Chapter 3

Therapeutic Exercise
Directions: Each group of numbered words phrases 28. have a low concentration of muscle
below is followed by a list of lettered statements. phosporylase
MATCH the lettered statement most closely 29. are usually responsible for tonic or sustained
associated with the numbered word or phrase. activity
30. are usually responsible for tonic or rapid
Questions 1 to10 activity
1. muscle cell 31. the energy source of these fibers is mainly
2. muscle cell protoplasm glycosis
3. a multinucleated cell 32. resistance to fatigue and the tetanus/twitch
4. muscle cell plasma membrane ratio are both high
5. muscle cell mitochondria 33. the functional unit of muscle organization
6. the muscle cell nuclei rest immediately under this 34. surrounds large bundles of muscle
structure organization
7. has mainly a metabolic function and has 35. have distinct cross-stations on longitudinal
granules of many sizes sections
8. usually 20-100 A in thickness A. type fibers
9. this has many fibrils B. type II fibers
10. contains mitochondria, fat and lipoprotein C. myofibrils
droplets D. motor unit
A. sarcosomes E. perymysium
B. sarcolemma
C. syncytial cell Questions 36 through 40
D. muscle fiber 36. the testing of strength against an immovable
E. sarcoplasm object
37. the testing of strength against a load that can
Questions 11 through 20 be moved
11. a wide isotropic band of the myofiril 38. the testing of strength in which torque
12. a wide anisotropic band of the myofibril must be generated against a preset rate-limiting
13. a dark line through the it/ one device
14. a dark line across the I band 39. active contraction of a muscle while it is
15. the sarcomere is the contractile unit between being passively stretched
two of these lines 40. contraction of a muscle while is shortening
16. diminishes in width during active muscle A. eccentric contraction
contraction B. concentric contraction
17. increases in width during passive stretching C. isometric contraction
of a muscle D. isotonic contraction
18. this line is made by the intersection of thin E. isokinetic contraction
action filaments
19. this line is formed by the bulges in the Questions 44 through 45
myosin filaments 41. increased musculoskeletal, circulatory, and
20. an area of myosin only respiratory adaptations that increase wok
A. I band capacity
B. A band 42. this is determined by the neuron
C. H zone 43. these tend to be the first used by a muscle
D. M line as the work load is increased from minimum to
E. Z line maximum
44. this can occur in a muscle at less than
Questions 21 through 35 antigravity strength when exercised too
21. the only contractile element of the muscle vigorously
cell 45. deterioration of a muscle response to a
22. usually called red fibers stimulus
23. usually called white fibers A. fatigue
24. slow twitch time B. muscle fiber type
25. fast twitch time C. conditioning or training effect
26. these generally have many mitochondria D. overwork weakness
27. these have sarcoplasm that is high in E. small tonic units
glycogen concentration
Questions 46 through 50

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46. muscle strength sufficient to move the joint 4. possible only during an
through a full range of motion with gravity eccentric contraction
eliminated
47. muscle strength sufficient to move a joint 62. Maximum strength can be obtained with
through a full range of motion against gravity 1. low weight (40% maximal)
48. strength sufficient to move a joint through a repetitions if done to the point of fatigue
full range of motion against gravity plus additional 2. high weight (85 to 100%
resistance, but not normal strength. maximal)repetitions if done to the point of
49. normal strength as compared with other s of fatigue
the same age and sex 3. isometric muscle strengthening
50. strength sufficient to move a joint only technique if the final measurement of
slightly strength is done isometrically
A. G 4. isotonic muscle strengthening
B. N technique if the final measurement of
C. P strength is done isotonically
D. Tr
E. F 63. Progressive resistive exercise
1. was first described by Delorme
51. exercise done by a therapist in which the 2. is based on weekly increases in
joints are moved through the10repetitive maximum (RM)
52. an exercise done by a therapist or both, in 3. can be used even if the muscle is not anti
which the gastrocnemius muscle is stretched gravity in strength
53. provides passive stretching for many hours 4. begins with 10 repetitions of one-half 10 RM
of the day without the assistance of a therapist. and ends with 10 RM
54. patient moves a joint through as much of the
normal range of motion as possible 64. Exercise to improve strength in muscles is
55. patient moves a joint through the entire the greatest that can be moved
range of motion that can be covered voluntarily, 1. should be done with caution and careful
and the therapist then moves the joint through the monitoring of strength
rest of the normal range of motion (or as much of 2. can be done by placing the joint moved in a
it as possible) gravity eliminated position
56. patient and therapist simultaneously try to 3. can be done with an assistive device such as
increase the range of motion of a joint a powder board
57. often used when joints are inflamed and 4. can be done with a cable and pulley assistive
swollen system such as that used in the Elgin
58. usually involves the use of springs or rubber exercise table
bands
59. often impossible because pain inhibits 65. The Oxford Technique
function 1. is essentially like the PRE program of
60. often needed even more than normal range Delorme except that the exercise is arranged
of motion exercise in motor unit diseases from the heaviest to the lightest weight
A. passive range of motion 2. is an isometric exercise technique
B. active range of motion 3. was designed to allow the use of lower
C. active assisted range of motion resistance as muscle fatigue ensued
D. two-joint muscle stretching 4. has definitely been shown to provide a faster
E. dynamic bracing improvement in strength than the PRE
technique of De Lorme
Directions: For each of the incomplete statements
below, ONE or MORE of the numbered completions is 66. Body building techniques that commonly
correct in each case select: used for producing muscle hypertrophy
A. if only 1,2, and 3 are correct 1. provide an
B. if only 1and 3 are correct adequate stimulus for generalized aerobic
C. if only 2 and 4 are correct conditioning
D. if only 4 is correct 2. usually
61. The maximum strength of a muscle is involve the use of multi ple (3 7) sets of 9 16
repetitions on alternate days
1. the maximum tension 3. often consist
developed per unit of cross-sectional area of a program of decreasing numbers of
2. occurs mainly when the muscle repetition with increasing resistance loads
is used in an isometric manner 4. use
3. most likely to occur when the maximum resistance (10 RM) constantly
muscle is at resting length

31
 rather than incremental increases or 1. cerebellar and corticospinal
decreases in resistance load input to the alpha motor neurons
2. muscle receptors such as the
67. A power program for a weight lifter intrafusal muscle system
1. 3. psychological influences such
is designed to produce muscle bulk or endurance as emotion
2. 4. different input to the alpha
is a program of decreasing numbers of motor neurons from the skin and tendon receptors
repetitions with increasing weight until the
last weight is the greatest that can be 73. An acceptable facilitatory stimulus should be
moved once minimally capable of causing
3. 1. motoneuron
is usually done on five to seven days each week discharge
4. 2. motoneuron
is good stimulus for aerobic physical conditioning inhibition
3. clonus
68. Isometric exercise 4. at least sub
1. is often clinically in a form called BRIME threshold effect toward discharging a
2. improves muscle strength with out muscle hyperthrophy motoneuron

3. does not significantly improve joint range of motion 74. The main difference between the therapeutic
effects of quick and slow passive stretch of a
4. is often difficult to measure in terms of the muscle muscle is
tension being exerted 1. there is actually no
significant therapeutic difference
69. Synchronization refers to 2. the pain experienced
1. maximal isometric tension by the patient is less with slow stretch
2. minimal isometric tension 3. the slow stretch is
3. the pattern of agonist cooperation to increase strength used only when muscle exhibit clonus
4. a muscle inhibitory or
4. the coordinated firing of motor units to increase strength relaxing effect is obtained by slow stretch,
while fast stretch is excitatory and facilitates
70. Biofeedback training muscle activity
1. involves the use of equipment that reveals to the patient
some internal parameter or event that would 75. In classical proprioceptive neuromuscular
otherwise have not been consciously known to the facilitation (PNF) techniques, a therapist might
patient stretch a muscle to
2. requires that the patient receiving the feed back 1. facilitate voluntary
volitionally use it to accomplish a desired goal activity in the muscle
3. using electromyographic equipment often improves the 2. increase the firing
results of an exercise program especially if the rate of the afferents from the muscle spindle
desired goals include muscle relaxation or specific 3. inhibit voluntary
muscle firing activity in the antagonistic muscles
4. is probably the most useful clinically in strike 4. focus the patient’s
rehabilitation attention on the movement of the muscles

71. Some of the most important parameters in 76. Proprioceptive neuromuscular

evaluating the patient who is going to receive facilitation(PNF) programs typically include
neuromuscular facilitation exercise include 1. deep cooling of
1. the distribution of abnormal tone and spastiolty in the muscles
trunk and extremities 2. muscle stretching
2. voluntary movements and the effect of abnormal tone 3. withdrawal reflexes
on them 4. superficial cooling
3. coordination of voluntary movements
4. motivation of the patient for the treatment and for 77. Noxious stimuli
improvement 1. produce a
generalized flexion synergy withdrawal
72. The peripheral influences on motoneuron 2. produce the same
excitability usually used in propreceptive general effect as tickling
neuromuscular facilitation exercise techniques 3. relax extensor tone
are by inhibition flexor antagonists

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 4. are often used as
part of a PNF program
78. Rood’s technique of superficial cooling of the
skin over a muscle or brushing the skin over a
muscle is
1. useful in increasing the activity level of a muscle
2. based on the observation that skin stimulation over a
muscle increases the gamma efferent activity to the 89.
muscle spindle system
3. due to a multisynaptic reflex connecting skin receptors90.
and muscles underlying the skin, and which in an
evolutionary sense may have been useful in avoiding
capture
4. not explainable with current neurophysiological
information
79. Central facilitation techniques
1. utilize synergies, associated reactions, and radiation
to get facilitation or inhibition of a muscle
2. utilize stroking or icing techniques
3. include the common practice of having a hemiplegic 91.
patient maximally activate the muscle on the normal
side while trying to voluntarily use the desired muscle 92.
on the affected side
4. should not be used simultaneously with PNF
techniques
Directions: Each group of numbered words or phrases
is followed by a list of lettered statements. MATCH he
lettered statement most closely associated with the
numbered word or phrase.
Questions 80 through 85
80. uses involuntary responses to movement of
the head and body for modification of muscle
tone or for eliciting a desired movement.
81. an eclectic program used in hemiplegia
rehabilitation employing central facilitation, PNF,
and peripheral cutaneous stimulation to move the
patient from mass synergy reactions to voluntary
motion contained in synergies, and then to
refined voluntary motion control
82. a method of exercise treatment using
classical PNF methods designed around
predetermined diagonal spiral movements that
are repeated many times
83. a method using cutaneous stimulation
(brushing and icing,etc.) to increase gamma
efferent activity
84. a method of exercise that uses extensive
bracing to allow desired movement while
prohibiting other movement
85. a method of exercise treatment that
emphasizes the development of bed and
wheelchair activities of daily living
A. Rood method
B. Brunnstrom method
C. Bobath method
D. Knott and Voss (Kabat) method
E. Deaver method
33
Questions 86 through 90
86. in a patient with acute rheumatoid arthritis,
this type of exercise might stretch the inflamed
tissues and result in joint instability
87. the safest type of resistive exercise in the
patient with acute rheumatoid arthritis
88. the safest type of resistive exercise in the
patient with acute rheumatoid arthritis
this may have to be accomplished in bed
with or without protective splints
this can be used in acute rheumatoid
arthritis if the joint is well supported and the
patient is not overly vigorously in the movement
A. passive range of motion
B. isotonic exercise
C. isometric exercise
D. active assisted range of motion
E. active assisted range of motion
F. rest
Questions 91 through 95
in subacute rheumatoid arthritis, the type of
range of motion exercise most commonly used
this type of resistive exercise can be done in
the subacute stage of rheumatoid arthritis if it is
done with done with caution and no joint
symptoms result
93. the safest type of resistive exercise in the
subacute stage of rheumatoid arthritis
94. the patient is weaned from this in the
subacute stage, unless doing so produces a
relapse
95. the best type of exercise to prevent or
reduce contractures in the subacute stage of
rheumatoid arthritis is usually
A. passive range of motion
B. isotonic exercises
C. isometric exercises
D. active-assisted range of motion
E. rest
Questions 96 through 100
96. useful as a prelude to exercise
97. an important technique for maintaining range
of motion in the chronic stage of rheumatoid
arthritis
98. rarely used in the chronic stage of
rheumatoid arthritis
99. these are often more important strength and
range of motion in the chromic stage of
rheumatoid arthritis
100. this is often important in the chronic stage of
rheumatoid arthritis to prevent excessive fatigue
And over stressing of joints
A. passive range of motion
B. active range of motion
C. rest
D. functional activities
E. heal
 4.
Questions 101 through 105 improved strength of abdominal and hip
101. this is important in the patient with ankylosing extensor muscles
spondylitis to prevent loss of vital capacity and
thoracic compliance 108. Probably the most useful technique for treating
102. this must be done in ankylosingspondylitis simple recurrent low back pain is
patients to avoid facilitating the fusion of the 1. traction
spine in the typical cervical flexion and thoracic 2. pelvic tilt exercise
kyphosis 3. knee-chest exercise
103. this should not be used in ankylosing spondylitis 4. bedrest
unless other therapies fail to prevent postural
deformity 109. Prescribing leg lifts in patients with simple
104. this is important ankylosing spondylitis to recurrent low back pain may
discourage fixed cervical flexion and thoracic 1. exacerbate the pain as the iliopsoas muscle
kyphosis pulls the lumbar spine into lordosis
105. this is important in ankylosing spondylitis to 2. strengthen the iliopsoas muscle and to some
discourage fixed cervical flexion and thoracic extent the abdominal muscles
kyphosis 3. be less helpful than prescribing book-line sit-
A. deep breathing exercise ups
B. active and active-assisted range of motion 4. increase intradiscal pressure in the lumbar
C. postural exercises spine
D. bed poritioning
E. truncal bracing 110. Knee-chest exercise are used in patients with
low back pain to
Directions: For each of the incomplete statements 1. strengthen the hip flexors
below, ONE or MORE of the numbered completions is 2. stretch the hamstring muscle
correct. In each case select: 3. strengthen the hamstring muscles
A. If only 1,2 and 3 are correct 4. stretch the soft tissue structures of the low
B. If only I and 3 are correct back
C. If only 2 and 4 are correct
D. If only 4 is correct 111. Hamstring muscle stretching is often done in
E. If all are correct patients with low back pain
1. with the patient sitting, knees extended,
106. Exercise programs for the hand in patients bouncing, the trunk forward to attempt to
with inflammatory arthritis are controversial touch the toes
because 2. with the patient standing, trying to touch the
1. many authorities toes
feel that nay exercise increases the loss of 3. with the patient sitting with one knee
joint stability extended and one flexed, with truncal
2. exercise takes bouncing to touch the toes of the extended
too much of the patient’s time and has been side
proven to be definitely effective 4. patients with low back pain should not be
3. hand exercise stretching the hamstring muscles since these
programs are very complicated and must be exercises increase the lumbar lordosis
designed for each patient and even for each
finger joint. 112. Pelvic tilt exercise is often prescribed for
4. They are clinically patients with low back pain because
proven to be useful following hand surgery in 1. abdominal muscle strengthening
patients with inflammatory arthritis. 2. reflex inhibition of back musculature
3. stretching of the low back structures to
107. The prescription of exercise for the patient with present fixed excessive lumbar lordosis
simple recurrent low back pain should achieve 4. permanent reduction of the lumbar lordosis
at least the following
1. 113. Stretching the hip flexors is often useful in
improved low back flexibility patients with hip flexion contractures and low
2. back pain. In this type of exercise,
improved posture with minimized lumbar 1. there is active
lordosis use of the Thomas test for hip flexion
3. contracture
improved body mechanics in all activities and 2. the patient lies
exercise supine with both hips in full extension

34
 3. the patient kneels
on one knee and rocks back and forth
4. the patient lies
prone
114. A hook-lying (or hook-line) sit-up is
1. done in the supine position with the knees
flexed
2. used to strengthen the hip flexors
3. used to strengthen the abdominal muscles
and to some extent the hip flexors
4. particularly useful during episodes of acute
back pain
115. Bridging is a useful exercise in patients with low
back pain if it can be done without exacerbating
the pain because it strengthens the
1. abdominal muscles
2. hip flexor muscles
3. neck flexor muscles
4. back and hip extensor muscles
116. Postural exercises in scoliosis
1. are used while in the Milwaukee brace since
this brace forces the patient to extend the
spine to prevent painful pressure on the chin
or neck
2. are used to elongate the spine low back are
used to elongate the spine
3. are used to reduce the lumbar lordosis and
dorsal kyphosis
4. can be done with a weight on the head to
improve the strength of the muscles that
distract the spine
117. Exercise in patients with scoliosis has been
shown to
1.
control and even improve the scoliotic curve
2.
increase the flexibility of the concave side of the
spinal curvature
3.
worsen the curvature when used without
adequate bracing
4.
improve respiration
118. Cotrel’s exercises for scoliosis include
1. elongation of the spine
2. derolation of the spine
3. lateral flexion of the spine
4. self powered cervical traction (the lower
extremities push on a bar to provide the
power for cervical traction through a double
pulley system )
119. Buerger’s exercises for treatment of peripheral
vascular disease
1. have not been shown to be effective in
controlled studies
2. do not increase muscle blood flow
35
3. are based on the theory that alternately
distending and emptying blood vessels
would make them capable of handling
greater quantities of blood
4. originally included the use of an electric
heating pad or hot water bottle on the limbs
120. Buerger-Allen exercises
1. Combine the postural program of Buerger
with active plantar flexion and dorsiflexion of
the ankle at a rate of 30 min
2. are less effective in increasing blood flow to
muscles than resistive exercise of the lower
extremities
3. increase the quantity of blood flowing to
lower extremity muscles
4. include walking to the point of claudictory
pain
121. Achieve muscle contraction
1. reduces the quantity of blood flowing in a
muscle during the contraction
2. increases the quantity of blood flowing in a
muscle during the contraction
3. increases the quantity of blood flowing in a
muscle between contractions
4. decreases the quantity of blood flowing in a
muscle between contractions
122. The most effective treatment (nonsurgical) of the
following treatment programs for peripheral
vascular disease is
1. Buerger’s exercises
2. vasoldilators
3. Buerger-Allen exercises
4. brisk walking to the point of claudicatory pain
(for at least one hour per day
123. The main advantages of immediate
postoperative fitting of a lower extremity
prosthesis are
1. psychological benefit to the patient of early
ambulation
2. early re establishment of proprioceptive
feedback by contact with floor
3. pain relief by prevention of stump edema
4. prevention of complications of prolonged bed
rest
124. Ambulation exercise with immediate
postoperative fit prosthesis should
1. involve no weigh bearing on the prosthetic
side for six weeks
2. involve only touchdown weight bearing the
first day after amputation
3. achieve full weight bearing by the fourth
postoperative week
4. involve progressively more weight bearing on
the temporary prosthesis until it is bearing a
maximum of 15 pounds (6 kg)
125. The most appropriate exercise regimen for a
patient with below-knee amputation and
immediate postoperative fitting is to
1. begin with
touchdown weight bearing on the prosthesis
and progress to a three-point gait using
parallel bars, crutches, or a walker
2. begin with three-
point gait using axillary crutches
3. after fitting the
permanent prosthesis, focus on obtaining
equal stride length and elimination of
prosthetic gait deficiencies
4. begin with a four-
point gait using axillary crutches
126. The exercise program for a lower extremity
amputee not fitted with an immediate post
operative prosthesis is aimed at
1.
preventing contractures of the hip and knee
2.
preventing loss of strength of the hip extensors,
flexors, and abductors as well as the knee
extensors and flexors
3.
rapid shrinkage of the stump (elimination of post
operative edema)
4.
preservation of the strength and range of motion
of joints in the remaining extremities
127. An infant with acquired flat feet would have
1. deficient internal rotation of the hips
2. a history of sleeping on the abdomen in the
frog leg position in the first few months of life
3. rapid shrinkage of the stump (elimination of
postoperative edema)
4. preservation of the strength and range of
motion of joints in the remaining extremities
128. The treatment program for an infant with
acquired flat feet who is not old enough to walk
should include
1. passive external rotation of the hips by the
parents
2. passive internal rotation of the hips by the
parents
3. massaging of the feet at least four times per
day
4. passive foot stretching by the parents in
which the forefoot is adducted while the heel
is inverted
36
129. Treatment of acquired flat feet in a child old
enough to walk might include
1. shoes having an adducted forefoot pattern
2. a lift under the medial side of the heel
3. attaching a bar to the sole of the shoes at
night to hold the hips in internal rotation
4. stretching the Achilles tendons
130. The treatment of the older child with flat feet
usually includes
1. stretching the Achilles tendons
2. strengthening the foot evertors
3. strengthening the foot invertors
4. encouraging the child to walk with feet
pointing outward
131. Treatment for foot strain in the adult might
include
1. toe pick-up exercises
2. standing with the feet in slight inversion
3. weight loss down to ideal weight
4. one-eighth inch wedge in the lateral border
of the heel of the shoe
132. The treatment program for a child with pigeon
toes must be based on the type of lower
extremity pathology producing it, such as
1. medial hip rotation, usually associated with
2. a history of “W” sitting
3. metatarsus varus
4. external hip rotation, usually associated with
a history of lying prone with the lower
extremities in the frog leg position
133. The typical exercise program for pigeon toeing
due to internal tibial torsion includes
1. passive rotation of the tibia and fibula into
external rotation
2. passive external rotation of the femur
3. “strengthening” the leg by grasping the
medial aspect of the knee and ankle and
using the thumbs to push against the fibula
4. a shoe bar can be used to keep the femur on
each side in internal rotation during the night
134. Pigeon-toed gait due to metatarsus varus is best
treated by
1. casting of the foot
in every case
2. encouraging “w”
sitting
3. using cable
“twister”
4. passively
stretching the forefoot toward normal
alignment
135. In treating gait dysfunction, it is important to
bear in mind that gait is affected by
1. a person’s body image
2. neurological muscle control competency
 3. conscious and unconscious sensory
feedback
4. perceptual orientation competence
136. The technical difference between walking and
running exercise is that the
1. stance phase of gait is decreased in running
2. swing phase of gait is increased in running
3. period of double stance (double support) is
longer in walking
4. period of double stance (double support)
occurs only in walking
137. Gait speed is
1. unconsciously chosen by each individual at
the speed giving the lowest energy
expenditure per unit distance
2. about 3 mph for adult males
3. unconsciously chosen by each individual
such that the pendulum periodicity of the
lower extremities fits the cadance
4. only 3 mph for adult males because the
slower you walk the less energy required for
ambulating any unit distance
138. Gait speed is unconsciously chosen by each
individual to allow maximum use of
1. large rather than small muscles
2. gravity and inertia rather than muscular
3. concentric rather than eccentric contractions
of muscles
4. eccentric or lengthening contractions of
muscles
139. Loss of motion at which joint produces the least
increase in the energy required for ambulation
1. knee
2. hip
3. both hips
4. ankle
140. A gait characterized by reduction of stance
phase on one side with sudden movements
downward of the head, arms and trunk at stance
phase on the same side is
1. due to gluteus medius weakness
2. due to anterior tibial muscle weakness
3. hysterical
37
4. antalgic
141. Some of the gait characteristics of normal aging
include
1. slower walking speed
2. shorter stride length
3. wider base of gait
4. relatively more time is spent in stance phase
142. Gait in women is
1. slower than in men (mainly due to shorter
stride length rather to slower cadenced
2. not related to the rule of choosing gait speed
based on the least energy expenditure per
unit distance
3. slower than normal in high heels
4. faster than men in a crowded area
143. The normal aging process produces an
involuntional gait involving a flexed attitude,
dorsal kyphosis, mild proximal muscle rigidity,
decreased automatic movements, and a
decrease in the amplitude of associated
movements, tending to indicate involutional
changes in the
1. pyramidal system
2. skeletal muscles
3. autonomic nervous system
4. extrapyramidal system
144. A prescription of progressive ambulation might
include
1. tilt table therapy
2. pool walking
3. walking in the parallel bars
4. walking with assistive devices such as
crutches, cane, walker, etc
145. In very severe gait, problems the wheelchair
may
1. be a liberating rather than confining device
2. be a better form of ambulation because of
the much lower level of energy required to
travel per unit of distance
3. be safer for some patients than attempts at
walking
4. have to be self- powered (usually electric) if
the upper extremities are also impaired
 Chapter 3
Answers and Commentary
1. D. Fact muscle fiber us a large syncytial cell type 1 fibers are also called slow or red fibers.
of variable size They have many mitochondria and a high level of
2. E. The sarcoplasm is filled with mitochondria, oxidative metabolism through the Krebs cycle.
nuclei, fat droplets etc. They have a slow twitch time and a high
3. C. See answer to question1 resistance to fatigue. They are usually used for
4. B. sustained and postural control activities. The type
5. A. II fibers mainly use the glycolytic easily, are fast
6. B. twitch, and are used for fast phase activity. The
7. E. separation of the red and white fibers in man is
8. B. not as obvious as it is most animals. There are
9. D. The myofibrils are the actual contractible also fibers that appear to be intermediate
elements of the muscle fiber between types I and II in their characteristics
10. E. 22. A. See answer to question 21
11. A. 23. B. See answer to question 21
12. C. 24. A. See answer to question 21
13. D. 25. B. See answer to question 21
14. E. 26. A. See answer to question 21
15. E. 27. B. See answer to question 21
16. A. 28. A. See answer to question 21
17. A. 29. A. See answer to question 21
18. E. 30. B. See answer to question 21
19. D. 31. B. See answer to question 21
20. C. 32. A. See answer to question 21
21. C. Muscle fibers have many myofibrils, which 33. D. See answer to question 21
are the actual contractile elements of the muscle 34. E. See answer to question 21
fiber. Muscle fibers can be typed according to 35. C. See answer to question 21
certain characteristic into type 1 and type 11 36. C. This type of exercise occurs when a
fibers. This fiber typing is visible grossly in many muscle contracts against resistance sufficient to
animals (i.e. light and dark meat in poultry). The prevent joint movement.

38
37. D. This type of exercise occurs when a
muscle contracts and joint motion occurs against
a resistance
38. E. This is exercise against a rate-limiting
device, usually on that maintains the torque
resistance to movement equal at all degrees of
rotation.
39. A. This type of muscle contraction occurs
while the muscle is being passively stretched or
lengthened. This is frequently used in gait and is
very efficient since it tends to maintain the resting
length of the muscle during the contraction.
40. B. A concentric contraction is one in which
the muscle actually shortens during contraction
41. C 63.
42. B. The nerve innervating a muscle
determines the fiber type of the muscle. The fiber
type of a muscle can be changed by surgically
switching the nerve innervating the muscle.
43. E. Motor units fire in a pattern that result is
selective firing of the smallest
44. D. It has been known for many years that
weakness of the lower motor neuron type or
muscle weakness due to muscle disease can
both be increased by resistive activity. Generally
the muscle weakness must be at or below
antigravity level to get significant overwork
weakness.
45. A. The mechanism of fatigue is still not
clearly defined.
46. C.
47. E.
48. A.
49. B.
50. D.
51. A. It is passive on the part of the patient
52. B Muscles that cross more than one joint
may shorten and restrict shorten and restrict joint
motion. The gastrocnemius crosses the knee and
the ankle and if tight would eliminate ankle and if
tight would eliminate ankle dorsiflexion while the
knee is extended and vice versa.
53. E. A brace rigged with springs or rubber
bands can exert tension in a desired direction on
a joint many hours of the day instead of the few
minutes of the day a therapist can usually give.
54. B.
55. C.
56. C.
57. A. Active exercise may further stretch
ligaments and other tissues and produce joint
laxity and other complication
58. E. See answer question 53.
59. B. Pain may prevent a patient from
voluntarily moving a joint through a full range of
motion. Some patients interpret this as “
weakness”, when actually it is pain inhibition of
voluntary function.
60. D. Some motor unit diseases such as the
Guillain-Barre syndrome may produce shortening
39
of two-joint muscles such as the gastrocnemius,
iliotibial tract, hamstrings, and so forth, more than
reduction in joint range of motion.
61. B. Maximum strength occurs when the
muscle is at resting length. This relationship of
the strength and length of a muscle is called the
length-tension curve. The best explanation for the
length tension relationship is the theory that
strength is a function of the number of bridges
formed between the sliding actin myosin
filaments.
62. E. The most important factor in increasing
strength appears to be fatigue rather than the
exact weight used or the type of exercise done.
E. De Lorme was not the first to use resistive
exercise therapeutically, but he was responsible
for the first widely accepted and practical system
of resistive exercise. It is based on determining
the greatest weight that a patient can lift
isotonically 10 times. This is the 10 repetitive
maximum or 10 RM. The patient does 10
repetitions of one half 10 RM, 10 repetitions of
three quarters 10 RM, and 10 repetitions of 10
RM daily. On the fifth day of each week of
therapy, the new 10 RM is established for the
next week of therapy.
64. E. De Lorme call the PRE program “ load-
assisting exercise” when it was done with
muscles below anti gravity in strength. The
exercise must be done cautiously and monitored
carefully to avoid overwork weakness.
65. B. This is a technique designed by
McGovern and Luscombe that uses the heaviest
resistance first rather than last as in progressive
resistance exercise (PRE). This allows the
muscles to do less work as they fatigue and is
often referred to as regressive resistance
exercise (PRE). It is widely used in physical
therapy with the addition of a preliminary warm-
up session.
66. C. Body builders are interested in muscle
bulk rather than muscle strength. They tend to
use the maximum weight that can be used for
one set of repetitions, since this seems to be
more effective in producing muscle bulk. This
type of exercise generally does not radically
improve aerobic physical fitness.
67. A. Power lifters fee that daily or almost daily
weight lifting is essential for maximum strength
development. Their programs are usually
designed toward being able to lift the maximum
weight one time, which is generally the way they
perform in competition. A power-lifting program is
not a radically effective one for improving aerobic
physical fitness.
68. E. It is often difficult in isometric exercise to
accurately measure the force being exerted by
the patient. This is particularly a problem in cases
where the patient has pain inhibition of function
or lacks motivation. The BRIME (brief repetitive
isometric exercise) program uses multiple 6-
second contractions with 20-second intervals
 between them. Isometric exercise seems to 81.
increase strength with much less hypertrophy of
the muscle than is seen with isotonic exercise. 82.
The range of motion of joints is not helped by 83.
some isometric exercise and some experts feel 84.
that the increased strength is joint-angle specific.
69. D. Increased muscle strength is not only a
function of increasing the cross-sectional area of 85.
muscle, but also of improved coordination in the 86.
firing of motor units. Increasing the isometric 87.
maximal force 20% often results in a doubling of 88.
the synchronization ratio. 89.
70. E. Studies have shown that biofeedback, is 90.
particularly useful in improving dorsiflexion and 91.
hand function in hemiplegic patients. 92.
71. E. All important factors in designing an 93.
exercise program. 94.
72. C. Sherrington and others have pointed out 95.
the importance of such peripheral influences as 96.
muscle, tendon, and skin receptors on alpha 97.
motoneuron excitability. 98.
73. D. The stimulus should at least increase the 99.
probability that motoneuron discharge will occur. 100.
74. D. Slow stretch desensitizes the muscle 101.
spindle and reduces the quantity of muscle 102.
activity at any given length of the muscle. This 103.
relaxes excessive tone. Quiet stretch facilitates 104.
muscle activity and may even result in clonus. 105.
75. E. 106.
76. A.
77. E. Noxious stimuli relax extensors and cause
flexor synergy. A painful or tickling stimulus to the
sole of the foot may cause flexor synergy with
resulting retraction of the lower extremity toward
the trunk. Some experts feel that this withdrawal
response to noxious stimuli is the etiology of
“paradoxical paraplegia” in which paraplegic
patients have flexion rather than the usually 107.
observed extension of the lower extremities in 108.
response to a pain stimulus.
78. A. Skin stimulation apparently excites 109.
cutaneous receptors that then produce an
increase in the firing of the gamma efferents to 110.
the muscle spindles. This resets the muscle
spindles to be more sensitive to stretch, which
facilitates muscle activity. In animals a
mutisynaptic reflex pathway has been 111.
documented in which skin stimulation causes
activation of cortical motoneurons and then alpha
motoneurons through the corticospinal tract.
79. B. Central facilitation probably results from 112.
central interconnection that allows strong activity
in a normal muscle to facilitate activity in the
same muscle on the contralateral side. These
techniques also take advantage of flexor synergy
patterns to facilitate activity in desired muscle.
80. C. The Bobath method does not emphasize 113.
the cooperation of the patient in voluntary activity,
but involves the initiation of activity by use of
head and neck proprioceptive and vestibular
reflexes.
40
B. The Brunnstrom method is perhaps most
useful in acute hemiplegia
D.
A.
E. A typical example would be the use of
long leg braces with pelvic band and hip joints
that allow only flexion in ambulation
E.
B.
A.
C.
E.
D.
A.
B.
C.
E.
D.
E.
B.
A.
D.
C.
A.
D.
E.
C.
B.
A. Many experts feel that hand exercise
programs are potentially dangerous in
rheumatoid arthritis because of the tendency of
acutely inflamed joints to be further injured
exercise of almost any kind. The exercise
program prescribed for each patient must be
based on a careful analysis of the
pathokiesiological forces at work in the patient’s
hands.
E.
D. Almost all types of low back pain respond
to bedrest.
E. Leg lifts should generally be used only by
those not having recurrent low back pain.
E. This exercise can be done by bringing the
knee to the chest either simultaneously or
alternately. It stretches the low back structures
and reverses the lumbar lordosis.
A. The method that is best for each patient
is the one that does not produce any further pain.
Number 3 is often referred to as the “ low back
protective” method of hamstring stretching.
A. The patient does pelvic tilt exercises by
lying supine with the knees in flexion and then
contracting the abdominal muscles to push the
low back metabolic rates. The exercises
have not been shown to improve lower extremity
circulation or to improve collateral circulation.
B. The Thomas test for hip flexion
contracture is bed on eliminating the lumbar
lordosis by hip flexion such that full extension of
the opposite hip is required to keep the thigh on
the table. A patient can use this test actively to
stretch the hip flexors. Lying supine does not fully
 extend the hips, since some of the apparent hip
extension is actually due to lumbar lordosis. Lying
supine does not fully extend the hips, since some
of the apparent hip extension is actually due to
lumbar lordosis. Lying prone helps prevent hip
flexion contractures. But does not fully extend the
hips. Full hip extension occurs in normal persons
usually only in standing and walking activities.
114. B. The book lying sit-up is done to
strengthen the abdominal muscles. The hips are
flexed to weaken the effect of the hip flexors in
producing the sit-up. This exercise is often painful
when the patient is having acute low back pain,
and its use is often delayed until the back is
relatively pain free.
115. D. This exercise should be used in patients
with low back pain only if it does not exacerbate
the pain.
116. E.
117. C. Exercise alone has not been shown to
control or improve progressive scoliosis. It is
used as an adjunct to bracing, surgery, and other
treatment methods. Exercise in scoliosis patients
has many benefits including improvement in
posture, increased spinal flexibility, improved
respiration, and increased strength of the
abdominal musculature for improved postural
support.
118. E. The combination of elongation, derotation,
and lateral-flexion exercise is often referred to as
EDF in scoliosis therapy.
119. E. Buerger’s 1924 program included raising
the limbs until they drained of blood, then
lowering them until hyperemic, and then resting
them in the Horizontal position. A heating pad
was placed on the limbs when they were in the
horizontal position. The use of the heating pad
was later stopped when it became known that
warming the extremities caused an increased
need for blood due to higher a normal gait until
the permanent prosthesis is obtained. After the
permanent prosthesis is available, gait training is
aimed at normalizing the gait with regard to equal
step lengths and eliminating prosthetic
deficiencies.
120. A. The postural exercises of Buerger were
adapted to allow active ankle motion during the
periods of elevation and dependency of the lower
limbs. This exercise does increase the quantity of
blood flowing to the lower extremity muscles, but
probably due to the active ankle motion rather
than to a postural effect. This exercise program is
less effective than lower extremity resistive
exercise in increasing the quantity of blood
flowing to lower extremity muscles.
121. B. Most studies indicate that blood flow is
reduced or even stopped in a muscle during
contradiction but is increased rapidly following
the cessation of the contraction. After a bout of
severe resistive exercise the blood flow to a
muscle can increase up to 30 times the resisting
level.
41
122. D. The studies of Larsen and Lassen have
shown that both blood flow to the lower
extremities and the patient’s ability to endure
walking are increased by a program of
intentionally walking at a brisk pace up to the
point of claudicatory pain. After a brief period of
rest to allow the pain to subside, the patient then
repeats the process.
123. E. Another advantage of immediate fit is the
economic savings to the patients because of
being able to return to work much earlier (usually
in 6 to 10 weeks rather than 3 to d6 months after
surgery).
124. C. There is no need to ever bear full weight
on a plaster type or temporary prosthesis. Full
weight bearing can begin after the wound is
healed and the patient receives the first
permanent type of prosthesis.
125. B. A normal gait cannot be achieved in a
temporary plaster of Paris socket, and
consequently no attempt is made to get a rather
than lateral to discourage calcaneovalgus. The
program is designed on the theory that foot attain
is due to excessive weight or stress on the foot
with subsequent tendency toward flattening of the
longitudinal arch.
126. E.
127. E. The infant who lies persistently in the frog
leg position may acquire flat feet by a process of
hip external rotation with loss of hip internal
rotation., shortening of the peroneal muscles,
stretching and weakening of the tibial muscles,
movement of the calcaneus into the valgus,
inversion of the feet, and abducted forefeet.
These factors are very important in
understanding the design of an exercise program
for the infant with acquired flat feet.
128. C. A home program is usually sufficient for
non-walking infants with acquired flat feet. The
parents are instructed to grasp the forefoot with
one hand and the hind foot with the other, and
then to stretch the foot such that the heel goes
into varus and the forefoot into adduction.
Simultaneous pressures should also be put on
the navicular bone to displace it medially.
129. E. The heel cord stretching is done only if the
heel cords are tight, which they often are due to
the prolonged “sitting on the feet” that occurs in
children of this age group.
130. B. The child is encouraged to walk with the
feet pointing straight ahead to counter the
external rotation of the hips and the tendency of
the feet to pronate. The heel cords are often tight
and may be the actual cause of flat feet in these
children since the heel goes into valgus to allow
foot dorsi flexion in walking. The foot invertors,
including the anterior and posterior tibial muscle,
should be strengthened. These children often
dorsiflex the feet using the peroneal group such
that dorsiflexion is done with foot eversion.
131. A. The toe pick-up exercises include picking
up objects from the floor with the toes. The heel
 wedge should be medial with the determinants of
gait, but produces the least increase in the
energy required for ambulation (as compared to
the knee and hip). The hip affects energy
consumption least when fixed at 150 degrees.
The position of fixation of the knee that at least
affects energy consumption of ambulation is the
narrowest angle of flexion possible (over
135degrees is especially bad for energy
conservation).
132. A. The most common etiology is tibial
torsion, which can be acquired or congenital. The
exercise program used in each case differs.
133. B. The parents are taught to encourage the
child not to sit on the legs with the legs in marked
internal rotation. They are also shown how to
passively rotate and straighten the tibia. These
exercises are directed at straightening and
unwinding the tibia rather than at the knee or
ankle joints. The bones of infants and your
children are sufficiently pliable to respond to this
molding process.
134. D. Passive stretching of the forefoot toward
the normal straight alignment is usually all that is
needed. If this is not sufficient, casting of the
foot, or shoes with swung-out sole design, may
be needed
135. E. Gait reflects many things about an
individual, including mood and at times even
cultural group.
136. D. The basic difference in walking and
running is that walking always involves at least a
short period of double support when both feet are
in contact with the ground.
137. A. The normal adult male walks about 3 mph
because the energy required for ambulating per
unit distance is lowest at this speed. Walking
more slowly requires more energy per unit
distance. The energy requirements is lowest at 3
mph because the natural pendulum periodicity of
the lower extremities matches the cadence,
allowing the least amount of muscle activity.
138. C. Eccentric contractions of muscles are
used in gait since they are more energy efficient
than concentric contractions. Gait speed is also
unconsciously set to allow the maximum use of
gravity and inertia.
139. D. Loss of ankle joint mobility interferes with
the determinants of gait, but produces the least
increase in the energy required for ambulation
42
(as compared to the knee and hip). The hip
affects energy consumption least when fixed at
150 degrees. The position of fixation of the knee
that least affects energy consumption of
ambulation is the narrowest angle of flexion
possible (over 135 degrees is especially bad for
energy conservation).
140. D. The antalgic or painful gait occurs when
the extremity or foot bearing the weight is painful.
The gluteus medius weakness gait produces
either a dropping of the opposite hip on stance
phase (uncompensated) or, during stance phase
(compensated), a swaying of the trunk over the
lower extremity having the weak gluteus medius.
Anterior tibial muscle weakness produces the
classical foot-drop, which is usually compensated
for by exaggerated hip and knee flexion on swing
phase or by circumducting the affected extremity
during swing-phase. The former is called a
steppage gait while the latter is called a
circumduction gait. Hysterical gaits usually
include such characteristics as slow motion,
overflow, bizarreness, inconsistency, and
indifference of the patient to the seriousness of
the gait disturbance.
141. F.
142. B. Women walk more slowly than men
because of shorter average stride length (due to
shorter average height) rather than slower
cadence. The stride length shortens further and
the energy cost is 15% higher when high heel are
worn. Both men and women tend to move their
joints sufficiently to capitalize fully on reduction of
energy use through the determinants of gait.
They are more likely to trip over small objects
and have more difficulty regaining balance once it
is lost.
143. D. The extrapyramidal system seems the
most impaired. Gait in the elderly is slower and
they are unable to move their joints sufficiently to
capitalize fully on reduction of energy use
through the determinants of gait. They are more
likely to trip over small objects and have more
difficulty regaining balance once it is lost.
144. E.
145. E. Rehabilitation personnel often attempt to
make patients ambulatory when overall health
status and safety factors would tend to indicate
that a wheel chair would be more appropriate.