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Cervical Spine Injury Medical Treatment Guidelines

General Guideline Principles

1. Time frames for specific interventions commence on the date of injury.

A. True B. False

2. Active interventions emphasizing patient responsibility, such as therapeutic exercise and/or functional treatment, are generally emphasized over passive modalities, especially as treatment processes.

A. True B. False

3. Exercise program goals should incorporate which of the following?

A. Patient strength B. Patient flexibility C. Patient education D. All of the above

4. If a given treatment or modality is not producing positive results within ______ weeks, the treatment should be either modified or discontinued.

A. 2 - 3 B. 3 - 4 C. 4 - 6 D. 6 - 12

5. The prognosis drops precipitously for returning an injured worker to work once he/she has been temporarily totally disabled for more than four months.

A. True B. False

6. The patient should never be released to work with non-specific and vague descriptions such as, 'sedentary' or 'light duty.'

A. True B. False

7. Some patients may require treatment after maximum medical improvement has been declared in order to maintain their functional state.

A. True B. False

Initial Diagnostic Procedures

8. When obtaining a description of pain, which of the following is of particular importance?

A. Whether raising the arm over the head alleviates radicular-type symptoms. B. Location of pain. C. Nature of symptoms. D. Alleviating and/or exacerbating factors.

9. The use of a patient-completed pain drawing is highly recommended, especially during the first ___________ following injury, to assure that all work-related symptoms are being addressed.

A. 4 days B. 10 days C. 14 days D. 30 days

10. Which of the following incomplete spinal cord injury syndromes is characterized by ipsilateral motor weakness and proprioceptive disturbance with contralateral alteration in pain and temperature perception below the level of the lesion?

A. Anterior cord syndrome B. Brown-Sequard syndrome C. Central cord syndrome D. Posterior cord syndrome

11. According to the American Spine Injury Association impairment scale, which spinal cord lesion is classified as: 'Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5.'?

A. B B. C C. D D. E

12. Neck pain is prevalent in the population with an annual rate of approximately 30-50%, however only between 2-12% report activity limitation.

A. True B. False

13. There is strong evidence that degenerative disc disease is related to whiplash and general non-radicular neck pain.

A. True B. False

14. Which of the following may increase neck pain?

A. Having a low BMI. B. Genetic factors, particularly in the older age group. C. Bicycling. D. Wearing a helmet during recreational activities.

Follow-Up Diagnostic Imaging and Testing Procedures

15. Which of the following generally renders the most information of the cervical spine?

A. Magnetic resonance imaging B. Myelography C. Computed Axial Tomography scanning D. X-ray

16. There is some evidence that the majority of workers over 60 show evidence of disc degeneration and posterior disc protrusions are present in the majority of asymptomatic workers over 40 years of age.

A. True B. False

17. There is some evidence that patients who smoke respond less well to nonoperative spine care and that quitting smoking results in greater improvement.

A. True B. False

18. Therapeutic injections should only be used after diagnostic injections and imaging studies have established pathology which has not clinically improved after active engagement of ________ weeks of physical therapy.

A. 2 - 4 B. 4 - 6 C. 6 - 8 D. 8 - 12

19. All injections must be accompanied by active therapy.

A. True B. False

20. Components of the functional capacity evaluation may include which of the following?

A. Musculoskeletal screen B. Coordination C. Lift/carrying analysis D. All of the above

Therapeutic Procedures - Non-Operative

21. Before diagnostic tests or referrals for invasive treatment take place, the patient should be able to clearly articulate all of the following, except:

A. The goals of the intervention. B. The alternatives available to such treatment. C. The general side effects and associated risks. D. The patient's agreement with the expected treatment plan.

22. Indications for biofeedback include which of the following?

A. Training to improve self-management of pain, anxiety, panic, anger or emotional distress. B. Opioid withdrawal. C. Insomnia/sleep disturbance. D. All of the above.

23. Common examples of functional change include all of the following, except:

A. Increased torque forces. B. Increased range of motion. C. Increased ability to progress in physical therapy. D. Decreased use of pain medication with increased function.

24. Absolute contraindications to diagnostic injections include pain of _____ points or less on a 10-point Visual Analog Scale measurement.

A. 3 B. 4 C. 5 D. 6

25. The post-procedure active therapy for radio frequency denervation - medial branch neurotomy/facet rhizotomy includes instruction and participation in a long-term home-based program of which of the following?

A. ROM B. Core strengthening C. Postural or neuromuscular re-education D. All of the above

26. Patients with addiction problems or high dose opioid or other drugs of abuse use should not use interdisciplinary rehabilitation in conjunction with inpatient or outpatient chemical dependence treatment programs.

A. True B. False

27. All of the following are true regarding therapeutic exercise programs, except:

A. Therapeutic exercise programs should emphasize education, independence, and the importance of an on-going exercise regimen. B. A therapeutic exercise program should not be initiated at the start of treatment rehabilitation. C. There is not sufficient evidence to support the recommendation of any particular exercise regimen over any other exercise regimen. D. There is good evidence that exercise alone or part of a multi-disciplinary program results in decreased disability for workers with non-acute low back pain.

28. Providers of care should have a thorough understanding of the patient's personality profile, especially if dependency issues are involved.

A. True B. False

29. Acetaminophen is an effective analgesic with anti-pyretic and anti-inflammatory activity.

A. True B. False

30. Chronic use of NSAIDs is generally not recommended due to increased risk of hepatic toxicity.

A. True B. False

31. Primary principles and objectives of the application of cervical orthosis include:

A. Control of the position through the use of control forces. B. Application of corrective forces to abnormal curvatures. C. The protection of the spinal cord and nerve root. D. Aid in spinal stability when soft tissues or osteoligamentous structures cannot sufficiently perform their role as spinal stabilizers. E. All of the above

32. In acute strain/sprain type injuries, use of cervical collars may prolong disability, limit early mobilization, promote psychological dependence, and limit self-activity.

A. True B. False

33. Education of which of the following should be the primary emphasis in the treatment of low back/neck pain and disability?

A. The patient and family B. The employer, insurer, and policy makers C. The community D. All of the above

34. There is some evidence that a 2 day course focusing on the biopsychosocial model with an emphasis on the goals of returning to usual activities and fitness is as effective in reducing disability as _____ sessions of manual therapy sessions provided by physiotherapists and more limited patient education.

A. 4 B. 6 C. 8 D. 10

35. Prolonged immobility results in all of the following, except:

A. Loss of muscle strength and flexibility. B. Promotion of bone mineralization. C. Impaired disc nutrition. D. Facilitation of the illness role.

36. Orthoses, such as cervical collars, are a form of immobility.

A. True B. False

37. As part of rehabilitation, every attempt should be made to simulate work activities so that the authorized treating physician may promote adequate job performance.

A. True B. False

38. Education and counseling for active therapy should include which of the following?

A. Understanding of the strength inherent in the human spine, spinal neutral postures, and stabilization musculature. B. How neuroscience explains pain perception. C. Use of active pain coping strategies that decrease fear and catastrophizing. D. All of the above.

Therapeutic Procedures - Operative

39. Post-operative treatment for posterior cervical laminoplasty may include 1 week of cervical bracing.

A. True B. False

40. All of the following are true regarding post-operative treatment for total artificial cervical disc replacement, except:

A. A formal physical therapy program should be implemented post-operatively. B. Active treatment, which patients should have had prior to surgery, will frequently require a repeat of the sessions previously ordered. C. The implementation of a gentle aerobic reconditioning program and neck education within the first post-operative week is appropriate in complicated post-surgical cases. D. The goals of the therapy program should include instruction in a long-term home based exercise program.

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