Therapeutic Modalities Quiz 2

A patient reports increased pain after two treatments of high-voltage pulsed current for wound healing. Which adjustment is MOST appropriate?

A) Decrease current amplitude

B) Increase treatment duration

C) Switch to continuous ultrasound

D) Change electrode polarity daily

Correct Answer: A) Decrease current amplitude

Rationale: Excessive current amplitude can irritate tissue and increase pain, so lowering intensity helps maintain therapeutic effect while improving tolerance. Longer treatment duration may worsen irritation. Changing to ultrasound ignores tolerance issues without directly addressing the problem. Polarity changes are used to match healing phases, not for immediate pain reduction.

Reference: Cameron MH. Physical Agents in Rehabilitation: From Research to Practice. 4th ed. 2013: Pages: 269-272.

Before initiating traction for a patient with cervical radiculopathy, a positive finding on which of the following tests would MOST likely indicate a contraindication?

A) Positive Spurling Test

B) Positive Valsalva Maneuver

C) Positive Vertebral Artery Test

D) Positive Hypomobility on Segmental Testing

Correct Answer: C) Positive Vertebral Artery Test

Rationale: Vertebral artery insufficiency is a contraindication to cervical traction due to risk of vascular compromise. A positive Spurling test is used to diagnose cervical radiculopathy. Increased symptoms with Valsalva suggests pathology, but does not preclude traction. Hypomobility may actually support the use of traction as an intervention.

Reference: Cameron MH. Physical Agents in Rehabilitation: From Research to Practice. 4th ed. 2013: Pages: 366-377, 387.

A patient with chronic knee osteoarthritis presents with stiffness and moderate swelling. Which modality is MOST appropriate to address both symptoms in the same treatment session?

A) Moist heat pack

B) Cold pack

C) Pulsed ultrasound at 1 MHz

D) Continuous ultrasound at 3 MHz

Correct Answer: C) Pulsed ultrasound at 1 MHz

Rationale: Pulsed ultrasound at 1 MHz provides non-thermal effects that promote healing and edema reduction while mild deep heating improves tissue extensibility for stiffness. Moist heat improves stiffness, but may worsen swelling. Cold reduces swelling, but increases stiffness. Continuous 3 MHz ultrasound heats superficial tissues without addressing edema.

Reference: Cameron MH. Physical Agents in Rehabilitation: From Research to Practice. 4th ed. 2013: Pages: 150-153, 168-175, 190

A patient with type II diabetes is prescribed paraffin bath therapy for the hands. Which factor is MOST important to verify before treatment?

A) Blood pressure

B) Fasting blood glucose

C) Nail length

D) Skin sensation

Correct Answer: D) Skin sensation

Rationale: Impaired sensation from neuropathy increases the risk of burns during paraffin application, making sensory testing essential before treatment. Blood pressure is important for overall health, but does not determine paraffin safety. Glucose levels affect long-term management, but are not immediate safety concerns. Nail length relates to hygiene, not treatment risk.

Reference: Cameron MH. Physical Agents in Rehabilitation: From Research to Practice. 4th ed. 2013: Pages: 150-158.

A patient is receiving transcutaneous electrical nerve stimulation for chronic low back pain. Which electrode placement strategy is MOST appropriate for pain modulation using the gate control theory?

A) Over dermatomes corresponding to pain

B) Over motor points of target muscles

C) Proximal to the spinal cord segment of pain origin

D) Along the antagonist muscle group

Correct Answer: A) Over dermatomes corresponding to pain

Rationale: Electrode placement over dermatomes corresponding to the pain site stimulates sensory fibers to inhibit nociceptive input at the spinal cord, consistent with gate control theory. Motor point stimulation targets muscle contraction, not sensory gating. Proximal spinal placement is less specific and less effective. Stimulating antagonist muscles does not align with the pain pathway.

Reference: Cameron MH. Physical Agents in Rehabilitation: From Research to Practice. 4th ed. 2013: Pages: 260-261.