tendon, causing a flexion force at the wrist joint C. Rupture of the central band (central slip) of the extensor hood mechanism, causing the lateral bands to slip in a volar direction at the PIP joint D. Overstretching or rupture of the collateral ligaments of the metacarpophalangeal (MP) joints ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

3. Each of the following is true regarding management of the patient with RA of the hands except: A. Progressive resistance exercise is contraindicated so long as there are signs of inflammation. B. Principles of joint protection and energy conservation are integral components of patient education to reduce deforming forces on involved joints and reduce excessive fatigue. C. Application of an orthosis should be avoided in the rheumatoid hand because it promotes loss of joint mobility. D. With MP joint deformities, forceful pinch and grip exercises are contraindicated.

ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

4. Your patient has a 5-year history of RA. There are no obvious deformities, but during this current exacerbation of the disease, the wrist and MP joints are swollen, red, tender, and warm. There is generally decreased range of motion (ROM), pain during joint motion, and increased pain at the end of the available range of each joint. An appropriate short-term goal and intervention is: A. Minimize deforming forces by maintaining ROM with gentle, passive stretching to the involved joints. B. Maintain joint mobility and decrease pain by using grade I or II joint-oscillation techniques. C. Increase muscle length by using contract–relax (hold–relax) techniques. D. Control pain by imposing continuous rest and using orthoses on the wrists and hands. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

5. A patient with RA of the hands and wrists is experiencing an acute flare of the disease. To protect the inflamed joints and minimize deforming forces on the hands and wrists, you should teach the patient to: A. Avoid all activities with the hands until there is no pain. B. Avoid strong gripping motions that require wrist extension, radial deviation of the wrist, and ulnar deviation of the fingers. C. Exercise the hands in functional ways such as wringing out a dishrag under warm water. D. Stretch the extrinsic finger tendons across all the joints simultaneously to gain mobility and counter contractures. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

6. Which of the following is a relative or absolute contraindication for wrist arthroplasty despite debilitating pain in the wrist region and diminished hand and upper extremity function from advanced arthritis? A. Significant, arthritis-related, ipsilateral limitation of motion of joints proximal and distal of the wrist B. Subluxation or dislocation of the radiocarpal joint C. Previous arthritis-related arthrodesis of the opposite wrist where arthrodesis of both wrists Copyright © 2018 by F. A. Davis Company

would potentially reduce, rather than improve, function D. The need to perform high-load, high-impact occupational tasks postoperatively ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

7. Which of the following is least appropriate after arthroplasty of the wrist? A. Manual stretching techniques to restore full ROM of the wrist during the final phase of rehabilitation B. Active wrist flexion/extension (greater emphasis on extension) and forearm pronation/supination (greater emphasis on supination) as soon as the immobilization device can be removed for exercise C. Low-intensity (about 1 lb) dynamic resistance exercises of the wrist and hand during the intermediate and late phases of rehabilitation D. Use of the hand for light functional activities at about 3 months postoperatively ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

8. Which of the following is a true statement about MP arthroplasty and postoperative management of the fingers? A. Repair of ruptured extrinsic finger flexor tendons often is coupled with MP joint replacement arthroplasty for the patient with RA and chronic tenosynovitis. B. After MP arthroplasty and removal of the postoperative compression dressing, a dynamic orthosis with an outrigger is worn to maintain the MP joints in full extension when the fingers are relaxed but allow active MP flexion within a limited range and unrestricted interphalangeal (IP) motions. C. If a patient has an ulnar drift deformity of the fingers, use of a dynamic orthosis is contraindicated postoperatively. D. Use of a static orthosis has been shown to be an ineffective alternative to a dynamic orthosis for improving ROM and function after MP arthroplasty. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

A. Because correction of a boutonnière deformity during PIP arthroplasty involves a central slip-splitting approach, it is important to postpone resisted PIP extension exercises for at least 6 to 8 weeks. B. When initiating ROM of the PIP joint after PIP arthroplasty, stabilize the MP and DIP joints in neutral. C. For functional grasp after PIP arthroplasty, more flexion of the PIP joints of the index and middle fingers is necessary than flexion of the ring and little fingers. D. After PIP arthroplasty that included correction of a swan-neck deformity, emphasize PIP flexion and DIP extension more so than PIP extension and DIP flexion. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

10. Which of the following is a true statement about carpometacarpal (CMC) arthroplasty of the thumb and postoperative management? A. For a patient with erosion of the articular surfaces and subluxation of the CMC joint, joint replacement arthroplasty with prosthetic implants is a far more common procedure than trapezial resection/tendon interposition arthroplasty with ligament reconstruction. B. A longer period of immobilization of the thumb is required after total joint arthroplasty with prosthetic implants than after trapezial resection/tendon interposition arthroplasty with ligament reconstruction. C. After CMC arthroplasty, the thumb is immobilized in palmar abduction. D. A priority in a postoperative exercise program is to gain active radial adduction combined with palmar adduction of the thumb (sliding the thumb across the palm) as early as possible. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

11. Each of the following descriptions of the flexor zones of the hand and forearm is correct except: A. Zone I is where the flexor digitorum superficialis (FDS) tendon inserts; if the tendon avulses, the patient will be unable to flex the DIP joint. B. Zone II, known as “no-man’s land,” is where the extrinsic flexor tendons (flexor digitorum superficialis and profundus) lie in close proximity; range-limiting adhesions that prevent tendon gliding are likely to develop in this area after injury and repair. C. Zone III is in the palm of the hand; injury in this area can damage the lumbricales and interfere with MP flexion. D. Zone IV includes the carpal tunnel; the extrinsic flexor tendons can adhere in the tunnel following inflammation.

ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

12. Each of the following is true about the use of early controlled motion after tendon repair in the hand and forearm except: A. When ROM exercises are initiated, they are performed within a protected range to minimize the risk of excessive stress on the repair site and gapping of the repaired tendon ends. B. It has been shown to increase the tensile strength of the scar at the repair site more effectively than the use of prolonged immobilization after a surgical repair. C. It is thought to improve synovial fluid diffusion, thereby improving tendon nutrition and promoting tendon healing. D. It is used more often after extensor tendon repair than after flexor tendon repair. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

13. 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: A. Scar management with pressure on the scar. B. Tendon-gliding exercises. C. Gentle prolonged stretch. D. Progressive resistance exercise. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

14. Your patient sustained a laceration of the palmar aspect of the fingers in zone II (“no-man’s land”) of the hand. The patient subsequently underwent a repair of the lacerated tissues. During the subacute (moderate protection) phase of healing, it is critical to: A. Keep the fingers immobile because there is poor circulation and therefore poor healing in this area. B. Begin tendon-gliding exercises to minimize the formation of range-limiting adhesions. C. Initiate maximum-level resistance exercises of the extrinsic flexors to regain normal strength of the injured muscle-tendon unit. D. Limit exercise to passive ROM to protect the healing tendons. ANS: B Copyright © 2018 by F. A. Davis Company

KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

15. Which of the following is true about regimens that employ customized orthoses and early controlled motion after flexor tendon repair in zone I, II, or III? A. May involve the use of a dorsal tenodesis orthosis that allows full active extension of the wrist and MP joints B. May involve the use of a dynamic dorsal blocking orthosis with elastic bands attached, providing full passive extension of the fingers and allowing limited active flexion of the fingers C. May involve the use of a dynamic dorsal blocking orthosis with elastic bands attached, allowing limited active finger extension and providing passive finger flexion D. May involve the use of a volar tenodesis orthosis that allows full ROM of the wrist while maintaining the fingers in full extension ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

16. Each of the following is true about lesions of the extensor tendons of the wrist and hand except: A. A mallet finger is a lesion of the extensor mechanism of the DIP joint and is managed nonoperatively with an orthosis for positioning in full extension. B. A lesion of the central tendon (central slip) of the extensor hood, if untreated, will result in a PIP flexion contracture and boutonnière deformity over time. C. If a tendon lesion occurs in zone V, PIP and DIP extension is disrupted, but MP extension remains intact. D. A laceration of the extensor tendons in zone VII can cause a wrist flexion deformity and requires surgery to repair the lesion. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

17. “Place-and-hold” exercises are: A. A form of dynamic exercises in which the patient actively moves through a series of hand positions to prevent tendon adhesions. B. Gentle muscle setting (isometric/static) exercises used during the early phase of rehabilitation after, for example, a tendon repair, whereby an involved finger is placed passively in a particular position (by the therapist or by the patient using the sound hand); the patient then is asked to try actively to hold the position without assistance. Copyright © 2018 by F. A. Davis Company

C. A form of isometric exercise in which the therapist places a finger in a particular position and then asks the patient to hold the position as manual resistance is applied to the contracting muscle. D. A form of stretching exercise in which a patient is asked to perform an isometric contraction of a muscle-tendon unit against low-intensity resistance followed by relaxation and elongation of that muscle. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

18. Each of the following is true about flexor tendon-gliding exercises except: A. Maintain or develop free gliding between the FDS and FDP tendons. B. To perform these exercises, the patient actively moves the fingers into five different positions. C. To perform these exercises, the therapist passively moves the patient’s fingers into five different positions in a particular sequence. D. Maintain or develop free gliding between the FDS and FDP tendons and adjacent bones. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

19. Your patient has an “extensor lag” of the MP joints. What does this suggest? A. It is possible to extend the MP joint passively through the full range of extension, but full active MP extension is not possible, owing to weakness of the extensor digitorum. B. Posterior (dorsal) sliding of the proximal phalanx on the head of the metacarpal is restricted. C. Full passive MP extension is not possible. D. It is possible to extend the MP joint passively through the full range of extension, but full active MP extension is not possible, owing to weakness of the lumbricales. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

20. Your patient has an “extensor lag” of the MP joint. The exercise of choice to remediate this problem is which of the following? A. While stabilizing the IP joints of one finger in extension, passively extend the MP joint of that finger. B. Have the patient move actively from the straight fist position to the tabletop position of the hand. Copyright © 2018 by F. A. Davis Company

C. Have the patient move actively from the full fist position of the hand to the tabletop position. D. Have the patient move actively from the full fist position of the hand to the hook fist position. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

21. Prerequisites for successful PIP arthroplasty include all of the following except: A. Adequate bone stock. B. No history of chronic synovitis. C. Intact neurovascular system. D. Functioning flexor/extensor mechanism. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

Chapter 20: The Hip

Multiple Choice

1. Osteoarthritis of the hip is typically characterized by a progressive decrease in range of motion (ROM) of the following movement combinations: A. External rotation and extension. B. Internal rotation and extension. C. External rotation and adduction. D. Equal loss of internal and external rotation. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

2. When applying mobilization with movement techniques at the hip with the patient lying on a table in the supine position, the primary purpose of the mobilization belt is to: A. Apply a pain-free inferolateral glide of the femur. B. Apply a pain-free inferior glide of the femur. C. Apply a pain-free inferomedial glide of the femur. D. Support the weight of the leg, making it easier for the therapist to perform the mobilization maneuvers. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

3. Which of the following surgical approaches for conventional total hip arthroplasty is associated with the highest risk of postoperative hip dislocation if the hip flexes (passively or actively) beyond 80° to 90° during the early postoperative weeks? A. Lateral B. Anterolateral C. Posterolateral D. All approaches pose an equally high risk. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic Copyright © 2018 by F. A. Davis Company

4. The term hybrid total hip arthroplasty refers to a(n): A. Hip replacement with a cemented femoral component and a noncemented acetabular component. B. Total hip replacement that is all metal. C. Alternate term for bipolar hemiarthroplasty of the hip. D. Alternate term for minimally invasive arthroplasty. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

5. A patient who underwent a right cemented total hip arthroplasty through a posterolateral conventional incision 3 to 4 weeks ago is permitted to do each of the following except: A. Flexion of the operated hip to 80° or 90°. B. Pivot to the right while bearing weight on the operated lower extremity. C. Ambulation with crutches or a walker, bearing weight on the operated lower extremity as tolerated. D. Active abduction of the operated hip while standing on the sound lower extremity. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

6. Your patient had a total hip replacement 3 days ago and will be discharged from the hospital tomorrow. Your home instructions should include, but are not limited to, each of the following except: A. Avoid moving the hip past midline when moving in bed; do not cross your legs. B. Perform ankle-pumping exercises on a regular basis throughout the day with the legs elevated. C. Perform assisted, progressing to active, ROM exercises of the hip and knee within protected ranges. D. Whenever possible, perform transfers toward the operated side. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

hemireplacement of the hip (hemiarthroplasty)? A. Noncomminuted intertrochanteric fracture B. Displaced subcapital (intracapsular) fracture C. Unstable subtrochanteric fracture D. Hemiarthroplasty is equally indicated for intracapsular and extracapsular fractures. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

8. You are initiating postoperative treatment for a 78-year-old woman who sustained an intertrochanteric fracture of the proximal femur 3 days ago and immediately underwent open reduction with internal fixation (screw-plate fixation). She has been referred to physical therapy for postoperative exercise and gait/functional training (initially with minimal weight bearing on the operated side). A decision has not yet been made about whether this patient will be discharged directly to home where she lives with her husband or to a subacute skilled nursing facility. Prior to discharge from the hospital during the next few days, which of the following is the lowest priority intervention? A. Gait training with a walker and transfer/bed mobility training B. Active-assistive range of motion (A-AROM), progressing to active range of motion (AROM) of the operated hip C. Open-chain, resistance exercises for the operated lower extremity D. Closed-chain, resisted exercises for the upper extremities and sound lower extremity, emphasizing extension in functional patterns ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

9. Which of the following signs and symptoms in the hip region and/or lower extremity is most consistent with the finding associated with trochanteric bursitis? A. Pain along the lateral aspect of the hip joint and possibly along the lateral thigh and knee to the insertion of the iliotibial band; pain typically worsens during long periods of asymmetrical standing with more weight shifted to the involved side B. Pain that becomes evident during extended periods of sitting, with most pain experienced in the buttock region over the ischial tuberosities C. Groin and anterior thigh pain that becomes evident or is aggravated during activities that require repetitive hip flexion D. Groin pain at rest that increases with weight bearing coupled with a positive Trendelenburg sign and pain with hip abduction ANS: A Copyright © 2018 by F. A. Davis Company

KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

10. Each of the following principles is important when designing a therapeutic exercise program to correct hip muscle length/strength imbalances except: A. When stretching the hip musculature, the spine and pelvis must be stabilized against the force. B. Contraction of the muscle opposite the range-limiting muscle (i.e., contracting the antagonist of the tight muscle) to assist with the stretching maneuver has the benefit of training the antagonist muscle to function in any newly gained range. C. Because of the functional demands placed on the lower extremities, it is more important to have full hip ROM than to have “normal” strength of hip musculature. D. Strengthening exercises should include closed-chain exercises to prepare for functional activities in weight-bearing postures. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

11. Which of the following exercises, designed to self-stretch the hamstrings, is the safest and utilizes the most effective stabilization? A. Patient stands, bends forward, keeping both knees straight, and attempts to touch the nose to the thighs. B. Patient stands on one leg, places the other leg on a table, bends forward with the back straight, and reaches toward the foot of the elevated leg. C. Patient sits on the floor in a hurdler’s position, keeps the back straight, and reaches toward the foot of the straight leg. D. Patient sits on the floor in a long-sitting position with the knees straight and does a bilateral toe touch. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

12. Which of the following is a correct statement about arthrodesis of the hip? A. It is the surgery of choice for the elderly (greater than 75 years old) patient with an intertrochanteric fracture. B. It is commonly performed arthroscopically in young, active individuals. C. It is the procedure of choice for treating severe osteoarthritis that affects both the acetabular and femoral components of the hip. D. It is considered a salvage procedure when revision arthroplasty is not an option. Copyright © 2018 by F. A. Davis Company

ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

13. If a patient stands in a fencer’s posture but with the back leg externally rotated and then lunges forward, this self-stretching maneuver primarily stretches which muscle groups of the back leg? A. Hip abductors and external rotators B. Hip flexors C. Hip extensors D. Hip adductors and internal rotators ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

14. The clinical prediction rule for the diagnosis of osteoarthritis of the hip developed by Sutlive and colleagues includes consideration of all of the following variables except: A. Self-reported squatting aggravates symptoms. B. Walking more than one block causes groin and anterior thigh pain. C. Passive internal rotation is less than or equal to 25°. D. Scour test with adduction causes lateral hip or groin pain. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

15. Recent advances in arthroscopy of the hip now allow all of the following procedures to be performed using this less invasive technique except: A. Microfracture to stimulate fibrocartilage growth. B. Acetabular labral repair. C. Resurfacing arthroplasty. D. Capsulorrhaphy for capsular laxity. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

16. Hip flexor structural 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: A. Lengthened stride. B. Posterior lurch of the trunk at foot contact. C. Lateral shift of the trunk over the stance leg when the opposite leg swings. D. Forward flexion of the trunk during weight bearing. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

Chapter 21: The Knee

Multiple Choice

1. Each of the following is an expected outcome of conservative management of osteoarthritis of the knees except: A. Maintaining functional range of motion and strength. B. Relieving pain. C. Regenerating worn articular cartilage. D. Preventing deformity. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

2. Your patient reports a sudden onset of severe pain yesterday in the (L) posterior thigh while sprinting. Today he is unable to fully extend his (L) knee while walking because of pain. Which of the following interventions is most appropriate to use when initiating therapy today? A. Passive knee flexion/extension within the pain-free range with the hip flexed to 90° B. Passive knee flexion/extension within the pain-free range with the hip positioned in 0° extension C. Active knee flexion but no passive or active extension D. Submaximal resisted knee flexion in the prone-lying position ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

3. Your patient has degenerative joint disease of the knees. Although currently her left knee is asymptomatic, she has been experiencing pain and periodic “giving way” of her right knee for the past week. Her physician prescribed anti-inflammatory medication to reduce joint swelling and pain and has referred the patient to you for evaluation and treatment. The patient is experiencing significant stiffness of the knee, especially in the morning and after sitting for an extended period of time. Although she indicates that pain and swelling have decreased during the past few days since she began taking the prescribed medication, pain is still notable during walking and with movement toward the end of the range of motion (ROM) (more so in flexion than extension). Knee ROM is limited (active and passive knee flexion 100°; passive knee extension lacks 10°; active knee extension lacks 20°). Strength of knee musculature is 4/5. She Copyright © 2018 by F. A. Davis Company

exhibits an antalgic gait pattern. Which of the following interventions is most appropriate for this patient at this time? A. Quadriceps setting exercises, active ROM within pain-free ranges, resisted multiple-angle isometrics, dynamic control of the knee with bilateral closed-chain exercises, activity modification, and use of a cane during ambulation B. Ice, rest, active-assistive ROM through the pain-free range, quads and hamstring setting exercises, ambulation with crutches until pain and swelling subside C. Low-intensity stretching to increase knee flexion, static and dynamic strengthening with unilateral closed-chain exercises, stationary cycling D. Activity modification and use for an assistive device during ambulation, vigorous resistance exercises of the asymptomatic knee to improve strength, isometric resistance exercise, eccentric but no concentric resisted exercises of the involved knee, low-intensity stretching ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

4. A quadriceps lag may be described as: A. Patient has full active knee extension but exhibits increased time to peak torque when knee extensors are evaluated on an isokinetic dynamometer. B. Patient has full passive knee flexion but limited passive knee extension. C. Patient cannot actively extend the knee to full extension even though there is full passive knee extension. D. Another term for knee extension contracture. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

5. A surgical procedure for a repair of a chondral defect of the medial femoral condyle involves the following: harvesting multiple plugs of intact articular cartilage along with some subchondral bone of the patient’s own tissue from a donor site (typically a nonweight-bearing portion of the joint surface) and implanting the plugs (using a press fit) into the site forming a bone-to-bone graft. This procedure is called: A. Autologous chondrocyte implantation. B. Mosaicplasty. C. Microfracture. D. Débridement and lavage. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic Copyright © 2018 by F. A. Davis Company

6. Each of the following is true about guidelines for rehabilitation after a procedure to repair an articular cartilage defect except: A. ROM exercises (within a protected range) typically are begun a few days postoperatively. B. Protective bracing is worn during early weight bearing and exercises. C. The larger the articular defect is, the slower the progression of postoperative rehabilitation will be. D. Swimming and cycling are allowed and encouraged within 2 weeks to stimulate circulation and healing with limited weight bearing. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

7. Which of the following is true about total knee arthroplasty (TKA)? A. When a cruciate-retaining prosthesis/procedure is used for a TKA, the anterior cruciate ligament (ACL) is not excised, thus providing greater anterior-posterior stability to the knee. B. A tricompartmental TKA involves replacing not only the articulating surfaces of the proximal tibia and distal femur but also the tibiofibular articulation. C. If a semiconstrained or unconstrained prosthetic implant is used, the medial and lateral collateral ligaments (MCL and LCL) must be intact or repairable for adequate postoperative medial-lateral stability of the replaced joint. D. A mobile-bearing prosthesis typically is selected for the elderly, relatively sedentary patient because this design permits full weight bearing immediately. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

8. Each of the following is true about postoperative management after primary TKA except: A. Based on the design of the prosthesis, the use of grade III posterior joint gliding techniques may be an appropriate intervention to increase knee flexion after cruciate-excising TKA but not after cruciate-retaining TKA. B. If the TKA involved cementless fixation, weight-bearing recommendations vary widely from weight bearing as tolerated while using a walker or crutches to touch-down weight bearing for 4 to 6 weeks after surgery. C. Although straight-leg-raising exercises for the operated lower extremity are initiated in supine and prone positions as soon as possible during the early postoperative period, they often are delayed for several weeks in side-lying positions to avoid varus/valgus stresses on the operated knee. Copyright © 2018 by F. A. Davis Company

D. Participation in high-impact physical activities should be avoided after TKA, as it may contribute to mechanical loosening of the implanted prosthesis over time. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

9. Which of the following correctly identifies biomechanical abnormalities that contribute to patellofemoral pain or patellar instability? A. Genu varum, overstretched lateral retinaculum, weakness of the vastus medialis obliques (VMO) muscle, excessive supination of the feet, weakness of the hip adductors and internal rotators B. Weakness of the VMO, tight lateral retinaculum, genu valgum, excessive external tibial torsion, excessive pronation of the feet, weakness of the hip abductors and external rotators C. Excessive internal tibial rotation, genu varum, weakness vastus lateralis muscle, tight lateral retinaculum, excessive supination of the feet, weakness of the hip adductors and internal rotators D. Excessive external tibial torsion, genu valgum, weak vastus lateralis muscle, overstretched lateral retinaculum, excessive pronation of the feet, weakness of the hip abductors and external rotators ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

10. Although interventions used to manage patellofemoral pain syndrome are based on an examination of each patient on an individual basis, each of the following interventions is commonly employed except: A. Strengthening the knee and hip extensors in weight-bearing and non-weight-bearing positions. B. Lateral gliding of the patella. C. Stretching the tensor fasciae latae (TFL) and iliotibial (IT) band. D. Using an insert (orthotic device) in a patient’s shoe to correct excessive foot pronation. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

11. During closed-chain strengthening of the quadriceps, knee ROM in which the greatest amount of patellofemoral compression occurs is: A. At all portions of the ROM (i.e., compressive forces are equal throughout the ROM). B. Between 30° of knee flexion to full extension. Copyright © 2018 by F. A. Davis Company

C. Between 60° of knee flexion to 30° of knee flexion. D. Between 60° of knee flexion to full knee flexion. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

12. A patient with a history of recurrent dislocation of the patella underwent a surgical procedure for realignment of the extensor mechanism. Considering the position of immobilization postoperatively, you would expect to find each of the following impairments when it is permissible to begin exercises except: A. Lack of full or almost full passive knee extension. B. Quadriceps (extensor) lag. C. Lack of full knee flexion. D. Weakness of the quadriceps and hamstrings. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

13. Which of the following is true about ligament injuries of the knee and post-injury management? A. The most common mechanism of injury of the ACL is forceful internal rotation of the tibia while the foot is planted. B. Under similar noncontact conditions, a man is far more likely to injure the ACL than a woman. C. MCL injuries are managed nonoperatively more often than are ACL, posterior cruciate ligament (PCL), or LCL injuries. D. Forceful hyperextension of the knee is the most common mechanism of injury of the PCL. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

14. You are seeing a patient to initiate exercises 5 days after reconstruction of the ACL with a patellar tendon autograft. During the first phase of the postoperative exercise program, your primary concern is: A. Preventing contractures at the knee. B. Preventing atrophy and reflex inhibition of the quadriceps. C. Imposing controlled loads on the knee while protecting the graft from excessive stresses. Copyright © 2018 by F. A. Davis Company

D. Preventing joint swelling. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

15. Each of the following is true about patellar tendon versus hamstring tendon autografts for ACL reconstruction except: A. A longer healing time and a more slowly progressed rehabilitation program are required with a hamstring tendon graft than with a patellar tendon graft. B. A patellar tendon graft is most appropriate for the skeletally immature patient. C. Anterior knee pain and difficulty kneeling are somewhat frequent complications with a patellar tendon graft but not with a hamstring tendon graft. D. A patellar tendon graft involves bone-to-bone fixation, whereas a hamstring tendon graft involves tendon-to-bone fixation. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

16. Which of the following is true about managing a tear of the medial or lateral meniscus? A. A tear of the peripheral portion (outer zone) of a meniscus does not lend itself well to surgical repair because this portion of the meniscus is avascular and does not heal well. B. A potential complication of a medial meniscus repair is intraoperative damage to or postoperative entrapment of the saphenous nerve. C. After meniscus repair, initially avoid knee flexion beyond 60° to 70° during weight-bearing exercises for about 2 months because flexion beyond this range can displace the repaired meniscus in a posterior direction. D. After meniscus repair, the knee is immobilized in approximately 45° of flexion. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

17. Your patient has only 50° of passive and active knee flexion (but full passive extension) 2 weeks after removal of a cast for a fracture of the tibia. The bone is now radiologically healed. Each of the following techniques will be of value to increase the range of knee flexion except: A. The hold–relax technique, with isometric contraction of the hamstrings with the knee at 45°, followed by relaxation, then passive movement into more flexion. B. Low-load, long-duration self-stretching of the quadriceps. Copyright © 2018 by F. A. Davis Company

C. Posterior glide of the tibia. D. Caudal glide of the patella. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

18. Your patient has a capsular pattern, decreased joint play in the knee, and restricted mobility of the patella after a prolonged period of immobilization following a fracture. Which of the following mobilization techniques can be used to increase knee flexion? A. Posterior glide of the tibia on the femur with the tibia positioned in lateral rotation; caudal glide of the patella B. Posterior glide of the tibia on the femur with the tibia positioned in lateral rotation; superior glide of the patella C. Posterior glide of the tibia on the femur with the tibia positioned in medial rotation; superior glide of the patella D. Posterior glide of the tibia on the femur with the tibia positioned in medial rotation; caudal glide of the patella ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

19. The primary value of a patient performing quadriceps setting exercises when the knee is immobilized in a long leg cast for an extended period of time is to: A. Strengthen the quadriceps muscle. B. Maintain mobility of the patella. C. Stretch the anterior portion of the knee capsule. D. Prevent a knee extension contracture. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

20. The “minimally invasive knee arthroplasty” is one type of surgical approach for performing TKA. When the surgeon chooses this approach, it is because: A. It is easier to perform and therefore is the choice of the less-experienced surgeon. B. The incidence of intraoperative complications is lower. C. It is an arthroscopic procedure, so the rehabilitation is shorter. D. It is less disruptive to the soft tissue, with increased rate of postoperative recovery and less Copyright © 2018 by F. A. Davis Company

postoperative pain. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

21. During the initial assessment of a patient who complains of a recent onset of “knee pain” when descending stairs and a sense of “giving way” both on the stairs and when walking, you ask several questions about recent knee injuries. Which of the following injuries would lead you to believe the patient might have injured his ACL? A. A forward fall onto his knee directly striking his patella B. A blow to the inside of his knee when his dog was jumping up to greet him C. A twisting injury when he slipped off the curb and his knee buckled inward D. A running injury resulting in pain along the inferior border of the patella and the tibial tubercle ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

22. Research studies in the literature surrounding ACL rehabilitation have coined the terms potential copers and potential noncopers to identify and classify individuals with ACL injury who are good versus poor candidates for nonoperative rehabilitation. True copers applies to individuals who: A. Resolve personally to use a gait-assistive device and reduce their activity level to avoid surgery and have no incidence of knee buckling for at least 1 year. B. Complete a course of rehabilitation in preparation for surgical repair of the ACL in order to return to vigorous work or sporting activities within 1 year of injury. C. Successfully return to full pre-injury activity 1 year after injury with no episodes of knee buckling, following a rehabilitation program without surgery. D. Do nothing and develop a quad avoidance gait pattern within 1 year of injury. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

Chapter 22: The Ankle and Foot

Multiple Choice

1. Which of the following most accurately describes the deformities that progressively develop in rheumatoid arthritis (RA) of the foot/ankle? A. Fixed supination of the foot, hallux valgus, hallux rigidus, dorsal subluxation of the proximal phalanges on the metatarsal heads B. Fixed pronation of the foot, hallux valgus, hallux rigidus, plantar subluxation of the proximal phalanges on the metatarsal heads C. Fixed pronation of the foot, hallux valgus, hallux rigidus, dorsal subluxation of the proximal phalanges on the metatarsal heads D. Fixed supination of the foot, hallux valgus, hallux rigidus, plantar subluxation of the proximal phalanges on the metatarsal heads ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

2. Your patient has RA and is complaining of pain in her ankles and feet when walking. You observe her gait and notice short steps and poor push-off. This is consistent with what deformity in RA? A. Everted calcaneus and pronated forefoot B. Inverted calcaneus and pronated forefoot C. Everted calcaneus and supinated forefoot D. Inverted calcaneus and supinated forefoot ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

3. Your patient has a diagnosis of RA and is developing a capsular pattern in the foot and ankle. Which joint-mobilization technique could perpetuate or worsen the impairment/deformity typically associated with RA of the foot and ankle? A. Stabilize the mortise and glide the talus in an anterior direction B. Stabilize the calcaneus and glide the cuboid in a plantar direction C. Stabilize the talus and glide the navicular in a dorsal direction D. Stabilize the talus and glide the calcaneus in a lateral direction Copyright © 2018 by F. A. Davis Company

ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

4. Your patient sustained a fracture of the right calcaneus as the result of a motor vehicle accident 3 months ago. After 10 weeks in a cast followed by a rocker bottom immobilization boot that prevented ankle and foot motion, the fracture shows radiological evidence of bony union. The patient has been ambulating (weight bearing as tolerated) while wearing the boot and is now supposed to discontinue wearing it slowly. Your examination reveals marked limitation of dorsi- and plantarflexion and a high, rigid arch. There is no visible swelling, and pain (2/10) occurs at the end of the day and during passive range of motion (PROM) with overpressure. Which of the following is the most appropriate intervention during the first week of therapy? A. PROM of the ankle (dorsiflexion/plantarflexion and calcaneal inversion/eversion) B. Gentle passive stretching of ankle musculature C. Grade II joint mobilization at the subtalar joint D. Grade III joint mobilization at the midtarsal joint ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

5. Each of the following is a true statement about total ankle arthroplasty (TAA) and postoperative rehabilitation except: A. At the close of surgery, the foot and ankle typically are immobilized in a neutral position in a well-padded compression dressing and short-leg posterior splint. B. A patient with peripheral arterial disease of the lower extremities in addition to advanced arthritis of the ankle is not an appropriate candidate for TAA. C. After a TAA that involved biological fixation, weight bearing on the operated lower extremity during ambulation with a walker initially is permissible only while wearing an ankle immobilizer and may need to be partially restricted for several weeks to allow time for some degree of bioingrowth to occur. D. TAA is an appropriate procedure for a patient with advanced arthritis combined with marked instability of the ankle. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

A. Increased mediolateral stability of the ankle. B. Alleviation of pain. C. Sufficient range of motion (ROM) of the ankle for functional activities. D. Decreased joint deformity. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

7. A patient underwent a triple arthrodesis of the hindfoot 12 weeks ago and is now allowed to ambulate without the rigid boot. The patient has been referred to you for exercises to improve ROM and strength of the operated lower extremity and to re-establish a normal gait pattern. Which of the following interventions is inappropriate to include in your treatment plan to restore this patient’s function? A. Passive stretching of the plantar flexors B. Grade III medial and lateral sustained glides to increase inversion and eversion C. Grade III sustained posterior glides of the talus on the tibia to increase dorsiflexion D. Closed-chain training to improve lower extremity control ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

8. A 40-year-old teacher who has been referred to you has experienced pain along the plantar aspect of the heel for more than 6 months. It is most noticeable when getting out of bed in the morning, upon standing after sitting for longer than 1 hour, and after playing racquetball. During walking, pain is most noticeable at the terminal stance/pre-swing phase of gait. The mostly likely disorder causing these symptoms is: A. Plantar fasciitis. B. Calcaneal bursitis. C. Achilles tendinitis. D. Posterior tibialis tendinitis. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

B. Anterior talofibular C. Calcaneofibular D. Deltoid ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

10. Following a severe, third-degree (grade 3) inversion sprain, your patient complains of pain just distal and lateral to the knee joint. The pain is likely the result of: A. Subluxation of the proximal tibiofibular joint. B. Tear of the lateral collateral ligament. C. Tear of the lateral head of the gastrocnemius. D. Referred pain from gait deviations due to sore ankle joints and ligaments. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

11. Your patient has regained normal strength (5/5) and ROM during rehabilitation following a traumatic injury that severely stressed several ligaments and joints of the ankle. He continues to have poor control while walking on gravel or other uneven surfaces. To address this problem, your exercise program should focus on: A. Strengthening exercises for the invertor and evertor muscles of the ankle using elastic resistance. B. Stretching the invertor and evertor muscles of the ankle. C. Performing progressive balance training with closed-chain disturbed balance activities on a rocker/balance board. D. Practicing walking on uneven surfaces while wearing a custom-made ankle/foot orthosis that controls inversion and eversion. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

12. Each of the following is true about surgical repair/reconstruction of the lateral ligament complex of the ankle and postoperative management except: A. The most common procedure is a direct repair and imbrication of the torn ligaments through an open surgical approach. B. After reconstruction of the lateral ligaments that includes a tendon autograft and tendon Copyright © 2018 by F. A. Davis Company

transposition (often the peroneus brevis tendon) to reinforce the lateral aspect of the ankle, there may be some permanent loss of full ankle inversion postoperatively. C. The ankle is immobilized in plantarflexion and slight eversion for 4 to 6 weeks postoperatively; therefore, the patient must remain nonweight bearing on the operated lower extremity during the period of immobilization to prevent rupture of the repair site. D. It is usually permissible to remove the ankle immobilizer by about 4 to 6 weeks postoperatively to begin active ROM exercises of the ankle. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

13. Your uncle called you last night after playing three games in a softball tournament yesterday. He indicated that late in the third game while trying to stretch a double into a triple, he felt a sudden sharp pain in his calf, which significantly interfered with his ability to continue running. He is able to move his foot “up and down,” but both motions are painful. He is also able to walk if he “takes it slow.” From the information your uncle gave you and the fact that he is a 42-yearold weekend warrior, your preliminary hypothesis is that your uncle may have sustained a(n): A. Fracture of the tibia. B. Achilles tendon rupture. C. Plantaris rupture. D. Syndesmosis injury. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

14. Which of the following special tests may be used to confirm or rule out a rupture of the Achilles tendon during a patient’s physical examination? A. Thompson test B. Anterior drawer of the ankle C. Talar tilt test D. Test for Homan’s sign ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region Difficulty: Basic

15. During initial evaluation of a patient with a complaint of low back pain, you perform a standing posture alignment screening and discover that his left leg appears shorter than the right Copyright © 2018 by F. A. Davis Company

as you compare iliac crests, greater trochanter, head of the fibula, and medial malleolus. What related possible foot deformity should you look for while still in standing? A. Excessive right foot pronation compared with the left B. Excessive left foot pronation compared with the right C. Excessive left foot supination compared with the right D. Hallux valgus on the right ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region Difficulty: Intermediate

16. John is a 25-year-old active athlete and outdoorsman who suffered a severe lateral ankle injury 5 years ago, resulting in progressive subtalar arthritis, pain, and instability of the ankle and hindfoot. His quality of life and ability to work are now restricted owing to the pain and instability despite repeated sessions in therapy. The surgical procedure of choice for John is most likely: A. Arthrodesis (fusion). B. Total ankle arthroplasty. C. Brostrom procedure. D. Watson-Jones procedure. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region Difficulty: Intermediate

Chapter 23: Advanced Functional Training

Multiple Choice

1. Plyometric drills are prescribed to improve which dimension of muscle performance? A. Balance B. Flexibility C. Power D. Endurance ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

2. As you develop progressions of exercise programs for varied patients, which of the following describes the appropriate use of plyometric drills? A. Pediatric programs should include plyometric drills because they are fun to perform and will engage the patient in functional activities. B. Patients with unstable joints should perform plyometric drills early in the course of therapy to challenge firing of antagonistic muscle groups. C. Every patient on a strengthening program should progress to plyometric drills during the return-to-function phase of rehabilitation. D. Patients in advanced phases of rehabilitation should be trained to return to high-demand functional activities and sports ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

3. All of the following are examples of plyometric activities for the upper extremities except: A. Overhead catching and throwing a weighted ball to a rebounder. B. Performing diagonal patterns with a barbell weight. C. Dribbling a basketball. D. Swinging a weighted golf club. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

4. Your patient is nearing the end of his rehabilitation for return to sport and is performing more of his program independently at home. As you are providing education regarding precautions and recognizing signs and symptoms, you discuss how much recovery time he should allow between sessions of high-intensity plyometric drills. Based on research, how much time do you suggest? A. 15–30 minutes B. 24 hours C. 48–72 hours D. 8–12 hours ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

5. Your patient is in the return-to-function phase of rehabilitation after recovering from a sprained ankle. She wants to be able to resume her hobby of extensive gardening and yard work. Which of the following combinations of progressions for balance describes less to more difficult activities? A. Stationary to moving surface, wide-base to narrow-base stance, high-magnitude to lowmagnitude perturbations B. Bilateral to unilateral stance, firm surface to soft surface, slow- to high-speed repetitions C. Narrow-base to wide-base stance, bilateral to unilateral activities, small- to large-range motions D. Single leg to tandem stance, open environment to closed environment, unresisted to resisted movements ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

6. Each of the following describes the concept and/or mechanism of plyometrics except: A. High-velocity eccentric to concentric muscle loading. B. Stretch-strengthening drills. C. Stretch-lengthening drills. D. Reactive neuromuscular training. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

7. Which of the following is true of the “amortization phase” of plyometric exercises? A. The contracting muscle reverses action from deceleration to acceleration of the load. B. The contracting muscle reverses action from acceleration to deceleration of the load. C. The time frame of this phase is increased as the plyometric activity is progressed. D. The stretch reflex is activated during this phase. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

8.When designing an exercise program to return a patient to his/her prior functional level, each of the following guidelines is true except: A. Proximal stability is a requirement for controlled distal mobility. B. Coordinated segmental and global stability of the spine is needed for execution of functional tasks with safe body mechanics. C. Stability of each joint is necessary for effective function of the extremities. D. Exercises for strength and power should precede balance and stability exercises. ANS: D KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

9. For an individual to be able to execute functional activities, it is necessary to have the ability to maintain the position of the body in equilibrium within the environment. This state of equilibrium is called: A. Power. B. Endurance. C. Postural stability. D. Strength. ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

10. Exercise programs developed specifically to increase strength will require a progression that focuses on: A. Increasing the number of repetitions. B. Increasing the resistance.

C. Increasing the speed of performance. D. Increasing the duration of the exercise. ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

11. An exercise program that is designed to train the neuromuscular system to react quickly for activities, sports, or occupations that require quick starts and stops consists of exercises in which of the following categories? A. Open-chain kinetic B. Isokinetic C. Plyometric D. Stretch-lengthening drills ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

12. You have been treating a 25-year-old soccer player, who has been recovering from hip bursitis. She is pain free and performing routine activities of daily living, walking and running without symptoms. She is now progressing to a phase of advanced functional training to prepare her for the quick turns, starts and stops, and dynamic single leg stances when kicking the soccer ball. Which of the following activities would be appropriate to include in her program to specifically achieve these functional tasks? A. Open-chain knee extension on a resistance machine after establishing her 1 Rep Max B. Single leg stance on a stable surface, increasing the duration to 90 seconds C. Zigzag forward hopping D. Pushing and pulling heavy objects ANS: C KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

13. Another term for the concept of plyometric training is reactive neuromuscular training. At the cellular and neuromuscular receptor level, which of the following describes the mechanism of plyometrics? A. The eccentric contraction stimulates and activates the monosynaptic stretch reflex in the muscle and so prepares the muscle for a concentric contraction.

B. The concentric contraction (stretch shortening drill) builds power that is released in the eccentric (lengthening drill) that follows. C. A slow eccentric (lengthening) contraction stretches the muscle spindle, transmitting a more powerful concentric (shortening) contraction. D. Quick eccentric loads expend energy that is then transmitted to the muscle spindle, resulting in muscular hypertrophy and increased power. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Difficult

14. Contraindications to the use of plyometrics include all of the following except: A. Individuals under 10 years or over 70 years. B. Painful joints. C. Acute inflammation. D. Unstable joints. ANS: A KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Basic

15. Moving and planting activities, in which the patient is required to move, change position, and then hold the position (freeze) are most appropriate for a patient returning to which activity/function? A. An usher at a sporting event who has to stand for long periods B. A traveler who needs to use escalators routinely both with luggage and without C. A receptionist who frequently transitions from sit to stand and escorts individuals to their meetings D. A tour guide who walks for long distances on cobblestones or other uneven surfaces ANS: B KEY: Book Part: Part IV: Exercise Interventions by Body Region DIF: Intermediate

Chapter 24: Exercise in the Older Adult

Multiple Choice

1. Exercise is described as planned, structured, and repetitive in nature. All of the following are examples of exercises for the older adult except: A. Tai Chi classes. B. Aerobic classes. C. Fixing meals. D. Walking with a weighted vest. ANS: C KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

2. Prevention through healthy life choices is important for slowing the decline of function in the older adult. Which of the following is an example of a prevention activity that a 70-year-old individual could adopt as a means to slow progression of primary aging? A. Sit down and rest several times per day. B. Sleep at least 10 hours per night. C. Avoid stairs to reduce risk of falls. D. Take an aerobics class 2–3 times per week. ANS: D KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

3. Aging that occurs as a natural developmental process as a result of the passage of time is defined as: A. Primary aging. B. Hypokinesis. C. Sarcopenia. D. Secondary aging. ANS: A KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

4. Older adults become less efficient during gait. A common gait deviation that contributes to this inefficiency is: A. Faster gait speed. B. Lack of hip extension. C. Exaggerated heel strike. D. Narrow step width. ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

5. Normal aging results in progressive loss of muscle mass characterized by: A. Death of alpha motorneurons at the spinal cord resulting in decline of innervation to individual muscles. B. Reduction in size but not number of muscle fibers. C. Atrophy of type I fibers and hypertrophy of Type II muscle fibers. D. Loss of muscle mass beginning in the sixth decade of life. ANS: A KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

6. Abnormally diminished muscular function or mobility experienced by many older adults in the old-old stage of life is defined as: A. Hypokinesis. B. Secondary aging. C. Senescence. D. Sarcopenia. ANS: A KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

7. The Wellness Aging Model Related to Illness, Injury, and Mobility (WAMI-3) exemplifies the concept that physical activity and exercise add life to years. All of the following behaviors will produce a leftward shift on the WAMI-3 indicating a decline in function except: A. Bed rest. B. Early mobilization. Copyright © 2018 by F. A. Davis Company

C. Hypokinesis. D. Osteoporosis. ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

8. Which of the following is a consideration when designing aerobic exercise programs for an older adult population? A. Aerobic exercise is contraindicated after age 80 unless it is performed in water. B. Maximum heart rate is age-related and decreases with age. C. Blood pressure decreases because of increased peripheral vascular resistance. D. Heart rate increases, resulting in greater cardiac stroke volume. ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

9. Which of the following best describes what is visually depicted in the WAMI-3 model? A. A comparison of three stages of life aging using chronological versus functional age. B. The progression of fall risk based on comorbidity, disease processes, and aging C. The progressive loss of strength and power, bone strength, muscle mass, and cardiovascular and pulmonary function associated with aging and the impact of physical activity and exercise. D. Representation of three stereotypes related to aging that have created a lack of focus on the importance of exercise and wellness for the older adult ANS: C KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

10. Which of the following combinations of activities best describes a balanced multidimensional exercise program designed for the older adult to emphasize healthy living? A. Passive range of motion (PROM), ambulation, resistance training with less than 5 pounds for the arms and less than 10 pounds for the legs B. Low-impact aerobics, water resistance exercises, active range of motion (AROM) C. Aerobics, flexibility, strengthening, balance D. Unweighted rowing, bicycling, neutral incline treadmill walking ANS: C KEY: Book Part: Part V: Special Areas of Therapeutic Exercise Copyright © 2018 by F. A. Davis Company

DIF: Intermediate

11. Which of the following accurately represents appropriate guidelines for developing a safe and effective progressive resistance training program for your patient who is age 85? A. High-intensity progressive resistance exercise is contraindicated in patients older than age 80. B. Each session should include warm-up, stretching, functional or sport-specific exercises, and cool-down. C. Strength cannot be gained in patients with low muscle mass, and resistance training will be detrimental. D. Resistance exercises beyond the seventh decade should only be performed as part of an aquatic program to reduce the stress on joints and soft tissue. ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

12. A 68-year-old female patient with mild osteoarthritis (OA) of the hips and knees and a recent diagnosis of sarcopenia obesity has been referred to you for strength training. What special considerations will be necessary for you to consider when developing a resistance training program for this individual? A. The first priority should be weight loss management to reduce the stress on the joints. The program should be designed to burn more calories than consumed using high-intensity, resistance exercises. B. Limit exercise to three times a week to control the inflammatory response of the OA and instruct the patient that resistance exercise must be performed at very low intensity because of the frailty associated with the sarcopenia. C. Resistance training is indicated for both diagnoses and should be tailored to match frequency, intensity, and duration of exercise to her abilities and goals. D. Resistance training is contraindicated because of the risk factors for potential stress fractures, falls, and cardiac compromise associated with her diagnoses. ANS: C KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

13. Your patient has type 2 diabetes mellitus and is on insulin. He arrives at 9 a.m. for a 1-hour resistance, aerobic, balance, and flexibility program under your supervision. You inquire whether he has checked his glucose level this morning and he indicates that it was 100 mg/dL. What decision do you make about his treatment today? A. No exercises can be performed; reschedule him for tomorrow. Copyright © 2018 by F. A. Davis Company

B. Call the emergency medical service because his condition is unstable. C. Proceed with exercises while monitoring his tolerance and provide a carbohydrate snack and fluids to assure hydration. D. Use this day to advance his program to the next level, challenging him with high-intensity, progressive activities ANS: C KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

14. A 60-year-old female is referred to rehabilitation for evaluation and assessment after several recent falls. Which of the following describes indications that are suspicious of tertiary osteoporosis? A. History of spinal compression fractures and a height loss of 3 inches B. Transient joint and bone pain C. Family history of osteoporosis, personal history of smoking and alcohol abuse D. Sedentary life-style, obesity, kyphotic posture ANS: A KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

15. Standardized testing should be used with all patients to establish a baseline for initiation of activities. The design of an exercise program for the older adult should include performance of specific tests to measure performance levels and tolerance for activities. Which of the following will provide a measure of self-perceived intensity of exercise based on level of exertion? A. Fracture risk assessment tool (FRAX®) B. Timed-up-and-Go test (TUG) C. Stopping Elderly Accidents, Deaths, & Injuries tool (STEADI) D. Borg scale of perceived exertion ANS: D KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

Chapter 25: Women’s Health: Obstetrics and Pelvic Floor

Multiple Choice

1. Each of the following is a normal change during pregnancy except: A. Increased secretion of insulin. B. Decreased ligamentous stability. C. Decreased resting heart rate. D. Increased thyroid activity. ANS: C KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

2. During the last trimester of pregnancy, pain in the groin area is often caused by overstretching of the: A. Broad ligament. B. Round ligament. C. Uterosacral ligament. D. Pubococcygeal ligament. ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

3. During pregnancy, each of the following changes in the respiratory system occurs except: A. Increased respiratory rate. B. Increased O2 consumption and increased work of breathing. C. Relatively unchanged or slightly decreased total lung capacity. D. State of hyperventilation throughout pregnancy. ANS: A KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

A. Superior and posterior B. Superior and anterior C. Inferior and posterior D. Inferior and anterior ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

5. Common postural changes/deviations that develop or become exaggerated during pregnancy include each of the following except: A. Decreased thoracic kyphosis. B. Increased internal rotation of the shoulders. C. Excessive lumbar lordosis. D. Genu recurvatum. ANS: A KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

6. Each of the following contributes to the potential for pelvic floor muscle dysfunction following pregnancy except: A. Planned cesarean delivery. B. Injury to the pudendal nerve. C. Tear/surgical laceration of the perineal body. D. Stretch to the pelvic floor during late stage of pregnancy. ANS: A KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

7. Which of the following is a true statement about diastasis recti? A. It affects function of only the rectus abdominis muscle. B. It is characterized by a separation of abdominal muscles at the linea alba. C. Corrective exercise is recommended if the diastasis is greater than 1 cm. D. The etiology during pregnancy is well understood. ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic Copyright © 2018 by F. A. Davis Company

8. Each of the following is true about diastasis recti except: A. A diastasis of the rectus abdominis is more prevalent in women with multiple pregnancies. B. Manual support of the abdominals during abdominal exercises over the course of pregnancy corrects a diastasis. C. The highest incidence of diastasis recti is during the third trimester. D. A separation of the rectus muscle along the linea alba that is more than two finger widths is clinically significant. ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

9. Which of the following is true about testing for a diastasis recti? A. The fingertips are placed vertically at the midline of the abdomen (parallel along the linea alba) at the level of the umbilicus to assess the size of the separation. B. Place the heel of your hand across the abdomen and apply light compression at the level of the umbilicus and have the patient cough. C. The test is performed with the patient in a hook-lying position and having her perform an abdominal contraction by lifting her head, shoulders, and trunk off the support surface. D. The fingertips are placed horizontally at the midline of the abdomen (perpendicular to the linea alba) at the level of the umbilicus to assess the size of the separation. ANS: D KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

10. Which of the following activities should be used initially to correct a diastasis recti postpartum? A. Have the patient lie supine, arms at sides, and do a partial sit-up (until scapulae clear the surface). B. Have the patient lie supine, arms across the abdomen, and perform leg lowering from a 90° position. C. Have the patient lie supine, arms across the abdomen, and perform head lifts. D. Have the patient avoid all abdominal exercises until the diastasis corrects itself. ANS: C KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

11. Which of the following is true about sacroiliac (SI) joint pain experienced during pregnancy? A. Pain often radiates from the buttock region distally to the foot. B. Asymmetrical lower extremity weight-bearing activities aggravate the pain. C. Resting on a soft support surface typically alleviates the pain. D. Hypomobility of the SI joint typically is evident. ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

12. Which of the following statements adequately represents aerobic exercise guidelines for a woman during an uncomplicated pregnancy? A. Continue exercise at levels prior to pregnancy with the understanding that a lower intensity of exercise results in the same level of exertion. B. Limit exercise to three times a week at a target heart rate during exercise based on a conventional age-based calculation. C. Women who have not been exercising prior to pregnancy should wait for 3 months after delivery to begin an exercise program. D. If a woman has exercised prior to pregnancy, all types of exercise can be continued throughout pregnancy, including those with ballistic end-range movements and rapid changes of direction. ANS: A KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

13. Which of the following is an absolute contraindication to participating in an exercise program during pregnancy? A. Diastasis recti B. Gestational diabetes C. Maternal type 1 diabetes D. Obesity ANS: C KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

and contact a physician before resuming exercise except: A. Transient pubic pain. B. Irregular heart rhythm. C. Vaginal bleeding. D. Uterine contractions that persist after cessation of exercise. ANS: A KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

15. An exercise program that includes posture training to counter the expected postural changes that occur during pregnancy should emphasize each of the following except: A. Strengthening scapular retractors. B. Strengthening hip extensors. C. Strengthening abdominals (low-intensity). D. Strengthening shoulder internal rotators. ANS: D KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

16. Varicose veins are aggravated during pregnancy due to all of the following except: A. Increased venous distensibility. B. Shift in the center of gravity superiorly and anteriorly. C. Increased uterine weight. D. Venous stasis in the legs. ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

17. Which of the following is true of nerve supply (innervation) of the pelvic floor complex? A. Damage to the nerve supply of the pelvic floor complex during labor and delivery is one of the main contributors to organ prolapse. B. There are multiple and varied innervations from inconsistent sacral levels that innervate this area. C. The pudendal nerve is the sole innervation for the pelvic floor. D. The nerve supply is at risk with a 4° episiotomy, often resulting in permanent paralysis of the anal sphincter.

ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

18. Which of the following is true about physical therapy intervention for pelvic floor dysfunction? A. Men are twice as likely as women to experience urinary incontinence but are unwilling to seek medical care. B. The primary contributing factor for pelvic floor dysfunction in men is prostate enlargement or prostate cancer treatment. C. Biofeedback used to help patients perform effective pelvic floor contractions is not possible for men because the penis and scrotum block visualization of the internal structures. D. Females who have not been pregnant and males do not experience pelvic floor dysfunction, because it is directly associated with childbearing and childbirth. ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

Chapter 26: Management of Lymphatic Disorders

Multiple Choice

1. Each of the following is true about lymphedema except: A. Pitting edema is classified as more severe than brawny edema. B. Lymphedema typically is seen with disorders of the venous or lymphatic systems but not with peripheral arterial vascular disease. C. Lymphedema typically is most apparent peripherally (e.g., over the dorsum of the foot) but can also manifest centrally (e.g., in the groin area). D. Secondary lymphedema as the result of trauma, surgery, or a tumor is far more common than primary lymphedema. ANS: A KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

2. Each of the following is a recommendation advocated for the prevention or management of lymphedema except: A. With unilateral upper extremity lymphedema, have blood pressure taken on the noninvolved arm. B. Avoid carrying heavy objects or lifting heavy weights with the involved upper extremity. C. Elevate the involved limb(s) on a regular basis. D. Use a hot tub for relaxation or to perform repetitive exercises to promote circulation. ANS: D KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

3. Which of the following correctly describes components of a comprehensive program and related procedures for management of lymphedema? A. Compressive bandaging or garments are worn only during rest, not during exercise. B. During manual lymphatic drainage (massage), the proximal areas, such as the groin or axilla, are cleared of fluid before the peripheral areas. C. Active exercises but not resistive exercises are included in the exercise program. D. A sequential pneumatic compression pump is used as an alternative, not an adjunct, to complex decongestive therapy.

ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

4. Which of the following factors associated with breast cancer surgery and adjuvant therapy is least likely to contribute to impaired shoulder mobility? A. Incisional pain B. Chemotherapy C. Fibrosis of tissues in the axillary area as the result of radiation therapy D. Increased thoracic kyphosis related to incisional pain or age ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

5. Which of the following is the least advisable means of preventing limitations of the glenohumeral joint and improving shoulder range of motion (ROM) after mastectomy? A. Self-assisted ROM of the involved upper extremity B. Wand exercises C. Pendulum exercises D. Wall-climbing exercises with the involved upper extremity ANS: C KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

6. Each of the following is true about a comprehensive exercise program for lymphatic drainage except: A. Exercises are performed in a specific sequence, exercising proximal muscle groups before distal muscle groups. B. If lymphedema is unilateral, exercises are performed with the noninvolved extremity before the involved extremity. C. Many of the active exercises of the involved limb(s) are performed with the limb(s) elevated above the heart. D. Each exercise for the involved limb(s) should be performed until the patient feels an aching in the exercising muscles to ensure a training effect. ANS: D KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate Copyright © 2018 by F. A. Davis Company

7. The purpose of the lymphatic system is to collect and transport fluid from the: A. Lungs to the venous system. B. Interstitial spaces to the venous system. C. Interstitial spaces to the kidneys. D. Interstitial spaces to the blood capillaries. ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

8. Signs and symptoms of chronic venous insufficiency can include any of the following except: A. Venous distention in the affected limb. B. Dependent peripheral edema. C. Brownish pigmentation of the affected limb. D. Severe pain with the limb in an elevated position. ANS: D KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

9. Which of the following describes the severity of lymphedema from least to most severe? A. Pitting, brawny, weeping B. Brawny, pitting, weeping C. Weeping, brawny, pitting D. Pitting, weeping, brawny ANS: A KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

10. You have completed the examination and evaluation and determined that your patient presents with right upper extremity lymphedema. The edema is soft and pitting without evidence of tissue fibrosis, and the patient reports that elevation of the extremity reduces the swelling temporarily. What stage of lymphedema do you document? A. Stage 0—latency stage B. Stage I—reversible stage C. Stage II—spontaneously irreversible Copyright © 2018 by F. A. Davis Company

D. Stage III—lymphostatic elephantiasis ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Basic

11. As part of the patient evaluation, you perform tests and measures to document your findings in a standard and objective way. You document a positive Stemmer sign when you find which of the following? A. There is tenderness of the lymph nodes on palpation. B. Skin on the dorsum of the fingers could not be pinched. C. Skin is shiny and red. D. Viscous fluid is weeping from the skin. ANS: B KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

12. Intervention goals for lymphedema include all of the following except: A. Educating the patient in techniques for self-management. B. Reducing the risk of infection. C. Softening of fibrotic tissue. D. Resolving the lymphedema and returning the lymphatic system to a normal state. ANS: D KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

13. The treatment of lymphedema with compression therapy to the limb involves a combination of bandaging and use of compression garments. The type of compression to use depends on the phase of lymphedema treatment and the desired outcome. Which of the following is true regarding the proper utilization of compression treatment? A. During phase II, a custom compression bandage or an AceTM wrap can be used by the patient for self-management. B. During phase I, only high-stretch bandages are used to provide continuous high resting and working pressure until limb reduction is achieved. C. Low-stretch bandaging is used to achieve limb reduction in phase I and to continue limb reduction intervention at night during phase II. D. Ace wraps are used during phase I to achieve limb reduction and during phase II to control limb size during vigorous activity. Copyright © 2018 by F. A. Davis Company

ANS: C KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Difficult

14. Axillary web syndrome is a relatively common condition that develops after treatment for breast cancer. It is recognized by which of the following signs and symptoms? A. A feeling of heaviness in the upper extremity during active flexion and adduction, indicating the initial sign of lymphedema B. Muscle guarding and tenderness of the cervical muscles with fibrosis of the sternocleidomastoid muscle limiting ROM of the neck C. Cording of the lymphatic vessels from the axilla to the antecubital space and/or forearm restricting shoulder mobility D. Weakness of the serratus anterior after lymph node dissection resulting from surgical damage to the long thoracic nerve ANS: C KEY: Book Part: Part V: Special Areas of Therapeutic Exercise DIF: Intermediate

15. Lymphatic dysfunction may result from all of the following except: A. Trauma. B. Congenital or hereditary factors. C. Infection. D. Diet. ANS: D KEY: Book Part: Special Areas of Therapeutic Exercise DIF: Basic

16. Which of the following is a true statement about lymphedema? A. It is a disease of the lymphatic system. B. It occurs when the transport capacity exceeds the lymphatic load. C. It consists primarily of water and protein found in the extracellular spaces. D. It is a natural immune response to trauma and initially is beneficial during the early phases of healing. ANS: D KEY: Book Part: Special Areas of Therapeutic Exercise DIF: Basic Copyright © 2018 by F. A. Davis Company

17. There are many interventions used to manage the signs and symptoms of lymphedema. Of the following, which is considered to be the least effective based on current evidence? A. Liposuction B. Manual lymphatic drainage C. Pneumatic compression pump D. Exercise ANS: C KEY: Book Part: Special Areas of Therapeutic Exercise DIF: Basic