ReActiv8 PT Certification Learning Assessment

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Dysfunction of the multifidus has been demonstrated in research in which of the following manners?(Required)

Decreased crossed sectional area (atrophy)

Delayed activation/timing

Accumulation of fatty infiltrates

All of the above

The primary role of the deep fibers of the multifidus muscle is to?(Required)

Produce rotation of the spine in the opposite direction

Produce extension of the spine

Produce control between segments of the spine and to provide afferent feedback to the motor control system

Produce control between segments of the spine and to rotate the spine

During the implant procedure the leads are fixated distally by deploying the opposing tines into which structure?(Required)

Deep multifidus at L3 to capture the L2 medial branch nerve

Facet capsular tissue at L3 to capture the L2 medial branch nerve

The supraspinous ligament at L4 to capture the L3 medial branch nerve

The intertransversarii muscle to capture the L2 medial branch nerve

Which of the following best describes a pattern of LBP that is consistent with an underlying loss of neuromuscular control?(Required)

Sharp localized pain that does not change with movement and has been present for at least 4 weeks

Pain, numbness and tingling that travels down into the patient's posterior thighs, is worse with walking and improves with sitting

Repeated occurrences of adverse symptoms (pain, spasms, instability), over time which are becoming longer in duration and more disabling

Central pain that is described as "pressure" that is worse in the early morning and improves when lying down.

Anticipatory Control of intervertebral motion, segmental control, slow twitch (Type I) fibers, sub-max sustained effort, 10-25% of maximum contraction are all characteristics of which of the following?(Required)

Superficial/outer core muscle system

Deep inner core muscle system

All spinal muscles

Core muscles

Chronic LBP due to disrupted muscle control is associated with neuroplastic changes in the motor cortex region of the brain. Which of the following is true related to such changes in the motor cortex?(Required)

They are easily identified on MRI scans

They are likely a contributing factor related to why certain patients don't respond to motor control type exercise therapy

They are difficult to measure, but thought to be permanent

They were demonstrated to be reversed in the ReActiv8-B trial

When performing the Multifidus Lift Test in a patient with CLBP, which of the following findings would need to be present for the test to be considered a positive?(Required)

A brisk multifidus contraction coming directly up under your fingertips

Pain while lifting the arm

Excessive compensatory contraction of adjacent longissimus muscle

Low back pain when the arm returns to the start position

Which of the following are clinical cues suggesting underlying loss of neuromuscular control?(Required)

Patient reports their back feels "stable"

Problems with low-load activities such as brushing teeth over sink, washing dishes, unloading dishes

Back pain improves when sitting or standing

All of the above

Which of the following factors would need to be present to maximize the probability of success with the restorative neuromodulation intervention discussed in a patient with CLBP?(Required)

+ prone instability test, no LE pain, and negative SI joint dysfunction testing

MRI findings showing no disc pathology and less than one year of pain

Previous favorable response to a facet joint directed radiofrequency ablation treatment

Previous favorable response to physical therapy treatments

The Multifidus Toe Touch Test (Aberrant movements) is one type of test we can perform to assess for the presence of compromised motor control in a patient with LBP. Which of the following would be considered a + Multifidus Toe Touch Test?(Required)

When they report pain on the way down to touch their toes

When they can’t touch their toes

When there is pain on the way back up from the toe touching movement

When pain radiates past their knee on the way down during the toe touching movement

Which of the following are key aspects of positioning the patient when preparing to perform the Prone Instability Test?(Required)

The patient lies on their stomach, with legs fully supported and arms overhead with elbows even with ears.

The patient lies on their stomach, with their hips on the edge of the table, feet on the floor and arms overhead with elbows even with ears.

The patient lies on their stomach, with their hips on the edge of the table, feet on the floor and arms above their head while holding on to the table.

The patient lies on their stomach just far enough on the table that their feet can touch the floor and arms in a comfortable position.

Which of the following best describes a + Prone Instability Test?(Required)

When pain present on PA gliding is reduced or abolished when the glide is repeated with the feet lifted from the floor

When pain present on PA gliding becomes increased when the glide is repeated with the feet lifted from the floor

When there is pain on more than one lumbar level with PA gliding

When the pain is essentially unchanged with PA gliding when the glide is repeated with the feet lifted from the floor

Which of the following is a common mistake that can be made by the tester while performing the MLT that can lead to a false negative result?(Required)

Palpating both sides of the multifidus muscle at the same time

Lifting the arm only 1 inch, not 2 inches up from the table

Placing a pillow under the pelvis to reduce lumbar lordosis

Palpating just lateral to the multifidus muscle, over the longissimus muscle

The "B-trial" study presented on restorative neurostimulation, on average, demonstrated significant reduction in pain and disability (Modified Oswestry Index) in subjects at the 2-year point post activation (3-year results are also included in the literature section of this course). Which of the following is/are true related to this study?(Required)

An overwhelming majority of subjects had pathoanatomical findings on MRI such as advanced disc degeneration, facet arthropathy, and Modic changes

Subjects had to demonstrate at least moderate multifidus fatty infiltration on MRI to get into the study

Subjects with grade 1 stable spondylolisthesis were excluded from the study

Approximately 80% of the subjects were taking opioid pain medication at the start of the study

Which of the following was not a key characteristic in subjects who were enrolled in the pivotal "ReActiv8-B" Trial?(Required)

Non-responsive to conservative care

Demonstrated a + Multifidus Lift Test

Had LBP which was greater than any leg pain

Did not demonstrate a clear indication for surgical intervention

Which of the following is/are true related to the grading system presented to assess the multifidus utilizing MRI scans?(Required)

Requires cross-sectional area measurements with a caliper

Can be used on T1 weighted images only

Dysfunction of the multifidus is graded as "severe" if >50% of the muscle has been infiltrated with fat

Has been validated at the lower levels of the lumbar spine only

Which of the following domains of rehab are suggested to be screened/addressed for patients referred to rehab following ReActiv8 implant?(Required)

Nutrition and sleep

Global movement

Balance

All of the above

Which of the following is a common course of improvement noted by patients following ReActiv8 implant?(Required)

Pain improves after about 8 weeks and then functional improvements follow

There is an immediate improvement in posture and function followed by pain relief at about 6 weeks

There is a notable improvement in posture and function at about 2-3 months post implant and reports of pain relief tends to come a bit later

There is no specific pattern, the response is quite variable

Which of the following is considered a contraindication for a patient who has a ReActiv8 implant?(Required)

Highly demanding activities such as long distance running and playing tennis

Manual therapy over the L3 segment

Use of moist heat or a cold pack/ice

Manual therapy to the thorax region

Real world commercial studies have demonstrated similar findings related reduction in disability and pain as were found in the "ReActiv8-B trial." Which of the following has also been noted as a result of the real-world use of ReActiv8?(Required)

Although B trial average age was 47 years, good outcomes are being demonstrated in older patients, even those that are into their 70's

The infection rate seems to be a little bit higher in real world cases

The time to see a reduction in pain seems to be little bit longer in real world cases

Even patients with radicular pain into their leg and past their knee are seeing good results with ReActiv8