Therapeutic Modalities
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Course Introduction
Therapeutic Modalities explores the principles and applications of various physical agents and techniques used in the rehabilitation of musculoskeletal and neuromuscular conditions. The course covers the physiological effects, indications, contraindications, and proper usage of modalities such as thermotherapy, cryotherapy, ultrasound, electrical stimulation, traction, and laser therapy. Students will gain an understanding of how these interventions contribute to pain reduction, tissue healing, inflammation control, and functional restoration. Emphasis is placed on clinical decision-making, safety considerations, and evidence-based practice in selecting and administering appropriate therapeutic modalities.
Recommended Textbook
Therapeutic Modalities 4th Edition by Chad Starkey
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19 Chapters
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Chapter 1: The Injury Response Process
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Sample Questions
Q1) What neurotransmitter is located in the brainstem and will increase blood pressure and cardiac output?
A) Dopamine
B) Epinephrine
C) Norepinephrine
D) Serotonin
Answer: A
Q2) In what tissue order must the different forms of therapeutic energy pass through to affect the target tissues?
A) Epithelial,adipose,muscular,nervous,connective
B) Epithelial,nervous,adipose,muscular,nervous
C) Epithelial,connective,nervous,muscular,adipose
D) Epithelial,adipose,connective,muscular,nervous
Answer: A
Q3) What type of tissue is the most abundant in the body?
A) Epithelial
B) Muscle
C) Adipose
D) Connective
Answer: D
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Chapter 2: The Physiology and Psychology of Pain
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Sample Questions
Q1) What does the verbal rating scale use to represent the current pain intensity of a patient?
A) 10-cm line
B) Different faces
C) Numbers 1 through 10
D) Descriptive terms
Answer: D
Q2) Which statements are true regarding the definition of pain? Select all that apply.
A) Pain is an unpleasant sensory and emotional experience.
B) Pain is associated only with actual tissue damage and not potential damage.
C) Pain is always an emotional experience.
D) Acute pain has an identifiable cause and extended duration.
E) Pain is just a simple sensation and not a process.
Answer: A,C
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Chapter 3: Development and Delivery of Intervention Strategies
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Sample Questions
Q1) Planning a treatment and rehabilitation program requires the integration of what complex skills? Select all that apply.
A) Clinical examination skills
B) Knowledge of pathology
C) Identification of the patient's level of function
D) Identification of the patient's participation restrictions
E) Knowledge of the current costs associated with common modalities
Answer: A,B,C,D
Q2) Which common tool used in the examination of orthopedic injuries can be measured with a handheld dynamometer?
A) Active range of motion
B) Muscle function assessment
C) Hypertrophy
D) Sensation
Answer: B
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Page 5
Chapter 4: Administrative Considerations
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Sample Questions
Q1) Which develops safety standards and regulations to prevent work-related injuries and illnesses?
A) Food and Drug Administration (FDA)
B) Health Insurance Portability and Accountability Act (HIPAA)
C) American Hospital Association (AHA)
D) Occupational Safety & Health Administration (OSHA)
Q2) A failure to maintain accurate,legible medical records may result in what charge?
A) Ordinary negligence
B) Professional negligence
C) Ordinary and professional negligence
D) Neither ordinary nor professional negligence
Q3) As a general rule,treatment tables should be ___high and ___apart.
A) 30 inches; 30 inches
B) 30 inches; 4 feet
C) 2 feet; 4 feet
D) 2 feet; 30 inches
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Chapter 5: Thermal Modalities
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Sample Questions
Q1) What statement is true regarding skin temperature and muscular temperature following cold treatments?
A) Unlike muscle,skin temperature continues to decrease for up to 30 minutes after modality removal.
B) Intramuscular cooling is increased when modality is applied following exercise.
C) Muscle cooling is diminished when the patient remains sedentary.
D) Skin temperature is a good indicator of the temperature of underlying tissues.
Q2) Cryotherapy modalities have a temperature range between 32°F and ____°F.
A) 65
B) 55
C) 45
D) 75
Q3) Which is a contraindication to cold application?
A) Chronic wound
B) Chronic pain
C) Neuralgia
D) Chronic muscle spasm
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Chapter 6: Clinical Application of Thermal Modalities
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Q1) According to the practical evidence,how should an ice pack be applied in order to obtain maximal intramuscular temperature decrease?
A) With an elastic wrap
B) With flexible plastic wrap
C) Without any wrap
D) With a nonflexible plastic wrap
Q2) What modality carries the greatest risk of frostbite?
A) Reusable cold pack
B) Plastic bag with crushed ice
C) Cold compression therapy unit
D) Chemical cold pack
Q3) Cold whirlpools are able to produce which effects? Select all that apply.
A) Decreased muscle spasm
B) Decreased muscle spasticity
C) Muscle relaxation
D) Increased cellular metabolism
E) Increased blood flow to the area treated
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Chapter 7: Therapeutic Ultrasound
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Sample Questions
Q1) When using ultrasound,what depth of tissue will a 3-MHz output frequency effectively treat?
A) 1 cm
B) 2 to 3 cm
C) 3 to 4 cm
D) 4 to 5 cm
Q2) Which interface results in 99.9 percent of ultrasound energy being reflected?
A) Soft tissue-air
B) Soft tissue-bone
C) Soft tissue-fat
D) Water-soft tissue
Q3) Which tissues and structures are highly reflective of ultrasound energy? Select all that apply.
A) Interface between soft tissue and bone
B) Musculotendinous junction
C) Intermuscular interfaces
D) Adipose tissue
E) Skin
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9
Chapter 8: Clinical Application of Therapeutic Ultrasound
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Sample Questions
Q1) To ensure safe application of therapeutic ultrasound,how often should the unit be calibrated?
A) Once a year
B) Every 6 months
C) Every other year
D) Quarterly
Q2) Which of the following structures should be treated with 3-MHz ultrasound? Select all that apply.
A) Patellar tendon
B) Medial collateral ligament
C) Brachialis
D) Vastus intermedius
E) Rotator cuff
Q3) When applying underwater ultrasound,about how far should the ultrasound head be from the body part?
A) 1 cm
B) 2 cm
C) 1 in.
D) 2 in.
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Page 10
Chapter 9: Shortwave Diathermy
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Sample Questions
Q1) What tissues are selectively heated via induction field shortwave diathermy? Select all that apply.
A) Muscle
B) Bone
C) Adipose
D) Skin
E) Nervous
Q2) Which modality offers the longest stretching window post-treatment?
A) Thermal ultrasound
B) Moist heat pack
C) Shortwave diathermy
D) Plug-in heat pack
Q3) What type of shortwave diathermy places the patient in the electromagnetic field produced by the unit?
A) Induction field generators
B) Capacitive field generators
C) Capacitive field generators and induction field generators
D) Neither the capacitive field generators nor the induction field generators
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Chapter 10: Clinical Application of Shortwave Diathermy
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Q1) Which of the following contraindicate the use of shortwave diathermy? Select all that apply.
A) Cancer
B) Thrombophlebitis
C) Sinusitis
D) Hematoma
E) Muscle spasm
Q2) When higher than moderate treatment temperatures are used,how often can patients receive treatments?
A) No more than one every 2 hours
B) No more than 2 every hour
C) No more than one every hour
D) No more than two in 1 day
Q3) Which is an appropriate parameter when heating tissue using pulsed shortwave diathermy?
A) 800 bursts per second
B) Burst duration of 65 microseconds
C) Interburst interval of 200 microseconds
D) RMS output of 150 W per burst
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Page 12
Chapter 11: Principles of Electrical Stimulation
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Q1) When examining the pulse characteristics,what is the most important factor when determining what type of tissue will be stimulated?
A) Phase duration
B) Interpulse interval
C) Intrapulse interval
D) Pulse duration
Q2) When examining the attributes of the pulse,which of the following will lead to an increase in the total charge of the pulse? Select all that apply.
A) Increase amplitude
B) Increase pulse duration
C) Decrease pulse duration
D) Increase interpulse interval
E) Increase cycle duration
Q3) What type of current does high-voltage pulsed stimulation use?
A) Monophasic
B) Biphasic
C) Pulsed
D) Asymmetrical
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Chapter 12: Electrical Stimulation Techniques
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Q1) When using electrical stimulation to address strength,which functional loads placed on the muscle have the potential to increase strength? Select all that apply.
A) 5 percent of the maximum voluntary isometric contraction
B) 10 percent of the maximum voluntary isometric contraction
C) 20 percent of the maximum voluntary isometric contraction
D) 30 percent of the maximum voluntary isometric contraction
E) 40 percent of the maximum voluntary isometric contraction
Q2) A nerve's response to the electrical stimulation is based on what factor(s)? Select all that apply.
A) Diameter of the nerve
B) Depth of the nerve
C) Phase duration of the current
D) Number of fibers the nerve innervates
E) Ramp of the current intensity
Q3) What tissue has the greatest resistance to current flow?
A) Cell membrane
B) Muscle tissue
C) Fascia
D) Tendon
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Page 14
Chapter 13: Clinical Application of Electrical Agents
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Sample Questions
Q1) What feature distinguishes microcurrent from other electrical modalities?
A) Microcurrent does not attempt to excite peripheral nerves.
B) Microcurrent only attempts to excite sensory nerves.
C) Microcurrent only attempts to excite motor nerves.
D) Microcurrent only attempts to excite nociceptive nerves.
Q2) What output modulation of interferential stimulation is analogous to the number of cycles per second?
A) Beat frequency
B) Burst duty cycle
C) Interburst interval
D) Premodulation
Q3) Why is neuromuscular electrical stimulation (NMES)able to provide stronger neuromuscular stimulation? Select all that apply.
A) Large amplitude
B) Long phase duration
C) Short phase duration
D) Lower intensities
E) Faster ramping
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Chapter 14: Intermittent Compression
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Sample Questions
Q1) Protein-rich matter is more responsive to intermittent compression than fluids.
A)True
B)False
Q2) When applying intermittent compression for long periods of time,which of the following should be checked regularly?
A) Capillary refill and unexpected pitting edema
B) Capillary refill and limb girth
C) Pitting edema and limb volume
D) Limb volume and limb girth
Q3) When subacute or chronic conditions exist,what is an intermittent or sequential compression unit best used for? Select all that apply.
A) Reducing edema
B) Preventing edema
C) Decreasing ecchymosis
D) Preventing ecchymosis
E) Increasing lymphatic return
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Chapter 15: Continuous Passive Motion
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Q1) Which of the following is reduced during the realignment of collagen that occurs with the use of continuous passive motion? Select all that apply.
A) Functional shortening of collagen
B) Cross-linking of collagen
C) Capsular adhesions
D) Tensile strength of tendon
E) Tensile strength of allografts
Q2) The decision to use continuous passive motion should be based on the specific pathology to be treated.
A)True
B)False
Q3) While continuous passive motion can be used on many different joints,what joint is it predominantly used with?
A) Knee
B) Shoulder
C) Ankle
D) Elbow
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Chapter 16: Cervical and Lumbar Traction
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Sample Questions
Q1) In general,what percentage of the body weight will cause separation of the cervical spine when the patient is in a reclined position?
A) 5 percent
B) 10 percent
C) 20 percent
D) 30 percent
Q2) What is the common treatment duration when using lumbar or cervical traction to treat muscle spasm?
A) 25 min
B) 10 min
C) 8 min
D) 20 min
Q3) In healthy vertebrae,approximately what percentage of the spine's weight-bearing load is transmitted through the facet joint?
A) 5 percent
B) 10 percent
C) 20 percent
D) 30 percent
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Chapter 17: Therapeutic Massage
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Sample Questions
Q1) Which of the following is an indication for the use of therapeutic massage?
A) Active inflammation
B) Area of sensory deficit
C) Hematoma
D) Pain-spasm cycle
Q2) What type of massage uses the thumbs or fingertips to stroke the tissue from opposite directions while targeting the underlying tissue structure to treat trigger points,tendinitis,or postsurgical scars?
A) Transverse friction massage
B) Circular friction massage
C) Sports massage
D) Active release technique of myofascial release
Q3) "Sports massage" is a broad term that is used to describe the combination of what massage techniques?
A) Effleurage and petrissage
B) Petrissage and friction massage
C) Effleurage and friction massage
D) Effleurage,petrissage,and friction massage
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Chapter 18: Electromyographic Biofeedback
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Sample Questions
Q1) What is the correct order of electromyographic biofeedback signal processing?
A) Identify; amplify; rectify; integrate; output
B) Identify; rectify; amplify; integrate; output
C) Identify; amplify; integrate; rectify; output
D) Identify; integrate; amplify; rectify; output
Q2) Which of the following modalities does not deliver energy to the body?
A) Ice pack
B) Moist heat pack
C) Ultrasound
D) Electromyographic biofeedback
Q3) The efficacy for electromyographic biofeedback is clinically well accepted for what scenario?
A) Reeducating muscle
B) Increasing strength
C) Decreasing pain
D) Reducing edema
Q4) Measurements from one biofeedback unit can be reliably compared to another brand of biofeedback unit.
A)True
B)False
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Chapter 19: Low-Level Laser Therapy
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Q1) Which of the following is considered a primary effect of therapeutic laser treatment?
A) Vasodilation of microvessels
B) Decreased ATP production
C) Decreased collagen production
D) Decreased macrophage activity
Q2) Longer laser wavelengths penetrate deeper into tissues than shorter wavelengths.
A)True
B)False
Q3) Which statement is true concerning a gallium arsenide (GaAs)laser?
A) GaAs is produced by a semiconductor diode chip.
B) GaAs produces a visible red light.
C) GaAs energy can penetrate tissues up to 5 cm deep.
D) GaAs delivers a light wave at 670 nm.
Q4) Laser production requires what essential components? Select all that apply.
A) Amplifying medium
B) Mechanism for exciting medium
C) Reflective mirror
D) Partially reflective mirror
E) Photoelectric crystal
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