Injury Risk in Elite Basketball Players

Injury Risk in Elite Basketball Players The elite basketball player is considered in this piece not only in terms of his potential for injury but also in terms of the potential of the physiotherapist and other sports professionals, to give advice, support and guidance so that he may practice his chosen sport as safely as is reasonably possible. We have looked at the nature, incidence and sites of injuries sustained. We have looked at the two most commonly injured sites (the knee and ankle) in specific detail. We have also discussed the relevant modalities of treatment that a physiotherapist can provide for their clients. There appears to be considerable controversy in the current literature, particularly in the field of pre-exercise stretching. As this is commonly accepted practice by participants, coaches, trainers and sports medicine professionals alike, we have reviewed the arguments both for and against in some detail. We have paid particular attention to its value in the prophylaxis of injury and the evidence to support it. The role of the physiotherapist in education and training of the elite athlete is also discussed. There are a number of sources quoted who regard it as a prime responsibility of the physiotherapist to give the athlete the information to allow them to train and participate as safely and effectively as possible. We have also considered the role of the physiotherapist in the prophylaxis of injury by looking at the various modalities of treatment and intervention that can be employed to make the field of play a safer place. In addition to the main-stream elite basketball player we have also looked at the role of the physiotherapist in the role of helping the disabled basketball player, some of whom have achieved elite status in their own right. They have their own specific problems and these are reviewed and discussed. Lastly we look at the specific gender differences in the sport. With many women finding that the sport is attractive, they participate at a top level of achievement. We look at the reasons why they have a different injury profile to men, both in terms of numbers of injuries but also in terms of the frequency of specific types of injury. The mechanisms of this difference is discussed together with the means whereby it can be addressed. Introduction Basketball is a world-wide sport practised by children in their backyard, adolescents in their playground, amateurs in their league games and elite athletes in their world-stage arenas. It is – by any standards – a fast game with inevitable physical contact, both intentional and accidental. Both these factors lead to the potential for injury. The explosive effort for the fast moves leads to particular pattern of muscle, ligament and tendon injury (see on) and the physical contact can lead to bruises, dislocations, fractures another injuries. It is a sport that is enjoyed by both sexes. Although it was originally conceived primarily as a male sport (for the YMCA)in an era when female participation in sport was a rarity, women now participate in it to elite levels and suffer injury to a similar extent to their male counterparts. The game itself has evolved dramatically since its humble beginnings when Dr James Naismith nailed two peach baskets at the ends of his gymnasium in 1891 (hence the name basketball) It was developed as a tool for fitness training by the YMCA. By 1927 The Harlem Globetrotters had been formed and by 1936 it was included as an Olympic sport. According to FIBA (Basketball governing body) over 400 million people play basketball on a world-wide basis Training for the fitness needed to play the sport can also lead touts own problems. One huge study by Ruhr M Kuala et al. (1994) (1) found that of all the injuries associated with basketball, 50% occurred during the matches and 50% occurred during training for the matches. This should be contrasted with the finding in study by Meeuwisse et al.(2) where injuries during the game were 3.7 times as likely to occur as in training. One could reasonably conclude that a large proportion of the injuries sustained in the â€Å"cut and thrust† of a full scale match are part of the risk package accepted in playing the game. The huge proportion of injuries sustained whilst training, however, should be largely preventable, as training should be ideally undertaken in carefully controlled circumstances. The physiotherapist, personal trainer and sports medicine specialist are ideally placed to advise and oversee poor practice in the training arena and to give advice and guidance to maximise training efficiency and to reduce the toll of injury. Any experienced sports care professional will tell you that the single most important factor in determining the likelihood of sustaining an injury is the occurrence of a previous injury (2). It therefore follows that prevention of any injury will help, not only in improving the immediate efficiency of the player, but will also confer protection against the possibility of recurring injury in any given site. Before we consider the mechanisms and prophylaxis of injuries in basketball, it would be prudent to consider the observed injuries from the sport, both in absolute number and site. The study by Meeuwisse(2003) (2) followed a cohort of 142 basketball players over a two year period and discovered that 44.7% of the players were injured in that time frame. As they recorded over 200 injuries in that time, it is clear that many players were injured more than once. The study by Ruhr M Kuala et al. (1994) (1) will be extensively quoted in this piece as it provides an enormous amount of meticulously collected data which has a high degree of confidence in its validity. It was based in Finland where the population has a particularly regimented system of bureaucratic personal information storage, especially with regard to injury and healthcare details. The entire population has to be registered with a nationally based health insurance, which records every accident and injury. This is of enormous value to studies such as this, as accurate statistics about entities such as specific sporting injuries can be derived comparatively easily. The study is also important in this specific regard as it encompasses an enormous cohort of basketball players analysing 39,541person years of basketball experience and 3,472 specific injuries. It’s worth considering the patterns of injury found in some detail as it has an impact on the deliberations in this piece. In terms of age distribution, it was found that injuries in thunder 15 yr. age group were comparatively rare and that the injury rate peaked in the 20 – 24 yr. age groups. Percentage of injuries by sites in basketball players (These results are slightly modified with some trivia removed) Injury Site % of total Lower limb Total 56.0 Thigh 2.5 Knee 15.8 Leg 2.0 Ankle 31.4 Foot 4.0 Other 0.4 Upper Limb total 19.3 Upper arm + Shoulder 2.6 Forearm and elbow 1.3 Palm + wrist Fingers 11.1 Other 0.4 Other Sites Total 24.7 Teeth 5.2 Eyes 3.0 Head + neck 7.4 Thorax + Abdomen 1.5 Back 5.4 Pelvis 0.9 Multiple sites 1.4 There are clearly a number of striking trends in these figures. The lower limbs sustaining the most injuries with 56% of the total. The ankle and knee taking the lion’s share of these. These results are clearly fairly predictable with the nature of the sport being one of sudden changes of acceleration and direction, many changes of direction(pivoting) involving turning forces impinging maximally on the knee and ankle. Both joints are intrinsically unstable for these modalities of movements. They are designed to be most effective in walking and running in a straight line. Although they can accommodate twisting movements, they are much less mechanically sound in these directions. The possibility of unanticipated, and therefore unraced, impacts is endemic in the sport and will increase the possibility of injury to these joins in particular. The upper limb has a substantial tally of injuries with the bulk being to the palm, wrist and fingers. Although it is not specified in this particular study, any experienced clinician would expect to see substantial proportion of hyperextensions and dislocations to the fingers and sprains and strains to the wrist (this is partially amplified in the next section). For a sport that involves considerable manipulative and throwing skills, it is, perhaps, surprising that the shoulder and upper arm account for only 2.6% of all the injuries. In contrast to the comments made about the knee and ankle, one can postulate that the shoulder, by virtue of its design to accommodate a much greater range and compass of movement, is less likely to be injured in the way that the knee and ankle are. Also, in the course of the normal game, it is subject to rather less overall mechanical force as both the knee and ankle have to assimilate peak loads of several times the body weight whereas the shoulder, unless involved in a fall, does not. Of the â€Å"Other Sites†, the neck and back are the commonest sites for injury. To a large extent, this again is a reflection of the explosive nature of the game with frequent changes of direction and velocity with high levels of acceleration. Having recognised the major sites of injury it is now prudent to discuss the main types of injury. Percentage injury by type in basketball players (These results are slightly modified with some trivia removed) Injury type + site % of total Sprains +strains 61.3 Knee 12.4 Ankle 29.5 Bruises + Wounds 22.2 Fractures 12.6 Fracture (other than dental) 7.6 Foot + ankle 18.5 Lower limb (other) 3.8 Fingers Palm + wrist 57.0 Upper limb (other) 4.2 Other (nondental) 16.6 Dental 4.9 Dislocations 1.7 Knee 0.5 Shoulder + elbow 0.3 Fingers 0.3 Others 2.2 Sprains and strains are the commonest type of injury in this sport with the ankle being the most frequently injured site in this respect. Considerable amounts of work and research have been done(2,3,4,5,6,7,8) to try to find mechanisms whereby ankle injuries can beat least reduced in both frequency and severity. This will be discussed in detail later. Knee strains and sprains are the next most frequent at12.4%. Similar amounts of work have been done to find ways of minimising knee injuries (9,10,11). The knee injury is notorious for producing long-term debilitating problems as not only is the acute injury painful and potentially debilitating in itself, but there is also the potential for Anterior Cruciate Ligament (ACL) damage and meniscal damage and wear as well. This may not be immediately apparent but may contribute to morbidity at a later date. This study (1) found that knee injuries were the most common cause of permanent disability In the longer term. During the time frame of this study, four basketball players sustained permanent injuries. In specific relation to knee and ankle injury, the Meiuwess study(2) found that the situation can be further amplified by the finding that the greatest number of injuries which resulted in seven or more sessions being lost in a season arose from the knee. Equally striking was the fact that the most common injury that involved less than seven sessions being lost, were injuries to the ankle. This underlines the comment made earlier that knee injuries tend to be potentially more serious than ankle injuries Bruises and wounds account for over 1/5th of the total types of injury and fractures account for just over 1/10th. In line with the comments made earlier about the frequency of hand, finger and wrist injury, it will come as no surprise therefore to see that the hand and wrist accounts for over half of the total of fractures. The foot and ankle account for 18.5% of total fractures. This is a reversal of the figures relating to site of injury. It would therefore appear that the hand gets injured less frequently that the foot, but when it does, it’s more likely to sustain the more serious (fracture) type of injury. Although the foot is more likely to be injured, it is more likely to suffer a strain or sprain rather than a fracture. In the study by Home et al.,(2004) (12) There was an unexpected, and slightly worrying, conclusion. They found that, in a study of fractures in sport, that (for men at least) basketball was the sport that put the participants at greatest risk of sustaining a fracture. The Knee and Basketball As we have already discussed, a knee injury is potentially more serious than just the implication of the immediate acute injury. For that reason, and for the fact that it is one of the two most commonly injured areas, we will look at the knee as a specific entity. We know that the single most important predictor for further injury is the past history of a preceding original injury. The knee is also significant insofar as the normal maxim of rest a joint until the inflammation has settled is rarely practical, as the knee is essential for locomotion and, as any experienced clinician knows, the vast majority of patients with resolving knee injuries will wait until the pain subsides to a tolerable level, and then start to walk on it. This effectively means that the joint is being stressed while resolving inflammation is present. Initially this may manifest itself as no more than a mildly aching knee, but it is likely that menisci, cruciate ligaments and articular surfaces are all being stressed in a â€Å"less than optimal† state. It is likely, on a first principles basis, that this type of mechanism may be, in part at least, responsible for the increased levels of arthritis and arthritis that is observed in lifelong athletes. (13,14) The paper by Meeuwisse (2) has been quoted several times in this piece. It is worth remembering that his team found that the knee waste joint which, if injured, gave rise to the longest periods of incapacity. It is therefore prudent to consider the mechanisms of injury, the treatment of those injuries and, possibly more importantly in the context of this piece, what can be done to minimise the incidence and impact of those injuries. We would commend an excellent paper by Bahr (2001) (3) on the subject. He discusses (amongst other things) the current thinking on knee injuries. He makes comment on the increasing incidence of cruciate ligament injuries. These injuries are seen with greatest frequency in athletes who participate in sports that involve â€Å"pivoting† – a movement which involves a fixed foot on the floor being used as a fulcrum topspin the body around – a movement which can put huge rotational stresses on the knee joint. As has been observed earlier in this piece, the knee is designed primarily to be efficient in dealing with movement in a sagittal plane. It is very poorly adapted to deal with rotational stresses. Bahr observes that the maximal incidence of cruciate ligament injury is in the 15-25 yr. old age group and in women three to five times more frequently than in men (see on) (14). He also refers to the post-injury, long-term complications of abnormal joint mechanics and the early onset of degenerative joint disease (15). Significantly he points to the fact that, although there has been an increasing trend recently (mainly because of improved operating techniques) to attempt to repair menisci and cruciate ligaments, this has not been accompanied by an apparent reduction in the rate of post-traumatic osteoarthritis. Similarly, arthroscopic repair of isolated meniscal damage has not been shown to reduce the incidence of arthritis. These factors all mitigate the argument that, although treatment is important, the identification of risk factors that predispose to injury is even more important. The Anterior Cruciate Ligament (ACL) is commonly injured in circumstances that many athletes would consider as normal or routine for their particular sport. Frequently the damage occurs without direct physical contact to the knee (9). This is strong evidence to support the â€Å"design fault† explanation of the aetiology. There is recent anecdotal data to suggest that improving the control of the knee may have an impact in reducing the incidence of these injuries. This views supported in a paper by Carafe (10) who looked at improving the proprioceptive and balance mechanisms in footballers over a three season period. They reported an 87% decrease in the incidence of injuries to the ACL. It may be significant that they studied semi-professional and amateur footballers who, presumably, did not train as efficiently of as skilfully as their professional footballer counterparts and therefore there was probably considerable room for improvement. Similarly constructed studies have shown similar pattern of improvement in young female football (11) and handball (16) players using a similar programme of training over a season. As has been pointed out earlier, such changes are more likely to be noticeable in females because of the higher incidence of ACL injury in the first place. Bahr points out that these studies were too small to allow a proper statistical evaluation of the reduction of injury to the ACL specifically, but there is sufficient evidence to conclude that the risk of serious knee injury can be significantly reduced by the introduction of structured training exercises that focus on improving the neuron-muscular control of the knee. Bahr makes the very salient point that balance (proprioceptive)training is not yet universally recognised by coaches and trainers as useful tool. As a result, he argues that it is the responsibility of doctors and physiotherapists to disseminate the knowledge that such training does reduce the incidence of serious short-term (and therefore long-term) knee injury. Anterior knee pain is a common, sometimes chronic presenting symptom in any sports related health professional’s clinic. There are many theories as to its aetiology and it is notoriously resistant to treatment. An unattributed paper (quoted by Minerva in the BMJ) (17)refers to Jumper’s knee where the pain is maximal near the attachment of the patella ligament. Ultrasound of the region can show an area of increased echogenicity in the inferior pole of the patella. Minerva quotes the study as observing that of 100 athletes seen in one clinic,18 had to give up their sport for over a year and about 1/3rd needed surgery in order to try to get resolution of the problem. In conclusion to this section we would refer the reader to the excellent paper by Adams WB (2004) (18) who reviews the current thinking on treatment options on both overuse syndromes and trauma tithe knee. The Ankle and Basketball As we have seen earlier, the ankle is the single most commonly injured site in the body during basketball comprising 31.4% of all the injuries observed (1) and ankle strains and sprains were the single commonest mechanism of injury observed with 1/3rd of all such injuries and 1/5th of all fractures. We will therefore also consider the ankles a special case. Bahr (3) quotes that in round figures 20% of sports related injuries involve the ankle. The vast majority of ankle injuries are simple sprains of the lateral and medial ankle ligaments. Proper functional care will allow the patient to return to work within a few days, or at worst a few weeks, with minimal squeal. Some sprains are found to cause prolonged disability in the form of chronic instability or persistent pain. Prophylaxis of injury is discussed elsewhere in this piece but it should be noted that taping and bracing are commonly employed techniques for protection, but their efficacy has only been demonstrated in sportsmen with a history of previous injury (5,6).There is little doubt that taping and bracing will reduce the incidence of sprains and result in less severe strains. â€Å"High-top† basketball boots have been introduced recently on the assumption that similar boots (18a) (viz. ski boots) reduce the incidence of ankle injury, but it has not yet produced any specific evidence that sprains and strains are reduced. Braces seen to be more effective than tape in preventing sprains of the ankle (7,8) Bracing has the advantage that it is more acceptable in terms of comfort for long-term use (6). Taping is commonly used but appears to be less effective than braces because it relies on adhesion to the skin to exert its protective influence. It can cause skin irritation and has to be reapplied on virtually every occasion where potential stress can occur. One of the major problems of doing research into ankle injuries is that qualitative and subjective measurements such as pain and immobility can be easily assessed, but the ankle joint is a very functionally complex structure and quantitative measurements of anything other than flexion/extension or rotation an very difficult. Its therefore heartening to read of a Dutch group who are developing a specially designed goniometer to use in researching the pathology of the ankle joint (19). This is only mentioned for the sake of completeness and we do not propose to go into any detail about the instrument. There is an excellent article by McKay on ankle injuries in basketball (20) but this is discussed at some length in the section on prophylaxis of injuries. Treatment of injuries The treatment of sports related injuries is a vast topic and specialism in itself. The sports medicine medical specialist and the physiotherapist sports specialist are technically knowledgeable people who have had to assimilate a vast quantity of information relative to their specialisation. It is therefore not proposed to present the topic in any great detail but to cover the elements of treatment of acute injuries and their subsequent treatment that are specifically important to the field of basketball. We will also present a brief literature review of some of the most recent papers in the field. In general terms, the old adage of ICE (immobilisation, compression and elevation) (20b) is a useful first-aid mnemonic which will help to minimise injury prior to assessment by a more specialist professional. In this article it is proposed to look primarily at the aspects of treatment which impinge on the areas covered in this piece and broad overviews. We shall restrict ourselves here to a brief literature review of some of the most important recent papers The area of dental trauma is highlighted in the analysis by Kujalaet al. (1994) (1) with 5.0% of all basketball injuries being dental. Airport by Randall (2005) (21) discusses the impact of dental injuries and suggests that sports field medical personnel should have at least basic training in the first-aid of dental injuries so that they can, at least, provide appropriate care until a dental specialist can be properly involved. A particularly controversial issue is raised by Dietzel and Hedlund(2005) (22) They review the current controversy about the use of analgesic and anti-inflammatory injections both in the acute phase of injury (to allow continued participation in a sporting event) or in the chronic recovery phase. This is a particularly well balanced article which evaluates both sides of the arguments for and against the use of injectable medications. Sanchez et al.(2005) (23) review the desperately important area of management of the potentially spine-injured athlete. This is an area which has had substantial changes in management techniques in the recent past. This paper is a particularly useful review of techniques of diagnosis and stabilisation of the injured athlete. Very significantly it highlights the role of pre-injury planning – so often overlooked – on the sports field. There are two recent papers which examine the thorny problem of concussion on the sports field (24,25). This has long posed a problem for the supervising healthcare specialist, both in terms of immediate diagnosis and subsequent action and treatment. The working â€Å"rule of thumb† has been that any player with definite signs of concussion(impaired consciousness or increased level of confusion) should be taken off the field and not returned to play for 48 hrs. In practice, this advice may be ignored by coaches who are anxious to keep their best players on the field and who may be ignorant of the potential side effects. McKean (24) and Johnston et al. (25) review the arguments in coherent manner and present the current thinking in a modern context. Injury types in relation to position played There are few studies that actually compare the rates and types of injury with actual position played on the court. Given the fact that Kuala, (1) reports that 50% of injuries are sustained in training rather than on the court, this may prove to be rather academic. The study by Meeuwisse (2003) (2), was one of the few that looked at this issue and regarded it as purely peripheral to the main mechanism of injury. However , they summed up the findings of the study in the phrase â€Å"Centres had the highest rate of injury, followed by guards, and then forwards. The relative risk of re-injury was significantly increased by previous injuries to the elbow, shoulder, knee, hand, lower spine or pelvis, and by concussions.† As part of their conclusions the research team commented that the predictive risk factors for injury were, in order of importance: previous injury, number of games played, the number of player contacts during a game, player position, and court location (this is a reference to the proximity to a hospital). In real terms, the players position is of much less importance in predicting injury than many other factors Clinical considerations The clinical implications of basketball injury must be viewed in the context of the benefits derived from playing any competitive sport– or indeed pursuing any degree of fitness. Virtually any sporting endeavour has a downside and indeed risks associated with it, but equally there are very considerable benefits to be gained as well. By concentrating (by necessity) on the risks of injury in basketball in this article we do not wish to ignore the balancing perspective of the health gains to also be derived. Clearly, one of the major benefits to be gained is the concurrent increase in cardiovascular fitness (13) This is in addition to the less easily quantifiable benefits of general fitness, social interaction, increase in self-confidence and satisfaction in participation which are common to most sporting endeavours. The study by Kuala et al. (1993) (13) looked at the incidence of degenerative joint conditions in elite athletes. It found that participation in sports generally could lead to premature osteoarthritis. Specifically it found that, in the elite international athletes studied there was a greater than predicted admission rate to hospital for treatments for osteoarthritis of the hip, knee and ankle. Very significantly, in the context of this article on physiotherapy, it concluded that proper treatment of injuries to these joints could significantly reduce the incidence of premature osteoarthritis in this group. It should be noted that this was a large control moderated study of over 2000 international athletes so the findings are clearly significant Disability and basketball It is important not to ignore the fact that basketball is played, not only by able-bodied sportsmen but also by those who have a concurrent disability as well. This group also presents a professional problem for the physiotherapist as. Not only are there the â€Å"normal â€Å"considerations for the able-bodied player that we have discussed in this piece, but also there may well be disability-specific considerations in the disabled player which will tax the physiotherapist every bit as much as those in their able-bodied counterparts. In consideration of this we would commend the reader to an excellent article by Chula (1994) (26) which discusses inconsiderable depth, the whole issue of sports specific medical considerations for people with a disability. The use of sports for the disabled as a therapeutic measure was championed by Sir Ludwig Guttmann, who was a specialist in spinal injuries. He pointed out not only the obvious physical benefits to be gained in improving functions of the body which the paraplegic ortetraplegic had not fully exploited in their pre-injury state togetherwith the obvious cardiovascular benefits that could be obtained, but healso pointed to the psychological benefits to be gained by socialisingand competing against others. The Disabled Person’s Employment Act (1944) was the first majorlegislative landmark in the effective rehabilitation of the disabledperson back into society and other legislation relating todiscrimination generally has helped the disabled person to achievelevels of attainment in sport that would have been unthinkable half acentury ago. The comments that have been made in this piece in relation toable-bodied people obviously apply, in general terms, to the disabledperson as well. Clearly it depends on the nature of the disability asto what specific measures need to be employed specifically, but thebasic principles are the same. Muscle groups need to be developed inorder to protect the joints that they work over. This is particularlyrelevant to the knee. Appropriate proprioceptive skills need to beenhanced if the risk of injury is to be kept to an acceptable minimum.More specific considerations that may involve the occupationaltherapist as well as the physiotherapist may include the prevention ofpressure problems from a wheelchair or calliper or the use ofrestraints in a patient who has sudden muscular spasms, so that theyare not thrown out of the wheelchair. The experienced physiotherapist will be well aware of the benefitsof sport in the disabled in improving strength, co-ordination andendurance. Basketball, in particular, is commonly employed in thewheelchair-bound patient, who has to learn transferable skills in orderto propel the wheel chair accurately as well as catch, intercept andpass the ball. Prophylaxis and pre-injury actions Earlier in this piece we briefly discussed a paper by Sanchez (23).and commended it for its tackling of the problem of anticipating an injury. This involved a significant amount of pre-planning andorganisation on the court and field of play. Such issues are of vitalimportance to the athletes although they may not either realise orappreciate it at the time. This type of forward thinking can lead to dramatic reductions in morbidity (or even in mortality) and should be the concern of each and every healthcare professional who is working in the field of acute sports injury. Prophylaxis can be considered not only as actual pre-planning thecourse of action needed if an injury is sustained (viz. are theresplints, bandages, sterile water and gloves etc. available?) but equally it can be considered as the correct training and preparation ofboth the players and the game officials, so that the game itself can beplayed in conditions of optimum safety. Although the first of these two considerations is clearly important, in the context of this piece, weshall consider the second element in detail. Prophylaxis of injury is a major concern. We have discussed thepredictive value of a pre-existing injury. It follows that, if thatinjury can be prevented, then the subject is statistically less likelyto suffer a further injury. Common sense is behind the definitive recommendation in the paperby Kuala et al., (1) where he states that, in an attempt to reduce the incidence of injuries in basketball, specific preventative measuresshould be employed to reduce the number of violent contacts betweenplayers. He cites improving the drafting of game rules so that violentinfringements of the rules can be mo Injury Risk in Elite Basketball Players Injury Risk in Elite Basketball Players The elite basketball player is considered in this piece not only in terms of his potential for injury but also in terms of the potential of the physiotherapist and other sports professionals, to give advice, support and guidance so that he may practice his chosen sport as safely as is reasonably possible. We have looked at the nature, incidence and sites of injuries sustained. We have looked at the two most commonly injured sites (the knee and ankle) in specific detail. We have also discussed the relevant modalities of treatment that a physiotherapist can provide for their clients. There appears to be considerable controversy in the current literature, particularly in the field of pre-exercise stretching. As this is commonly accepted practice by participants, coaches, trainers and sports medicine professionals alike, we have reviewed the arguments both for and against in some detail. We have paid particular attention to its value in the prophylaxis of injury and the evidence to support it. The role of the physiotherapist in education and training of the elite athlete is also discussed. There are a number of sources quoted who regard it as a prime responsibility of the physiotherapist to give the athlete the information to allow them to train and participate as safely and effectively as possible. We have also considered the role of the physiotherapist in the prophylaxis of injury by looking at the various modalities of treatment and intervention that can be employed to make the field of play a safer place. In addition to the main-stream elite basketball player we have also looked at the role of the physiotherapist in the role of helping the disabled basketball player, some of whom have achieved elite status in their own right. They have their own specific problems and these are reviewed and discussed. Lastly we look at the specific gender differences in the sport. With many women finding that the sport is attractive, they participate at a top level of achievement. We look at the reasons why they have a different injury profile to men, both in terms of numbers of injuries but also in terms of the frequency of specific types of injury. The mechanisms of this difference is discussed together with the means whereby it can be addressed. Introduction Basketball is a world-wide sport practised by children in their backyard, adolescents in their playground, amateurs in their league games and elite athletes in their world-stage arenas. It is – by any standards – a fast game with inevitable physical contact, both intentional and accidental. Both these factors lead to the potential for injury. The explosive effort for the fast moves leads to particular pattern of muscle, ligament and tendon injury (see on) and the physical contact can lead to bruises, dislocations, fractures another injuries. It is a sport that is enjoyed by both sexes. Although it was originally conceived primarily as a male sport (for the YMCA)in an era when female participation in sport was a rarity, women now participate in it to elite levels and suffer injury to a similar extent to their male counterparts. The game itself has evolved dramatically since its humble beginnings when Dr James Naismith nailed two peach baskets at the ends of his gymnasium in 1891 (hence the name basketball) It was developed as a tool for fitness training by the YMCA. By 1927 The Harlem Globetrotters had been formed and by 1936 it was included as an Olympic sport. According to FIBA (Basketball governing body) over 400 million people play basketball on a world-wide basis Training for the fitness needed to play the sport can also lead touts own problems. One huge study by Ruhr M Kuala et al. (1994) (1) found that of all the injuries associated with basketball, 50% occurred during the matches and 50% occurred during training for the matches. This should be contrasted with the finding in study by Meeuwisse et al.(2) where injuries during the game were 3.7 times as likely to occur as in training. One could reasonably conclude that a large proportion of the injuries sustained in the â€Å"cut and thrust† of a full scale match are part of the risk package accepted in playing the game. The huge proportion of injuries sustained whilst training, however, should be largely preventable, as training should be ideally undertaken in carefully controlled circumstances. The physiotherapist, personal trainer and sports medicine specialist are ideally placed to advise and oversee poor practice in the training arena and to give advice and guidance to maximise training efficiency and to reduce the toll of injury. Any experienced sports care professional will tell you that the single most important factor in determining the likelihood of sustaining an injury is the occurrence of a previous injury (2). It therefore follows that prevention of any injury will help, not only in improving the immediate efficiency of the player, but will also confer protection against the possibility of recurring injury in any given site. Before we consider the mechanisms and prophylaxis of injuries in basketball, it would be prudent to consider the observed injuries from the sport, both in absolute number and site. The study by Meeuwisse(2003) (2) followed a cohort of 142 basketball players over a two year period and discovered that 44.7% of the players were injured in that time frame. As they recorded over 200 injuries in that time, it is clear that many players were injured more than once. The study by Ruhr M Kuala et al. (1994) (1) will be extensively quoted in this piece as it provides an enormous amount of meticulously collected data which has a high degree of confidence in its validity. It was based in Finland where the population has a particularly regimented system of bureaucratic personal information storage, especially with regard to injury and healthcare details. The entire population has to be registered with a nationally based health insurance, which records every accident and injury. This is of enormous value to studies such as this, as accurate statistics about entities such as specific sporting injuries can be derived comparatively easily. The study is also important in this specific regard as it encompasses an enormous cohort of basketball players analysing 39,541person years of basketball experience and 3,472 specific injuries. It’s worth considering the patterns of injury found in some detail as it has an impact on the deliberations in this piece. In terms of age distribution, it was found that injuries in thunder 15 yr. age group were comparatively rare and that the injury rate peaked in the 20 – 24 yr. age groups. Percentage of injuries by sites in basketball players (These results are slightly modified with some trivia removed) Injury Site % of total Lower limb Total 56.0 Thigh 2.5 Knee 15.8 Leg 2.0 Ankle 31.4 Foot 4.0 Other 0.4 Upper Limb total 19.3 Upper arm + Shoulder 2.6 Forearm and elbow 1.3 Palm + wrist Fingers 11.1 Other 0.4 Other Sites Total 24.7 Teeth 5.2 Eyes 3.0 Head + neck 7.4 Thorax + Abdomen 1.5 Back 5.4 Pelvis 0.9 Multiple sites 1.4 There are clearly a number of striking trends in these figures. The lower limbs sustaining the most injuries with 56% of the total. The ankle and knee taking the lion’s share of these. These results are clearly fairly predictable with the nature of the sport being one of sudden changes of acceleration and direction, many changes of direction(pivoting) involving turning forces impinging maximally on the knee and ankle. Both joints are intrinsically unstable for these modalities of movements. They are designed to be most effective in walking and running in a straight line. Although they can accommodate twisting movements, they are much less mechanically sound in these directions. The possibility of unanticipated, and therefore unraced, impacts is endemic in the sport and will increase the possibility of injury to these joins in particular. The upper limb has a substantial tally of injuries with the bulk being to the palm, wrist and fingers. Although it is not specified in this particular study, any experienced clinician would expect to see substantial proportion of hyperextensions and dislocations to the fingers and sprains and strains to the wrist (this is partially amplified in the next section). For a sport that involves considerable manipulative and throwing skills, it is, perhaps, surprising that the shoulder and upper arm account for only 2.6% of all the injuries. In contrast to the comments made about the knee and ankle, one can postulate that the shoulder, by virtue of its design to accommodate a much greater range and compass of movement, is less likely to be injured in the way that the knee and ankle are. Also, in the course of the normal game, it is subject to rather less overall mechanical force as both the knee and ankle have to assimilate peak loads of several times the body weight whereas the shoulder, unless involved in a fall, does not. Of the â€Å"Other Sites†, the neck and back are the commonest sites for injury. To a large extent, this again is a reflection of the explosive nature of the game with frequent changes of direction and velocity with high levels of acceleration. Having recognised the major sites of injury it is now prudent to discuss the main types of injury. Percentage injury by type in basketball players (These results are slightly modified with some trivia removed) Injury type + site % of total Sprains +strains 61.3 Knee 12.4 Ankle 29.5 Bruises + Wounds 22.2 Fractures 12.6 Fracture (other than dental) 7.6 Foot + ankle 18.5 Lower limb (other) 3.8 Fingers Palm + wrist 57.0 Upper limb (other) 4.2 Other (nondental) 16.6 Dental 4.9 Dislocations 1.7 Knee 0.5 Shoulder + elbow 0.3 Fingers 0.3 Others 2.2 Sprains and strains are the commonest type of injury in this sport with the ankle being the most frequently injured site in this respect. Considerable amounts of work and research have been done(2,3,4,5,6,7,8) to try to find mechanisms whereby ankle injuries can beat least reduced in both frequency and severity. This will be discussed in detail later. Knee strains and sprains are the next most frequent at12.4%. Similar amounts of work have been done to find ways of minimising knee injuries (9,10,11). The knee injury is notorious for producing long-term debilitating problems as not only is the acute injury painful and potentially debilitating in itself, but there is also the potential for Anterior Cruciate Ligament (ACL) damage and meniscal damage and wear as well. This may not be immediately apparent but may contribute to morbidity at a later date. This study (1) found that knee injuries were the most common cause of permanent disability In the longer term. During the time frame of this study, four basketball players sustained permanent injuries. In specific relation to knee and ankle injury, the Meiuwess study(2) found that the situation can be further amplified by the finding that the greatest number of injuries which resulted in seven or more sessions being lost in a season arose from the knee. Equally striking was the fact that the most common injury that involved less than seven sessions being lost, were injuries to the ankle. This underlines the comment made earlier that knee injuries tend to be potentially more serious than ankle injuries Bruises and wounds account for over 1/5th of the total types of injury and fractures account for just over 1/10th. In line with the comments made earlier about the frequency of hand, finger and wrist injury, it will come as no surprise therefore to see that the hand and wrist accounts for over half of the total of fractures. The foot and ankle account for 18.5% of total fractures. This is a reversal of the figures relating to site of injury. It would therefore appear that the hand gets injured less frequently that the foot, but when it does, it’s more likely to sustain the more serious (fracture) type of injury. Although the foot is more likely to be injured, it is more likely to suffer a strain or sprain rather than a fracture. In the study by Home et al.,(2004) (12) There was an unexpected, and slightly worrying, conclusion. They found that, in a study of fractures in sport, that (for men at least) basketball was the sport that put the participants at greatest risk of sustaining a fracture. The Knee and Basketball As we have already discussed, a knee injury is potentially more serious than just the implication of the immediate acute injury. For that reason, and for the fact that it is one of the two most commonly injured areas, we will look at the knee as a specific entity. We know that the single most important predictor for further injury is the past history of a preceding original injury. The knee is also significant insofar as the normal maxim of rest a joint until the inflammation has settled is rarely practical, as the knee is essential for locomotion and, as any experienced clinician knows, the vast majority of patients with resolving knee injuries will wait until the pain subsides to a tolerable level, and then start to walk on it. This effectively means that the joint is being stressed while resolving inflammation is present. Initially this may manifest itself as no more than a mildly aching knee, but it is likely that menisci, cruciate ligaments and articular surfaces are all being stressed in a â€Å"less than optimal† state. It is likely, on a first principles basis, that this type of mechanism may be, in part at least, responsible for the increased levels of arthritis and arthritis that is observed in lifelong athletes. (13,14) The paper by Meeuwisse (2) has been quoted several times in this piece. It is worth remembering that his team found that the knee waste joint which, if injured, gave rise to the longest periods of incapacity. It is therefore prudent to consider the mechanisms of injury, the treatment of those injuries and, possibly more importantly in the context of this piece, what can be done to minimise the incidence and impact of those injuries. We would commend an excellent paper by Bahr (2001) (3) on the subject. He discusses (amongst other things) the current thinking on knee injuries. He makes comment on the increasing incidence of cruciate ligament injuries. These injuries are seen with greatest frequency in athletes who participate in sports that involve â€Å"pivoting† – a movement which involves a fixed foot on the floor being used as a fulcrum topspin the body around – a movement which can put huge rotational stresses on the knee joint. As has been observed earlier in this piece, the knee is designed primarily to be efficient in dealing with movement in a sagittal plane. It is very poorly adapted to deal with rotational stresses. Bahr observes that the maximal incidence of cruciate ligament injury is in the 15-25 yr. old age group and in women three to five times more frequently than in men (see on) (14). He also refers to the post-injury, long-term complications of abnormal joint mechanics and the early onset of degenerative joint disease (15). Significantly he points to the fact that, although there has been an increasing trend recently (mainly because of improved operating techniques) to attempt to repair menisci and cruciate ligaments, this has not been accompanied by an apparent reduction in the rate of post-traumatic osteoarthritis. Similarly, arthroscopic repair of isolated meniscal damage has not been shown to reduce the incidence of arthritis. These factors all mitigate the argument that, although treatment is important, the identification of risk factors that predispose to injury is even more important. The Anterior Cruciate Ligament (ACL) is commonly injured in circumstances that many athletes would consider as normal or routine for their particular sport. Frequently the damage occurs without direct physical contact to the knee (9). This is strong evidence to support the â€Å"design fault† explanation of the aetiology. There is recent anecdotal data to suggest that improving the control of the knee may have an impact in reducing the incidence of these injuries. This views supported in a paper by Carafe (10) who looked at improving the proprioceptive and balance mechanisms in footballers over a three season period. They reported an 87% decrease in the incidence of injuries to the ACL. It may be significant that they studied semi-professional and amateur footballers who, presumably, did not train as efficiently of as skilfully as their professional footballer counterparts and therefore there was probably considerable room for improvement. Similarly constructed studies have shown similar pattern of improvement in young female football (11) and handball (16) players using a similar programme of training over a season. As has been pointed out earlier, such changes are more likely to be noticeable in females because of the higher incidence of ACL injury in the first place. Bahr points out that these studies were too small to allow a proper statistical evaluation of the reduction of injury to the ACL specifically, but there is sufficient evidence to conclude that the risk of serious knee injury can be significantly reduced by the introduction of structured training exercises that focus on improving the neuron-muscular control of the knee. Bahr makes the very salient point that balance (proprioceptive)training is not yet universally recognised by coaches and trainers as useful tool. As a result, he argues that it is the responsibility of doctors and physiotherapists to disseminate the knowledge that such training does reduce the incidence of serious short-term (and therefore long-term) knee injury. Anterior knee pain is a common, sometimes chronic presenting symptom in any sports related health professional’s clinic. There are many theories as to its aetiology and it is notoriously resistant to treatment. An unattributed paper (quoted by Minerva in the BMJ) (17)refers to Jumper’s knee where the pain is maximal near the attachment of the patella ligament. Ultrasound of the region can show an area of increased echogenicity in the inferior pole of the patella. Minerva quotes the study as observing that of 100 athletes seen in one clinic,18 had to give up their sport for over a year and about 1/3rd needed surgery in order to try to get resolution of the problem. In conclusion to this section we would refer the reader to the excellent paper by Adams WB (2004) (18) who reviews the current thinking on treatment options on both overuse syndromes and trauma tithe knee. The Ankle and Basketball As we have seen earlier, the ankle is the single most commonly injured site in the body during basketball comprising 31.4% of all the injuries observed (1) and ankle strains and sprains were the single commonest mechanism of injury observed with 1/3rd of all such injuries and 1/5th of all fractures. We will therefore also consider the ankles a special case. Bahr (3) quotes that in round figures 20% of sports related injuries involve the ankle. The vast majority of ankle injuries are simple sprains of the lateral and medial ankle ligaments. Proper functional care will allow the patient to return to work within a few days, or at worst a few weeks, with minimal squeal. Some sprains are found to cause prolonged disability in the form of chronic instability or persistent pain. Prophylaxis of injury is discussed elsewhere in this piece but it should be noted that taping and bracing are commonly employed techniques for protection, but their efficacy has only been demonstrated in sportsmen with a history of previous injury (5,6).There is little doubt that taping and bracing will reduce the incidence of sprains and result in less severe strains. â€Å"High-top† basketball boots have been introduced recently on the assumption that similar boots (18a) (viz. ski boots) reduce the incidence of ankle injury, but it has not yet produced any specific evidence that sprains and strains are reduced. Braces seen to be more effective than tape in preventing sprains of the ankle (7,8) Bracing has the advantage that it is more acceptable in terms of comfort for long-term use (6). Taping is commonly used but appears to be less effective than braces because it relies on adhesion to the skin to exert its protective influence. It can cause skin irritation and has to be reapplied on virtually every occasion where potential stress can occur. One of the major problems of doing research into ankle injuries is that qualitative and subjective measurements such as pain and immobility can be easily assessed, but the ankle joint is a very functionally complex structure and quantitative measurements of anything other than flexion/extension or rotation an very difficult. Its therefore heartening to read of a Dutch group who are developing a specially designed goniometer to use in researching the pathology of the ankle joint (19). This is only mentioned for the sake of completeness and we do not propose to go into any detail about the instrument. There is an excellent article by McKay on ankle injuries in basketball (20) but this is discussed at some length in the section on prophylaxis of injuries. Treatment of injuries The treatment of sports related injuries is a vast topic and specialism in itself. The sports medicine medical specialist and the physiotherapist sports specialist are technically knowledgeable people who have had to assimilate a vast quantity of information relative to their specialisation. It is therefore not proposed to present the topic in any great detail but to cover the elements of treatment of acute injuries and their subsequent treatment that are specifically important to the field of basketball. We will also present a brief literature review of some of the most recent papers in the field. In general terms, the old adage of ICE (immobilisation, compression and elevation) (20b) is a useful first-aid mnemonic which will help to minimise injury prior to assessment by a more specialist professional. In this article it is proposed to look primarily at the aspects of treatment which impinge on the areas covered in this piece and broad overviews. We shall restrict ourselves here to a brief literature review of some of the most important recent papers The area of dental trauma is highlighted in the analysis by Kujalaet al. (1994) (1) with 5.0% of all basketball injuries being dental. Airport by Randall (2005) (21) discusses the impact of dental injuries and suggests that sports field medical personnel should have at least basic training in the first-aid of dental injuries so that they can, at least, provide appropriate care until a dental specialist can be properly involved. A particularly controversial issue is raised by Dietzel and Hedlund(2005) (22) They review the current controversy about the use of analgesic and anti-inflammatory injections both in the acute phase of injury (to allow continued participation in a sporting event) or in the chronic recovery phase. This is a particularly well balanced article which evaluates both sides of the arguments for and against the use of injectable medications. Sanchez et al.(2005) (23) review the desperately important area of management of the potentially spine-injured athlete. This is an area which has had substantial changes in management techniques in the recent past. This paper is a particularly useful review of techniques of diagnosis and stabilisation of the injured athlete. Very significantly it highlights the role of pre-injury planning – so often overlooked – on the sports field. There are two recent papers which examine the thorny problem of concussion on the sports field (24,25). This has long posed a problem for the supervising healthcare specialist, both in terms of immediate diagnosis and subsequent action and treatment. The working â€Å"rule of thumb† has been that any player with definite signs of concussion(impaired consciousness or increased level of confusion) should be taken off the field and not returned to play for 48 hrs. In practice, this advice may be ignored by coaches who are anxious to keep their best players on the field and who may be ignorant of the potential side effects. McKean (24) and Johnston et al. (25) review the arguments in coherent manner and present the current thinking in a modern context. Injury types in relation to position played There are few studies that actually compare the rates and types of injury with actual position played on the court. Given the fact that Kuala, (1) reports that 50% of injuries are sustained in training rather than on the court, this may prove to be rather academic. The study by Meeuwisse (2003) (2), was one of the few that looked at this issue and regarded it as purely peripheral to the main mechanism of injury. However , they summed up the findings of the study in the phrase â€Å"Centres had the highest rate of injury, followed by guards, and then forwards. The relative risk of re-injury was significantly increased by previous injuries to the elbow, shoulder, knee, hand, lower spine or pelvis, and by concussions.† As part of their conclusions the research team commented that the predictive risk factors for injury were, in order of importance: previous injury, number of games played, the number of player contacts during a game, player position, and court location (this is a reference to the proximity to a hospital). In real terms, the players position is of much less importance in predicting injury than many other factors Clinical considerations The clinical implications of basketball injury must be viewed in the context of the benefits derived from playing any competitive sport– or indeed pursuing any degree of fitness. Virtually any sporting endeavour has a downside and indeed risks associated with it, but equally there are very considerable benefits to be gained as well. By concentrating (by necessity) on the risks of injury in basketball in this article we do not wish to ignore the balancing perspective of the health gains to also be derived. Clearly, one of the major benefits to be gained is the concurrent increase in cardiovascular fitness (13) This is in addition to the less easily quantifiable benefits of general fitness, social interaction, increase in self-confidence and satisfaction in participation which are common to most sporting endeavours. The study by Kuala et al. (1993) (13) looked at the incidence of degenerative joint conditions in elite athletes. It found that participation in sports generally could lead to premature osteoarthritis. Specifically it found that, in the elite international athletes studied there was a greater than predicted admission rate to hospital for treatments for osteoarthritis of the hip, knee and ankle. Very significantly, in the context of this article on physiotherapy, it concluded that proper treatment of injuries to these joints could significantly reduce the incidence of premature osteoarthritis in this group. It should be noted that this was a large control moderated study of over 2000 international athletes so the findings are clearly significant Disability and basketball It is important not to ignore the fact that basketball is played, not only by able-bodied sportsmen but also by those who have a concurrent disability as well. This group also presents a professional problem for the physiotherapist as. Not only are there the â€Å"normal â€Å"considerations for the able-bodied player that we have discussed in this piece, but also there may well be disability-specific considerations in the disabled player which will tax the physiotherapist every bit as much as those in their able-bodied counterparts. In consideration of this we would commend the reader to an excellent article by Chula (1994) (26) which discusses inconsiderable depth, the whole issue of sports specific medical considerations for people with a disability. The use of sports for the disabled as a therapeutic measure was championed by Sir Ludwig Guttmann, who was a specialist in spinal injuries. He pointed out not only the obvious physical benefits to be gained in improving functions of the body which the paraplegic ortetraplegic had not fully exploited in their pre-injury state togetherwith the obvious cardiovascular benefits that could be obtained, but healso pointed to the psychological benefits to be gained by socialisingand competing against others. The Disabled Person’s Employment Act (1944) was the first majorlegislative landmark in the effective rehabilitation of the disabledperson back into society and other legislation relating todiscrimination generally has helped the disabled person to achievelevels of attainment in sport that would have been unthinkable half acentury ago. The comments that have been made in this piece in relation toable-bodied people obviously apply, in general terms, to the disabledperson as well. Clearly it depends on the nature of the disability asto what specific measures need to be employed specifically, but thebasic principles are the same. Muscle groups need to be developed inorder to protect the joints that they work over. This is particularlyrelevant to the knee. Appropriate proprioceptive skills need to beenhanced if the risk of injury is to be kept to an acceptable minimum.More specific considerations that may involve the occupationaltherapist as well as the physiotherapist may include the prevention ofpressure problems from a wheelchair or calliper or the use ofrestraints in a patient who has sudden muscular spasms, so that theyare not thrown out of the wheelchair. The experienced physiotherapist will be well aware of the benefitsof sport in the disabled in improving strength, co-ordination andendurance. Basketball, in particular, is commonly employed in thewheelchair-bound patient, who has to learn transferable skills in orderto propel the wheel chair accurately as well as catch, intercept andpass the ball. Prophylaxis and pre-injury actions Earlier in this piece we briefly discussed a paper by Sanchez (23).and commended it for its tackling of the problem of anticipating an injury. This involved a significant amount of pre-planning andorganisation on the court and field of play. Such issues are of vitalimportance to the athletes although they may not either realise orappreciate it at the time. This type of forward thinking can lead to dramatic reductions in morbidity (or even in mortality) and should be the concern of each and every healthcare professional who is working in the field of acute sports injury. Prophylaxis can be considered not only as actual pre-planning thecourse of action needed if an injury is sustained (viz. are theresplints, bandages, sterile water and gloves etc. available?) but equally it can be considered as the correct training and preparation ofboth the players and the game officials, so that the game itself can beplayed in conditions of optimum safety. Although the first of these two considerations is clearly important, in the context of this piece, weshall consider the second element in detail. Prophylaxis of injury is a major concern. We have discussed thepredictive value of a pre-existing injury. It follows that, if thatinjury can be prevented, then the subject is statistically less likelyto suffer a further injury. Common sense is behind the definitive recommendation in the paperby Kuala et al., (1) where he states that, in an attempt to reduce the incidence of injuries in basketball, specific preventative measuresshould be employed to reduce the number of violent contacts betweenplayers. He cites improving the drafting of game rules so that violentinfringements of the rules can be mo

Midterm Review

Chapter 161. ) All of the following factors contributed to explosive economic growth during the Gilded Age EXCEPT: Question options: a) availability of capital for investment. b) a growing supply of labor. c) abundant natural resources. d) low tariffs. e) federal land grants to railroads. 1 / 1 point2. ) By 1890, the majority of Americans: Question options: a) worked as farmers. b) worked as independent craftsmen. c) worked in the mining industry. d) were moving into the middle class. e) worked for wages. 1 / 1 point3. ) The second industrial revolution was marked by: Question options: a) a return to handmade goods. b) a more equalized distribution of wealth. c) the rapid expansion of industry across the South. d) the acceleration of factory production and increased activity in the mining and railroad industries. e) a decline in the growth of cities. 4. ) The ____________ made possible the second industrial revolution in America. a) oil industry b) railroads c) iron industry d) textiles e) cotton gin| 1 / 1 point5. In 1883, ____________ divided the nation into the four time zones still used today. Question options: a) the major railroad companies b) the federal government c) a coalition of mining and lumber companies d) an organization of Western states e) a group of businessmen from Chicago| 1 / 1 point6. ) In the nineteenth century, pools, trusts, and mergers were: a) unheard of. b) used only rarely. c) against the law. d) seen as beneficial by consumers. e) ways that manufacturers sought to control the marketplace. 0 / 1 point7. Between 1897 and 1904, a wave of financial mergers led to the creation of the following corporations, all of which dominated major parts of the economy EXCEPT: a) U. S. Steel. b) J. P. Morgan. c) Standard Oil. d) International Harvester. e) Quaker Oats. 0 / 1 point8. ) One significant economic impact o f the second industrial revolution was: a) a more stable economy. b) frequent and prolonged economic depressions. c) higher prices. d) a more equitable distribution of wealth. e) the introduction of socialism. 0 / 1 point9. ) Andrew Carnegie and John D. Rockefeller: Question options: a) faced no criticism for their business practices. b) led the way in social reform. c) advocated government regulation of business. d) built up giant corporations that dominated their respective markets. e) were both immigrants. 1 / 1 point9. ) The American working class: Question options: a) were paid less than their European counterparts. b) worked under safe conditions, and fatal factory accidents were uncommon. c) did not include women and children. d) was quickly making gains and moving into the middle class. e) lived in desperate conditions. 10. ) In How the Other Half Lives, Jacob Riis: Question options: a) highlighted the benefits of the second industrial revolution. b) discussed the lives of wealthy Americans. c) focused on the wretched conditions of New York City slums. d) provided a fictional account of life in 1890. e) wrote about captains of industry. 0 / 1 point11. ) Bonanza farms: a) were small, self-sufficient farms. b) were the sharecropping farms found in the South. c) typically had 3,000 acres of land or more. d) were free homesteads in California. e) were settled along the railroad lines of the Union Pacific. 1 / 1 point12. ) The economic development of the American West was based on: Question options: a) farming solely. b) lumber, mining industries, tourism, and farming. c) the continued reliance on self-sufficient farming. d) transportation modes other than the railroad. e) the cooperation of the Plains Indians. 1 / 1 point13. ) What did hunters shoot while riding the railroads across the West? Question o ptions: a) horses b) deer c) antelope d) Indians e) buffalo| 1 / 1 point14. Which statement about Chief Joseph’s appeal to an audience in Washington, D. C. , in 1879 is FALSE? Question options: a) He did not wish to speak to the audience, but had been coerced to do so by President Hayes. b) He asked the white man for more than just talk, as he saw talk as broken promises. c) He believed that the Indians and the white man could live in peace, without trouble between them. d) He asked the policymakers of Washington to extend the same laws to the Indians as to the white man. e) He attempted to convince his audience that its belief that Indians were like wild animals was false. 15. ) What was the aim of Carlisle, a boarding school for Indians? a) to prepare them for reservation life b) to train them in the professional skills necessary to return to the reservations as doctors and teachers c) to convert them to Christianity so that they would become missionaries on the reservation s d) to civilize the Indians, making them â€Å"American† as whites defined the term e) to prepare them to enlist in the U. S. military16. ) The Civil Service Act of 1883: Question options: a) created a merit system for government workers. b) favored candidates with political influence. c) was passed in response to the assassination of President Lincoln. d) applied only to women. e) applied only to elected officeholders. 17. ) The Interstate Commerce Commission was established in 1887 to: Question options: a) distribute land allocations to railroad companies. b) standardize the transportation of animal feed between states. c) oversee state taxes. d) regulate railroad gauge size. e) ensure that railroads charged farmers and merchants reasonable and fair rates. 18. ) The Greenback-Labor Party: Question options: a) wanted banks to control the money supply. b) wanted to increase the amount of money in circulation. c) wanted to decrease the money supply. d) was unable to elect any of its candidates, even on the local level. e) supported the use of force against striking workers. 0 / 1 point19. ) The Grange was an organization that: a) pushed for the eight-hour day. b) sought to raise railroad rates. c) opposed government regulation of shipping charges. d) pushed for railroads to acquire more land in the West. e) established cooperatives for storing and marketing farm output. 1 / 1 point20. During the second industrial revolution, the courts: Question options: a) supported the interests of workers. b) supported the interests of consumers. c) refused to hear any cases related to business interests. d) tended to favor the interests of industry over those of labor. e) tended to favor the interests of labor over those of industry. 0 / 1 point21. ) One of the reasons that the Great Strike of 1877 was important is that: Question options: a) not since the Civil War had so many people been killed. b) it underscored the tensions produced by the rapid industrialization of the time. c) the victory won by labor was the greatest for the labor movement in American history. d) it proved the theory of Social Darwinism. e) it demonstrated how effective the Knights of Labor could be in organizing workers. 22. ) The Knights of Labor: Question options: a) was an inclusive organization that advocated for a vast array of reforms. b) organized only skilled, white, native-born workers. c) did not admit women. d) never had more than a few hundred members. e) cooperated with big business. 23. ) The Social Gospel: Question options: a) was another term for Social Darwinism. b) was financed by corporate donations. c) was part of the Catholic Church. d) called for an equalization of wealth and power. e) did not support aid to the poor. 25. ) The Haymarket Affair: Question options: a) began with the Great Strike of 1877. b) originated in New York City. c) involved American farmers on strike. d) brought about the end of Reconstruction. e) was provoked by the 1886 bombing at a Chicago labor rally.Chapter 171 / 1 point1. ) Farmers believed that their plight derived from all of the following EXCEPT: Question options: a) high freight rates charged by railroads. b) excessive interest rates for loans from bankers. c) the high tariff policies of the federal government. d) the fiscal policy that reduced the supply of money in the economy. e) the free and unlimited coinage of silver. 1 / 1 point2. ) The Farmers’ Alliance: Question options: a) successfully worked with banks. b) was subsidized by the railroad industry. c) sought to improve conditions through cooperatives. d) achieved its goals and disbanded shortly after its founding. e) was limited only to the Northeast. The Populist platform: a) called for the end of a ll government. b) supported the interests of big business. c) called for government control of business. d) appealed only to industrial workers. e) appealed only to farmers. Which was NOT part of the Populist platform? Question options: a) a graduated income tax b) direct election of U. S. senators c) government ownership of railroads d) higher tariffs e) workers’ right to form unions| The severe depression of 1893: Question options: a) was quickly over, and the economy was soon booming. b) caused little if any hardship. c) affected only factory workers. d) was a period in which labor and capital worked together harmoniously. e) was marked by high and long-term unemployment, exemplified by Coxey’s Army. How were federal troops used in the Pullman Strike of 1894? Question options: a) As moderators between the employees and employers b) To help suppress the strikers on behalf of the owners c) They were not used at all. d) As workers themselves, to replace the striking workers e) As spies, such as an early Federal Investigation BureauQuestion 7 0 / 1 point| William Jennings Bryan: a) wrote utopian novels. b) ran for president in 1896 on the free silver platform. c) argued in favor of the gold standard. d) ran as a Republican and a Populist in 1896. e) was especially popular in the Northeast. Who migrated to Kansas during the Kansas Exodus? Question options: a) Indians b) working-class families c) Chinese d) blacks e) white sharecroppersQuestion 9 0 / 1 pointPlessy v. Ferguson: Question options: a) was a unanimous decision. b) sanctioned racial segregation. c) voided the Thirteenth Amendment. d) limited the hours that women could legally work. e) was fully supported by Booker T. Washington. Question 10 1 / 1 pointIn Plessy v. Ferguson (1896), the Supreme Court: a) ruled that â€Å"separate but equal† accommodations were constitutional. b) ruled that â€Å"separate but equal† accommodations were unconstitutional. c) supported the right of women to vote. d) supported the right of workers to join unions. e) supported the right of African-Americans to vote. The new immigrants: a) were seen as no different from the old immigrants. b) received a warm welcome in America. c) came from southern and eastern Europe. d) were few in number. e) came mostly from Great Britain. Question 12 0 / 1 pointThe Immigration Restriction League: Question options: a) called for increased immigration from Asia. b) was founded by new immigrants. c) wanted to bar immigrants under the age of eighteen. d) wanted to bar immigrants who were illiterate. e) wanted to end all immigration. Question 13 1 / 1 pointThe Chinese Exclusion Act of 1882: Question options: a) led to an increase in civil rights for Chinese people and Chinese-Americans living in the United States. b) only barred immigration of Chinese women. c) led to the deportation of the 105,000 Chinese people living in the United States in 1882. d) led to a decrease in discrimination and violence against the Chinese. e) was the first time race was used to exclude an entire group of people from entering the Uni ted States. Question 14 0 / 1 pointFounded in 1886, the American Federation of Labor: Question options: a) was led by Terence Powderly. b) restricted membership to only skilled workers. c) was structured much like the Knights of Labor. d) restricted membership to only unskilled workers. e) successfully organized immigrant workers. Question 15 0 / 1 pointThe American Federation of Labor’s founder Samuel Gompers used the idea of â€Å"freedom of contract† to: a) argue against interference by judges with workers’ right to organize unions. b) argue for the right of workers to form political parties to shape government. c) argue for direct confrontation between unions and corporations. d) justify the exclusion of women and blacks from the American Federation of Labor. e) explain the American Federation of Labor’s policy of admitting unskilled workers to its union. American territorial expansionism: Question options: a) began in 1890. b) was a feature of Americ an life since well before independence. c) began with the Spanish-American War. d) began with the war in the Philippines. e) began with the Monroe Doctrine. Question 17 0 / 1 pointJournalists who worked for newspapers like William Randolph Hearst’s New York Journal, which sensationalized events to sell papers, were called: Question options: a) yellow journalists. b) trustees. c) social reformers. d) muckrakers. e) freelancers. Question 18 0 / 1 point| Which statement about the Spanish-American War is true? Question options: a) The war lasted only four months and resulted in less than 400 battle casualties. b) Congress indicated that it was going to war to annex Cuba. c) The war came as little surprise given the fact that William McKinley campaigned in 1896 on a platform favoring imperial expansion. d) Admiral Dewey secured Manila Bay by defeating the Spanish in a bloody three-day battle. e) The treaty that ended the war granted U. S. citizenship to the peoples of the Philippines, Puerto Rico, and Guam. Question 19 0 / 1 point| In 1899, President William McKinley explained in an interview with Methodist Church leaders that his decision to annex the Philippines: Question options: a) was an easy foreign-policy decision. b) was dishonorable and undermined U. S. democracy. c) was in part based on his desire to educate and uplift the Filipinos. d) was bad for U. S. business interests. e) was part of his plan to grant Filipinos U. S. citizenship. Question 20 0 / 1 pointThe Platt Amendment: Question options: a) recognized Cuban autonomy. b) granted independence to Puerto Rico. c) limited the U. S. presence in the Philippines. d) authorized the United States to intervene militarily in Cuba. e) provided for the annexation of Hawaii. Question 21 0 / 1 pointThe Philippine War: Question options: a) resulted in Filipino independence. b) was far longer and bloodier than the Spanish-American War. c) was little debated at the time. d) was part of the American effort to liberate the Philippines. e) is well remembered today. Question 22 0 / 1 pointAll of the following statements about Emilio Aguinaldo are true EXCEPT: Question options: a) Aguinaldo led the Filipino armed struggle for independence against Spain. b) Aguinaldo led the Filipinos in the war against the United States. c) Aguinaldo believed that Filipinos could only govern themselves with U. S. assistance. d) Aguinaldo opposed American imperialism. e) Aguinaldo argued that the United States was betraying its own values by annexing the Philippines. Question 23 0 / 1 pointThe â€Å"white man’s burden†: Question options: a) refers to the horrors of lynching. b) refers to the failure of Reconstruction. c) was a term coined by Mark Twain. d) comes from a poem by Rudyard Kipling. e) comes from a speech by Booker T. Washington. Question 24 0 / 1 pointDuring the â€Å"Age of Empire,† American racial attitudes: Question options: a) had a global impact. b) inspired laws adopted in Canada that expanded the rights of Chinese people. c) inspired Australians to grant suffrage to native peoples. d) influenced South Africans’ decision to abandon apartheid. e) had a limited impact. Question 25 1 / 1 pointSupporters of the Anti-Imperialist League: a) wanted to civilize â€Å"savage† peoples. b) argued in favor of â€Å"benevolent† imperialism. c) maintained that Filipinos were entitled to U. S. citizenship. d) argued that Puerto Ricans were entitled to U. S. citizenship. e) believed that American energies should be directed at home, not abroad.Question 1 0 / 1 pointThe word â€Å"Progressivism† came into common use around 1910: Question options: a) as a way of describing a broad, loosely defined political movement of individuals and groups. b) as an anti-business term. c) denoting a group that appealed only to women. d) as another term for socialism. e) and represented those who advocated revolution. Question 2 0 / 1 pointThe Progressive movement drew its strength from: Question options: a ) big business. b) farmers. c) middle-class reformers. d) military leaders. e) socialists. Question 3 0 / 1 pointDuring the Progressive era: Question options: a) cities declined in importance. b) social reformers concentrated their efforts on rural areas. c) cities attracted only the wealthy. d) urban development highlighted social inequalities. e) cities competed with rural areas for government projects. Question 4 1 / 1 pointNewspaper and magazine writers, who exposed the ills of industrial and urban life, fueling the progressive movement, were known as: a) yellow journalists. b) trustees. c) social reformers. d) muckrakers. e) freelancers. Question 5 0 / 1 pointThe writer whose work encouraged the passage of the Meat Inspection Act was: Question options: a) Henry George. b) Theodore Dreiser. c) Upton Sinclair. d) Ida Tarbell. e) Lincoln Steffens. Question 6 0 / 1 pointDuring the Progressive era: Question options: a) new immigration from southern and eastern Europe reached its pea k. b) overall immigration declined dramatically. c) the main point of entry for European immigrants was Boston. d) the vast majority of immigrants came from Ireland. e) all immigration was banned. Question 7 0 / 1 pointDuring the Progressive era: Question options: a) growing numbers of native-born white women worked as domestics. b) most African-American women worked in factories. c) most eastern European immigrant women worked as telephone operators. d) growing numbers of native-born white women worked in offices. e) the number of married women working declined. Question 8 0 / 1 pointThe term â€Å"Fordism†: a) refers to Henry Ford’s invention of the automobile. b) was used by labor unions, who hailed Ford’s innovative approach. c) describes an economic system based on limited production of high-end goods. d) refers to Henry Ford’s effort to organize workers into a union. e) describes an economic system based on mass production and mass consumption. Scientific management: Question options: a) was a way to ensure industrial freedom. b) was pioneered by Frederick W. Taylor. c) was welcomed by skilled workers. d) was introduced by Samuel Gompers. e) put worker concerns ahead of profit. Question 10 0 / 1 pointIn the early twentieth century, the Socialist Party advocated for all of the following EXCEPT: Question options: a) free college education. b) legislation to improve the condition of laborers. c) public ownership of railroads. d) national health insurance. e) public ownership of factories. Question 11 0 / 1 pointBy 1912, the Socialist Party: Question options: a) appealed only to immigrants. b) appealed only to industrial workers. c) had elected scores of local officials. d) was concentrated in New York City. e) had yet to elect a member to Congress. Question 12 0 / 1 pointWhich statement about the American Federation of Labor in the early twentieth century is FALSE? Question options: a) the AFL represented skilled workers only. b) AFL membership tripled between 1900 and 1904. c) the AFL forged closer ties with corporate leaders to stabilize employee relations. d) the AFL established pension plans for long-term workers. e) the AFL proposed an overthrow of the capitalist system. Question 13 0 / 1 pointWhat Progressive-era issue became a crossroads where the paths of labor radicals, cultural modernists, and feminists intersected? Question options: a) trust-busting b) the initiative and referendum c) women’s suffrage d) unionism e) birth controlQuestion 14 1 / 1 pointWhich of the following is NOT a characteristic of Progressive reformers? Question options: a) Progressives were mainly urban and middle class. b) Progressives pursued radical alternatives to capitalism. c) Progressives implemented several of the reforms advocated earlier by Populists. d) Progressives were involved in a variety of reforms in the political, economic, and social realms. e) Progressives believed in the spirit of human progress . Question 15 0 / 1 pointWhich of the following social groups was NOT heavily involved in the Progressive movement? Question options: a) big-city-machine politicians b) the urban middle class c) women d) muckraker journalists e) white ProtestantsQuestion 16 0 / 1 pointAll of the following statements about Urban Progressives are true EXCEPT: a) They worked to reform the structure of government. b) They sought to establish public control of gas and water works. c) They raised taxes to increase spending on schools and parks. d) They sought to improve public transportation. e) They worked with political machines. Question 17 1 / 1 pointProgressive governor of Wisconsin, Robert La Follette, instituted all of the following reforms EXCEPT: Question options: a) utilizing primary elections to select candidates. b) taxing corporate wealth. c) regulating railroads and utilities. d) drawing on nonpartisan university faculty. e) using political bosses to staff his administration. Question 18 1 / 1 pointElectoral reform during the Progressive era: Question options: a) expanded the electorate significantly. b) had little impact, especially in the cities. c) enfranchised African-Americans. d) actually limited many Americans’ right to vote. e) did away with all residency requirements for voting. Question 19 1 / 1 pointAll of the following measures expanded democracy during the Progressive era EXCEPT: Question options: a) the Seventeenth Amendment to the Constitution. b) the use of primary elections among party members to select candidates. c) the Nineteenth Amendment to the Constitution. d) the popular election of judges. e) literacy tests and residency requirements. Question 20 1 / 1 pointA cause not widely championed by Progressives was: a) regulating industry. b) women’s suffrage. c) prohibiting alcohol. d) civil rights for blacks. e) reducing the poverty of the cities. The Progressive presidents were: Question options: a) Theodore Roosevelt, William Howard Taft, and Woodrow Wilson. b) Grover Cleveland, William McKinley, and Theodore Roosevelt. c) Abraham Lincoln, Ulysses S. Grant, and Rutherford B. Hayes. d) Benjamin Harrison, Grover Cleveland, and William McKinley. e) William Howard Taft, Woodrow Wilson, and Warren G. Harding. Question 22 0 / 1 pointWho used the Sherman Antitrust Act to dissolve J. P. Morgan’s Northern Securities Company? Question options: a) Theodore Roosevelt b) Samuel Gompers c) William Howard Taft d) Louis Brandeis e) Woodrow WilsonQuestion 23 0 / 1 pointAs a Progressive president, Theodore Roosevelt: Question options: a) demanded less economic regulation. b) supported the interests of big business. c) supported the conservation movement. d) dismantled the Interstate Commerce Commission. e) established the Federal Reserve system. Question 24 1 / 1 pointIn 1912, New Freedom: Question options: a) was Theodore Roosevelt’s campaign pledge that government should have a greater regulatory role. b) was Eugene Debs’s campaign pledge that government should abolish all private property. c) was Woodrow Wilson’s campaign pledge that governm ent should renew economic competition with less government intervention. d) was the campaign slogan of the women’s suffrage movement. e) was a term coined by Margaret Sanger for the birth-control movement. Question 25 0 / 1 pointAs a Progressive president, Woodrow Wilson: Question options: a) raised tariffs immediately. b) aggressively engaged in trust-busting. c) always advocated for the interests of labor. d) created no new government agencies. e) signed into law the Keating-Owen Act.Question 1 0 / 1 pointBetween 1898 and 1934, the United States intervened militarily numerous times in Caribbean countries: Question options: a) in order to gain territory for the United States. b) in order to spread liberty and freedom in the region. c) because the democratic leaders of the region asked the United States for aid in suppressing rebellions. d) in order to fight European powers who sought to establish colonies in the area. e) in order to protect the economic interests of American banks and investors. Question 2 0 / 1 pointTheodore Roosevelt’s taking of the Panama Canal Zone is an example of: Question options: a) his ability to speak softly in diplomatic situations when he knew he was outgunned. b) international Progressivism—the United States was intervening with the sole purpose to uplift the peoples of Central America. c) liberal internationalism, since he worked closely with the French to work out a deal favorable to Panama. d) his belief that civilized nations had an obligation to establish order in an unruly world. e) one of the many wars in which Roosevelt involved the United States. Question 3 0 / 1 pointThe Roosevelt Corollary: a) claimed the right of the United States to act as a police power in the Western Hemisphere. b) claimed the right of the United States to act as a police power in Asia. c) claimed the right of the United States to act as a police power in Africa. d) was also known as Dollar Diplomacy. e) contradicted the Monroe Doctrine. Question 4 0 / 1 pointDollar Diplomacy: Question options: a) characterizes the foreign policy of Theodore Roosevelt. b) was put in place by Woodrow Wilson regarding Mexico. c) was used by William Howard Taft instead of military intervention. d) was seldom used and never successfully. e) was applied only in Asia. Question 5 0 / 1 pointWoodrow Wilson’s moral imperialism in Latin America produced: Question options: a) eight years of unprecedented stability in the region. b) more military interventions than any other president before or since. c) economic growth and diversity for the region. d) very little to show for the policy, as his attention was mostly on Europe. e) strong allies for the United States in World War I, especially Mexico. Question 6 0 / 1 pointAs president, Woodrow Wilson: Question options: a) pledged to continue Dollar Diplomacy. b) emphasized the profit aspect of foreign trade. c) never resorted to military intervention abroad. d) pledged to stay o ut of Latin America and kept his word. e) believed that the export of U. S. manufactured goods went hand in hand with the spread of democracy. Question 7 1 / 1 pointWorld War I: a) was known as the Good War. b) resulted in limited casualties. c) pitted the British against France. d) began with the assassination of an American diplomat. e) was rooted in European contests over colonial possessions. As war broke out in Europe, Americans: Question options: a) were deeply divided. b) were rather ambivalent. c) mostly supported the British. d) mostly supported the Germans. e) supported U. S. involvement. Question 9 1 / 1 pointThe policy of U. S. neutrality was: Question options: a) honored by all the combatants. b) tested only by the British. c) tested only by the Germans. d) tested by both the British and Germans. e) vetoed by President Wilson. Question 10 0 / 1 pointWilson’s Fourteen Points included all of the following principles EXCEPT: Question options: a) an end to colonization. b) self-determination for all nations. c) freedom of the seas. d) open diplomacy. e) free trade. Question 11 0 / 1 point| The Fourteen Points attempted to: Question options: a) consolidate political power at home. b) provide a peace agenda to create a new democratic world order. c) quiet growing criticism from the Republicans that Wilson was an inept leader. d) outline the Progressive Party’s campaign platform for the 1920 election. e) organize alliances after the war among fourteen prominent nations. Question 12 1 / 1 pointThe Fourteen Points: Question options: a) were proposed by Germany. b) were endorsed by all the Allies. c) established the right of imperial governments to rule. d) sought to establish the right of national self-determination. e) supported the Bolshevik Revolution. Question 13 0 / 1 pointDuring World War I, federal powers: Question options: a) stayed the same. b) were delegated to the states. c) expanded greatly. d) were limited. e) changed little. Question 14 1 / 1 pointThe Committee on Public Information: Question options: a) was directed by William Jennings Bryan. b) protec ted civil liberties. c) was a government agency that sought to shape public opinion. d) was affiliated with the Socialist Party. e) was limited in its efforts. Question 15 1 / 1 pointThe Nineteenth Amendment: a) barred states from using race as a qualification for voting. b) barred states from using sex as a qualification for voting. c) was never ratified. d) prohibited states from denying Chinese immigrants the right to vote. e) prohibited states from denying any immigrants the right to vote. The Eighteenth Amendment: Question options: a) prohibited the manufacture and sale of alcoholic beverages. b) prohibited the manufacture and sale of any German products. c) was never ratified. d) barred states from passing laws prohibiting alcohol manufacture or sale. e) protected the beer industry. Question 17 1 / 1 pointThe Espionage Act (1917) and the Sedition Act (1918): Question options: a) expanded civil liberties during World War I. b) were aimed only at immigrants. c) were rarely enforced. d) restricted freedom of speech. e) were opposed by Woodrow Wilson. Question 18 1 / 1 pointThe anti-German crusade included all of the following measures EXCEPT: Question options: a) changing â€Å"hamburger† to â€Å"liberty sandwich. † b) changing â€Å"sauerkraut† to â€Å"liberty cabbage. c) banning German music. d) the decline in teaching German language. e) barring German-Americans from serving in the military. Question 19 1 / 1 pointW. E. B. Du Bois: Question op tions: a) agreed with Booker T. Washington that blacks should accept segregation. b) chose scholarship over political action. c) founded the National Association for the Advancement of Colored People (NAACP). d) worked closely with Woodrow Wilson. e) agreed with Booker T. Washington that vocational education was best for African-Americans. Question 20 0 / 1 pointâ€Å"The Great Migration† refers to: Question options: a) whites settling the West. b) Indian removal. c) blacks moving from the South to the North. d) blacks moving from the North to the South. e) the massive influx of southern and eastern European immigrants. Question 21 0 / 1 pointWho led a black separatist movement? Question options: a) W. E. B. Du Bois b) Booker T. Washington c) Frederick Douglass d) Langston Hughes e) Marcus GarveyQuestion 22 1 / 1 pointIn response to the Russian Revolution that led to the creation of the communist Soviet Union, the United States: Question options: a) diplomatically recognized the Soviet Union. b) aided supporters of communist rule in the Soviet Union during a civil war in 1918. c) invited the Soviet Union to the Versailles peace conference. d) pursued a policy of anticommunism that would remain at the center of American foreign policy during the twentieth century. e) invited Vladimir Lenin, the head of the Soviet Union, to the United States. Question 23 1 / 1 pointHow did World W ar I and the rhetoric of freedom shape the labor movement and workers’ expectations? a) World War I had a minimal impact on the labor movement. b) There were very few labor strikes after the war. c) Wartime propaganda did not shape the way workers viewed the postwar period. d) The wartime language of democracy and freedom inspired hopes among American workers that social and economic justice was at hand. e) Workers abandoned their push for the eight-hour day. Question 24 1 / 1 pointThe Red Scare: Question options: a) was caused by the fear of a Russian invasion. b) advanced the cause of labor. c) strengthened the Industrial Workers of the World. d) was an influenza epidemic. e) was an intense period of political intolerance inspired by labor strikes and fears of the Russian Revolution. Question 25 0 / 1 pointThe Treaty of Versailles: Question options: a) was a fair and reasonable document given the circumstances. b) allowed Germany equal participation in the negotiation proce ss. c) required Germany to pay over $33 billion in reparations. d) rejected Wilson’s idea for a League of Nations. e) declared Ireland’s independence. Question 26 0 / 1 pointThe Treaty of Versailles: Question options: a) was never ratified by the United States Senate. b) was supported by Republicans. c) was written by Henry Cabot Lodge. d) ended American involvement in Mexico. e) created the United Nations. Question 27 0 / 1 pointSenators opposing America’s participation in the League of Nations: a) believed that it was too complicated an organization to join. b) argued that it would threaten to deprive the country of its freedom of action. c) complained that they would only support it if the league was located in New York. d) were convinced that Great Britain was not going to join, thus making it a weak organization. e) were ultimately defeated, and the United States joined the league in 1921.Chapter 181 / 1 pointRailroads were to the late nineteenth century wh at ____________ were to the 1920s. Question options: a) cars b) radios c) stock markets d) telephones e) airplanesQuestion 2 1 / 1 pointThe backbone of economic growth during the 1920s was the increased consumption of: Question options: a) televisions. b) railroad cars. c) automobiles. d) steel. e) textiles. Question 3 0 / 1 pointDuring the 1920s, consumer goods: Question options: a) were marketed only to wealthy Americans. b) had little impact on American life. c) included vacuum cleaners and washing machines, which Americans paid for exclusively in cash. d) were frequently purchased on credit. e) increased the demand for domestic servants. Question 4 0 / 1 pointDuring the 1920s: a) an estimated 40 percent of the population remained in poverty. b) real wages rose faster than corporate profits. c) wealth became more evenly distributed. d) small auto companies flourished. e) New England experienced an industrial revival. Question 5 1 / 1 pointAgriculture in the 1920s: Question option s: a) enjoyed its golden age. b) did not see an increase in mechanization or use of fertilizers and insecticides. c) did not significantly increase production. d) experienced declining incomes and increased bank foreclosures. e) experienced an increase in the number of farms and farmers. Question 6 0 / 1 pointThe Equal Rights Amendment: Question options: a) was proposed by the Women’s Trade Union League. b) proposed to eliminate all legal distinctions based on sex. c) protected mother’s pensions. d) had widespread support from all major female organizations. e) became law along with an amendment banning child labor. Question 7 0 / 1 pointFor the feminist woman in the 1920s, freedom meant: Question options: a) voting. b) owning her own property. c) the ERA. d) the right to choose her lifestyle. e) becoming a wife and mother. Question 8 1 / 1 pointThe flapper: a) epitomized the change in standards of sexual behavior. b) represented a new political movement. c) represente d a new economic radicalism. d) disapproved of smoking. e) demanded a return to earlier standards of behavior. Question 9 0 / 1 pointDuring the 1920s: Question options: a) the Federal Trade Commission aggressively regulated business. b) government polices reflected the pro-business ethos of the decade. c) Nebraska senator George W. Norris represented the interests of business. d) the Harding administration distanced itself from the business community. e) the courts became increasingly pro-labor. Question 10 0 / 1 pointPresident Harding’s call for a return to normalcy meant: Question options: a) bringing back the Progressive spirit of reform. b) demobilizing from World War I. c) getting women back into the home from their wartime jobs. d) a call for the regular order of things, without excessive reform. e) an end to the radicalism of the Red Scare. Question 11 1 / 1 pointThe McNary-Haugen Bill: Question options: a) was supported by Calvin Coolidge. b) was designed to make U. S . Steel more competitive. c) proposed the government purchase of farm products so as to raise prices. d) proposed the government purchase of textiles so as to raise prices. e) outlawed lynching. Question 12 0 / 1 pointAmerican foreign policy during the 1920s: Question options: a) reflected the close working relationship between government and business. b) expanded on Woodrow Wilson’s goal of internationalism. c) included the lowering of tariffs. d) discouraged American business investment abroad. e) included a complete retreat from military intervention. Question 13 0 / 1 pointThe Scopes trial illustrated a divide between: Question options: a) modernism and fundamentalism. b) Progressives and Democrats. c) liberalism and conservativism. d) cultural diversity and nativism. e) feminism and machismo. Question 14 0 / 1 pointThe Scopes trial of 1925: Question options: a) involved a teacher who espoused Social Darwinism. b) pitted creationists against evolutionists. c) was a victory for religious fundamentalism. d) was a victory for birth-control advocates. e) ended once and for all the discussion of teaching the theory of evolution in public schools. Question 15 0 / 1 pointAll of the following statements about the1924 Immigration Act are true EXCEPT: Question options: a) the 1924 Immigration Act reflected the Progressive desire to improve the quality of democratic citizenship and to employ scientific methods to set public policy. b) the 1924 Immigration Act satisfied the demands of large farmers in California, who relied heavily on seasonal Mexican labor, by not setting limits on immigration from the Western Hemisphere. c) the 1924 Immigration Act barred immigration from Asia. d) the 1924 Immigration Act limited immigration from Europe. e) the 1924 Immigration Act sought to ensure that more immigrants came from southern and easte rn Europe than from northern and western Europe. Question 16 0 / 1 pointThe 1924 Immigration Act: a) prohibited all Mexican immigration. b) set quotas based on the census of 1900. c) set quotas that favored immigration from northern and western Europe. d) set quotas that favored immigration from southern and eastern Europe. e) expanded Asian immigration. Question 17 1 / 1 pointThe Harlem Renaissance: Question options: a) included writers and poets such as Langston Hughes and Claude McKay. b) included singers such as Etta James and Dinah Washington. c) privileged an African heritage over that of the black experience in the South. d) downplayed racism in America. e) represented a rejection of capitalism. Question 18 1 / 1 point| In 1928, Herbert Hoover: Question options: a) won the presidency, primarily because of his sterling reputation and the general, apparent prosperity of the nation. b) lost the presidency, primarily because he was a Catholic. c) called for repeal of Prohibition. d) ran for president as a Democrat. e) had little government experience. Question 19 0 / 1 pointThe Great Depression was caused by all of the following factors EXCEPT: Question options: a) a land speculation bubble in Florida. b) an unequal distribution of wealth. c) an agricultural recession throughout the decade. d) stagnated sales in the auto and consumer goods industries after 1926. e) increased government regulation of banking and the stock market. A main cause of the Great Depression was: a) Hoover’s ties with business. b) increased European demand for American goods. c) declining American purchasing power. d) excessive government regulation of business. e) the 1924 Immigration Act. Question 21 1 / 1 pointHoover’s response to the Depression included all of the following measures EXCEPT: Question options: a) a tax increase. b) higher tariffs. c) the Reconstruction Finance Corporation. d) the Federal Home Loan Bank System. e) a reduction in the size of the army. Question 22 1 / 1 pointPresident Hoover responded to the onset of the Depression by: Question options: a) immediately increasing government aid to the unemployed. b) cutting taxes. c) decreasing tariffs. d) reassuring Americans that â€Å"the tide had turned. † e) resigning from office. Question 23 1 / 1 pointThe Hawley-Smoot Tariff: Question options: a) raised taxes on imported goods. b) increased international trade. c) was vetoed by Hoover. d) had no effect on the economy in 1930. e) improved the economy slightly in 1930. Question 24 1 / 1 pointThe Reconstruction Finance Corporation: a) offered aid to home owners facing foreclosure. b) made loans to failing businesses. c) offered direct relief to the unemployed. d) was vetoed by Hoover. e) ended the Great Depression.Question 1 0 / 1 pointDuring the Roosevelt administration, the Democratic Party emerged into a coalition that included all of the following EXCEPT: Question options: a) farmers. b) the white supremacist South. c) the business elite. d) industrial workers. e) northern African-Americans. Question 2 0 / 1 pointLiberalism during the New Deal came to be understood as: Question options: a) limited government and free market enterprise. b) active government to uplift less fortunate members of society. c) a trust in the government to regulate personal behavior. d) individual autonomy, limited government, and unregulated capitalism. e) workers’ ownership of the mea ns of production. Question 3 0 / 1 pointThe Great Depression and the economic crisis that ensued discredited supporters of: Question options: a) Keynesian economics. b) liberalism. c) unregulated capitalism. d) fascism. e) communism. Question 4 1 / 1 pointIn his 1932 campaign for the presidency, Franklin D. Roosevelt promised Americans a policy change he called the: a) New Freedom. b) New Nationalism. c) New Deal. d) Fair Deal. e) Great Society. Question 5 0 / 1 pointThe New Deal: Question options: a) included a reliance on economic planning. b) was based on socialism. c) was based on fascism. d) was similar to Stalin’s economic policy. e) rejected the thinking of John Maynard Keynes. | Question 6 0 / 1 pointThe first thing that Roosevelt attended to as president was the: Question options: a) housing crisis. b) farming crisis. c) banking crisis. d) unemployment crisis. e) tariff crisis. Question 7 0 / 1 pointThe Glass-Steagall Act: Question options: a) maintained the gold standard. b) had little impact on the banking system. c) made legal the buying and selling of stocks by banks. d) established the Federal Deposit Insurance Corporation. e) is still in effect today. Question 8 1 / 1 pointThe National Industrial Recovery Act: a) was never passed. b) established codes that set standards for production, prices, and wages in several industries. c) established codes that continued the open-shop policies of the 1920s. d) encouraged â€Å"cutthroat† competition between businesses. e) was modeled on Stalin’s economic policies. Question 9 0 / 1 pointThe Civilian Conservation Corps: Question options: a) was created during the â€Å"Second New Deal. † b) w as headed by Hugh S. Johnson. c) put young women to work in schools. d) put older workers back to work. e) put young men to work in national parks. Question 10 0 / 1 point| Which New Deal program put the federal government for the first time in the business of selling electricity in competition with private companies? Question options: a) the Tennessee Valley Authority b) the Rural Electrification Administration c) the National Recovery Act d) the Reconstruction Finance Corporation e) the Works Project AdministrationQuestion 11 0 / 1 pointThe Agricultural Adjustment Act: Question options: a) raised farm prices by establishing quotas and paying farmers not to plant more. b) lowered farm prices by establishing quotas and paying farmers to grow more. c) was beneficial to sharecroppers and tenant farmers. d) established a government program of distributing food to the hungry. e) was limited to the West Coast. Question 12 0 / 1 pointThe First New Deal: a) was a series of experiments, some of which succeeded and some of which failed. b) led to the construction of few public facilities. c) ended unemployment. d) ended the Great Depression. e) provided relief t o very few Americans. Question 13 1 / 1 pointWhich two New Deal programs did the Supreme Court rule unconstitutional? Question options: a) Securities and Exchange Commission and Public Works Administration b) National Recovery Administration and Civilian Conservation Corps c) Glass-Steagall Act and Agricultural Adjustment Act d) Wagner Act and National Recovery Administration e) Agricultural Adjustment Act and National Recovery AdministrationQuestion 14 0 / 1 pointBy 1935, the New Deal: Question options: a) had ended the Depression. b) had the full support of the Supreme Court. c) was validated in the United States v. Butler decision. d) faced mounting pressures and criticism. e) was declared unconstitutional. Question 15 0 / 1 pointWhich statement best describes Huey Long, Upton Sinclair, and Dr. Francis Townsend? Question options: a) They all challenged Roosevelt to move further to the left of center. b) They were all supported by the Republican Party. c) Each was a socialist radi cal. d) Despite representing interesting movements, none of them had much of a following. e) They all ended up in jail during World War II for having communist sympathies. Question 16 0 / 1 pointThe Share Our Wealth movement was: Question options: a) led by Dr. Francis Townsend and directed at Americans over the age of sixty. b) led by Henry Ford and directed at auto manufacturers. c) led by Father Charles E. Coughlin and directed at Catholics. d) led by Louisiana senator Huey Long and gained a national following. e) introduced by Franklin Roosevelt as part of the New Deal. Question 17 0 / 1 pointThe Second New Deal: Question options: a) focused on economic security. b) focused on economic relief. c) focused on business recovery. d) focused on civil liberties. e) included no new taxes. | Question 18 1 / 1 pointThe Social Security Act of 1935: Question options: a) was vetoed by President Roosevelt. b) was the British version of the welfare state. c) designed a program of relief funded only by federal money. d) included old-age pensions, unemployment relief, and aid to families with dependent children. e) covered all workers, regardless of race or gender. Question 19 0 / 1 pointThe New Deal concentrated power in the hands of: Question options: a) the executive branch. b) the legislative branch. c) the judicial branch. d) local government. e) state government. Question 20 0 / 1 pointWhy did FDR try to change the balance on the Supreme Court? a) He feared the Supreme Court might invalidate the Wagner and Social Security acts. b) He was worried about being able to run for a third term as president. c) He needed the Court’s support for upcoming war measures against Germany. d) He feared that the Supreme Court might invalidate the National Recovery Act or the Agricul tural Adjustment Act. e) He feared that the Supreme Court might deem sit-down strikes unconstitutional. Question 21 0 / 1 point| Under New Deal reform, African-Americans: Question options: a) worked in integrated CCC camps. b) benefited from the â€Å"southern veto. † c) were universally covered by the Fair Labor Standards Act. d) passed a federal antilynching law. e) were mostly excluded from Social Security benefits. Question 22 1 / 1 pointFederal housing policy: Question options: a) undermined racism. b) expanded funding to integrated neighborhoods. c) weakened the power of local governments. d) reinforced residential segregation. e) was part of the Social Security Act. | Question 23 0 / 1 pointIn 1938, Congress established the House Un-American Activities Committee, which: Question options: a) was part of the expanded notion of civil liberties under the New Deal. b) subscribed to an expanded definition of â€Å"un-American† that included liberal Democrats and labor organizers. c) was immediately vetoed by the president. d) focused on racism in the South. e) focused only on communists. Question 24 0 / 1 pointWhat ended the Great Depression? Question options: a) New Deal programs b) the rebound of the stock market c) World War II spendingd) laissez-faire government e) a bailout by J. P. Morgan Question 25 0 / 1 point The New Deal failed to generate: Question options: a) hope. b) an economic recovery. c) jobs. d) social security. e) labor reform.Question 1 1 / 1 pointThe Four Freedoms: Question options: a) was a campaign slogan of the Republicans. b) were the war aims of Nazi Germany. c) were President Roosevelt’s statement of the Allied w ar aims. d) included the freedom to join the Communist Party. e) did not apply to Jehovah’s Witnesses. Question 2 0 / 1 point| During the 1930s, the Good Neighbor Policy: Question options: a) included the renewal of the Platt Amendment. b) maintained the right of American military intervention in Latin America. c) was a foreign policy based on the recognition of the autonomy of Latin American countries, including those that were ruled by dictatorships. d) was a foreign policy that recognized the autonomy of Latin American countries but assisted in democratic revolutions. e) included a continued U. S. military presence in Haiti and Nicaragua. Question 3 0 / 1 pointWho is considered the founder of fascism? a) Benito Mussolini b) Adolf Hitler c) Francisco Franco d) Joseph Stalin e) Hideki TojoQuestion 4 0 / 1 pointFrance and Britain’s policy toward Germany of giving concessions in hopes of avoiding war was called: Question options: a) isolationism. b) detente. c) internationalism. d) appeasement. e) provocation. Question 5 1 / 1 pointAs fascism rose in Europe and Asia during the 1930s, most Americans: Qu estion options: a) supported U. S. intervention. b) supported U. S. neutrality. c) wanted to move beyond isolationism. d) remained ambivalent. e) favored an end to international trade. Question 6 0 / 1 pointIn 1940, the â€Å"cash and carry† plan: Question options: a) allowed Great Britain to purchase U. S. arms on a restricted basis. b) allowed Germany to purchase U. S. arms on a restricted basis. c) allowed Japan to purchase U. S. arms on a restricted basis. d) allowed all belligerents to purchase U. S. arms on a restricted basis. e) was voted down by Congress. Question 7 1 / 1 pointMen like Henry Ford, Charles Lindbergh, and Father Coughlin were members of the a) America Now! ommittee, an interventionist group. b) Anti-Semitism Society, a group that blamed the Jews for the war. c) America First committee, an isolationist group. d) Lend-Lease League, a group that supported technology for the war. e) Free Paris Society, a group that advocated the liberation of Paris. Questio n 8 1 / 1 pointThe Lend-Lease Act: Question options: a) authorized military aid to Germany and Japan. b) authorized military aid to those fighting against Germany and Japan. c) excluded China. d) excluded the Soviet Union. e) maintained trade relations with Japan. Question 9 1 / 1 pointDecember 7, 1941, is known as a â€Å"date that will live in infamy,† referring to: Question options: a) the German invasion of Poland. b) the Japanese assault on Indochina. c) the Japanese attack on Pearl Harbor. d) the German declaration of war against the United States. e) Jeannette Rankin’s vote against a declaration of war. Question 10 0 / 1 pointâ€Å"D-Day† refers to the: Question options: a) Allied invasion of the Soviet Union. b) Allied invasion of Japan. c) Japanese attack on Pearl Harbor. d) dropping of the atomic bombs on Japan. e) Allied invasion of Europe at Normandy. Question 11 0 / 1 pointWhat was the â€Å"final solution†? Question options: a) the Allied op eration for D-Day b) Adolf Hitler’s plan to mass-exterminate â€Å"undesirable† peoples c) the United States’ plan for the atomic bombs to be dropped on Japan d) Japan’s plan to attack Pearl Harbor e) Joseph Stalin’s plan to spread communism throughout the worldQuestion 12 0 / 1 pointIn the United States during World War II: Question options: a) unemployment declined, production soared, and income taxes increased. b) the economy grew only slightly. c) income taxes increased only for the wealthy. d) little was done to regulate the economy. e) the actual size of the federal government shrank as the New Deal ended. Question 13 1 / 1 pointThe Office of War Information: Question options: a) imprisoned isolationists. b) cast the War’s sole goal as retaliation against the Japanese. c) attempted to stir up nationalist hysteria. d) was a New Deal social program. e) used radio, film, and press to give the war an ideological meaning. Question 14 0 / 1 pointWomen working in defense industries during the war: Question options: a) were viewed as permanent workers after the war, so long as they did a good job. b) were told by advertisers that they were fighting for freedom. c) had little impact on the war effort. d) were small in number, as most women took clerical work or joined the military service as nurses. e) were all young, single women who left their jobs once they got married. Question 15 1 / 1 pointThe GI Bill of Rights: a) was very limited in scope. b) included scholarships for education and low-cost mortgage loans for veterans. c) extended benefits to very few veterans. d) did not include job training. e) had limited impact on postwar society. Question 16 1 / 1 pointThe program that began in 1942 that allowed experienced Mexican agricultural workers to cross the border to work under government labor contracts was called the: Question options: a) bracero program. b) Chicano program. c) migrant-worker program. d) â€Å"zoot suit† program. e) pueblo program. Question 17 1 / 1 pointUnder the bracero program: Question options: a) Mexican immigrants were denied entry to the United States. b) Mexican immigrants were eligible for citizenship. c) Mexicans were encouraged to immigrate, but they were denied the right of citizenship. d) Indians were encouraged to leave their reservations. e) marriages between Mexicans and Americans were banned. Question 18 0 / 1 pointExecutive Order 9066: Question options: a) was overturned by the Supreme Court. b) authorized the internment of German-Americans. c) authorized the internment of Italian-Americans. d) authorized the internment of Japanese-Americans. e) exempted all those who were technically American citizens. Question 19 0 / 1 pointIn Korematsu v. United States, the Supreme Court: a) deemed Japanese internment unconstitutional. b) upheld the legality of Japanese internment. c) deemed loyalty oaths constitutional. d) barred Japanese-Americans from serving in the U. S. military. e) apologized for Japanese internment. Question 20 1 / 1 pointDuring World War II, African-Americans: Question options: a) experienced full equality before the law. b) witnessed the end of Jim Crow laws. c) served in integrated units in the armed forces. d) received equal access to the GI Bill of Rights benefits. e) witnessed the birth of the modern civil rights movement. Question 21 0 / 1 pointBlack internationalism during World War II: Question options: a) was a new movement with no historical antecedents. b) was a complete rejection of Marcus Garvey’s political ideals. c) was rejected by W. E. B. Du Bois. d) rested on the idea that the plight of black Americans was connected to the plight of people of color worldwide. e) supported colonial rule. Question 22 1 / 1 pointThe dropping of the atomic bombs on Hiroshima and Nagasaki: a) had little impact on the course of the war. b) did little damage and caused few casualties. c) brought the war to an end but remains controversial. d) brought the war to an end and ca used no controversy. e) was vetoed by President Truman. At the Yalta conference in 1945: a) wartime American-Soviet cooperation was at its peak. b) Stalin was denied permission to maintain control of the Baltic states. c) Churchill agreed to end British colonial control of India. d) Stalin agreed to enter the war against the Japanese immediately. e) no plans were made regarding Poland. Question 24 0 / 1 pointThe Atlantic Charter: Question options: a) was made between Stalin and Hitler. b) outlawed submarine warfare. c) endorsed the freedoms from want and fear. d) established the World Bank and the General Agreement on Tariffs and Trade (GATT). e) established the United Nations. Question 25 0 / 1 pointWorld War II: Question options: a) led to Japan emerging as a regional power. b) led to Germany emerging as a regional power. c) led to a strengthened and victorious France. d) produced a radical redistribution of world power. e) led to the Soviet Union emerging as the dominant world power. Bottom of Form Bottom of Form