Industrial Rehab Flashcards
Which finding is a relative contraindication to cryotherapy?
(a) Acute inflammation
(b) Pain
(c) Acute hematoma
(d) Impaired sensation
Answer: (d)
Commentary: Cryotherapy, that is, the therapeutic use of cold by means such as ice, cold packs, or cold water immersion is commonly used to decrease pain, muscle soreness, fatigue and acute inflammation. Relative contraindications include cold intolerance, cryoglobulinemia, impaired sensation or cognitive defects. Cold intolerance can lead to decreased compliance and increased muscle guarding. Cryoglobulinemia results in immune complex precipitation at lower temperatures. Impaired sensation or cognitive defects may lead to tissue injury. Cryotherapy can be effective in decreasing the swelling or bleeding that commonly accompany tissue injuries.
Reference: Lane E, Latham T. Managing pain using heat and cold therapy. Paediatr Nurs
2009;21:14-18
2013
Which ergonomic recommendation for computer stations is NOT appropriate for an injured
worker with upper extremity cumulative trauma disorder?
(a) Neutral position of the wrists
(b) Forearm position horizontal to the floor
(c) Elevated positioning of the mouse
(d) Mid-line positioning of the keyboard
Answer: (c)
Commentary: Ergonomic evaluation of the computer workstation is important for both the
prevention and the treatment of cumulative trauma disorders. All the listed ergonomic
recommendations are appropriate, with the exception of elevated placement of the mouse. More
midline and level mouse placement is recommended, especially in cases of de Quervain
tenosynovitis.
Reference: Foye PM, Cianca JC, Prather H. Industrial medicine and acute musculoskeletal
rehabilitation. 3. Cumulative trauma disorders of the upper limb in computer users. Arch Phys
Med Rehabil 2002;83(3 Suppl):S14-5
2013
Repetitive transcranial magnetic stimulation (rTMS) of the motor cortex appears to have
therapeutic value in the treatment of
(a) fatigue.
(b) hypertension.
(c) stroke.
(d) seizure
Answer: (c)
Commentary: With demonstrated facilitation of motor recovery after stroke, rTMS has been used
in 2 ways: (1) frequency stimulation less than 1 Hz to the unaffected hemisphere, reducing its
inhibitory effects on the affected hemisphere and (2) frequency stimulation greater than 1Hz to
the affected hemisphere, increasing its excitability. Studies suggest possible greater benefit when
the lesion is subcortical rather than cortical. Frequencies greater than 20 Hz, especially when
intensity is higher, theoretically may increase the risk of seizure. Benefits of rTMS have been
shown in preliminary studies of those with both chronic and acute stroke.
Possible adverse or undesirable effects of rTMS include seizure (with treatment frequencies
greater than 20 Hz) and increasing blood pressure (with higher treatment frequencies after
chronic stroke.) Transcranial magnetic stimulation can be used to evaluate central fatigue, but has
not been used for treatment of fatigue.
Reference: Corti M, Patten C, Triggs W; Repetitive transcranial magnetic stimulation of motor
cortex after stroke; Am J Phys Med Rehabil 2012 ;91:254-70.
2013
Which deep heat method recommends the use of protective eyewear to prevent the formation of
cataracts?
(a) Ultrasound
(b) Short wave diathermy
(c) Fluidotherapy
(d) Microwave diathermy
Answer:(d)
Commentary: Microwave diathermy is another form of electromagnetic energy that uses
conversion as its primary form of heat production.Temperature distribution in a particular tissue is affected largely by its water content. In general, tissues with high water content absorb greater amounts of energy and are selectively heated. General heat precautions should be observed with microwave procedures. Metal implants, pacemakers, sites of skeletal immaturity, reproductive organs and brain, and fluid-filled cavities (eye, bullae, effusions, etc.) should be avoided. Microwaves can cause cataracts and protective eye wear should be worn by both patient and therapist to reduce risk.
2012
Which non-surgical treatment for carpal tunnel syndrome is shown to provide significant short-term benefit?
(a) Magnet therapy
(b) Laser therapy
(c) Therapeutic exercise
(d) Therapeutic ultrasound
Answer: (d)
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Commentary: Patients suffering from carpal tunnel syndrome are often offered nonsurgical treatments. Current evidence shows significant benefit from therapeutic ultrasound treatments, splinting, yoga, and carpal bone mobilization. However, trials involving the use of magnet therapy, laser therapy, therapeutic exercise, and chiropractics have not produced significant benefits compared to placebo or control treatments.
2013
Repetitive transcranial magnetic stimulation (rTMS) of the motor cortex appears to have therapeutic value in the treatment of
(a) fatigue.
(b) hypertension.
(c) stroke.
(d) seizure
Answer: (c)
Commentary: With demonstrated facilitation of motor recovery after stroke, rTMS has been used in 2 ways: (1) frequency stimulation less than 1 Hz to the unaffected hemisphere, reducing its inhibitory effects on the affected hemisphere and (2) frequency stimulation greater than 1Hz to the affected hemisphere, increasing its excitability. Studies suggest possible greater benefit when the lesion is subcortical rather than cortical. Frequencies greater than 20 Hz, especially when intensity is higher, theoretically may increase the risk of seizure. Benefits of rTMS have been shown in preliminary studies of those with both chronic and acute stroke.
Possible adverse or undesirable effects of rTMS include seizure (with treatment frequencies greater than 20 Hz) and increasing blood pressure (with higher treatment frequencies after chronic stroke.) Transcranial magnetic stimulation can be used to evaluate central fatigue, but has not been used for treatment of fatigue.
2013
Which ergonomic recommendation for computer stations is NOT appropriate for an injured worker with upper extremity cumulative trauma disorder?
(a) Neutral position of the wrists
(b) Forearm position horizontal to the floor
(c) Elevated positioning of the mouse
(d) Mid-line positioning of the keyboard
Answer: (c)
Commentary: Ergonomic evaluation of the computer workstation is important for both the prevention and the treatment of cumulative trauma disorders. All the listed ergonomic recommendations are appropriate, with the exception of elevated placement of the mouse. More midline and level mouse placement is recommended, especially in cases of de Quervain tenosynovitis.
2013
Which therapeutic modality delivers medication to the site of pathology by promoting the
movement of charged particles through the skin under an imposed electrical field?
(a) Phonophoresis
(b) Low energy laser
(c) Ultraviolet radiation
(d) Iontophoresis
Answer: (d)
Commentary: Iontophoresis is a physical medicine modality that delivers topical medicine, such
as corticosteroids, through the skin and into soft tissues. A current is created to direct a particular
solution away from the electrode and into the surrounding tissue. Phonophoresis utilizes
ultrasound rather than current to deliver the topical medication. Low energy laser and ultraviolet
radiation are not used to deliver topical medications.
2010
Which phenomenon is an effect of functional electrical stimulation (FES) as it pertains to gait?
(a) Decrease in muscle spasticity
(b) Increase in physiologic cost of gait
(c) Decrease in voluntary muscle strength
(d) Decrease in stride length
Answer: (a)
Commentary: In addition to a decrease in muscle spasticity, FES decreases the physiologic cost
of gait, increases voluntary muscle strength, and increases stride length.
2010
The use of a magnetic knee wraps in patients suffering with mild to moderate knee osteoarthritis
has been shown to
(a) decrease edema.
(b) increase walking distance.
(c) increase isokinetic strength.
(d) increase range of motion.
Answer: (c)
Commentary: The application of magnetic knee wraps has been shown to increase isokinetic
strength and improve pain scales. Edema, walking distance and range of motion were not
outcome measures.
2010
When applying cryotherapy in the treatment of musculoskeletal disorders, which of the following
events is NOT a contraindication to its use?
(a) Paroxysmal cold hemoglobinuria
(b) Impaired sensation
(c) Arterial insufficiency
(d) Spasticity
Answer : (d)
Commentary: Contraindications for the use of cryotherapy include paroxysmal cold
hemoglobinuria, impaired sensation and arterial insufficiency. Other contraindications are cold
hypersensitivity, cryopathies, cold intolerance, cryotherapy-induced neurapraxia, and Raynaud
disease. Spasticity is one of the general uses of cryotherapy in addition to musculoskeletal
injuries and pain syndromes, postoperative conditions and emergency treatment of minor burns.
2012
Which deep heat method recommends the use of protective eyewear to prevent the formation of cataracts? (a) Ultrasound (b) Short wave diathermy (c) Fluidotherapy (d) Microwave diathermy
Answer:(d)
Commentary: Microwave diathermy is another form of electromagnetic energy that uses
conversion as its primary form of heat production. Temperature distribution in a particular tissue
is affected largely by its water content. In general, tissues with high water content absorb greater
amounts of energy and are selectively heated. General heat precautions should be observed with
microwave procedures. Metal implants, pacemakers, sites of skeletal immaturity, reproductive
organs and brain, and fluid-filled cavities (eye, bullae, effusions, etc.) should be avoided.
Microwaves can cause cataracts and protective eye wear should be worn by both patient and
therapist to reduce risk.
2012
Answer: D
Commentary:Functional restoration programs produce a greater improvement in endurance, but
no differences are noted between functional restoration programs and active individual therapy
programs.
Answer: C
Commentary:The physician should be concerned if there is a time gap between the ultrasound
application and the stretching activity. In order to be effective, the deep heating that is
accomplished with the ultrasound application should be combined with a period of prolonged
passive stretching, both during and immediately after the ultrasound application. This can be
achieved by having the patient stand during the ultrasound application and after it. An
appropriate treatment time with ultrasound is 8 to 12 minutes and the patient may experience a
transient deep ache in the treatment application area.
2009
Which factor is a contraindication for phonophoresis?
A. Contractures
B. Neuromas
C. Tendonitis
D Skeletal immaturity
Option d is correct.
In phonophoresis ultrasound is used to facilitate transdermal migration of topically applied medications. Corticosteroids are the most frequently used agents and the anti-inflammatory effects of the medication and ultrasound may be synergistic. Indications for phonophoresis are osteoarthritis, bursitis, capsulitis, tendonitis, strains, fasciitis, epicondylitis, tenosynovitis, contracture, scar tissue, neuromas, and adhesions. Contraindications for use of phonophoresis (or ultrasound) include general heat precautions, skeletal immaturity, and locations near the eyes, brain, reproductive organs, a pacemaker, a menstruating or gravid uterus, laminectomy sites, or malignancy.
2014
A journalist is interested in writing an article about work options for the chronically disabled population. When discussing vocational rehabilitation, you inform him that
A governmental rehabilitation agencies are mostly funded by state resources.
B the emphasis is to provide services for patients with mild disabilities.
C tax incentives cannot be offered to employers who offer job training.
D after completion of training and placement in a job for 60 days, a file is usually closed.
Option d is correct.
The Rehabilitation Act of 1973 authorized federal funding for state rehabilitation agencies to provide a variety of services to qualified persons with disabilities. The federal government supplies 80% of the funding for state vocational rehabilitation agencies, whereas the states must provide the remaining 20%. State agencies administer the programs under the Rehabilitation Services Administration in the Department of Education. The intent of the Rehabilitation Act was to provide services to persons with disabilities, with emphasis placed on serving those with more severe disabilities. Tax incentives for potential employers can help convince industry to offer training. Once an individual has completed training and has been placed for 60 days, the state vocational rehabilitation agency considers the case a “success” and closes its file. No follow-up evaluation is typically provided.
2014
