CHT Therapeutic Interventions 2 — Questions and Answers
Question 1: A patient with Dupuytren's contracture post-fasciectomy develops a flexion contracture at the PIP joint. Which orthotic intervention is most appropriate during the early postoperative phase?
- Dynamic extension splint worn at night only
- Serial static extension splint worn continuously except during exercise (Correct answer)
- Static progressive splint worn only during the day
- Circumferential casting changed weekly
Correct answer: Serial static extension splint worn continuously except during exercise
Serial static extension splints worn continuously (except during exercise) provide sustained stretch to correct PIP flexion contractures following fasciectomy.
Question 2: When applying kinesiotaping to reduce dorsal hand edema, the tape should be applied with the elastic property oriented in which direction?
- Proximal to distal with no tension
- Distal to proximal with light tension on the base only (Correct answer)
- Distal to proximal with full stretch throughout
- Circumferentially around each digit
Correct answer: Distal to proximal with light tension on the base only
Kinesiotape for edema reduction is applied distal to proximal with tension only on the anchor to create lymphatic lift and direct fluid toward proximal lymph nodes.
Question 3: A therapist is using iontophoresis with dexamethasone for a patient with trigger finger. Which polarity should the dexamethasone be placed under?
- Positive (anode)
- Negative (cathode) (Correct answer)
- Either polarity is acceptable
- Alternating polarity
Correct answer: Negative (cathode)
Dexamethasone is negatively charged, so it is driven into tissue from the negative electrode (cathode) during iontophoresis.
Question 4: Which technique is MOST appropriate for treating hypersensitivity in a patient with a healed fingertip amputation?
- Immediate immersion in ice water for 10 minutes
- Graded desensitization using textures progressing from soft to coarse (Correct answer)
- Vibration at high frequency applied directly to the scar
- Transcutaneous electrical nerve stimulation at sensory threshold only
Correct answer: Graded desensitization using textures progressing from soft to coarse
Graded desensitization with progressively coarser textures systematically reduces hypersensitivity by habituating the nervous system.
Question 5: A patient 4 weeks post-flexor tendon repair (zone II) is in a place-and-hold program. The BEST description of this exercise is:
- Passive flexion followed by active extension of the repaired finger
- Passive placement of the finger into flexion followed by active hold without active flexion (Correct answer)
- Active flexion against light resistance with passive return
- Alternating active flexion and extension against a rubber band
Correct answer: Passive placement of the finger into flexion followed by active hold without active flexion
Place-and-hold involves passively positioning the finger in flexion and then having the patient actively maintain (hold) that position, generating low tendon tension without full excursion.
Question 6: Which parameter is MOST important when selecting a frequency for neuromuscular electrical stimulation (NMES) to produce a tetanic muscle contraction for hand intrinsic re-education?
- Pulse duration of 100–200 microseconds
- Frequency of 35–50 Hz (Correct answer)
- Ramp time of 5 seconds
- Duty cycle of 1:5 (on:off)
Correct answer: Frequency of 35–50 Hz
A frequency of 35–50 Hz produces the fused tetanic contraction needed for functional muscle re-education during NMES.
Question 7: A CHT is fabricating a wrist cock-up splint for a patient with carpal tunnel syndrome. The recommended wrist position to minimize carpal tunnel pressure is:
- 10–15° of wrist extension (Correct answer)
- Neutral (0°) with slight ulnar deviation
- 30° of wrist extension
- 20° of wrist flexion
Correct answer: 10–15° of wrist extension
Mild wrist extension of 10–15° minimizes carpal tunnel pressure and is the standard orthotic position for carpal tunnel syndrome management.
CHT Therapeutic Interventions 2
A patient with Dupuytren's contracture post-fasciectomy develops a flexion contracture at the PIP joint.
Which orthotic intervention is most appropriate during the early postoperative phase?