Knowledge Base Interventions What should a PT do if the long term functional goal is achieved in short period? Eg. 8 weeks long goal is achieved in 4 weeks? Should the PT be discharged or need to set a new goal? If patient complains of pain after mobilization for more than a day, what should be a wise decision taken by PT? The compression garments are different than intermittent mechanical compression? I read a Q for l/l edema pressure should be 35 mmhg, for U/l it should be 25 mmhg and in TherapyEd it suggested it shouldn’t exceed the diastolic BP AND some suggested that it should be between SBP and DBP? Will you please throw some more light on it? When using Electrical Stimulation for wound healing, what are the benefits of using a negative vs. positive polarity and continuous vs pulsed current? When treating for edema, using the monopolar electrode placement, where do you suggest to place the “dispersive” electrode? Example: a patient has pitting edema on anterior tibialis – would you place the dispersive electrode further up along the anterior tib or somewhere up on the thigh? I understand the need for a negative pressure room for isolation and airborne precaution. I have previously come across questions of the direction of air flow in these scenarios. I read examples and still get confused. Any tips on how to understand this process? Also, are positive pressure rooms used only in immunosuppressed patients? What would be the most appropriate next step for a therapist treating a wound that is macerated? How do we identify to select an assistive device for a patient rehabilitating from TBI, SCI, etc.? There are lots of options that we can take it like cane, axillary crutch, and walker. How do I distinguish between them? If a patient’s left innominate is locked in posterior rotation that means anterior rotation is restricted so the intervention would be MET of Left hip flexors? For the PNF techniques, is Rhythmic Stabilization and Alternating Isometrics similar, or somewhat different in terms of indications? When treating a hyperglycemia patient, exercise helps to decrease glucose levels. However, if the patient took insulin meds before, should the PT then wait for a period of time and then proceed with exercise to avoid possible effects of hypoglycemia? Individuals with scoliosis have S or C shaped curve and are named based on the convexity. Would this mean that the muscles on the concave side would be shortened and the muscles on the convex side stretched? If so how would we go about with interventions? Would I strengthen trunk extensors, glutes, and abs. Or focus more on stretching (based on the limitations of ROM) the iliopsoas, lateral trunk flexors, and low back extensors? When is a plastic AFO indicated and when is a steel enforced AFO indicated? I don’t understand how a thrust manipulation of the thoracic spine can assist with improving hypomobility of the cervical neck. What is the proper progression of Kegel exercises? I’m seeing different things in different texts. Starting Supine vs. Sitting? Starting with just contractions or with holding urine flow while sitting on toilet? In O’Sullivan, under multiple sclerosis, treatment for spasticity includes maintained stretch held for 30 mins to 3 hrs which can decrease stretch reflex activity. Won’t that cause fatigue and in turn results in relapsing of the condition? I have a question on biofeedback. When the muscle needs relaxation, do you give high or low sensitivity? TherapyEd says to give low sensitivity and Scorebuilders says the opposite, what is right? The Anterior Drawer Test is used to assess ACL integrity, but this test is not that necessary to enquire if ACL is ruptured, as compared to tests like Lachman’s, Slocum’s and Lateral Pivot Shift, isn’t it? Please explain the concept of tensile and compressive stresses on both menisci in McMurray’s test. E.g. Which menisci suffers which force during internal rotation at the knee? When it says – INTERNAL ROTATION AT THE KNEE, does it mean tibial IR or femoral IR at the knee? A patient comes in OPD for treatment of partial meniscectomy after 2 weeks and complains about pain in calf muscle. The signs include pain, inflammation and swelling in calf. My question: Can DVT happen after 2 weeks or is there any other reason for that? How do we initiate exercises wrt flexor tendon and extensor tendon repair? Which joints in the wrist should be given active and passive exercises? Is Ultrasound given for TMJ dysfunction? If so will the parameters be like 3MHz at 0.5-1 W/cm2, pulsed at 20% duty cycle, for 5-10 min? I guess if we use 1MHz it may cause periosteal pain. Where should be the placement for TENS in pregnancy? In delivery and labor time? What should be done with patellofemoral syndrome, with hamstring stretched or strengthen? I believe that as IT band is tighten, it should be stretched. After taking other review courses and studying integ, I learned that with a venous stasis ulcer, you should NOT use intermittent compression due to it increasing the risk of causing a pulmonary embolism. I learned that more so, if the patient’s ABI is > .7 or 70% blood flow, and they have good capillary refill, normal foot temp, and a good dorsalis pedius pulse, an Unna boot or stationary compression is more so indicated. I recently took a practice test which basically said that intermittent compression was NOT a contraindication to a venous stasis ulcer and that you could use intermittent compression with a venous stasis ulcer. Do you know for a fact if intermittent compression is a contraindication to a venous stasis ulcer? How do I treat patients with conversion or psychosomatic type conditions? Or should I refuse to treat them and refer to a psychologist? For interventions, what is the correct progression: should you have a patient perform closed chain exercises or open chain exercises first? My initial thought was that you should do open chain first then progress to closed chain. Exceptions would be ACL surgery where open chain is contraindicated. For example, what would be the best intervention for a patient who has fair strength after long thoracic nerve injury. Would I be correct to chose the open chain activity of supine arm overhead with weights instead of closed chain activities such as standing wall push-ups? When is it appropriate to use an ISOKINETIC machine for ACL repairs? I have a patient in clinic who is s/p 8 months ACL repair and every few months she has been going for isokinetic testing as she wants to return to playing college lacrosse. From my understanding, isokinetic machines can be set at a constant speed in which the limb has to move throughout the ROM. Is the purpose of the machine just for strengthening and to assess something like quads/hamstrings ration? What is a positive vertebral artery sign and what might be an appropriate immediate response when it is elicited clinically? (question edited).
What should a PT do if the long term functional goal is achieved in short period? Eg. 8 weeks long goal is achieved in 4 weeks? Should the PT be discharged or need to set a new goal?
If patient complains of pain after mobilization for more than a day, what should be a wise decision taken by PT?
The compression garments are different than intermittent mechanical compression? I read a Q for l/l edema pressure should be 35 mmhg, for U/l it should be 25 mmhg and in TherapyEd it suggested it shouldn’t exceed the diastolic BP AND some suggested that it should be between SBP and DBP? Will you please throw some more light on it?
When using Electrical Stimulation for wound healing, what are the benefits of using a negative vs. positive polarity and continuous vs pulsed current?
When treating for edema, using the monopolar electrode placement, where do you suggest to place the “dispersive” electrode? Example: a patient has pitting edema on anterior tibialis – would you place the dispersive electrode further up along the anterior tib or somewhere up on the thigh?
I understand the need for a negative pressure room for isolation and airborne precaution. I have previously come across questions of the direction of air flow in these scenarios. I read examples and still get confused. Any tips on how to understand this process? Also, are positive pressure rooms used only in immunosuppressed patients?
How do we identify to select an assistive device for a patient rehabilitating from TBI, SCI, etc.? There are lots of options that we can take it like cane, axillary crutch, and walker. How do I distinguish between them?
If a patient’s left innominate is locked in posterior rotation that means anterior rotation is restricted so the intervention would be MET of Left hip flexors?
For the PNF techniques, is Rhythmic Stabilization and Alternating Isometrics similar, or somewhat different in terms of indications?
When treating a hyperglycemia patient, exercise helps to decrease glucose levels. However, if the patient took insulin meds before, should the PT then wait for a period of time and then proceed with exercise to avoid possible effects of hypoglycemia?
Individuals with scoliosis have S or C shaped curve and are named based on the convexity. Would this mean that the muscles on the concave side would be shortened and the muscles on the convex side stretched? If so how would we go about with interventions? Would I strengthen trunk extensors, glutes, and abs. Or focus more on stretching (based on the limitations of ROM) the iliopsoas, lateral trunk flexors, and low back extensors?
I don’t understand how a thrust manipulation of the thoracic spine can assist with improving hypomobility of the cervical neck.
What is the proper progression of Kegel exercises? I’m seeing different things in different texts. Starting Supine vs. Sitting? Starting with just contractions or with holding urine flow while sitting on toilet?
In O’Sullivan, under multiple sclerosis, treatment for spasticity includes maintained stretch held for 30 mins to 3 hrs which can decrease stretch reflex activity. Won’t that cause fatigue and in turn results in relapsing of the condition?
I have a question on biofeedback. When the muscle needs relaxation, do you give high or low sensitivity? TherapyEd says to give low sensitivity and Scorebuilders says the opposite, what is right?
The Anterior Drawer Test is used to assess ACL integrity, but this test is not that necessary to enquire if ACL is ruptured, as compared to tests like Lachman’s, Slocum’s and Lateral Pivot Shift, isn’t it?
Please explain the concept of tensile and compressive stresses on both menisci in McMurray’s test. E.g. Which menisci suffers which force during internal rotation at the knee? When it says – INTERNAL ROTATION AT THE KNEE, does it mean tibial IR or femoral IR at the knee?
A patient comes in OPD for treatment of partial meniscectomy after 2 weeks and complains about pain in calf muscle. The signs include pain, inflammation and swelling in calf. My question: Can DVT happen after 2 weeks or is there any other reason for that?
How do we initiate exercises wrt flexor tendon and extensor tendon repair? Which joints in the wrist should be given active and passive exercises?
Is Ultrasound given for TMJ dysfunction? If so will the parameters be like 3MHz at 0.5-1 W/cm2, pulsed at 20% duty cycle, for 5-10 min? I guess if we use 1MHz it may cause periosteal pain.
What should be done with patellofemoral syndrome, with hamstring stretched or strengthen? I believe that as IT band is tighten, it should be stretched.
After taking other review courses and studying integ, I learned that with a venous stasis ulcer, you should NOT use intermittent compression due to it increasing the risk of causing a pulmonary embolism. I learned that more so, if the patient’s ABI is > .7 or 70% blood flow, and they have good capillary refill, normal foot temp, and a good dorsalis pedius pulse, an Unna boot or stationary compression is more so indicated. I recently took a practice test which basically said that intermittent compression was NOT a contraindication to a venous stasis ulcer and that you could use intermittent compression with a venous stasis ulcer. Do you know for a fact if intermittent compression is a contraindication to a venous stasis ulcer?
How do I treat patients with conversion or psychosomatic type conditions? Or should I refuse to treat them and refer to a psychologist?
For interventions, what is the correct progression: should you have a patient perform closed chain exercises or open chain exercises first? My initial thought was that you should do open chain first then progress to closed chain. Exceptions would be ACL surgery where open chain is contraindicated. For example, what would be the best intervention for a patient who has fair strength after long thoracic nerve injury. Would I be correct to chose the open chain activity of supine arm overhead with weights instead of closed chain activities such as standing wall push-ups?
When is it appropriate to use an ISOKINETIC machine for ACL repairs? I have a patient in clinic who is s/p 8 months ACL repair and every few months she has been going for isokinetic testing as she wants to return to playing college lacrosse. From my understanding, isokinetic machines can be set at a constant speed in which the limb has to move throughout the ROM. Is the purpose of the machine just for strengthening and to assess something like quads/hamstrings ration?
What is a positive vertebral artery sign and what might be an appropriate immediate response when it is elicited clinically? (question edited).