Advanced Modalities in Physical Therapy
Exam Questions
Course Introduction
This course explores the principles and application of advanced therapeutic modalities used in physical therapy practice. Emphasizing evidence-based approaches, students will study the physiological effects, indications, contraindications, and clinical integration of modalities such as electrical stimulation, therapeutic ultrasound, laser therapy, cryotherapy, thermotherapy, shockwave therapy, and hydrotherapy. The course includes critical analysis of current research, case-based discussions, and practical laboratory sessions designed to enhance clinical decision-making and proficiency in selecting and administering advanced modalities for diverse patient populations.
Recommended Textbook Michlovitzs Modalities for Therapeutic Intervention 6th Edition by James W. Bellew PT EdD
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17 Chapters
315 Verified Questions
315 Flashcards
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Sample Questions
Q1) What type of energy does diathermy use to heat biological tissues?
A) High-frequency sound waves
B) Electromagnetic radiation
C) Compressive and distractive forces
D) Convective currents
Answer: B
Q2) Conditions or factors of a patient that make using a specific modality inadvisable are called
A) Indications
B) Contraindications
C) Summations
D) Limitations
Answer: B
Q3) "Therapeutic modality" can imply the type of energy used by the modality, the method of application of the modality, and which of the following?
A) Agents that alter metabolic rates in biological tissues
B) Modes of therapy frequencies that are synchronous with the body's energy
C) Any type of intervention that results in healing of tissues
D) A specific energy range of the modality
Answer: D
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Chapter 2: Cold Therapy Modalities
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Sample Questions
Q1) Which of the following cold therapy applications is most appropriate for the given scenario?
A) Cold whirlpool for left upper extremity pain in patient with hypertension
B) Ice massage for right lateral epicondylitis in patient with history of cryoglobulinemia
C) Controlled cold therapy unit for acute left ankle sprain in patient with medical history of diabetic neuropathy
D) Cold pack to cervical spine following whiplash injury in patient with leukemia
Answer: D
Q2) Which of the following cold therapy modalities has the most research support for effectiveness in the treatment of myofascial pain syndrome?
A) Ice massage
B) Vapocoolant spray
C) Cold compression unit
D) Gel cold pack
Answer: A
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4
Chapter 3: Therapeutic Heat
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Sample Questions
Q1) Decreased muscle tone or spasm in response to heat is primarily caused by
A) Increased rate of firing of type II efferents, resulting in relaxation response
B) Decreased rate of firing of type Ib efferents, resulting in decreased production of neurotransmitters at the neuromuscular junction
C) Increased golgi tendon organ (GTO) activity, resulting in decreased stretch on muscle spindle
D) Decreased gamma efferent activity, resulting in decreased muscle spindle activity
Answer: D
Q2) Which of the following statements about paraffin baths is true?
A) Paraffin conducts heat to tissues slower than water of the same temperature.
B) Paraffin has a higher specific heat than water.
C) Paraffin should never be used over healed burn areas because this tissue is very fragile.
D) When used to increase joint range of motion, a patient should do active exercises while immersed in the paraffin.
Answer: A
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Chapter 4: Therapeutic Ultrasound
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Sample Questions
Q1) The relationship between US frequency and depth of penetration is
A) Higher frequency US penetrates deeper than lower frequency US.
B) Lower frequency US penetrates deeper than higher frequency US.
C) Lower frequency US penetrates less deep when compared to higher frequency US.
D) There is no relationship between the US frequency and the depth of penetration.
Q2) The technique used to reduce the risk of burning while still getting an effective treatment with an ultrasound applicator with a high beam nonuniformity ratio (BNR) is to
A) Move the US applicator while applying the US.
B) Use pulsed rather than continuous US.
C) Turn down the intensity of the applied US.
D) Use water rather than ultrasonic gel during the US application.
Q3) A common mistake made by therapists in heating a tissue using ultrasound is
A) Selecting the incorrect frequency
B) Selecting the incorrect applicator size
C) Selecting the incorrect mode: pulsed or continuous
D) Applying US over too large of an area
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Chapter 5: Hydrotherapy: the Use of Water As a Therapeutic Agent
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Sample Questions
Q1) The "dive reflex" causes which of the following physiological responses when most of the body is immersed in water?
A) Increased heart rate
B) Peripheral vasodilation
C) Shunting of blood to vital organs
D) Decreased blood flow to the brain
Q2) A 38-year-old male with cerebral palsy is referred for balance and gait training secondary to severe balance and endurance problems that were the result of a medication reaction used to treat anxiety. Which of the following is true regarding pool therapy for this patient?
A) Pool therapy is contraindicated for this patient because of his severe balance problems.
B) He would likely benefit from exercise on a treadmill in a pool to improve endurance.
C) Pool therapy can be used to improve endurance, balance, and gait.
D) He cannot begin pool therapy until his anxiety is controlled by medication.
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Chapter 6: Electromagnetic Modalities: Laser, Diathermy, and
Pulsed Electromagnetic Fields
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Sample Questions
Q1) Dosage for LLLT should be documented as which of the following?
A) Watts per square centimeter or point
B) Joules per square centimeter or point
C) Photons per centimeter or point
D) Milliamps per centimeter or point
Q2) Which of the following answers includes only contraindications and precautions for diathermy?
A) Metal implants, pacemaker, muscle spasm
B) Over cancerous tissue, hemophilia, over testes
C) Pregnancy, pelvic inflammatory disease, non-acute inflammation
D) Infection, chronic obstructive pulmonary disease (COPD), mechanical joint pain
Q3) Which of the following modalities would be the best choice to heat the posterior hip joint capsule prior to joint mobilization?
A) Pulsed electromagnetic fields (PEMFs)
B) Continuous shortwave diathermy (CSWD)
C) Low-level laser therapy (LLLT)
D) 3 MHz continuous ultrasound
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Page 8
Chapter 7: Spinal Traction
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Sample Questions
Q1) Which of the following is the most important parameter to consider when the goal of traction is separation of lumbar vertebral bodies?
A) Using heat before and during traction
B) Selecting an appropriate force
C) Using the supine position with the legs supported on a small stool
D) Using an intermittent setting
Q2) What is the evidence of the effect of lumbar traction on intradiscal pressures?
A) Intradiscal pressures increase during traction then gradually decrease after traction. B) Intradiscal pressures decrease during traction then rapidly return to normal after traction.
C) There is no effect on intradiscal pressure during or after traction.
D) The effect on intradiscal pressure during traction is unpredictable.
Q3) How much traction force is required to overcome friction of the lower body when doing lumbar traction?
A) One-half to three-quarters of body weight
B) Approximately 20 pounds
C) Up to approximately one-half of body weight
D) Greater than 150 pounds
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9
Chapter 8: Intermittent Pneumatic Compression
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Sample Questions
Q1) Which of the following treatment parameters for IPC would be best for a patient with upper extremity post-mastectomy stage 1 or 2 lymphedema?
A) 30 to 50 mmHg for 60 minutes once or twice per day
B) 50 to 80 mmHg for 30 minutes three or four times per day
C) 80 to 100 mmHg for 20 minutes once per day
D) 100 to 120 mmHg for 10 minutes every 2 hours
Q2) Which of the following instructions would be most helpful for a patient who has just completed the first IPC treatment for lower extremity edema?
A) Put the leg in a dependent position as soon as possible to prevent ischemia.
B) Compensatory swelling in other areas of the body is an expected response to IPC.
C) Avoid moving the treated limb for as long as possible.
D) Wear compression garments to maintain changes in limb volume.
Q3) Which of the following is a contraindication for IPC?
A) Persistent lower extremity edema secondary to congestive heart failure
B) Chronic venous stasis ulcer on the foot
C) Acute local dermatological infection
D) Lymphatic edema following mastectomy
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Chapter 9: Foundations of Clinical Electrotherapy
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Sample Questions
Q1) What can be done clinically to decrease impedance between the electrode and the skin?
A) Use smaller electrodes to disperse the current over a smaller area.
B) Use electrodes with gel or adhesive conductive agents.
C) Apply a thin layer of dry gauze between the electrode and the skin.
D) Strap electrodes tightly to the skin or place a sandbag on top of the electrode.
Q2) Low-intensity direct current (LIDC) is most commonly used clinically for which of the following?
A) Promotion of wound healing by augmenting the current of injury
B) Control of postoperative pain
C) Facilitation of capillary bed circulation in superficial tissues
D) Desensitization of trigger points
Q3) According to Ohm's law, an 80 volt (V) circuit passing through 4 ohms of tissue impedance (resistance) will have how many amps (A) of current?
A) 240 A
B) 160 A
C) 0.05 A
D) 20 A
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11
Chapter 10: Clinical Electrical Stimulation: Application and Techniques
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Sample Questions
Q1) What is a "motor point"?
A) Location of receptors in the skin that best respond to electrical stimulation
B) Place where the greatest motor response is found for a given amount of stimulation
C) Point over a muscle where point stimulation will locate greatest resistance to current
D) Hypothetical location of alpha motor neuron in the muscle
Q2) What will happen to the current density under each electrode if lead wires are bifurcated and attached to multiple electrodes?
A) Decreased at each individual electrode
B) Increased at each individual electrode
C) Decreased at the original electrodes and increased under the newly added electrodes
D) No change
Q3) How often can a typical disposable electrode be reused before it should be discarded?
A) Once
B) Twice
C) Depends on the amount of adhesive gel that is applied to the electrode
D) 15 to 20 times
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Chapter 11: Mechanisms of Pain and Use of Therapeutic Modalities
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Sample Questions
Q1) Which of the following best describes the evidence-supported level of stimulation amplitude, or intensity, to be used when administering TENS?
A) The amplitude should be just above the sensory threshold.
B) Current amplitude should never rise beyond the motor threshold.
C) Current amplitude should be increased to noxious levels for best effectiveness.
D) Current amplitude should be as strong as is tolerated while still comfortable.
Q2) When selecting small electrodes to administer TENS, which of the following must be considered in regard to the patient's perception and tolerance of the stimulation?
A) Hypersensitivity reactions
B) Inter-electrode distance
C) Current density
D) The electrode polarity
Q3) Analgesic tolerance is most likely to occur with what type of opioid receptor?
A) Kappa
B) Mu
C) Delta
D) Gamma
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Page 13
Chapter 12: Therapeutic Modalities for Improving Range of Motion
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Sample Questions
Q1) Which of the following recommendations is most critical when using therapeutic modalities to increase ROM?
A) Stretching of the restricted tissue should occur during and/or immediately after administration of the therapeutic modality.
B) Thermal modalities should never be used to increase ROM in tissues that are restricted as a result of a burn.
C) Only aggressive manual stretching should be used after administration of a therapeutic modality to increase ROM.
D) Benefits from using therapeutic modalities to increase ROM are only observed for chronic conditions resulting in restricted ROM.
Q2) 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?
A) Motor level stimulation over the antagonist muscle
B) Motor level stimulation over the spastic muscle
C) Sensory level stimulation over the spastic muscle
D) Sensory level stimulation over the antagonist muscle
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14
Chapter 13: Electrotherapy for Musculoskeletal Disorders
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Sample Questions
Q1) Which of the following types of ES is required for ES of denervated muscle?
A) Direct current (DC)
B) Alternating current (AC)
C) Biphasic pulsed
D) Interferential
Q2) What two goals do biofeedback and electrotherapy have in common?
A) Stimulation and recruitment of muscle fibers
B) Enhancement of circulatory dynamics and reduction of muscle spasm
C) Increase in muscle strength and motor unit recruitment
D) Reduction of pain
Q3) Which of the following is a contraindication for biofeedback?
A) Muscle spasticity
B) Diabetes
C) Peripheral neuropathy
D) There are no contraindications for biofeedback.
Q4) During NMES, what pattern of recruitment of motor units will most likely occur?
A) Spatial and temporal
B) Smallest to largest
C) Largest to smallest
D) Only the largest motor units will be recruited.
Page 15
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Chapter 14: Neuromuscular Electrical Stimulation Nmes
and Functional Electrical Stimulation Fes in Patients With
Neurological Diagnoses
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Sample Questions
Q1) Which of the following is supported by the literature when performing cycling FES for patients with spinal cord injuries?
A) 10 or 20 minutes every day
B) 30 to 60 minutes three times per week
C) 10 minutes three times per day, three to four times per week
D) 60 to 90 minutes five times per week
Q2) Which of the following is the primary benefit of FES cycling for spinal cord injured patients?
A) Increased strength of lower extremity muscles
B) Decreased incidence of pressure wounds
C) Improved cardiovascular health
D) Facilitation of standing and walking using the Parastep system
Q3) Studies have shown that FES for upper extremity function has been effective in facilitating functional use of the extremity in which of the following patient populations?
A) Those who have had a stroke
B) Those with traumatic brain injury
C) Those having a spinal cord injury
D) All of the above
Page 16
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Chapter 15: Therapeutic Modalities for Tissue Healing
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Sample Questions
Q1) Which parameters of ultraviolet C (UVC) light will reduce bacterial counts in chronic wounds?
A) UVC source perpendicular to and 1 inch from wound, repeated exposures of 10 seconds
B) UVC source perpendicular to and 1 inch from wound, repeated exposures of 180 seconds
C) UVC source 25 degrees from perpendicular to and 1 inch from wound, repeated exposure of 90 seconds
D) UVC source perpendicular to and 3 to 5 inches from wound, repeated exposures of 3 minutes
Q2) Which of the following is a proposed mechanical effect of intermittent pneumatic compression (IPC) that promotes wound healing?
A) Increased peak blood flow velocity
B) Decreased arterial blood pressure
C) Increased venous blood pressure
D) Decreased oxygenated blood
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17
Chapter 16: Alternative Modalities for Pain and Tissue Healing
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Sample Questions
Q1) Which of the following is the proposed physiological effect of HBOT?
A) Increased release of nitrous oxide from red blood cells
B) Release of histamine and bradykinins into the circulatory system
C) Softening of tropocollagen bonds in connective tissues
D) Increased amount of physically dissolved oxygen in plasma
Q2) Which of the following patients should not have hyperbaric oxygen therapy treatment?
A) A 23-year-old male with migraine headaches
B) A 36-year-old female with untreated pneumothorax
C) A 66-year-old male with complex regional pain syndrome
D) An 82-year-old female with refractory osteomyelitis
Q3) Which statement regarding magnet therapy is correct?
A) Most magnets used for therapeutic effects produce a pulsed magnetic field.
B) Magnet therapy originated about 50 years ago with the development of the unipolar magnet.
C) Results of research have yet to show any effect of magnetic fields on cell function in vitro.
D) Bipolar magnets are arranged so that both poles are facing or in contact with the skin.
Page 18
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Chapter 17: Electrophysiological Testing of Nerves and Muscles
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Sample Questions
Q1) Which of the following muscles is most commonly examined in an NCS for possible axonotmesis of the median nerve?
A) Abductor digiti minimi
B) Flexor digitorum profundus
C) Abductor pollicis brevis
D) Extensor digitorum brevis
Q2) Which of the following statements regarding the effect of age on the results of an NCS is true?
A) Values for children under age 7 are about twice the values of adults.
B) Values decline about 1 to 2 meters per second for each decade over age 60.
C) Age has a minimal effect on values in children and adults.
D) Normal adult values are not achieved until after age 18.
Q3) Why must the temperature of the examination room be kept at a constant temperature and skin temperature monitored during nerve conduction studies?
A) Fluctuations in temperature will cause patients to be uncomfortable during the test.
B) Decreased temperatures will result in slowing of nerve conduction velocity.
C) Muscle response to stimulation will be altered if the temperature varies.
D) Decreased temperatures will result in faster nerve conduction velocities.
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