Advanced Therapeutic Exercise
Pre-Test Questions
Course Introduction
Advanced Therapeutic Exercise delves into the scientific principles and evidence-based practices that underlie the design, implementation, and progression of therapeutic exercise programs for individuals recovering from injury or managing chronic conditions. The course emphasizes detailed assessment techniques, exercise prescription, and the integration of functional movement patterns to enhance physical rehabilitation outcomes. Students explore the physiological and biomechanical responses to exercise, advanced manual therapy interventions, and strategies for addressing complex patient presentations. Case studies and practical labs equip learners with the skills needed to adapt exercise regimens for populations with diverse needs, ensuring safe and effective return to optimal function.
Recommended Textbook
Therapeutic Exercise Foundations and Techniques 7th Edition by Carolyn Kisner
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512 Verified Questions
512 Flashcards
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Chapter 1: Therapeutic Exercise: Foundational Concepts
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Sample Questions
Q1) 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)
Answer: D
Q2) 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.
Answer: D
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Chapter 2: Prevention, Health, and Wellness
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Q1) 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.
Answer: D
Q2) 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
Answer: C
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4
Chapter 3: Range of Motion
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Sample Questions
Q1) 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
Answer: D
Q2) 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.
Answer: C
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Chapter 4: Stretching for Improved Mobility
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Q1) 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
Q2) 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.
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Chapter 5: Peripheral Joint Mobilizationmanipulation
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Q1) 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
Q2) 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
Q3) 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.
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Chapter 6: Resistance Exercise for Impaired Muscle
Performance
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Sample Questions
Q1) 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
Q2) 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.
Q3) 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
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Chapter 7: Principles of Aerobic Exercise
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Sample Questions
Q1) 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%
Q2) 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
Q3) 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.
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Page 9
Chapter 8: Exercise for Impaired Balance
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Sample Questions
Q1) 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.
Q2) 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.
Q3) 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.
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Chapter 9: Aquatic Exercise
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Q1) 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
Q2) 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
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Chapter 10: Soft Tissue Injury, Repair, and Management
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Q1) 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
Q2) 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.
Q3) 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.
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12
Chapter 11: Joint, Connective Tissue, and Bone Disorders and Management
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Sample Questions
Q1) 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
Q2) 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
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Page 13
Chapter 12: Surgical Interventions and Postoperative Management
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Sample Questions
Q1) 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.
Q2) 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
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Chapter 13: Peripheral Nerve Disorders and Management
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Sample Questions
Q1) 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
Q2) 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.
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15
Chapter 14: The Spine: Structure, Function, and Posture
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Sample Questions
Q1) 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.
Q2) 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
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16
Chapter 15: The Spine: Management Guidelines
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Sample Questions
Q1) 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.
Q2) 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.
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Chapter 16: The Spine: Exercise and Manipulation
Interventions
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Q1) 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.
Q2) 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.
Q3) 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.
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Chapter 17: The Shoulder and Shoulder Girdle
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Q1) 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
Q2) 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.
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Chapter 18: The Elbow and Forearm Complex
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Q1) 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
Q2) 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.
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Page 20
Chapter 19: The Wrist and Hand
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Q1) 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.
Q2) 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.
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Chapter 20: The Hip
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Q1) 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.
Q2) 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.
Q3) 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.
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Page 22
Chapter 21: The Knee
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Q1) 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.
Q2) 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 postoperative pain.
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23
Chapter 22: The Ankle and Foot
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Q1) 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
Q2) 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.
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Chapter 23: Advanced Functional Training
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Q1) 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.
Q2) 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.
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Page 25
Chapter 24: Exercise in the Older Adult
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Q1) 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.
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
Q2) 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.
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Chapter 25: Womens Health: Obstetrics and Pelvic Floor
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Q1) 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.
Q2) 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.
Q3) 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.
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Chapter 26: Management of Lymphatic Disorders
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Q1) 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
Q2) 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
Q3) 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.
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