Question 1

Which of the following best describes the &#34;stretch window,&#34; or the optimal time in which to stretch following heating of a tissue?&#10;A) A period of time in which tissue temperature will continue to rise and stretching should be done following this waiting period&#10;B) A period of time in which stretching should be applied, as the change in tissue temperature is likely at peak&#10;C) A period of time in which metabolic activity of the tissues is greatest, thus stretching has the greatest opportunity to increases tissue healing&#10;D) A period of time in which strengthening exercises are recommended due to increased blood flow in the area heated

Accepted Answer

The "stretch window" is the optimal time for stretching following heating of a tissue, and it occurs when the tissue temperature is at its peak. This is when the tissue is most pliable and receptive to stretching, making it easier and safer to perform. Waiting too long after heating or stretching too soon can lead to injury.

Question 2

When heating muscle tissues prior to stretching, what is the minimum increase in temperature for eliciting plastic deformation in the tissues?&#10;A) 39&#176;F&#10;B) 15&#176;F&#10;C) 60&#176;F&#10;D) 100&#176;F&#10;

Accepted Answer

When heating muscle tissues prior to stretching, a minimum increase in temperature of 39°F (about 4°C) above normal body temperature is generally considered necessary to achieve plastic deformation in the tissues. This increase in temperature helps to make the collagen within the muscle fibers more pliable, which can improve the effectiveness of stretching and potentially reduce the risk of injury. It's important to note that heating should be done carefully to avoid burns or excessive heating, which can damage the tissues.

Question 3

Which of the following recommendations is most critical when using therapeutic modalities to increase ROM?&#10;A) Stretching of the restricted tissue should occur during and/or immediately after administration of the therapeutic modality.&#10;B) Thermal modalities should never be used to increase ROM in tissues that are restricted as a result of a burn.&#10;C) Only aggressive manual stretching should be used after administration of a therapeutic modality to increase ROM.&#10;D) Benefits from using therapeutic modalities to increase ROM are only observed for chronic conditions resulting in restricted ROM.

Accepted Answer

Stretching during or immediately after the administration of therapeutic modalities is critical to maximize the effects of the modality and increase ROM. This helps to prevent the tissue from contracting again and reinforces the gains made during the treatment session. B is incorrect because thermal modalities can be used to increase ROM in burned tissues if they are not actively inflamed. C is incorrect because aggressive manual stretching after administration of a therapeutic modality may cause further tissue damage or injury. D is incorrect because therapeutic modalities can be beneficial for both chronic and acute conditions resulting in restricted ROM.

Question 4

For a patient having undergone ankle immobilization following a sprain, which of the following clinical measures best supports the administration of therapeutic modalities?&#10;A) Active range of motion (AROM) ankle dorsiflexion of +2 degrees&#10;B) AROM ankle inversion of 40 degrees&#10;C) 4+/5 strength of the ankle evertors&#10;D) Decreased stance time during gait

Accepted Answer

AROM ankle dorsiflexion of +2 degrees indicates limited range of motion, which may benefit from therapeutic modalities such as joint mobilization, stretching or massage. The other options do not provide as clear indication of the need for therapeutic modalities.

Question 5

For which of the following diagnoses would use of extracorporeal shockwave therapy be most indicated?&#10;A) Restricted wrist flexion following prolonged immobilization stemming from a distal radius fracture&#10;B) Restricted dorsiflexion stemming from chronic plantar fasciitis&#10;C) Limited shoulder flexion due to posterior shoulder tightness&#10;D) A knee flexion contracture following a total knee arthroplasty

Accepted Answer

Extracorporeal shockwave therapy (ESWT) is most commonly used for the treatment of chronic plantar fasciitis, as it has been shown to be effective in reducing pain and improving function in this condition. It is not typically used for the other diagnoses listed, which may require other interventions such as physical therapy, stretching, or surgery.

Question 6

Which one of the following is not a commonly used clinical method of using electrical stimulation for improving range of motion (ROM) affected by spasticity?&#10;A) Motor level stimulation over the antagonist muscle&#10;B) Motor level stimulation over the spastic muscle&#10;C) Sensory level stimulation over the spastic muscle&#10;D) Sensory level stimulation over the antagonist muscle

Accepted Answer

Motor level stimulation is used to facilitate the antagonist muscle, which helps to reduce spasticity and improve ROM. Sensory level stimulation over the spastic muscle can help to reduce spasticity and improve ROM by activating inhibitory pathways. Motor level stimulation over the spastic muscle can also be used to induce fatigue and reduce spasticity. However, sensory level stimulation over the antagonist muscle is not a commonly used clinical method for improving ROM affected by spasticity.

Question 7

Extracorporeal shockwave therapy is thought to impart what physiological effect?&#10;A) An inflammatory response in the target tissues and changes in the viscoelasticity of those tissues&#10;B) Changes in cell membrane permeability to facilitate angiogenesis&#10;C) Hyperpolarization of the peripheral free nerve endings to decrease pain&#10;D) An increase in microvascular blood flow to perfuse injured tissues

Accepted Answer

Extracorporeal shockwave therapy is thought to impart an inflammatory response in the target tissues and changes in the viscoelasticity of those tissues. This can lead to increased blood flow and the stimulation of tissue regeneration.

Answer: D
 Extracorporeal shockwave therapy is also thought to cause an increase in microvascular blood flow to perfuse injured tissues. This can promote healing and reduce pain.

Options B and C are not correct as there is no evidence to suggest that extracorporeal shockwave therapy causes changes in cell membrane permeability or hyperpolarization of peripheral free nerve endings to decrease pain.

Question 8

Which of the following modalities is most appropriate to use on a patient with decreased ROM due to restrictions in the posterior hip capsule?&#10;A) Pulsed ultrasound&#10;B) Pulsed shortwave diathermy&#10;C) Heating pad&#10;D) Extracorporeal shockwave therapy

Accepted Answer

Pulsed shortwave diathermy is effective for deep tissue heating, which can help increase tissue extensibility and improve range of motion in the posterior hip capsule.

Question 9

Which of the following modalities is most appropriate for use over the Achilles tendon to facilitate an increase in dorsiflexion ROM?&#10;A) Heating pack&#10;B) Fluidotherapy&#10;C) Continuous ultrasound&#10;D) Paraffin wax

Accepted Answer

Continuous ultrasound has been shown to be effective in increasing dorsiflexion ROM when applied over the Achilles tendon due to its ability to increase tissue temperature and improve extensibility of collagen fibers. Heating pack, fluidotherapy, and paraffin wax may provide some superficial warming and relaxation, but do not have the same depth of penetration as ultrasound and may not be as effective in increasing ROM.

Question 10

Which of the following best describes the current amplitude necessary when neuromuscular electrical stimulation (NMES) is used to increase ROM through muscle activation?&#10;A) An amplitude that is greater than 80% of the maximal voluntary isometric contraction&#10;B) An amplitude that elicits fasciculations, but below the level of tetany&#10;C) An amplitude that elicits muscle contractions capable of moving the joint through the desired ROM&#10;D) An amplitude that is just below the motor threshold

Accepted Answer

The current amplitude necessary when NMES is used to increase ROM through muscle activation should elicit muscle contractions that are capable of moving the joint through the desired ROM. This means that the amplitude should be high enough to produce some movement but not so high that it causes discomfort or fatigue in the patient.

Deck 12: Therapeutic Modalities for Improving Range of Motion