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Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... True / False Questions 1. The average head weighs about 15-20 pounds. True False 2. Bilaterally the trapezius works to perform flexion of the head on the neck. True False 3. The semispinalis capitis and cervicis are postural supports for the head. True False 4. The suboccipitals are little muscles and not important at all as a group. True False 5. The occipitofrontalis muscle is a combination of the occipitalis and the frontalis muscles. True False 6. Whiplash is an injury resulting from a sudden impact that causes a violent hyperextension of the head and neck followed by hyperflexion and perhaps an additional hyperextension. True False 7. A torticollis is a condition that is another name for a simple stiff neck. True False 14-1 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... 8. A headache is defined as a diffuse pain in various areas of the head where the pain is not confined to the distribution of a nerve. True False 9. All headaches are caused my muscle pain. True False 10. The suboccipitals can entrap the brachial plexus. True False Multiple Choice Questions 11. A condition that may cause numbness, pain, and tingling on the back of the head is called _______________. A. temporomandibular joint syndrome B. occipital nerve entrapment C. torticollis D. brachial plexus entrapment 12. If a client presents with a headache and high blood pressure the therapist should A. give a shorter treatment to the client. B. have the client fill out many forms. C. refer the client to the appropriate health professional. D. give the client a regular supine and prone treatment. 14-2 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... 13. When a client has a tension headache, the therapist should start the client in the ___________________ position. A. supine B. prone C. side-lying D. seated only 14. The trapezius opposes the action of __________________ bilaterally. A. lateral flexion B. rotation C. extension D. flexion 15. The trapezius is a prominent superficial muscle and therefore should be treated __________ in a protocol of the head and neck. A. last B. second C. first D. not at all 16. The levator scapulae is usually involved in stiff neck issues and may also be involved in subluxations as it attaches to the ___________________. A. spinous processes of C1-3 B. transverse processes of C1-C4 C. atlas D. the body of the vertebrae of C1-3 17. The splenius capitis and cervicis oppose the sternocleidomastoid in _____________. A. extension B. lateral flexion C. flexion D. rotation 14-3 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... 18. The splenius capitis and cervicis work as synergists with the sternocleidomastoid to perform _____________. A. lateral flexion B. extension C. flexion D. hyperextension 19. Muscles that are heavily involved in whiplash injuries are the ____________ and _______________. A. rhomboids; serratus anterior muscles B. splenius capitis; cervicis muscles C. serratus anterior; pectoralis minor muscles D. quadratus lumborum; rhomboids muscles 20. The three muscles layered at the mastoid process are the splenius capitis, sternocleidomastoid, and the _______________________. A. splenius cervicis B. semispinalis capitis C. trapezius D. longissimus capitis 21. The large muscle that supports the trapezius beneath it is called the _______________. A. splenius capitis B. rectus capitis posterior minor C. semispinalis capitis D. splenius cervicis 22. The rotatores and multifidi are deep ________________ muscles. A. paraspinal B. shoulder girdle C. shoulder joint D. lumbar 14-4 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... 23. The _______________ lifts the brow and wrinkles the forehead. A. occipitalis B. frontalis C. trapezius D. temporalis 24. The muscle that is shaped like a shell and is often involved in TMJ syndrome is called the ________________. A. frontalis B. occipitalis C. masseter D. temporalis 25. A little known fact about the sternocleidomastoid is that because it attaches laterally at the mastoid process it is capable of performing ______________ bilaterally at the atlantooccipital joint. A. extension B. flexion C. lateral flexion D. rotation Fill in the Blank Questions 26. Therapists should _________ and _______________ the head to passively shorten the sternocleidomastoid to treat it. ________________________________________ 27. Whiplash victims must have emergency care to rule out _________, ______________, and ______________. ________________________________________ 14-5 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... 28. After medical care for whiplash victims conservative modalities might include _____________, _____________, ______________, and ______________. ________________________________________ 29. Another name for torticollis is _________________. ________________________________________ 30. Torticollis can be caused by infection __________________ or can be ______________. ________________________________________ 31. The two categories for the 13 classifications for headaches from the International Headache Society are called the ______________ and _____________ categories. ________________________________________ 32. Massage therapy given between headache episodes has been proven by the Touch Research Institute to ________________, _______________, and __________. ________________________________________ 33. The term stiff neck is a catchall for ______________ in neck movements. ________________________________________ 34. The muscles involved in occipital nerve entrapment would likely be the ________________ and the ______________ muscles. ________________________________________ 35. The scalenes are _____________ of the cervical spine and anterior neck. ________________________________________ 14-6 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... 36. Clients that complain of nausea, vomiting, and unilateral pain in the head may have a particular type of headache called the ________________. ________________________________________ 37. The upper and lower trapezius performs elevation and depression respectively and are therefore categorized as its own ____________ and _____________. ________________________________________ 38. The muscles attached to the occipital ridge that the therapist might treat with circular friction could include _______________, ____________, ____________, and _____________. ________________________________________ 39. When the therapist draws his hands superiorly from the mid-thoracic region of the client to the occipital ridge, he is most likely stretching the fibers of the ___________. ________________________________________ 40. The first spinous process that you can palpate on the back of the neck is __________. ________________________________________ 41. Deep to the trapezius and to the semispinalis capitis is the ______________, which spans from the occiput to the spinous process of C1. ________________________________________ 42. The suboccipital that connects the transverse process of C1 to the spinous process of C2 is the ___________________. ________________________________________ 14-7 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... 43. The therapist must be really careful when treating the scalenes because of the proximity of the ___________________. ________________________________________ 44. Techniques that can be applied to the sternocleidomastoid in a shortened position include _______________, ___________, and _________________. ________________________________________ 45. The alternating-hands neck stretch ___________ the fibers of the soft tissue parallel to the cervical spine. ________________________________________ 46. Treating a client who is experiencing a migraine at the time of treatment is _____________________. ________________________________________ 47. A(n) _______________ is a useful tool for clients who suffer headaches to track them. ________________________________________ 48. The primary category for headaches includes the classifications of _____________, ___________, and ____________ headaches. ________________________________________ 49. The head actually weighs _____________ when it is in a head-forward posture. ________________________________________ 14-8 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... 50. Rounded shoulders may lead to a head-forward posture and put a lot of stress on the _______________ as a result. ________________________________________ 14-9 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key True / False Questions 1. The average head weighs about 15-20 pounds. FALSE The average head weighs between 10 and 13 pounds. Bloom's: Knowledge Difficulty: Easy Learning Outcome: 14-4 2. Bilaterally the trapezius works to perform flexion of the head on the neck. FALSE Bilaterally the trapezius works to perform extension of the head on the neck. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-3 3. The semispinalis capitis and cervicis are postural supports for the head. TRUE Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-3 Learning Outcome: 14-4 14-10 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 4. The suboccipitals are little muscles and not important at all as a group. FALSE The suboccipitals are superior cervical and occipital postural head supporters that provide extension bilaterally for the head, but also connect to C1 and C2 for rotation and lateral flexion. They are very important base muscles and are very connected to pathologies of the head and neck such as headaches. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-4 Learning Outcome: 14-5 5. The occipitofrontalis muscle is a combination of the occipitalis and the frontalis muscles. TRUE Bloom's: Application Bloom's: Knowledge Difficulty: Easy Learning Outcome: 14-1 Learning Outcome: 14-2 6. Whiplash is an injury resulting from a sudden impact that causes a violent hyperextension of the head and neck followed by hyperflexion and perhaps an additional hyperextension. TRUE Bloom's: Application Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-1 Learning Outcome: 14-4 14-11 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 7. A torticollis is a condition that is another name for a simple stiff neck. FALSE It is a spasmodic contraction of neck muscles that is more severe than a simple stiff neck. Bloom's: Application Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-1 Learning Outcome: 14-4 8. A headache is defined as a diffuse pain in various areas of the head where the pain is not confined to the distribution of a nerve. TRUE Bloom's: Application Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-1 Learning Outcome: 14-4 9. All headaches are caused my muscle pain. FALSE There are 13 known classifications for headaches that physicians use for diagnosis and there are many causes of headaches that have nothing to do with muscles or muscle pain. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-1 Learning Outcome: 14-4 14-12 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 10. The suboccipitals can entrap the brachial plexus. FALSE The suboccipitals are not stationed near the brachial plexus; the scalenes are known for entrapping the brachial plexus. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-1 Learning Outcome: 14-4 Multiple Choice Questions 11. A condition that may cause numbness, pain, and tingling on the back of the head is called _______________. A. temporomandibular joint syndrome B. occipital nerve entrapment C. torticollis D. brachial plexus entrapment The occipital nerve can be entrapped by the semispinalis capitis and subsequently the trapezius, which could cause numbness, pain, and tingling on the back of the head. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-1 Learning Outcome: 14-4 14-13 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 12. If a client presents with a headache and high blood pressure the therapist should A. give a shorter treatment to the client. B. have the client fill out many forms. C. refer the client to the appropriate health professional. D. give the client a regular supine and prone treatment. The unknown quantity of high blood pressure presents another undiagnosed condition with a symptom of a headache. The possibilities of complications of a more serious problem are only up to a physician to diagnose. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-1 Learning Outcome: 14-4 Learning Outcome: 14-5 13. When a client has a tension headache, the therapist should start the client in the ___________________ position. A. supine B. prone C. side-lying D. seated only The client should not be placed prone when experiencing a headache. The supine position allows access to the head and neck muscles and maximum relaxation. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-1 Learning Outcome: 14-4 Learning Outcome: 14-5 14-14 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 14. The trapezius opposes the action of __________________ bilaterally. A. lateral flexion B. rotation C. extension D. flexion The trapezius performs extension bilaterally so would be an antagonist to flexion. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-3 15. The trapezius is a prominent superficial muscle and therefore should be treated __________ in a protocol of the head and neck. A. last B. second C. first D. not at all The shoulder girdle muscles should be treated first in a sequence of working the head and neck muscles. The trapezius is particularly superficial and houses much tension. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-5 Learning Outcome: 14-7 Learning Outcome: 14-9 14-15 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 16. The levator scapulae is usually involved in stiff neck issues and may also be involved in subluxations as it attaches to the ___________________. A. spinous processes of C1-3 B. transverse processes of C1-C4 C. atlas D. the body of the vertebrae of C1-3 As the muscle shortens it pulls on the vertebrae and C1 and C2 are the pivot joints, which make them particularly vulnerable. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-4 17. The splenius capitis and cervicis oppose the sternocleidomastoid in _____________. A. extension B. lateral flexion C. flexion D. rotation The splenius capitis and cervicis perform extension bilaterally so oppose the SCM in flexion. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-3 14-16 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 18. The splenius capitis and cervicis work as synergists with the sternocleidomastoid to perform _____________. A. lateral flexion B. extension C. flexion D. hyperextension All three muscles do same side lateral flexion and are therefore synergists. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-3 19. Muscles that are heavily involved in whiplash injuries are the ____________ and _______________. A. rhomboids; serratus anterior muscles B. splenius capitis; cervicis muscles C. serratus anterior; pectoralis minor muscles D. quadratus lumborum; rhomboids muscles The splenius capitis and cervicis are unique as they can act bilaterally, unilaterally, and independently of each other. They are prevalent in whiplash injuries. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-3 Learning Outcome: 14-4 Learning Outcome: 14-5 14-17 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 20. The three muscles layered at the mastoid process are the splenius capitis, sternocleidomastoid, and the _______________________. A. splenius cervicis B. semispinalis capitis C. trapezius D. longissimus capitis The longissimus capitis is deep to the splenius capitis and SCM. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-7 21. The large muscle that supports the trapezius beneath it is called the _______________. A. splenius capitis B. rectus capitis posterior minor C. semispinalis capitis D. splenius cervicis Deep to the trapezius is the semispinalis capitis that provides a cushioning support for the trapezius. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-3 14-18 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 22. The rotatores and multifidi are deep ________________ muscles. A. paraspinal B. shoulder girdle C. shoulder joint D. lumbar These muscles are nestled deep next to the spine located on the full length of the spinal column. Bloom's: Knowledge Difficulty: Easy Learning Outcome: 14-2 Learning Outcome: 14-3 23. The _______________ lifts the brow and wrinkles the forehead. A. occipitalis B. frontalis C. trapezius D. temporalis The frontalis lifts the brow and wrinkles the forehead. No other muscle in the list is in the line of pull to perform the action. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-3 14-19 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 24. The muscle that is shaped like a shell and is often involved in TMJ syndrome is called the ________________. A. frontalis B. occipitalis C. masseter D. temporalis The temporalis is shaped like a shell and strategically placed on the side of the head to attach to the mandible making it often involved in TMJ syndrome. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-4 Learning Outcome: 14-5 25. A little known fact about the sternocleidomastoid is that because it attaches laterally at the mastoid process it is capable of performing ______________ bilaterally at the atlantooccipital joint. A. extension B. flexion C. lateral flexion D. rotation The position of the muscle bilaterally gives it this ability and adds to the dimensional quality of the muscle. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Hard Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-3 14-20 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key Fill in the Blank Questions 26. Therapists should _________ and _______________ the head to passively shorten the sternocleidomastoid to treat it. flex; laterally flex Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-5 Learning Outcome: 14-7 27. Whiplash victims must have emergency care to rule out _________, ______________, and ______________. fractures; concussions; damage to the spinal cord Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-4 28. After medical care for whiplash victims conservative modalities might include _____________, _____________, ______________, and ______________. massage therapy; physical therapy; chiropractic; acupuncture Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-4 29. Another name for torticollis is _________________. wry neck Bloom's: Knowledge Difficulty: Easy Learning Outcome: 14-4 14-21 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 30. Torticollis can be caused by infection __________________ or can be ______________. central nervous system disorder; congenital Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-4 31. The two categories for the 13 classifications for headaches from the International Headache Society are called the ______________ and _____________ categories. primary; secondary Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-4 32. Massage therapy given between headache episodes has been proven by the Touch Research Institute to ________________, _______________, and __________. (Give three.) reduce the number of headaches; decrease pain intensity; lower stress hormone levels; increase regular sleep patterns; increase serotonin levels Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-4 33. The term stiff neck is a catchall for ______________ in neck movements. limitations Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-4 14-22 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 34. The muscles involved in occipital nerve entrapment would likely be the ________________ and the ______________ muscles. trapezius; semispinalis capitis Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-4 Learning Outcome: 14-5 35. The scalenes are _____________ of the cervical spine and anterior neck. stabilizers Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-3 Learning Outcome: 14-4 36. Clients that complain of nausea, vomiting, and unilateral pain in the head may have a particular type of headache called the ________________. migraine Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-4 37. The upper and lower trapezius performs elevation and depression respectively and are therefore categorized as its own ____________ and _____________. agonist; antagonist Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-3 14-23 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 38. The muscles attached to the occipital ridge that the therapist might treat with circular friction could include _______________, ____________, ____________, and _____________. the trapezius; splenius capitis; longissimus capitis; sternocleidomastoid; semispinalis capitis; some suboccipitals; the occipitalis Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Hard Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-7 39. When the therapist draws his hands superiorly from the mid-thoracic region of the client to the occipital ridge, he is most likely stretching the fibers of the ___________. trapezius. Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Hard Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-7 40. The first spinous process that you can palpate on the back of the neck is __________. C2 Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-7 14-24 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 41. Deep to the trapezius and to the semispinalis capitis is the ______________, which spans from the occiput to the spinous process of C1. rectus capitis posterior minor Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Hard Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-7 42. The suboccipital that connects the transverse process of C1 to the spinous process of C2 is the ___________________. obliquus capitis inferior Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Hard Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-7 43. The therapist must be really careful when treating the scalenes because of the proximity of the ___________________. brachial plexus Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Hard Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-7 Learning Outcome: 14-9 14-25 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 44. Techniques that can be applied to the sternocleidomastoid in a shortened position include _______________, ___________, and _________________. stripping; jostling; deep transverse friction; ischemic pressure with a pincher palpation Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Hard Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-7 Learning Outcome: 14-9 45. The alternating-hands neck stretch ___________ the fibers of the soft tissue parallel to the cervical spine. lengthens Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-7 Learning Outcome: 14-8 46. Treating a client who is experiencing a migraine at the time of treatment is _____________________. contraindicated Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-4 Learning Outcome: 14-9 47. A(n) _______________ is a useful tool for clients who suffer headaches to track them. headache log Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-7 Learning Outcome: 14-9 14-26 Chapter 014 The Balancing Act: Structural Perspectives of the Head and Neck... Key 48. The primary category for headaches includes the classifications of _____________, ___________, and ____________ headaches. migraines; tension-type; cluster Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-4 Learning Outcome: 14-9 49. The head actually weighs _____________ when it is in a head-forward posture. more Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-4 Learning Outcome: 14-9 50. Rounded shoulders may lead to a head-forward posture and put a lot of stress on the _______________ as a result. posterior cervical muscles Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 14-2 Learning Outcome: 14-3 Learning Outcome: 14-4 14-27