NPTE-PT Therapeutic Modalities Application 5 — Questions and Answers
Question 1: A PT uses biofeedback with surface electromyography (sEMG) for a patient with patellofemoral pain syndrome. The primary therapeutic goal of this application is to:
- Reduce pain via gate control mechanism
- Improve voluntary motor recruitment and muscle re-education of the VMO (Correct answer)
- Decrease spasticity through reciprocal inhibition
- Increase local blood flow via vasodilation
Correct answer: Improve voluntary motor recruitment and muscle re-education of the VMO
sEMG biofeedback provides real-time visual or auditory feedback to help patients consciously improve VMO activation timing and magnitude.
Question 2: During ultrasound treatment, a patient reports pain under the transducer during stationary application. The MOST likely cause and correct response is:
- Normal periosteal stimulation; continue treatment
- Standing waves causing periosteal damage; move the transducer continuously (Correct answer)
- Insufficient coupling gel; increase intensity
- Incorrect frequency; switch from 1 MHz to 3 MHz
Correct answer: Standing waves causing periosteal damage; move the transducer continuously
Stationary transducer application creates standing waves that can cause periosteal burns; the transducer must be kept in continuous motion.
Question 3: A PT applies cryotherapy using an ice massage technique to a patient's Achilles tendon. The correct sequence of sensations the patient should experience is:
- Warmth → burning → analgesia → aching
- Cold → aching → burning → analgesia (Correct answer)
- Burning → cold → analgesia → numbness
- Cold → warmth → aching → burning
Correct answer: Cold → aching → burning → analgesia
The CBAN sequence (Cold, Burning, Aching, Numbness/Analgesia) describes the progression of sensory changes during ice massage.
Question 4: A PT is treating a patient with a fresh (48-hour-old) quadriceps contusion. Which physical agent is MOST appropriate at this stage?
- Moist heat pack for 20 minutes
- Continuous ultrasound at 1.5 W/cm²
- Cryotherapy with compression (Correct answer)
- Shortwave diathermy
Correct answer: Cryotherapy with compression
Cryotherapy with compression is the standard acute-phase treatment to reduce inflammation, hemorrhage, and secondary hypoxic injury.
Question 5: Which parameter determines the depth of penetration for therapeutic ultrasound when selecting between 1 MHz and 3 MHz?
- Intensity (W/cm²)
- Duty cycle
- Frequency (Correct answer)
- Beam non-uniformity ratio (BNR)
Correct answer: Frequency
Frequency determines depth: 1 MHz penetrates 4–5 cm (deep) while 3 MHz penetrates 1–2 cm (superficial).
Question 6: A PT applies electrical stimulation using the Russian protocol (medium-frequency burst NMES) for quadriceps strengthening post-ACL reconstruction. The on:off duty cycle most commonly used is:
- 1:1 (equal work and rest)
- 1:5 (short on, long rest) (Correct answer)
- 2:1 (more work than rest)
- 1:10 (minimal work)
Correct answer: 1:5 (short on, long rest)
A 1:5 on:off ratio is standard for NMES strengthening protocols to allow muscle recovery and minimize fatigue during stimulated contractions.
Question 7: A PT is treating a patient with post-mastectomy lymphedema using complete decongestive therapy (CDT). Which adjunct physical agent modality is CONTRAINDICATED in this condition?
- Manual lymphatic drainage
- Compression bandaging
- Therapeutic heat applied to the affected extremity (Correct answer)
- Remedial exercises
Correct answer: Therapeutic heat applied to the affected extremity
Heat increases local blood flow and protein-rich fluid filtration into the interstitium, worsening lymphedema in an already compromised lymphatic system.
NPTE-PT Therapeutic Modalities Application 5
A PT uses biofeedback with surface electromyography (sEMG) for a patient with patellofemoral pain syndrome.
The primary therapeutic goal of this application is to: