Manual Therapy and Physical Agents
Test Preparation
Course Introduction
This course delves into the principles and clinical application of manual therapy techniques and physical agents used in physical rehabilitation. Students will explore various forms of hands-on therapy such as joint mobilization, soft tissue manipulation, and myofascial release, alongside the physiological effects and therapeutic uses of modalities including heat, cold, ultrasound, and electrical stimulation. Emphasis is placed on assessment, patient safety, contraindications, evidence-based practice, and integration of manual and agent-based interventions to enhance functional outcomes for musculoskeletal and neuromuscular conditions.
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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2
Chapter
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15 Verified Questions
15 Flashcards
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Sample Questions
Q1) Which of the following outcomes is most recommended for determining the effectiveness of therapeutic modalities?
A) Pain reduction
B) Functional improvements
C) Changes in range of motion
D) Reduction of stiffness
Answer: B
Q2) Which of the following modalities is capable of delivering heat to tissues?
A) Intermittent compression
B) Handheld ice cups
C) Continuous ultrasound
D) TENS
Answer: C
Q3) 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
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Chapter 2: Cold Therapy Modalities
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23 Verified Questions
23 Flashcards
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Sample Questions
Q1) Which of the following cold therapy techniques has the greatest danger of causing a neurapraxia or axonotmesis?
A) Ice bag around the elbow for more than 1 hour
B) Cold water bath for a sprained ankle for 15 minutes
C) Vapocoolant spraying of the hamstrings at their origin
D) Ice massage for 5 minutes over the lateral epicondyle
Answer: A
Q2) Which of the following cold therapy applications best fits the given patient problem?
A) Ice massage for acute exacerbation of metacarpophalangeal joint pain in patient with rheumatoid arthritis
B) Cold whirlpool for patient with acute anterior thigh contusion
C) Vapocoolant spray for limited knee flexion in patient who is 3 days post total knee surgery
D) Cold pack for patient with shoulder pain 2 days following traumatic subluxation
Answer: D
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Chapter 3: Therapeutic Heat
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23 Verified Questions
23 Flashcards
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Sample Questions
Q1) One advantage of heat over cold therapy is
A) Heat increases the resistance of collagen to a deforming force, resulting in improved scar strength.
B) Heat decreases soft tissue swelling more than cold.
C) Heat decreases joint stiffness, while cold increases stiffness.
D) Heat decreases cellular metabolism, reducing the risk of hypoxic injury.
Answer: C
Q2) Select which treatment duration is appropriate for the given heating agent.
A) Moist hot pack to increase blood flow in subacute thigh strain, no less than 45 minutes
B) Fluidotherapy to achieve "vigorous" heating of the hand, 5 minutes
C) Air-activated heat wrap for acute back pain, 4 to 8 hours
D) Paraffin bath "dip and reimmerse" to increase collagen extensibility, 3 minutes after creating wax glove
Answer: C
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5
Chapter 4: Therapeutic Ultrasound
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20 Verified Questions
20 Flashcards
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Sample Questions
Q1) 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
Q2) The best estimate of effective radiating area (ERA) of the ultrasound applicator is
A) Area of the faceplate of the applicator
B) Area of the piezoelectric crystal
C) Area of the total applicator including handle
D) There is no way to estimate the ERA.
Q3) There is strong substantiated evidence for the use of continuous US to treat
A) Pain and dysfunction of carpal tunnel syndrome
B) Pain and dysfunction associated with lateral epicondylitis
C) Limited range of motion (ROM) associated with frozen shoulder
D) Dysfunction associated with nonspecific shoulder conditions
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Chapter 5: Hydrotherapy: the Use of Water As a Therapeutic Agent
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20 Verified Questions
20 Flashcards
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Sample Questions
Q1) A 66-year-old woman fell and sprained her left wrist 2 days ago. Today she will begin physical therapy for the sprained wrist. She has pain and moderate swelling of the wrist, and she is unable to perform active ROM exercises because of pain with movement. Which of the following would be an appropriate hydrotherapy treatment for her wrist today?
A) High-boy whirlpool with water temperature of 38°C with maximum agitation
B) Small whirlpool with water temperature at 25°C with low agitation
C) Low-boy whirlpool with water temperature at 80°C with moderate agitation
D) Pool therapy to enable patient to exercise while her left wrist is healing
Q2) Your patient is a 64-year-old female with chronic back pain. Which of the following is the most appropriate hydrotherapy intervention for this patient?
A) Floating on her stomach in a pool while performing arm and leg raises
B) Swimming laps in a pool using standard overhead freestyle stroke
C) Sitting in a low-boy whirlpool with warm water with the agitation directed at her back
D) Floating on her back in a pool while performing arm and leg exercises
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Page 7
Chapter 6: Electromagnetic Modalities: Laser, Diathermy, and
Pulsed Electromagnetic Fields
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20 Verified Questions
20 Flashcards
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Sample Questions
Q1) 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
Q2) Thermal effects of diathermy are believed to be caused by which of the following?
A) Accelerated motion of ions, dipoles, and/or electron clouds
B) Depolarization of peripheral neurons, resulting in vasodilation
C) Magnetic optimization of resonance frequencies
D) Attenuation of energy beam as it travels through tissue interfaces
Q3) Which is true regarding the physical properties of laser light?
A) Laser light is generated by spontaneous emission.
B) Light from a laser scatters like an overhead lamp.
C) The color of laser light depends on the medium through which it travels.
D) Laser light is monochromatic and coherent.
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Page 8
Chapter 7: Spinal Traction
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15 Verified Questions
15 Flashcards
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Sample Questions
Q1) 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
Q2) Which of the following is an appropriate guideline regarding the patient's response to traction?
A) Some discomfort is expected during traction and may temporarily increase afterward.
B) Traction should relieve pain in an extremity but may increase neck or back pain.
C) Pain increases during traction are common but should diminish afterward.
D) The patient should not have an increase in symptoms during or after traction.
Q3) What is the evidence on the effect of cervical traction on intervertebral foramina dimensions?
A) Decrease during traction application
B) Correction of intervertebral foraminal impingement
C) Increase during traction application
D) No effect on foramina dimensions
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Page 9
Chapter 8: Intermittent Pneumatic Compression
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15 Flashcards
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Sample Questions
Q1) Venous thromboembolism (VTE) can be prevented by the use of intermittent pneumatic compression (IPC) and which of the following?
A) Frequent superficial massage of immobilized limbs
B) Resistance exercises for the affected limbs
C) Alternate application of heat and cold modalities to the limbs
D) Avoidance of bedrest and early mobilization
Q2) Shortness of breath following IPC may indicate
A) The pressure was set too high during treatment and must be reduced next treatment.
B) The duration of the treatment was too long and must be reduced next session.
C) There may be a fluid overload in the lungs or a pulmonary embolism.
D) This is a normal response to IPC and there is no cause for concern.
Q3) IPC pressure must be above which of the following arterial capillary pressures to be useful in assisting an arteriovenous (A-V) pressure gradient and encouraging the absorption of edema?
A) 30 mmHg
B) 10 mmHg
C) 60 mmHg
D) 120 mmHg
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Chapter 9: Foundations of Clinical Electrotherapy
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20 Verified Questions
20 Flashcards
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Sample Questions
Q1) Which electrochemical effects match the given electrode polarity?
A) Hydrochloric acid produced under the anode results in softening of hard scar tissue.
B) The alkaline reaction under the cathode results in softening of the underlying tissues.
C) Sodium hydroxide that builds up under the anode results in sclerosis of tissues.
D) The chemical reactions that occur under the cathode are related to an increase in acidity.
Q2) Which of the following statements is true about charge?
A) There are three types of charge: positive, negative, and neutral.
B) Like charges attract, whereas opposite charges repel.
C) Charge is neither created nor destroyed.
D) Charge cannot be transferred between objects.
Q3) The greatest amount of electrothermal heating occurs with which of the following currents?
A) Alternating current
B) Direct current
C) Monophasic pulsed current
D) Biphasic pulsed current
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11
Chapter 10: Clinical Electrical Stimulation: Application and Techniques
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20 Flashcards
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Sample Questions
Q1) Which pair of parameters is most commonly varied or manipulated to elicit the various forms of TENS such as conventional, acupuncture, and burst train?
A) Frequency and amplitude
B) Frequency and rise time
C) Frequency and pulse duration
D) Pulse duration and waveform shape
Q2) Which of the following most likely explains the physiological response to noxious-level stimulation (hyperstimulation) that results in analgesia?
A) Release of endogenous opioids in the central nervous system
B) Closing the "gate" to nociception in the spinal cord
C) Blocking of nociceptive receptors in the skin
D) Release of histamine and prostaglandins into the circulatory system
Q3) Which of the following is NOT believed to occur during treatments using iontophoresis?
A) Electromigration
B) Electroporation
C) Electrosaturation
D) Electroosmosis
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Chapter 11: Mechanisms of Pain and Use of Therapeutic Modalities
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Sample Questions
Q1) 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
Q2) Which of the following best describes the recommended increase in current amplitude when using TENS?
A) 10% per day
B) 10% per week
C) 25% each treatment
D) 50% each day
Q3) ___________ is a form of amplitude modulated alternating current and __________ is a form of burst modulated alternating current.
A) Interferential; Aussie
B) Interferential; brief intense
C) Russian; Aussie
D) Russian; interferential
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Chapter 12: Therapeutic Modalities for Improving Range of Motion
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Sample Questions
Q1) Extracorporeal shockwave therapy is thought to impart what physiological effect?
A) An inflammatory response in the target tissues and changes in the viscoelasticity of those tissues
B) Changes in cell membrane permeability to facilitate angiogenesis
C) Hyperpolarization of the peripheral free nerve endings to decrease pain
D) An increase in microvascular blood flow to perfuse injured tissues
Q2) Which of the following best describes the "stretch window," or the optimal time in which to stretch following heating of a tissue?
A) A period of time in which tissue temperature will continue to rise and stretching should be done following this waiting period
B) A period of time in which stretching should be applied, as the change in tissue temperature is likely at peak
C) A period of time in which metabolic activity of the tissues is greatest, thus stretching has the greatest opportunity to increases tissue healing
D) A period of time in which strengthening exercises are recommended due to increased blood flow in the area heated
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14
Chapter 13: Electrotherapy for Musculoskeletal Disorders
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16 Verified Questions
16 Flashcards
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Sample Questions
Q1) Which of the following ranges of frequencies represents the force-frequency relationship?
A) 10 to 20 Hz
B) 30 to 50 Hz
C) 50 to 80 Hz
D) 80 to 100 Hz
Q2) Which of the following is the key factor in the efficacy of NMES strengthening protocols?
A) Size of electrodes placed over the muscle to be stimulated
B) Selection of electrical stimulation (ES) waveform
C) Age and sex of the patient
D) Intensity of training
Q3) Which of the following parameters can be decreased to help limit fatigue during NMES?
A) Frequency
B) Fall-time
C) Off-time
D) Interpulse interval
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15
Chapter 14: Neuromuscular Electrical Stimulation Nmes
and Functional Electrical Stimulation Fes in Patients With
Neurological Diagnoses
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16 Flashcards
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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) FES for decreasing shoulder subluxation in patients post-CVA
A) Is most effective when postponed until 6 months post-CVA
B) Should be applied to the posterior deltoid and supraspinatus muscles
C) Should be applied over the upper trapezius muscle to elevate the shoulder girdle
D) Is effective when applied for 10 minutes per day over a 3-week period
Q3) Which set of parameters is most appropriate for treating urge incontinence?
A) 50 pps, 5 seconds on: 50 seconds off, 30 minutes, three times/day
B) 12 pps, 5 seconds on: 15 seconds off, 30 minutes, three times/day
C) 50 pps, 5 seconds on: 15 seconds off, 60 minutes, three times/week
D) 12 pps, 10 seconds on: 50 seconds off, 60 minutes, three times/week
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Chapter 15: Therapeutic Modalities for Tissue Healing
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22 Verified Questions
22 Flashcards
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Sample Questions
Q1) 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
Q2) Conventional pulsed ultrasound has been recommended for the inflammatory phase of tissue healing because
A) Collagen fibers will be better aligned to prevent formation of adhesions.
B) A more rapid progression to the proliferative phase of healing will occur.
C) Greater analgesic effects occur, promoting earlier joint motion.
D) Enhancement of inflammation will occur, promoting greater microcirculation to tissues.
Q3) Which of the following represents the recommended duration and frequency of treatment for chronic wounds when using ES?
A) 15 minutes per day, 2 to 4 days per week
B) 30 minutes per day, 3 days per week
C) 45 minutes per day, 5 days per week
D) 60 minutes per day, 7 days per week
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Page 17
Chapter 16: Alternative Modalities for Pain and Tissue
Healing
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Sample Questions
Q1) Which of the following is a likely explanation of the physiological effects of pulsed magnetic fields?
A) Inhibition of interstitial edema and facilitation of ribonucleic acid (RNA) formation
B) Movement of ions across cell membranes and stimulation of deoxyribonucleic acid (DNA) transcription
C) Increased release of inflammatory hormones and facilitation of fibrinogenesis
D) Facilitation of nerve conduction velocity and release of endogenous substrates
Q2) Which of the following conditions has some support in research literature for possible beneficial effects from treatment with MIRE?
A) Temporomandibular joint (TMJ) dysfunction
B) Osteoarthritis of the knees
C) Low back pain
D) Peripheral neuropathy
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Chapter 17: Electrophysiological Testing of Nerves and Muscles
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Sample Questions
Q1) Electrically generated action potentials propagate along a nerve
A) Only orthodromically
B) Only antidromically
C) In both directions
D) Orthodromically for sensory nerves and antidromically for motor nerves
Q2) A patient with a neuropathic disorder will have which of the following characteristic recruitment patterns during an EMG exam?
A) Decreased number of motor units firing at a faster than normal rate
B) Small-amplitude, short-duration polyphasic motor units accomplished with little effort
C) Increased number of fasciculations and miniature end-plate potentials
D) Reduced insertional activity and frequent end-plate spikes
Q3) Results of electroneuromyography (ENMG) are best used for which of the following purposes?
A) Identifying the location of a neuromuscular impairment
B) Diagnosing impairments that lead to peripheral neuropathies
C) Indentifying the actual cause of a nerve or muscle impairment
D) Diagnosing anatomical anomalies that may compress a nerve
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