CMT Patient Evaluation & Treatment Planning 3 — Questions and Answers
Question 1: When using the International Classification of Functioning (ICF) model in treatment planning, 'participation restrictions' refers to:
- Tissue-level pathology such as a torn ligament
- Problems experienced in involvement in life situations (Correct answer)
- Limitations in executing tasks or actions
- Contextual environmental barriers
Correct answer: Problems experienced in involvement in life situations
Participation restrictions in the ICF model describe problems a person experiences in involvement in life situations, such as inability to return to work or recreational activities.
Question 2: A patient's muscle energy technique (MET) treatment session reveals that the right sacral sulcus is deep, the right inferior lateral angle (ILA) is posterior-inferior, and the lumbosacral spring test is positive. This presentation is consistent with:
- Right-on-right forward sacral torsion (Correct answer)
- Left-on-right backward sacral torsion
- Bilateral sacral flexion
- Right unilateral sacral extension
Correct answer: Right-on-right forward sacral torsion
A deep right sulcus with a posterior-inferior right ILA and a positive spring test on the sacral base indicates right-on-right forward sacral torsion.
Question 3: Which red flag finding during a patient intake warrants immediate medical referral before initiating manual therapy?
- Night pain that disturbs sleep
- Saddle anesthesia with recent bowel/bladder dysfunction (Correct answer)
- Morning stiffness lasting 30 minutes
- Pain that increases with prolonged sitting
Correct answer: Saddle anesthesia with recent bowel/bladder dysfunction
Saddle anesthesia combined with bowel or bladder dysfunction suggests cauda equina syndrome, a surgical emergency requiring immediate medical referral.
Question 4: A treatment plan goal is measurable if it includes which of the following components?
- A description of the dysfunction being addressed
- A specific, quantifiable criterion for success with a target date (Correct answer)
- The manual technique to be applied
- The frequency of treatment sessions
Correct answer: A specific, quantifiable criterion for success with a target date
Measurable goals must specify a quantifiable criterion (e.g., pain ≤2/10, ROM ≥120°) and include a target date to allow objective tracking of progress.
Question 5: During palpation of lumbar segments, a manual therapist identifies a rigid vertebra with restricted spring and tenderness. The most appropriate initial intervention would be:
- High-velocity low-amplitude thrust to the segment
- Grade I oscillation to reduce pain and promote fluid exchange (Correct answer)
- Passive straight-leg raise to assess neural tension
- Soft tissue inhibition to the erector spinae at that level
Correct answer: Grade I oscillation to reduce pain and promote fluid exchange
Grade I oscillations are appropriate for acutely painful, restricted segments as they work within pain-free range to promote neurophysiological pain inhibition.
Question 6: The concept of 'joint end-feel' during passive range of motion testing helps the therapist distinguish between:
- Muscle strength deficits and sensory deficits
- Normal anatomical limits and pathological restrictions (Correct answer)
- Neurological involvement and vascular compromise
- Acute and chronic pain presentations
Correct answer: Normal anatomical limits and pathological restrictions
End-feel quality (firm, hard, empty, springy, boggy) reveals whether a range of motion limit is a normal anatomical boundary or a pathological restriction.
Question 7: In a patient with chronic neck pain, the fear-avoidance model predicts that catastrophizing beliefs about pain will most likely lead to:
- Rapid return to full function with minimal intervention
- Avoidance behavior, disuse, and increased disability (Correct answer)
- Increased pain tolerance over time
- Spontaneous tissue healing without behavioral change
Correct answer: Avoidance behavior, disuse, and increased disability
According to the fear-avoidance model, catastrophizing leads to fear, avoidance of movement, disuse, and a self-perpetuating cycle of increased disability.
CMT Patient Evaluation & Treatment Planning 3
When using the International Classification of Functioning (ICF) model in treatment planning, 'participation restrictions' refers to: