Neuromuscular (Backho)

Front 1

Term

Inability to recognize familar objects with one form of sensation

Back 1

Agnosia

Hint 1

Loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss.

Front 2

Term

Inability to initiate movement

Back 2

Akinesia

Hint 2

Inability to initiate movement due to difficulty selecting and/or activating motor programs in the central nervous system.
Common in severe cases of Parkinson's disease, akinesia is a result of severely diminished dopaminergic cell activity in the direct pathway of movement.

Front 3

( / ) Hemiplegia
(Side / Name)

Severe difficulty in verbal expression with impairment in object naming and writing abilityes.

Back 3

Expressive or Broca's right hemiplegia.

Hint 3

Region in the frontal lobe of one hemisphere (usually the left) of the hominid brain with functions linked to speech production.

Front 4

Term

Most common and severe form of aphasia characterized by reduced speech and comprehension.
Reading and writing are impaired as well.

Back 4

Global aphasia

Hint 4

Type of aphasia that is commonly associated with a large lesion in the perisylvian area of the frontal, temporal and parietal lobes of the brain causing an almost total reduction of all aspects of spoken and written language. It involves a "left side blowout" which includes Broca's area, Wernicke's area and the Arcuate fasciculus. It can also be seen in the initial stages of large left middle cerebral artery injuries that may progressively improve to become expressive aphasia.

Front 5

Term

Severe distubance in auditory comprehension.
Reading, writing and word recognition are also impaired.

Back 5

Recpetive or Wernicke's

Hint 5

Receptive aphasia, also known as Wernicke’s aphasia, fluent aphasia, or sensory aphasia, is a type of aphasia traditionally associated with neurological damage to Wernicke’s area in the brain, However, the key deficits of receptive aphasia do not come from damage to Wernicke's area; instead, most of the core difficulties are proposed to come from damage to the medial temporal lobe and underlying white matter.

Front 6

Term

Inability to execute learned purposeful movements, despite having the desire and the physical capacity to perform the movements.

Back 6

Disorder of motor planning,
but is not caused by incoordination, sensory loss, or failure to comprehend simple commands

Hint 6

Apraxia

Front 7

Term

These patients have deficits in their ability to plan or complete motor actions that rely on semantic memory. They are able to explain how to perform an action, but unable to "imagine" or act out a movement such as "pretend to brush your teeth" or "pucker as though you bit into a sour lemon." The ability to perform an action automatically when cued, however, remains intact. This is known as automatic-voluntary dissociation.
For example, they may not be able to pick up a phone when asked to do so, but can perform the action without thinking when the phone rings.

Back 7

Ideomotor apraxia

Front 8

Inability to conceptualize a task and impaired ability to complete multistep actions. Consists of an inability to select and carry out an appropriate motor program.
For example, the patient may complete actions in incorrect orders, such as buttering bread before putting it in the toaster, or putting on shoes before putting on socks. There is also a loss of ability to voluntarily perform a learned task whengiven the necessary objects or tools.
For instance, if given a screwdriver, the patient may try to write with it as if it were a pen, or try to comb one's hair with a toothbrush.

Back 8

Ideational/conceptual apraxia

Front 9

A75
A patient who is recovering from a right CVA reports being thirsty and asks for a can of soda.
The PT gives the patient the soda with instructions to open the can. The patient is unable to complete the task.
Later, afterthe treatment session when the patient is alone, the therapist observes the patient is drinking from the can, having opened the can.
The therapist suspects the patient may have a primary deficit in:

1. Anosognosia.
2. Ideational apraxia.
3. Unilateral neglect.
4. Ideomotor apraxia.

Back 9

4
With ideomotor apraxia, a patient cannot perform a task upon command but can do the task when on his/her own.

Hint 9

INCORRECT CHOICES :
With ideational apraxia, a patient cannot perform the task at all.
Unilateral neglect might lead the patient to ignore the can completely if positioned on his/her left side.
Anosognosia is a more severe form of neglect with lack of awareness and denial of the severity of one's paralysis.

Front 10

Inability to recognize objects by touch alone

Back 10

Astereognosis

Hint 10

Individuals with tactile agnosia may be able to identify the name, purpose, or origin of an object with their left hand but not their right, or vice-versa, or both hands. Astereognosis refers specifically to those who lack tactile recognition in both hands. In the affected hand(s) they may be able to identify basic shapes such as pyramids and spheres (with abnormally high difficulty) but still not tactilely recognize common objects by easily recognizable and unique features such as a fork by its prongs (though the individual may report feeling a long, metal rod with multiple, pointy rods stemming off in uniform direction).

Front 11

Inability to move muscles together in a coordinated manner.

Back 11

Asynergia

Front 12

Uncoordinated movements, especially gait.

Lack of voluntary coordination of muscle movements

Back 12

Ataxia

Hint 12

Front 13

Slow, involuntary, worm-like, twisting motions.

Lesions to the brain are most often the direct cause of the symptoms, particularly to the corpus striatum

Back 13

Symptom characterized by slow, involuntary, convoluted, writhing movements of the fingers, hands, toes, and feet and in some cases, arms, legs, neck and tongue.

Hint 13

Athetosis

Front 14

Burning sensation, which are painful.
Often associated with complex regional pain syndrome type1 (formerly reflex sympathetic dystrophy).

Back 14

Causalgia

Front 15

A common and bizarre breathing pattern characterized by a period of apnea lasting 10~60 seconds followed by gradually increasing, then decreasing depth and frequency of respirations.
It acoomapnies depression of ( ) lobe and ( ) dysfunction.

Back 15

Abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea. The pattern repeats, with each cycle usually taking 30 seconds to 2 minutes.

Hint 15

Cheyne-Stokes Respiration

Frontal, diencephalic

Front 16

Sul A 118
A patient suffered a severe traumatic brain injury and multiple fractures after a motor vehicle accident. The patient is recovering in the intensive care unit.
The physical therapy referral requests PROM and positioning.
On day 1, he is semialert and drifts in and out during physical therapy.
On day 2, the patient is less alert with changing status. Signs and symptoms that would require emergency consultation with a physician include:

1. Developing irritability with increasing symptoms of photophobia, disorientation, and restlessness.
2. Decreasing function of cranial nerves IV, VI, and VII.
3. Positive Kernig's sign with developing nuchal rigidity.
4. Decreasing consciousness with slowing of pulse and Cheyne-Stokes respirations.

Back 16

4
Signs of increased intracranial pressure secondary to cerebral edema and brain herniation include decreasing consciousness with slowing of pulse and Cheyne-Stokes respirations. Cranial nerve dysfunction is typically noted in CN II (papilledema) and CN III (dilation of pupils).

Hint 16

INCORRECT CHOICES :
The other choices are signs of meningeal irritation and CNS infection. All of the problems listed are serious and can be life-threatening.

Front 17

Abnormal involuntary movement disorder, one of a group of neurological disorders called dyskinesias

Back 17

Chorea

Huntington's disease

Front 18

A rhythmic oscillation of a muscle in response to sustained stretch in patients with upper motoneuron disease.
Typically seen in patients with stroke, multiple sclerosis, spinal cord damage and hepatic encephalopathy.
Locations : Ankle (medial gastrocnemius), Patella (knee cap), Triceps surae, Biceps brachii

Back 18

Clonus

Hint 18

Series of involuntary, rhythmic, muscular contractions and relaxations.
Sign of certain neurological conditions, particularly associated with upper motor neuron lesions involving descending motor pathways, and in many cases is, accompanied by spasticity

Front 19

Contraction of the extensor muscles of the upper and lower extremities because of an injury at the level of the brain stem

Back 19

Decerebrate Rigidity

Front 20

Contraction of the flexor muscles of the upper extremities with contraction of the extensor muscles of the lower extremities.

Back 20

Decorticate Rigidity

Front 21

Syndrome

Encompassing an array of neuropsychiatric symptoms, including a disturbance in consciousness/attention and cognition that develops acutely and tends to fluctuate.
The change in cognition (memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance, must be one that is not better accounted for by a pre existing, established, or evolving dementia.

Back 21

Delirium

Hint 21

Features
1. Disturbance of consciousness (that is, reduced clarity of awareness of the environment, with reduced ability to focus, sustain, or shift attention)
2. Change in cognition (e.g., problem-solving impairment or memory impairment) or a perceptual disturbance (hallucination)
3. Onset of hours to days, and tendency to fluctuate
4. Behaviour may be either overactive or underactive, and sleep is often disturbed, with loss of the normal Circadian rhythm.
5. Behaviour may be either overactive or underactive, and sleep is often disturbed, with loss of the normal Circadian rhythm.

Front 22

Disease

Broad category of brain disease that includes any disease that causes loss of cognitive ability (the ability to think and reason clearly) that is severe enough to affect a person's daily functioning.

Back 22

Demetia

Hint 22

The most common affected areas include:
memory, visual spatial, language, attention, and executive function (problem solving).
It reduces the ability to learn, reason, retain or recall past experience and there is also loss of patterns of thoughts, feelings and activities.

Front 23

Lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye.
It is a type of ataxia.
It is sometimes described as an inability to judge distance or scale.

Back 23

Dysmetria

Hint 23

Frenkel exercises

System of slow repetitious exercises. They increase in difficulty over the time of the program.(20,000 to 30,000 repetitions )
The patient watches his hand or arm movements (for example) and corrects them as needed.
'finger-to-nose test'

Front 24

Technique for evaluating and recording the electrical activity produced by skeletal muscles.

Back 24

Electromyography (EMG)

Front 25

Sul A22
A factory worker injured the right arm in a factory press with damage to. the ulnar nerve at the elbow.
A diagnostic electromyogram (EMG) was performed 3 weeks after the injury with evidence of spontaneous fibrillation potentials. In this case, the PT recognizes that:

1. Denervation has occurred.
2. Reinnervation is complete.
3. Neurapraxia has occurred.
4. Reinnervation is in process.

Back 25

1
Spontaneous fibrillation potentials and positive sharp waves present on EMG 2 to 3 weeks after injury are evidence of denervation. This occurs with axonotmesis, a class 2 peripheral nerve injury (PNI) with axonal damage and Wallerian degeneration distal to the lesion.

Hint 25

INCORRECT CHOICES:
Polyphasic motor units of low amplitude and short duration are evidence of reinnervation. Neurapraxia is a class 1 PNI
with local compression or blockage. EMG typically reveals no spontaneous activity.

Front 26

Neuropathic disease has the following defining EMG characteristics: (3)

Back 26

1. An action potential amplitude that is twice normal due to the increased number of fibres per motor unit because of reinnervation of denervated fibres
2. An increase in duration of the action potential.
3. A decrease in the number of motor units in the muscle (as found using motor unit number estimation techniques)

Front 27

Myopathic disease has these defining EMG characteristics : (3)

Back 27

1. A decrease in duration of the action potential
2. A reduction in the area to amplitude ratio of the action potential
3. A decrease in the number of motor units in the muscle (in extremely severe cases only)

Front 28

B7
A patient presents with weakness and atrophy of the biceps brachii resulting from an open fracture of the humerus. The therapist's examination includes needle electromyography (EMG) of the biceps.
The muscle response anticipated after the needle is inserted and prior to asking the patient to contract the muscle is:

1. Fibrillation potentials.
2. Electrical silence.
3. Polyphasic potentials.
4. Interference patterns.

Back 28

2
Inserting an EMG needle into a normal muscle causes a burst of electrical activity (insertional activity), after which the muscle produces no sound (electrical silence).

Hint 28

INCORRECT CHO ICES : Fibrillation potentials are spontaneous activity seen in relaxed denervated muscle, and polyphasic potentials are produced in the contracted muscle undergoing reorganization.

Front 29

Process that results when a nerve fiber is cut or crushed, in which the part of the axon separated from the neuron's cell body degenerates distal to the injury.

Back 29

Wallerian degeneration

Front 30

Seddon’s classifications of peripheral nerve damage.

When the majority of the supporting structures of the nerve are preserved, but disruption of the nerve fibers is still observed.
Wallerian degeneration often occurs in the near the proximity of the injury site

Back 30

Axonotmesis

Hint 30

Front 31

Seddon’s classifications of peripheral nerve damage.

Least serious form of nerve injury

Back 31

Neurapraxia

Front 32

Seddon’s classifications of peripheral nerve damage.

The most serious degree of nerve injury.
It involves the disruption of the nerve and the nerve sheath.

Back 32

Neurotmesis

Front 33

Sul A 119
A PT receives a referral for a patient with neurapraxia involving the ulnar nerve secondary to an elbow fracture.
Based on knowledge of this condition, the therapist expects that:

1. Regeneration is likely in 6-8 months.
2. Nerve dysfunction will be rapidly reversed, generally in 2-3 weeks.
3. Regeneration is likely after 1-1 1/2 years.
4. Regeneration is unlikely because surgical approximation of the nerve ends was not performed.

Back 33

2
Neurapraxia is a mild peripheral nerve injury (conduction block ischemia) that causes transient loss of function.
Nerve dysfunction is rapidly reversed, generally within 2-3 weeks.
An example is a compression injury to the radial nerve from falling asleep with the arm over the back of a chair (Saturday night palsy).

Hint 33

INCORRECT CHOICES :
If the nerve is cut, the distal part degenerates (Wallerian degeneration). Regeneration (nerve growth and repair) is dependent upon intact Schwann cell and continuity of the nerve pathway. Regrowth is at the rate of 1-4 mrn/d. In this case, the nerve injury was not severe enough to initiate regeneration.

Front 34

Syndrome

Can occur in generalized peripheral neuropathies in which the distal portions of the nerve degenerate resulting in anesthesia of the distal extremities in a pattern as if the patient was wearing long gloves and stockings.

Back 34

Guillain-Barre syndrome

(=Glove and stocking Anesthesia)

Front 35

Guillain–Barré syndrome

Diagnosis

Back 35

1. Testing : cerebrospinal fluid (CSF), Electromyography (EMG) and nerve conduction studies

2. Criteria : progressive weakness in legs and often arms, and areflexia

Front 36

Guillain-Barre syndrome treatment of greatest concern

Back 36

Supportive care is the cornerstone of successful management in the acute patient.
Of greatest concern is respiratory failure due to paralysis of the diaphragm, the muscle most important for breathing.

Front 37

Disease

A painful inflammation of the posterior root ganglion, caused by a virus, resulting in the formation of vesicles (fluid filled sacs) along the course of the nerve.
Viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body (left or right), often in a stripe

Back 37

Herpes Zoster (shingles)

Hint 37

Virus remains latent in the nerve cell bodies and, less frequently,the non-neuronal satellite cells of the dorsal root, cranial nerve or autonomic ganglia, without causing any symptoms. Years or decades after the initial infection, the virus may break out of nerve cel bodies and travel down nerve axons to cause viral infection of the skin in the region of the nerve. The virus may spread from one or more gangli alongnerves of an affected segment and infect the corresponding dermatome (an area of skin supplied by one spinal nerve causing a painful rash. Although the rash usually heals within two to four weeks, some sufferers experience residualnerve pain for months or years, acondition called postherpetic neuralgia.

Front 38

Herpes zoster treatment of complication.

Back 38

The aims of treatment are tolimit the severity and duration of pain, shorten the duration of a shingles episode, and reduce complications.
Symptomatic treatment is often needed for the complication of 'postherpetic neuralgia'.

Front 39

Syndrome

Ptosis of the eyelid, contriction of the pupil and sweating of the ipsilateral face often accompanying stroke invloving the ( ) or ( ) arteries

Back 39

Horner's Syndrome

anterior inferior or posterior inferior cerebellar arteries.

Hint 39

Signs and symptoms

1. partial ptosis (drooping of the upper eyelid from loss of sympathetic innervation to the superior tarsal muscle, also known as Müller's muscle)
2. upside-down ptosis (slight elevation of the lower lid)
3. anhidrosis (decreased sweating on the affected side of the face)
4. miosis (small pupils)
5. enophthalmos (the impression that the eye is sunk in) (because of loss of sympathetic innervation to the orbitalis muscle, also known as one of three Müller's muscle. The third one is circular fibres of ciliary muscle).
6. loss of ciliospinal reflex
7. bloodshot conjunctiva, depending on the site of lesion.

Front 40

( )

- Benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces (between 2nd−3rd and 3rd−4th metatarsal heads.
This problem is characterised by pain and/or numbness, sometimes relieved by removing footwear.

This problem is characterised by pain and/or numbness, sometimes relieved by removing footwear.

Back 40

Morton's Neuroma

Front 41

Determines the speed of propagation of an acton potential along a nerve or muscle fiber.

Back 41

Nerve Conduction Velocity (NCV) tests.

Front 42

Nerve conduction velocity

Disease : (5)

Back 42

1. Amyotrophic Lateral Sclerosis (ALS)
2. Carpal Tunnel syndrome
3. Guillain-Barre syndrome
4. Lambert-Eaton Myasthenic Syndrome
5. Peripheral Diabetic Neuropathy

Hint 42

1. Amyotrophic Lateral Sclerosis (ALS) : To be specific, motor nerve conduction studies of the Median, Ulnar, and peroneal muscles should be performed, as well as sensory nerve conduction studies of the Ulnar and Sural nerves.
2. Carpal Tunnel syndrome : One common electrodiagnostic measurement includes the difference between sensory nerve conduction velocities in the pinkie finger and index finger. In most instances of CTS, symptoms will not present until this difference is greater than 8 m/s.
3. Guillain-Barre syndrome
4. Lambert-Eaton Myasthenic Syndrome :Nerve conduction studies performed on the Ulnar motor and sensory, Median motor and sensory, Tibial motor, and Peroneal motor nerves in patients with LEMS have shown that the conduction velocity across these nerves is actually normal. However, the amplitudes of the compound motor action potentials may be reduced by up to 55%, and the duration of these action potentials decreased by up to 47%.
5. Peripheral Diabetic Neuropathy

Front 43

Condition

Rapid, usually back and forth, movement of the eyeballs.

Condition of involuntary eye movement, acquired in infancy or later in life, that may result in reduced or limited vision.

Back 43

Nystagmus

Front 44

Inhibition of muscles antagonistic to those being facilitated.

Back 44

Reciprocal Inhibition

Hint 44

Process of muscles on one side of a joint relaxing to accommodate contraction on the other side of that joint.
Joints are controlled by two opposing sets of muscles, extensors and flexors, which must work in synchrony for smooth movement.
When a muscle spindle is stretched and the stretch reflex is activated, the opposing muscle group must be inhibited to prevent it from working against the resulting contraction of the homonymous muscle.
This inhibition is accomplished by the actions of an inhibitory interneuron in the spinal cord.

Front 45

Loss of balance in standing when the eyes are closed

Back 45

Romberg's Sign

Hint 45

Maintaining balance of main sensory inputs

1. Joint position sense (proprioception), carried in the dorsal columns of the spinal cord;
2.Vision
3.Vestibular apparatus

The Romberg test is a test of the body's sense of positioning (proprioception), which requires healthy functioning of the dorsal columns of the spinal cord.

Front 46

Neurological disorder
Characterized by the inability of an individual to perceive more than a single object at a time

Back 46

Simultanagnosia (=Somatagnosia)

Hint 46

For instance, if presented with an image of a table containing both food and various utensils, a patient will report seeing only one item, such as a spoon.

Cause : bilateral lesions to the junction between the parietal and occipital lobes

Front 47

A deep coma with abnomal posturing.
Disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness.

Back 47

Vegetative States

Front 48

( )

Visual field loss on the left or right side of the vertical midline.

Cause : damage to the (ipsilateral / contralateral) ( ) tract

Back 48

Homonymous hemianopsia

contralateral, optic

Hint 48

Vascular and neoplastic (malignant or benign tumours) lesions from the optic tract, to visual cortex can cause a contralateral homonymous hemianopsia.
Injury to the right side of the brain will affect the left visual fields of each eye.
The more posterior the cerebral lesion, the more symmetric (congruous) the homonymous hemianopsia will be.

Front 49

( )
Partial blindness where vision is missing in the outer half of both the right and left visual field
Cause : Injury at the ( ).

Also known as ( ) vision.

Back 49

Bitemporal hemianopsia

Optic chiasm

tunnel

Hint 49

Front 50

Sul A29
PT examines a patient with a right CVA and determines that the patient has a profound deficit of homonymous hemianopsia.
The BEST INITIAL strategy to assist the patient in compensating for this deficit is to:

1. Teach the patient to turn the head to the affected left side.
2. Provide constant reminders, printed notes on the left side, telling the patient to look to the left.
3. Place items, eating utensils on the left side.
4. Rearrange the room so while the patient is in bed, the left side is facing the doorway.

Back 50

1
A patient with homonymous hemianopsia needs to be made aware of the deficit and instructed to turn the head to the affected left side (a compensatory training strategy).

Hint 50

INCORRECT CHOICES:
Initial strategies include placing items on the right (unaffected side), not the left side, so that the patient can successfully interact with the environment. Later, as there is ability to compensate, items can be moved to midline and finally to the affected left side.

Front 51

One eye is resule of damage to the optic nerve

Back 51

Blindeness

Front 52

B18
An elderly person has lost significant functional vision over the last 4 years and complains of blurred vision and difficulty reading. The patient frequently mistakes images directly in front, especially in bright light. When walking across a room, the patient is able to locate items in the environment using peripheral vision when items are located to both sides.
Based on these findings, the therapist suspects:

1. Glaucoma.
2. Homonymous hemianopsia.
3. Cataracts.
4. Bitemporal hemianopsia.

Back 52

3
Cataracts, a clouding of the lens, results in a gradual loss of vision; central vision is lost fust, then peripheral.

Hint 52

INCORRECT CHOICES :
Glaucoma produces the reverse symptoms: loss of peripheral vision is fust, then central, progressing to total blindness. Hemianopsia is field defect in both eyes that often occurs following stroke. There was no mention of cerebrovascular accident (CVA) in the question.

Front 53

Cerebral Vascular Accident

( ) cerebral artery syndrome

1. Most commonly involved in a stroke.
2. Contralateral hemiplegia, mostly (upper/lower) extremity involvement, and loss of sensation primarily in the arm and face.
3. Homonymous heianopsia is common.
4. ( ) aphasia

Back 53

Middle cerebral artery syndrome

upper

global

Hint 53

1.Paralysis (-plegia) or weakness (-paresis) of the contralateral face and arm (faciobrachial)
2.Sensory loss of the contralateral face and arm.
3.Damage to the dominant hemisphere (usually the left hemisphere) results in aphasia i.e. Broca's or Wernicke's
4.Damage to the non-dominant hemisphere (usually the right hemisphere) results in contralateral neglect syndrome
5.Large MCA infarcts often have déviation conjuguée, a gaze preference towards the side of the lesion, especially during the acute period. Contralateral homonymous hemianopsia is often present.

Front 54

A 178
A patient is referred for rehabilitation after a middle cerebral artery stroke.
Based on this diagnosis, a PT can expect that the patient will present with:

1. Contralateral hemiplegia with central poststroke pain and involuntary movements.
2. Contralateral hemiparesis and sensory deficits; the arm more involved than the leg.
3. Decreased pain and temperature to the face and ipsilateral ataxia with contralateral pain and thermal loss of the body.
4. Contralateral hemiparesis and sensory deficits; the leg more involved than the arm.

Back 54

2
A CVA affecting the middle cerebral artery will result in symptoms of contralateral hemiparesis and hemisensory deficits with greater involvement of the arm than the leg.

Hint 54

INCORRECT ANSWERS :
The findings presented in choice 1 are characteristic of a CVA affecting the posterior cerebral artery syndrome (central territory). The findings presented in choice 3 are characteristic of a CVA affecting the vertebral arter and posterior inferior cerebellar artery (lateral medullary syndrome). The findings presented in choice 4 are characteristic of a CVA affecting the anterior cerebral artery.

Front 55

Cerebral Vacular Accident

( ) cerebral artery syndrome

1. Rarely involved.
2. (Upper/Lower) more frequently affected resulting in contralateral hemiplegia and sensory loss.
3. Can result in mental cunfusion, aphasia and contralateral neglect if involvement is extensive on the dominant side

Back 55

Anterior artery syndrome

Lower

Hint 55

Signs and Symptoms

1.Hemiparesis or hemiplegia contralaterally, involving primarily the lower limbs and pelvic floor musculature
2.Sensory deficits contralaterally, involving primarily the leg and perineum
3.Apraxia (due to branches to the supplementary motor area and corpus callosum)
4.Disconnection syndrome (due to callosal branches)
5.Anosmia (due to branches of the olfactory bulb and olfactory tract)
6.Urinary incontinence
7.Grasp reflex and or sucking reflex contralaterally (if circle of Willis compromised)

Front 56

Cerebral Vacular Accident

( ) cerebral artery syndrome

Reduction of the function of the portions of the brain supplied by that vessel: the occipital lobe, the inferomedial temporal lobe, a large portion of the thalamus, and the upper brainstem and midbrain.

Back 56

Posterior artery syndrome

Hint 56

Signs and Symptoms

1. Contralateral homonymous hemianopsia
2. cortical blindness with bilateral involvement of the occipital lobe branches
3. visual agnosia
4. prosopagnosia
5. dyslexia, Anomic aphasia, color naming and discrimination problems
6. memory defect
7. topographic disorientation

Front 57

Cerebral Vacular Accident

1. Othen results in death from the edema associated with the infarct.
2. If the patient survives and the lesion affected the pons, the result could be quadriaresis and bulbar palsy or a "locked-in" state whereby the patient can only communicate by eye blinking.

Back 57

Vertebral-basilar

Front 58

Cerebral Vacular Accident

( ) cerebellar

Result In severe ataxia, dysarthria (loss of muscle articulartion control), dysmetria, (finger to nose test), and contralateral loss of pain and temperature.

Back 58

Superior cerebellar

Hint 58

Pathology of Superior cerebellar artery

The SCA is frequently the cause of 'trigeminal neuralgia',
where it compresses the trigeminal nerve causing lancinating pain in the distribution of this nerve on the patient's face.

Front 59

Cerebral Vacular Accident

( ) cerebellar

Results in Wallenberg's syndrome, which is characterized by vertigo, nausea, hoarseness, dysphgia, ptosis, and decreased impairment of sensation in the ipsilateral face and contralateral torso and limbs.
( ) syndrome might also appear.

Back 59

Posterior inferior cerebellar

Horner's Syndrome

Hint 59

Posterior inferior cerebellar artery (PICA), the largest branch of the vertebral artery, is one of the three main arterial blood supplies for the cerebellum, part of the brain. Occlusion of the posterior inferior cerebellar artery or one of its branches, or of the vertebral artery leads to Wallenberg syndrome, also called lateral medullary syndrome.

Front 60

Cerebral Vacular Accident

( ) cerebellar
Results in unilateral deafness, loss of pain and temperature on the contralateral side, paresis of lateral gaze, unilateral Horner's sndrome (ptosis, constricted pupil and loss of sweating), plus ataxia, vertigo and nystagmus.

Back 60

Anterior inferior

Front 61

Brunnstrom Approach

Stage of Recovery Following a Stroke

Stage 1

Back 61

Flaccid, no limb movement

Hint 61

Immediately following a stroke there is a period of flaccidity whereby no movement of the limbs on the affected side occurs.

Front 62

Brunnstrom Approach

Stage of Recovery Following a Stroke

Stage 2

Back 62

Synergies may appear. Spasticity begins to develop. Minimal voluntary movement.

Hint 62

Recovery begins with developing spasticity, increased reflexes and synergic movement patterns termed obligatory synergies. These obligatory synergies may manifest with the inclusion of all or only part of the synergic movement pattern and they occur as a result of reactions to stimuli or minimal movement responses.

Front 63

Brunnstrom Approach

Stage of Recovery Following a Stroke

Stage 3

Back 63

Sasticity increases and may become severe.
Voluntary control of movements synergies appears.

Hint 63

Spasticity becomes more pronounced and obligatory synergies become strong. The patient gains voluntary control through the synergy pattern, but may have a limited range within it.

Front 64

Brunnstrom Approach

Stage of Recovery Following a Stroke

Stage 4

Back 64

Some movements independent of the synergies.
Spasticity begins to decline.

Hint 64

Spasticity and the influence of synergy begins to decline and the patient is able to move with less restrictions. The ease of these movements progresses from difficult to easy within this stage.

Front 65

Brunnstrom Approach

Stage of Recovery Following a Stroke

Stage 5

Back 65

If patient progresses, synergies no longer dominate and movement becomes more complex.

Hint 65

Spasticity continues to decline, and there is a greater ability for the patient to move freely from the synergy pattern. Here the patient is also able to demonstrate isolated joint movements, and more complex movement combinations.

Front 66

Brunnstrom Approach

Stage of Recovery Following a Stroke

Stage 6

Back 66

Spasticity is gone.

Coordination and movement approach normal.

Hint 66

Spasticity is no longer apparent, allowing near-normal to normal movement and coordination.

Front 67

Sul A60
A patient is recovering from stroke and demonstrates good recovery in his lower extremity (out-of-synergy movement control). Timing deficits are apparent during walking. Isokinetic training can be used to improve:

1. Rate control at slow movement speeds.
2. Rate control at varying movement speeds.
3. Reaction time.
4. Initiation of movement.

Back 67

2
Patients during recovery from stroke frequently exhibit problems with rate control during walking. They are able to move
at slow speeds but, as speed of movement increases, control decreases. An isokinetic device can be an effective training
modality to remediate this problem.

Hint 67

INCORRECT CHOICES:
Both initiation of movement and reaction time may be impaired but are not the likely cause of timing deficits during speed changes while walking.

Front 68

A 130
A PT receives a referral from an acute care therapist to treat a patient with right hemiparesis in the home.
The referral indicates that the patient demonstrates good recovery: both involved limbs are categorized as stage 4 (some movements out-of-synergy).
The patient is ambulatory with a small-based quad cane.
The activity that would be MOST beneficial for a patient at this stage of recovery is:

1. Supine, bending the hip and knee up to the chest with some hip abduction.
2. Sitting, marching in place with alternate hip and flexion.
3. Standing, lifting the foot up behind and slowly lowering it.
4. Standing, small-range knee squats.

Back 68

3
Stage 4 recovery is characterized by some movement combinations that do not follow paths of either flexion or extension obligatory synergies. Knee flexion in standing is an out-of synergy movement.

Hint 68

INCORRECT CHOICES:
All other choices include some degree of in-synergy movements: the supine and sitting options are flexion synergy movements, and the other standing option focuses on knee and hip extension (extension synergy movements).

Front 69

Gait Problems

Trunk / Plevis

Back 69

Foward trunk from weak hip extension or flexion contracture.

Front 70

Gait Problems

Hip
( ) gait due to weak ( ) on (ipsi/contra) lateral.

Back 70

Trendelenberg's,

abductors,

contralateral

Front 71

Gait Problems

Knee
(1) Flexion during forward progression -
(2) Hyperextension during forward progression

Back 71

(1) flexion contracture combined with weak knee extensors and/or poor proprioception.

(2) plantarflexion contractures past 90deg or severe spasticity in quadriceps or weak knee extensors.

Front 72

Sul A 126
During initial standing, a patient with chronic stroke is pushing strongly backward, displacing the center-of-mass at or near the posterior limits of stability.
The most likely cause of this is:

1. Spasticity of the tibialis anterior.
2. Spasticity of the gastrocnemius-soleus.
3. Contracture of the hamstrings.
4. Contraction of the hip extensors.

Back 72

2
The muscles of the foot and ankle move the long lever of the body forward and backward (ankle strategy).
The gastrocnemiussoleus moves the body backward, and the anterior tibialis moves the body forward.
Poststroke, spasticity of th gastrocnemiussoleus and weakness of the anterior tibialis are common.

Hint 72

INCORRECT CHOICES:
Action of the hip extensors would result in a backward lean with the center of motion occurring at the hip (hip strategy). Contracture of the hamstrings increases knee flexion and forward trunk lean. Spasticity occurs in lower extremity antigravity extensor muscles, not the anterior tibialis.

Front 73

Sul A33
A patient recovering from stroke is having difficulty bearing weight on the left leg. The patient is unable to advance the tibia forward and abbreviates the end of the stance phase on the left going directly into swing phase.
The MOST likely cause of the patient's problem is:

1. Weakness or contracture of hip extensors.
2. Spasticity or contracture of the plantar flexors.
3. Spasticity of the anterior tibialis muscle.
4. Weakness or contracture of the dorsiflexors.

Back 73

2
Forward advancement of the tibia from midstance to heel-off is controlled by eccentric contraction of the plantar flexors; from heel-off to toe-off, the plantar flexors contract concentrically.
Either spasticity or contracture of the plantar flexors would limit this forward progression. Patients compensate by going right into swing, typically with a circumducted gait or with increased hip and knee flexion because there is no push off.

Hint 73

INCORRECT CHOICES:
Spasticity or contracture of the dorsiflexors is typically not seen and could not cause this deficit. Weakness of the hip extensors would be evident at heel-strike with a backward lean of the trunk.

Front 74

Gait Problems

Ankle / Foot
( ) gait from spasticity or contractures of gastroc-soleus.

Back 74

Equinus

Front 75

A67
A patient with right hemiparesis has difficulty clearing the more affected foot during the swing phase of gait.
An appropriate physical therapy intervention for the right lower extremity might include:

1. Sitting on a therapy ball, alternating lateral side steps and back to neutral.
2. Pushing backward while sitting on a rolling stool.
3. Forward step-ups in standing using graduated height steps.
4. Assumption of bridging.

Back 75

3
Decreased foot clearance during swing may result from weak hip and knee flexors or may be the result of a drop foot (weak dorsiflexors or spastic plantarflexors). Step-ups represent the best choice to functionally strengthen the hip and knee flexors using task-specific training.

Hint 75

INCORRECT CHOICES :
Bridging promotes knee flexion with hip extension. The sitting activities promote hip abduction (therapy ball) and knee extension (pushing backward).

Front 76

A 114
The BEST choice for positioning strategy for a patient recovering from acute stroke who is in bed and demonstrates a flaccid upper extremity is:

1. Supine with the affected arm flexed with the hand resting on the stomach.
2. Side-lying on the sound side with the affected shoulder protracted, and the arm extended resting on a pillow.
3. Supine with the affected elbow extended and the arm positioned close to the side of the trunk.
4. Side-lying on the sound side with the affected upper extremity flexed overhead.

Back 76

2
Most patients with stroke recover from flaccidity and develop spasticity. Positioning for the patient with early stroke stresses
(1) protection against ligamentous strain and the development of a painful subluxed shoulder and
(2) positions counter to the typical spastic posture of flexion and adduction with pronation. Side-lying with the affected upper extremity supported on a pillow with the shoulder protracted and the elbow extended accomplishes both of these goals.

Hint 76

INCORRECT CHOICES :
The other positions fail to accomplish these goals. The affected arm should not be flexed (choice 1) as flexion adduction spasticity typically develops in the affected upper extremity. Supine with arm extended at the side (choice 3) and sidelying on sound side with affected arm flexed overhead (choice 4) do not provide needed support for a painful, subluxed shoulder.

Front 77

A 167
While evaluating the gait of a patient with right hemiplegia, the PT notes foot drop during midswing on the right.
The MOST LIKELY cause of this deviation is:

1. Inadequate contraction of the ankle dorsiflexors.
2. Excessive extensor synergy.
3. Decreased proprioception of foot-ankle muscles.
4. Excessive flexor synergy.

Back 77

1
Weakness or delayed contraction of the ankle dorsiflexors or spasticity in the ankle plantar flexors may cause foot drop during midswing.

Hint 77

INCORRECT CHOICES:
Excessive extensor synergy would cause plantarflexion during stance. Decreased proprioception of the foot-ankle muscles would cause difficulties with foot placement and balance during stance. A strong flexor synergy can cause dorsiflexion with hip and knee flexion during swing.

Front 78

A171
A PT observes genu recurvatum during ambulation in a patient with hemiplegia. The patient has been using a posterior leaf spring (PLS) orthosis since discharge from subacute rehabilitation 4 weeks ago. The therapist has previously administered Fugl-Meyer Assessment of Physical Performance and determined the lower extremity score to be 22 (of a possible 34) with strong synergies in the lower extremity and no out-of-synergy movement.
The most likely cause of this deviation is:

1. Extensor spasticity.
2. Hip flexor weakness.
3. Dorsiflexor spasticity.
4. Hamstring weakness.

Back 78

1
A hyperextended knee can be caused by extensor spasticity, quadriceps weakness (a compensatory locking of the knee), or by plantarflexion contractures or deformity. The most likely cause in this case is extensor spasticity, which is consistent with strong obligatory synergies (stage 3 recovery).

Hint 78

INCORRECT CHOICES :
Spasticity in dorsiflexors is atypical and would not cause knee hyperextension. Hip flexor and hamstring weakness would result in decreased lower extremity clearance during swing.

Front 79

Perceptual Problems Associated with Stroke

Emotional highs & lows (emotional lability) – involuntary outbursts of laughing, crying)

◦ Interrupt the behavior with distractions.
◦ Change the subject or call their name.
◦ Accept behavior in matter-of-fact way. Continue conversation and ignore display of emotion.
◦ Watch for fatigue & encourage rest period if due to fatigue.
◦ Often manageable with medications.

Back 79

Right-Brain Strokes

Front 80

Perceptual Problems Associated with Stroke

Cautious or compulsive behavior

◦ Offer encouragement and positive feedback. (EX: “Keep going”; “good”; “that’s right”)
◦ Develop pace to allow survivor to work or function at comfortable pace
◦ Watch for fatigue – encourage survivor to ask for help with daily tasks without guilt

Back 80

Left-Brain Strokes

Front 81

Perceptual Problems Associated with Stroke

Apraxia
(difficulty translating ideas or performing function into action)

◦Give short phrase instructions geared to achieving the goal (“Come to the kitchen”)
◦ See if patient can “sing the answer”.
◦ Use carrier phrases patient can complete, like “you want a ________.”

Back 81

Left-Brain Strokes

Front 82

Perceptual Problems Associated with Stroke

Aphasia - difficulty speaking (expressive) or understanding what is being said (receptive)

◦ Be patient – give them time to give a response to questions or comments.
◦ Keep questions simple – being able to give yes or no answers is best.
◦ Encourage survivor to point to objects or make gestures to s how what they want
◦Use a word or picture board.
◦ Speak clearly & concisely – use one idea at a time.

Back 82

Left-Brain Strokes

Front 83

Perceptual Problems Associated with Stroke

Aphasia - difficulty speaking (expressive) or understanding what is being said (receptive) ◦Be patient – give them time to give a response to questions or comments.

◦ Keep questions simple – being able to give yes or no answers is best.
◦ Encourage survivor to point to objects or make gestures to show what they want
◦ Use a word or picture board.
◦ Speak clearly & concisely – use one idea at a time.

Back 83

Left-Brain Strokes

Front 84

Perceptual Problems Associated with Stroke

(1) Poor judgment affecting personal safety.
(2) Diminished body image with left sided neglect.
(3) Quick and impulsive.

Back 84

Right hemisphere affected (left hemiparesis).

Front 85

Perceptual Problems Associated with Stroke

(1) Easily frustrated with high levels of anxiety.
(2) Inability to communicate verbally.
(3) Cautious and slow.

Back 85

Right hemisphere affected (left hemiparesis).

Front 86

Perceptual Problems Associated with Stroke

Spatial-perceptual problems (neglect of left side – unaware they have a left side)

◦ Place items they need on the right side to be seen – turn dinner plate so all food is seen and eaten.
◦ Reminders that they have a left side – touch it, rub it, massage it
◦ Encourage survivor to scan (turn head side to side) to see what’s being ignored on the affected side.

Back 86

Right-Brain Strokes

Front 87

Perceptual Problems Associated with Stroke

Back 87

Right hemisphere affected (left hemiparesis).

Front 88

Perceptual Problems Associated with Stroke

(1) Problems with spatial relationships and hand-eye coordination.
(2) Irritability, short attention span.
(3) Cannot retain information, difficulty learning individual steps.

Back 88

Right hemisphere affected (left hemiparesis).

Front 89

Perceptual Problems Associated with Stroke

Poor judgment (especially own safety) & impulsiveness

◦ Don’t overestimate survivor’s abilities
◦ Stay with survivor & monitor activity
◦ Keep their environment safe – arrange it for visual or sensory problems.

Back 89

Right-Brain Strokes

Front 90

Perceptual Problems Associated with Stroke

(1) Apraxia.
(2) Difficulty starting and sequencing tasks.
(3) Perseveration.

Back 90

Left hemisphere affected (right hemiparesis).

Front 91

Perceptual Problems Associated with Stroke

Confusion & Memory loss

◦ Write out step-by-step directions for tasks (dressing, laundry, making sandwich)
◦ Set fixed schedules if possible for meals, routine events like church, dinner out
◦ Give new information a little at a time, slowly – give survivor time to process it.
◦ Memory aids (calendars, appointment books, post-it notes and pictures where things are located)
◦ Do not point out the survivor’s memory problems.

Back 91

Right-Brain Strokes

Front 92

Perceptual Problems Associated with Stroke

Short attention span – distractions & loss of concentration

◦ Quiet down environment. Turn off TV and radio – unplug phone
◦ Divide tasks into steps
◦ Encourage survivor to slow down – go step-by-step
◦ Supervise project that could be harmful if distracted (i.e. cooking, ironing)
◦ Install chime on door to alert for patient leaving house.

Back 92

Right-Brain Strokes

Front 93

B27
The patient with left hemiplegia would be LEAST likely to respond in therapy if the motor learning strategies emphasized:
1. Maximum use of verbal cues.
2. Encouraging the patient to slow down.
3. Simplification/restructuring of the environment including removal of all clutter.
4. Maximum use of demonstration and gesture.

Back 93

4
The patient with left hemiplegia typically demonstrates visuospatial perceptual deficits. Maximum use of demonstration and gesture would be inappropriate to assist this patient in the relearning of motor tasks.

Hint 93

INCORRECT CHOICES :
The other choices are all valid motor learning strategies that can be used to assist the patient with left hemiplegia.

Front 94

Impairments related mostly to the input or reception of language, with difficulties either in auditory verbal comprehension or in the repetition of words, phrases, or sentences spoken by others.
Speech is easy and fluent, but there are difficulties related to the output of language as well, such as paraphasia.

'Fluent aphasias'

Back 94

Receptive aphasia

Hint 94

Examples of fluent aphasias are: Receptive aphasia, Transcortical sensory aphasia, Conduction aphasia, Anomic aphasia

Front 95

Communication issues

( ) aphasia
Pharase questions for simple "yes" or "no" responses to avoid confusion and frustration.

Nonfluent aphasias, are difficulties in articulating, but in most cases there is relatively good auditory verbal comprehension.

Back 95

Expressive aphasia

Front 96

Medical scale used to assess individuals after a closed head injury, including traumatic brain injury, based on cognitive and behavioural presentations as they emerge from coma.

Back 96

Rancho Los Amigos

Hint 96

Front 97

Rancho Los Amigos

Level 1

Back 97

No response.

Completely unresponsive to any stimuli.

Hint 97

Not respond to sounds, sights, touch or movement.

Front 98

Rancho Los Amigos

Level 2

Back 98

Generalized response.

Patient reacts inconsistently and non specifically to stimuli.

Hint 98

•Demonstrates generalized reflex response to painful stimuli.

•Responds to repeated auditory stimuli with increased or decreased activity.

•Responds to external stimuli with physiological changes generalized, gross body movement and/or not purposeful vocalization.

•Responses noted above may be same regardless of type and location of stimulation.

•Responses may be significantly delayed.

Front 99

Rancho Los Amigos

Level 3

Back 99

Localized response.

Patient reacts inconsistently but specifically to stimuli.

Hint 99

• Demonstrates withdrawal or vocalization to painful stimuli.

• Turns toward or away from auditory stimuli.

• Blinks when strong light crosses visual field.

• Follows moving object passed within visual field.

• Responds to discomfort by pulling tubes or restraints.

• Responds inconsistently to simple commands.

• Responses directly related to type of stimulus.

• May respond to some persons (especially family and friends) but not to others.

Front 100

Rancho Los Amigos

Level 4

Back 100

Confused-inappropriate.

Patient able to respond to simple commands but not do complex tasks.
Memory is impaired.

Hint 100

• Be very confused and frightened;

• Not understand what he feels, or what is happening around him;

• Overreact to what he sees, hears or feels by hitting, screaming, using abusive language, or thrashing about. This is because of the confusion;

• Be restrained so he doesn't hurt himself;

• Be highly focused on his basic needs; ie., eating, relieving pain, going back to bed, going to the bathroom, or going home;

• May not understand that people are trying to help him;

• Not pay attention or be able to concentrate for a few seconds;

• Have difficulty following directions;

• Recognize family/friends some of the time;

• With help, be able to do simple routine activities such as feeding himself, dressing or talking.

Front 101

Rancho Los Amigos

Level 5

Back 101

Confused-inppropriate.

Patient is able to respond to simple commands but not do complex tasks.
Memory is impaired.
Verbalization is inappropriate.

Hint 101

• Be able to pay attention for only a few minutes;

• Be confused and have difficulty making sense of things outside himself;

• Not know the date, where he is or why he is in the hospital;

• Not be able to start or complete everyday activities, such as brushing his teeth, even when physically able. He may need step-by-step instructions;

• Become overloaded and restless when tired or when there are too many people around; have a very poor memory, he will remember past events from before the accident better than his daily routine or information he has been told since the injury;

• Try to fill in gaps in memory by making things up; (confabulation)

• May get stuck on an idea or activity (perseveration) and need help switching to the next part of the activity;

• Focus on basic needs such as eating, relieving pain, going back to bed, going to the bathroom, or going home.

Front 102

Rancho Los Amigos

Level 6

Back 102

Confused-appropriate.

Aptient is dependent upon external input but can perform consistently.
Memory improved.

Hint 102

•Be somewhat confused because of memory and thinking problems, he will remember the main points from a conversation, but forget and confuse the details. For example, he may remember he had visitors in the morning, but forget what they talked about;
•Follow a schedule with some assistance, but becomes confused by changes in the routine;
•Know the month and year, unless there is a serious memory problem;
•Pay attention for about 30 minutes, but has trouble concentrating when it is noisy or when the activity involves many steps. For example, at an intersection, he may be unable to step off the curb, watch for cars, watch the traffic light, walk, and talk at the same time;
•Brush his teeth, get dressed, feed himself etc., with help;
•Know when he needs to use the bathroom;
•Do or say things too fast, without thinking first;
•Know that he is hospitalized because of an injury, but will not understand all the problems he is having;
• Be more aware of physical problems than thinking problems;

Front 103

Rancho Los Amigos

Level 7

Back 103

Automatic-appropriate.

Can perform automatically and appropriately in struted environments.
Judgment remains impaired.

Hint 103

•Follow a set schedule
•Be able to do routine self care without help, if physically able. For example, he can dress or feed himself independently; have problems in new situations and may become frustrated or act without thinking first;
•Have problems planning, starting, and following through with activities;
•Have trouble paying attention in distracting or stressful situations. For example, family gatherings, work, school, church, or sports events;
•Not realize how his thinking and memory problems may affect future plans and goals. Therefore, he may expect to return to his previous lifestyle or work;
•Continue to need supervision because of decreased safety awareness and judgement. He still does not fully understand the impact of his physical or thinking problems;
•Think slower in stressful situations;
•Be inflexible or rigid, and he may be stubborn. However, his behaviors are realted to his brain injury;
•Be able to talk about doing something, but will have problems actually doing it.

Front 104

Rancho Los Amigos

Level 8

Back 104

Purposeful-appropriate.

Patient acts appropriately though not perfectly.
May have some-problems in stressful or unusual circumstances.

Hint 104

•Realize that he has a problem in his thinking and memory;
•Begin to compensate for his problems;
•Be more flexible and less rigid in his thinking. For example, he may be able to come up with several solutions to a problem;
•Be ready for driving or job training evaluation;
•Be able to learn new things at a slower rate;
•Still become overloaded with difficult, stressful or emergency situations;
•Show poor judgement in new situations and may require assistance;
•Need some guidance making decisions;
•Have thinking problems that may not be noticeable to people who did not know the person before the injury.

Front 105

Traumatic Brain injury

An objective way to describe a patient's level of consciousness.

Back 105

Neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 1

Hint 105

Glasgow Coma Scale

Front 106

B3
A therapist wishes to use behavior modification techniques as part of a plan of care to help shape the behavioral responses of a patient recovering from traumatic brain injury (TBI).
The BEST form of intervention is to:

1. Reprimand the patient every time an undesirable behavior occurs.
2. Use frequent reinforcements for all desired behaviors.
3. Allow the patient enough time for self-correction of the behavior.
4. Encourage the staff to tell the patient which behaviors are correct and which are not.

Back 106

2
Behavioral modification is best achieved through use of positive reinforcements for all desired behaviors.

Hint 106

INCORRECT CHOICES:
Negative behaviors should be ignored not reprimanded. Self correction is not a form of behavior modification.

Front 107

Glasgow Coma Scale

3 category

score

Back 107

1. Eye response (4)

2. Verbal response (5)

3. Behavior response (6)

Hint 107

Front 108

Glasgow Coma Scale

(1) Minimum Score

(2) Brain injury score
a. minor
b. moderate
c. severe

Back 108

(1) 3

(2) 13, 9~12, <9

Hint 108

Front 109

Behavioral Difficulties

State of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and sense of well-being

Crying, apathetic, poor self-care

Back 109

Depression

Front 110

Behavioral Difficulties

Child-like, follws therapist around

Back 110

Dependent

Front 111

Behavioral Difficulties

Blames others for problems or lack of progress;
May not go to treatment.

Back 111

Denial

Hint 111

(=abnegation)

Psychological defense mechanism

Sigmund Freud

Person is faced with a fact that is too uncomfortable to accept and rejects it instead, insisting that it is not true despite what may be overwhelming evidence

Front 112

Behavioral Difficulties

Behavior that causes physical or emotional harm to others, or threatens to. It can range from verbal abuse to the destruction of a victim’s personal property.

Irritable, impulsive, and restless

Back 112

Aggressive

Front 113

Behavioral Difficulties

Sexually inappropriate.

Back 113

Verbally or physically

Front 114

Behavioral Difficulties

Agitated

Back 114

Low frustration tolerance, combative, impatient

Front 115

Behavioral Difficulties

Poor judgment

Back 115

Regarding actions and behaviors

Front 116

Neurological Problems

( ) or ( ) disease
1. Degenerative disease that involves both upper and lower motor neurons.
2. Cranial nerves can be affected as well.
3. Weakness may appear in ( ) first.
4. The earliest symptoms ( ), ( )

Back 116

Amyotrophic lateral sclerosis
or
Lou Gehrig's disease

Hands

weakness / muscle atrophy

Hint 116

Characteristic : Rapidly progressive weakness due to muscle atrophy and muscle spasticity, difficulty in speaking (dysarthria), swallowing (dysphagia), and breathing (dyspnea)

Goals : Delaying loss of strength, maintaining endurance, limiting pain, preventing complications, and promoting functional independence

Front 117

Sul A 149
A patient has a 2-year history of amyotrophic lateral sclerosis (ALS) and exhibits moderate functional deficits. The patient is still ambulatory with bilateral canes but is limited in endurance. An important goal for the physical therapy plan of care (POC) should be to prevent:

1. Radicular pain and paresthesias.
2. Overwork damage in weakened, denervated muscle.
3. Further gait deterioration as a result of ataxia.
4. Further functional loss as a result of myalgia.

Back 117

2
ALS is a progressive degenerative disease that affects both upper and lower motor neurons. An important early goal of physical therapy is to maintain the patient's level of conditioning while preventing overwork damage in denervated muscle (lower motor neuron injury).

Hint 117

INCORRECT CHOICES:
Myalgia is common in lower motor neuron lesions. It can be ameliorated but not prevented. Ataxia and radicular pain are not associated with ALS.

Front 118

Physical therapists goals for individuals with ALS

Back 118

Delaying loss of strength, maintaining endurance, limiting pain, preventing complications, and promoting functional independence

Front 119

Neurological Problems

( )
- Idiopathic unilateral facial nerve paralysis.
- Difficulty : ( 1 ), ( 2 ), ( 3 )
- Decreased taste sensation ( ) of tongue.

Back 119

Bell's palsy

(1) wrinkling th forehead,
(2) closing the eye tightly,
(3) smiling

Anterior 2/3 of tongue

Front 120

Neurological Problems

( )
- Polyneuropathy of probable immune-mediated viral origin, resulting in symmetric motor paralsis and progressive muscular weakness that develops quickly.
- ( UMN / LMN / Both ) affecting the cranial and paeripheral nerves.
- Muscle weakness prgresse :
a. from (upper / lower ) extremities
b. from (distal / proxima) or (distal / problem

Back 120

Guillain-Barre Syndrome

Lower

LMN

lower / distal

Front 121

Neurological Problems

( )
- Disseminated sclerosis or encephalomyelitis disseminata, is an inflammatory disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged.

- The disease may be relatively mild, have bouts of remissions and exacerbatons or get progressively worse.

Back 121

Multiple sclerosis

Hint 121

Adverse effects

One of the most common is irritation at the injection site for glatiramer acetate and the interferons.
Over time, a visible dent at the injection site, due to the local destruction of fat tissue, known as lipoatrophy, may develop.
Interferons may produce flu-like symptoms;

Front 122

Sul A30
A patient with Multiple sclerosis (MS) exhibits moderate fatigue during a 30-minute exercise session. When the patient returns for the next regularly scheduled session 2 days later, the patient reports going right to bed after the last session. Exhaustion was so severe, the patient was unable to get out of bed until late afternoon of the next day.
The PT's BEST strategy is to:

1. Treat the patient in a warm, relaxing environment.
2. Utilize a massed practice schedule.
3. Utilize a distributed practice schedule.
4. Switch the patient to exercising in a warm pool.

Back 122

3
Common problems in MS include fatigue and heat intolerance.
Exercise intensity should be reduced and a distributed practice schedule used in which rest times equal or exceed exercise times.

Hint 122

INCORRECT CHOICES:
A massed practice schedule in which the exercise time exceeds the rest time is contraindicated as is a warm environment or warm pool, which can increase fatigue.

Front 123

Sul A 113
A patient has a 3-year history of multiple sclerosis (MS). One of the disabling symptoms is a persistent and severe diplopia, which leaves the patient frequently nauseated and immobile.
A beneficial intervention strategy to assist the patient in successfully participating in rehabilitation would be to:

1. Provide the patient with special glasses that magnify images.
2. Instruct the patient to close both eyes and practice movements without visual guidance.
3. Provide the patient with a soft neck collar to limit head and neck movements.
4. Patch one eye.

Back 123

4
Double vision (diplopia) can be managed by patching of one eye. Patients are typically on an eye patching schedule that alternates the eye that is patched. Loss o depth perception can be expected with eye patching but is not as disabling as diplopia.

Hint 123

INCORRECT CHOICES :
Having the patient use magnifiying glasses or a soft neck coUar does not correct the primary deficit. Although practice with eyes closed may be part of a rehabilitation program, it also does not address the primary deficit. This patient will need eyes open for daily functional activity.

Front 124

A 155
A patient with multiple sclerosis (MS) demonstrates strong bilateral lower extremity extensor spasticity in the typical distribution of antigravity muscles.
This patient would be expected to demonstrate:

1. Sitting with the pelvis laterally tilted and both lower extremities in windswept position.
2. Sacral sitting with increased extension and adduction of lower extremities.
3. Sitting with both hips abducted and externally rotated.
4. Skin breakdown on the ischial tuberosities and lateral malleoli.

Back 124

2
Spasticity is typically strong in antigravity muscles. In the lower extremities, this is usually the hip and knee extensors, adductors, and plantar flexors. Strong extensor tone results in sacral sitting with the pelvis tilted posteriorly. This results in a rounded upper spine (kyphotic) and forward head.

Hint 124

INCORRECT CHOICES:
A laterally tilted pelvis with both lower extremities in a windswept position is likely the result of asymmetrical spasticity. Hips are typically adducted and internally rotated with extended lower extremities (scissoring position). Skin breakdown can occur on the ischial tuberosities with sacral sitting; breakdown on the lateral malleoli is not likely.

Front 125

A 156
A patient with multiple sclerosis (MS) has been on prednisolone for the past 4 weeks. The medication is now being tapered off. This is the third time this year the patient has received this treatment for an MS exacerbation.
The PT recognizes possible adverse effects of this medication are:

1. Weight gain and hyperkinetic behaviors.
2. Hypoglycemia and nausea or vomiting.
3. Muscle wasting, weakness, and osteoporosis.
4. Spontaneous fractures with prolonged healing or malunion.

Back 125

3
This patient is receiving systemic corticosteroids to suppress inflammation and the normal immune system response during an MS attack. Chronic treatment leads to adrenal suppression. There are numerous adverse reactions/side effects that can occur. Those affecting the patient's capacity to exercise include muscle wasting and pain, weakness, and osteoporosis, Weight loss is common (anorexia) with nausea and vomiting.

Hint 125

INCORR ECT CHOICES :
Adrenal suppression produces hyperglycemia, not hypoglycemia. Spontaneous fractures are not typical. Hyperkinetic behavior is not an expected adverse effect.

Front 126

B4
A patient with multiple sclerosis (MS) presents with dysmetria in both upper extremities.
Which of the following interventions is the BEST choice to deal with this problem?

1. 3-lb weight cuffs to wrists during activities of daily living (ADL) training.
2. Pool exercises using water temperatures greater than 85 degrees F.
3. Proprioceptive neuromuscular facilitation (PNF) patterns using dynamic reversals with carefully graded res istance.
4. Isokinetic training using low resistance and fast movement speeds.

Back 126

3
Dysmetria is a coordination problem in which the patient is unable to judge the distance or range of movement (overshoots or undershoots a target). Adding manual resistance with PNF can assist the patient in slowing down the movement and achieving better control.

Hint 126

INCORRECT CHOICES:
The patient lacks speed control. Low-resistance, fast-speed isokinetic training is contraindicated. The resistance of water (pool therapy) could help control the speed of movements but the temperature is too warm (patients with MS demonstrate heat intolerance). Weight cuffs could also help slow the movements down but would unnecessarily fatigue the patient (patients with MS demonstrate problems with excessive fatigue).

Front 127

Neurological Problems

( )
- Muscular dystrophy that may occur decades after the initial episode of polio.
- New denervation occurs with asymmetrical muscular weakness
- Myalgia, Joint pain, Variable asymmetrical muscle atrophy with decreased strength.

Back 127

Postpolio Syndrome

Hint 127

Poliomyelitis—a viral infection of the nervous system—after the initial infection.
Typically the symptoms appear 15–30 years after recovery from the original paralytic attack, at an age of 35 to 60. Symptoms include acute or increased muscular weakness, pain in the muscles, and fatigue. The same symptoms may also occur years after a nonparalytic polio (NPP) infection.
Fatigue is usually the most disabling symptom.

Front 128

Neurological Problems

Postpolio syndrome
Tratmetn focus

Back 128

Low intensity Ex neverr to the point of fatigue.
Stop exercise with pain or weakness.

Front 129

A182
A 62-year-old patient developed polio at the age of 6 with significant lower extremity paralysis. The patient initially wore bilateral long leg braces for a period of 2 years and then recovered enough to stop using the braces but still required bilateral Lofstrand crutches, then a cane to ambulate. Recently, the patient has been complaining of new difficulties and has had to start using crutches again. The PT suspects postpolio syndrome.
The BEST INITIAL intervention for this patient based on current findings is to:

1. Initiate a lower extremity resistance training program utilizing 80% one repetition maximum.
2. Initiate a moderate conditioning program consisting of cycle ergometry 3 times a week of 60 minutes at 75% maximal HR.
3. Instruct in activity pacing and energy conservation techniques.
4. Implement an aquatic therapy program consisting of daily 1-hour aerobics.

Back 129

3
The therapist should initially teach this patient ·activity pacing and energy conservation techniques. It is important to balance rest with activity in order to not further weaken muscles affected by progressive postpolio muscular atrophy.

Hint 129

INCORRECT CHOICES:
Resistance training, conditioning, and aquatic therapy may be helpful in improving activity tolerance if kept at low to moderate intensities (not evident in the incorrect choices). They should not be the therapist's initial priority.

Front 130

B11
A patient with postpolio syndrome started attending a supervised outpatient exercise program. The patient failed to show up for follow-up sessions. The patient reported increased muscle pain and being too weak to get out of bed for the past 2 days. The patient is afraid to continue with the exercise class. The therapist's BEST course of action regarding exercise is to:

1. Decrease the intensity and duration but maintain a frequency of 3 times/wk.
2. Discharge the patient from the program because exercise is counterproductive in postpolio syndrome.
3. Decrease the frequency to once a week for an hour session, keeping the intensity moderate.
4. Reschedule exercise workouts for early morning when there is less fatigue.

Back 130

1
Clinical manifestations of postpolio syndrome include myalgias, new weakness as well as atrophy, and excessive fatigue with minimal activity. Nonexhaustive exercise and general body conditioning are indicated. A change in the exercise prescription (intensity and duration) is warranted.

Hint 130

INCORRECT CHOICES:
The patient should not exercise to the point of fatigue and exhaustion. A frequency of once a week is too little to be beneficial. Rescheduling exercise to early morning does not address the needed change in exercise prescription. Stopping exercise completely will not help this patient.

Front 131

Neurological Problems

( )

- Widespread pain accompanied by tenderness of muscles and adjacent soft tissues

- Chronic widespread pain and allodynia (a heightened and painful response to pressure)

Back 131

Fibromyalgia

Front 132

Neurological Problems

( )

- Persistent, deep aching pains in muscle

- Nonarticular in origin

- Characterized by well-defined, highly sensitive tender spots(tigger pints)

- Chronic pain caused by multiple trigger points and fascial constrictions.

- Characteristic features of a myofascial trigger point include: focal point tenderness, reproduction of pain upon trigger point palpation, hardening of the muscle upon trigger point palpation, pseudo weakness of the involved muscle, referred pain, and limited range of motion following approximately 5 seconds of sustained trigger point pressure.

Back 132

Myofascial pain syndrome

Hint 132

MPS and fibromyalgia

MPS and fibromyalgia share some common symptoms, such as hyperirritability, but the two conditions are distinct. However, a patient may suffer from MPS and fibromyalgia at the same time.
In fibromyalgia, chronic pain and hyperirritability are pervasive.
By contrast, while MPS pain may affect many parts of the body, it is still limited to trigger points and hot spots of referred pain.

Front 133

Neurological Problems

( )

- Start in deep visceral tissues and is felt in a body region remote from the site of pathology, resulting in tenderness and pain in superficial locations.

- Pain perceived at a location other than the site of the painful stimulus

Back 133

Referred pain

Front 134

Referred pain

(1) Medial left arm and jaw pain :
(2) Right subscapular pain :
(3) Thoracic or flank pain :
(4) Left upper quadrant and shoulder pain :
(5) Right upper quadrant pain :

Back 134

(1) Heart
(2) Gallbladder
(3) Kidney
(4) spleen
(5) Liver

Front 135

Neurological Problems

Disorder arising in the inner ear. Its symptoms are repeated episodes of positional vertigo,that is, of a spinning sensation caused by changes in the position of the head.

Most common cause of the symptoms of 'vertigo'.

Back 135

Benign paroxysmal positional vertigo (BPPV)

Hint 135

Disturbance within the inner ear. The inner ear has fluid-filled tubes called semicircular canals. The canals are very sensitive to movement of the fluid, which occurs as you change position. The fluid movement allows your brain to interpret your body's position and maintain your balance.

Front 136

Neurological Problems

Disorder of the inner ear.

Characteristic :
(1) Vertigo (Attacks of rotational)
(2) Low-pitched tinnitus
(3) Hearing loss. (usually affects just one ear).
(4)

Back 136

Ménière's disease (Meniere)

Front 137

Sul A 142
A patient is referred to physical therapy for vestibular rehabilitation. The patient presents with spontaneous nystagmus that can be suppressed with visual fixation, oscillopsia, and loss of gaze stabilization. Additional postural findings include intense disequilibrium, and an ataxic wide-based gait with consistent veering to the left.
Based on these findings, the PT determines the patient is most likely exhibiting signs and symptoms of:

1. Benign paroxysmal positional vertigo (BPPV).
2. Acoustic neuroma.
3. Meniere's disease.
4. Acute unilateral vestibular dysfunction.

Back 137

4
This patient is presenting with classic signs and symptoms of unilateral vestibular dysfunction. An abnormal vestibular ocular reflex (VOR) produces nystagmus (involuntary cyclical movements of the eye), loss of gaze stabilization during head movements, and oscillopsia (an illusion that the environment is moving). Abnormal vestibulospinal function produces impairments in balance and gait. Veering to once side is indicative of unilateral vestibular dysfunction (in this case on the left side).

Hint 137

INCORRECT CHOICES: BPPV is associated with episodic vertigo, nausea, blurred vision, and autonomic changes that occur with head movement and typically stop within 30 seconds once the head is static. Acoustic neuroma is a benign tumor affecting CN VIII and is associated with progressive hearing loss, tinnitus, and disequilibrium. Meniere's disease is associated with symptoms of nausea and vomiting, episodic vertigo, and fullness in the ear with low-frequency hearing loss.

Front 138

PNF diagonals

Starts with hip lateral rotation, adduction, and extension and goes to medial rotatin, abduction and flexion

Back 138

D2 Flexion for lower extremity

Front 139

PNF diagonals

Starts with glenohumeral medial rotation, abduction and extension and goes to lateral rotation, adduction a

Back 139

D1 flexion for upper extremity.

Front 140

PNF diagonals

Start with hip medial rotation, abduction and extension and goes to lateral rotation, adduction and flexion.

Back 140

D1 flexion for lower extremity

Front 141

PNF diagonals

Starts with glenohumeral medial rotation, adduction and extension and goes to lateral rotation, abduction and flexion.

Back 141

D2 flexion for upper extremity

Front 142

PNF diagonals

Supine or sitting choppig, upper trunk flexion with rotation and upper extrimity (D1 / D2) (flexion / extension) facilitates rolling to prone position.

Back 142

D1 extension

Front 143

PNF diagonals

Lower extremity (D1 / D2) (flexion / extension) helps rolling in any direction.

Back 143

D1 flexion

Front 144

PNF Technique

( )
Compression of the trunk or an extremity.
Compression through a joint stimulate joint receptors.
Facilitate (alpha / gamma) motor neuron.
Facilitate (stability / mobility)

Back 144

Approximation

alpha

stability

Front 145

PNF Technique

( )
Joint separation stimulates joint receptors.
Muscle stretch stimulates muscle spindle stretch receptor.
Facilitates Alpha Motor Neuron.
Facilitates Strength.

Back 145

Traction

Front 146

PNF Technique

A group of techniques that allow for agonist contraction followed by antagonist contraction without pause or relaxation.

Back 146

Reversal of Antagonists

Front 147

PNF Technique

Utilizes isotonic contractions of first agonists, then antagonists performed against resistance.
Contraction of stronger pattern is selected first with progression to the weaker pattern.
The limb is moved through full ROM.

Back 147

Dynamic Reversa (Slow Reversals)

Front 148

PNF Technique

Utilizes alternating isotonic contractions of first agonists, then antagonists against resistance, no motion is allowed.

Back 148

Rhythmic Stabilization

Front 149

PNF Technique

Repeated isotonic contractions from the lengthened range, induced by quick stretches and enhanced by resistance; performed through the range or part of range at a point of weakness.
Technique is repeated during one pattern or until contraction weakens.

Back 149

Repeated Contractions

Front 150

PNF Technique

Voluntary relaxation followed by passive progressing to active-assisted and active-resisted movements to finally active movements.
Verbal commands are used to set the speed and rhythm of the movements.
Light tracking resistance is used during the resistive phase to facilitate movement.

Back 150

Rhythmic Initiation

Front 151

PNF Technique

A relaxation technique usually performed in a position of comfort and below a level that causes pain. Strong isometric contraction of the restricting muscles (antagonists) is resisted, followed by voluntary relaxation, and passive movement into the newly gained range of the agonist pattern.

Back 151

Hold-relax

Hint 151

The hold-relax method of PNF stretching is facilitated by the golgi tendon organ to allow a reflexive relaxation of the muscle. It can be done individually or with assistance from a trainer or physical therapist. The danger of the hold relax PNF stretching technique is that with this inhibition of muscle activity, it may predispose an athlete to injury if done prior to an athletic event.

Front 152

PNF Technique

A relaxation technique usually performed at a point of limited ROM in the agonist pattern. Strong, small range isotonic contraction of the restricting muscles (antagonist) with emphasis on the rotators is followed by an isometric hold. The contraction is held for few seconds and is then followed by voluntary relaxation and movement into the new range of the agonist pattern. Movement can be passive but active contraction is preferred.

Back 152

Contract-Relax

Hint 152

The first part of this stretch is similar to the hold-relax whereby the muscle being stretched is isometrically contracted for 3 to 6 seconds, then the antagonist muscle will immediately contract for 3 to 6 seconds. The joint is then pushed into its new range.

Front 153

Those that appear and disappear in an expected order during infant development.
They are important signs of a normally functioning nervous system when present at the right stage of development; likewise, abnormal absence of an expected reflex at a given stage of infant development, or presence of (or reappearance of) a reflex beyond the normal time it is normally found implies some abnormal function of the nervous system.

Back 153

Primitive Reflexes

Hint 153

1 Moro reflex
2 Walking/stepping reflex
3 Rooting reflex
4 Sucking reflex
5 Tonic neck reflex
6 Palmar grasp reflex
7 Plantar reflex
8 Galant reflex
9 Swimming reflex

Front 154

Infant reflex

( )
1. Trigger: Loud noise (even baby’s own cry!), sudden movement, or sensation of falling
2. Response: Baby cries and extends legs, arms, and fingers, arches back, then retracts arms and legs
3. Duration: ( )
4. Reason: Baby’s first attempts to protect himself from harm If baby startles himself awake: Try swaddling him to make him feel more secure

Back 154

Moro reflex (also called startle reflex)

3~6

Hint 154

Bilateral absence of the reflex
: Damage to the infant's central nervous system

unilateral absence of the reflex
: Injury due to birth trauma (e.g., a fractured clavicle or injury to the brachial plexus).
Erb's palsy or some other form of paralysis

Front 155

Infant reflex

( )
1. Trigger: Holding baby upright with his feet on a flat surface
2. Response: Baby lifts one foot, then the other, as if walking
3. Duration: ( )
4. Reason: May prepare baby developmentally for walking several months from now

Back 155

Walking (or stepping) reflex

2 months

Hint 155

The walking or stepping reflex is present at birth; though infants this young cannot support their own weight. When the soles of their feet touch a flat surface they will attempt to 'walk' by placing one foot in front of the other. This reflex disappears at six weeks due to an increased ratio of leg weight to strength.
It reappears as a voluntary behavior around eight months to one year old.

Front 156

Infant reflex

( )
1. Trigger: A gentle stroke on the newborn’s cheek
2. Response: Baby turns toward the touch, with mouth open
3. Duration: Until baby is ( ) ~ ( ) months old
4. Reason:

Back 156

Root reflex

3~4

Helps baby find food

Hint 156

The rooting reflex is present at birth and disappears around four months of age, as it gradually comes under voluntary control. The rooting reflex assists in the act of breastfeeding. A newborn infant will turn his head toward anything that strokes his cheek or mouth, searching for the object by moving his head in steadily decreasing arcs until the object is found.
After becoming used to responding in this way, (if breastfed, approximately three weeks after birth), the infant will move directly to the object without searching.

Front 157

Infant reflex

( )
1. Trigger: Something, such as a nipple (breast or bottle) or parent’s finger, touching roof of baby’s mouth
2. Response: Baby sucks on nipple
3. Duration: ( ) ~ ( ) months
4. Reason:

Back 157

Suck reflex

3~4

Helps baby eat

Hint 157

The sucking reflex is common to all mammals and is present at birth. It is linked with the rooting reflex and breastfeeding. It causes the child to instinctively suck anything that touches the roof of their mouth, and simulates the way a child naturally eats

Front 158

Infant reflex

( )
1. Trigger: Lying on his back with head turned to one side
2. Response: The arm on that side extends, while the opposite arm bends at the elbow (a “fencing” position) 3. Duration: ( )
4. Reason: May prepare baby developmentally for voluntary reaching later

Back 158

Asymetric Tonic neck reflex

About six months (sometimes not present until two months of age)

Hint 158

Asymmetric tonic neck reflex or 'fencing posture' is present at one month of age and disappears at around four months. When the child's head is turned to the side, the arm on that side will straighten and the opposite arm will bend (sometimes the motion will be very subtle or slight). If the infant is unable to move out of this position or the reflex continues to be triggered past six months of age, the child may have a disorder of the upper motor neurons.
According to researchers, the tonic neck reflex is a precursor to the hand/eye coordination of the infant. It also prepares the infant for voluntary reaching.

Front 159

Infant reflex

( ) Reflex
1. Stimulus : maintain pressure to palm of hand or to ball of foot under toes
2. Response : maintain flexion of fingers or toes.
3. Integrated : palmar ( ) ~ ( ) months.

Back 159

Grasp

palmar 4 ~ 6

plantar 9

Hint 159

The palmar grasp reflex appears at birth and persists until five or six months of age. When an object is placed in the infant's hand and strokes their palm, the fingers will close and they will grasp it with a palmar grasp. The grip is strong but unpredictable; though it may be able to support the child's weight, they may also release their grip suddenly and without warning. The reverse motion can be induced by stroking the back or side of the hand.

Front 160

( ) reflex

1. Trigger: Pressing a finger or other object, such as a rattle, into baby’s palm
2. Response: Baby makes a fist and tries to grab finger
3. Duration: ( )
4. Reason: May prepare baby developmentally for voluntary grasping later
5. Fun fact: Baby’s grip can be strong enough to support his entire body weight

Back 160

Grasping(palmar) reflex

3months

Front 161

Infant reflex

( )
1. Trigger: A gentle stroke on the sole of the foot (from heel to toe)
2. Response: Foot turns in and toes flare up
3. Duration: ( )
4. Reason: Perhaps an attempt to protect against falling

Back 161

Babinski’s reflex

4 ~ 6 months

Hint 161

A plantar reflex is a normal reflex that involves plantar flexion of the foot, which moves toes away from the shin and curls them down. An abnormal plantar reflex (aka Babinski Sign) occurs when upper motor neuron control over the flexion reflex circuit is interrupted. This results in a dorsiflexion of the foot (foot angles towards the shin, big toe curls up). This also occurs in babies under ~1 year, because of low myelination of the corticospinal tracts. As these tracts develop to adult form, the flexion-reflex circuit is inhibited by the descending corticospinal inputs, and the normal plantar reflex develops.
Also known as the Babinski reflex, this is a sign of neurological abnormality in adults (e.g., upper motor neurone lesion)

Front 162

Infant reflex

( ) reflex
When the skin along the side of an infant's back is stroked, the infant will swing towards the side that was stroked.
Period : Within ( ) months.

Back 162

Galant reflex

4~6 months

Hint 162

The Galant reflex, also known as Galant's infantile reflex, is present at birth and fades between the ages of four to six months.
When the skin along the side of an infant's back is stroked, the infant will swing towards the side that was stroked. If the reflex persists past six months of age, it is a sign of pathology.

Front 163

Reflex actions originating in the central nervous system that are exhibited by normal infants, but not neurologically intact adults, in response to particular stimuli.
These reflexes disappear or are inhibited by the frontal lobes as a child moves through normal child development

Back 163

Neonatal Primitive Reflexes

(=called infantile, infant or newborn reflexes)

Front 164

Infant reflex

( ) Reflex
1. Stimulus : noxious stimuli to the ball of foot of extremity fixed in extension; tested in supine position.
2. Resoponse :
a. Opposite lower extremity flexes, then adducts and extends.
b. In patients with hemiplegia, lifting the uninvolved leg off the ground during ambulation results in increased extensor tone in the involved leg.
3. Integrated : ( ) ~ ( ) months.

Back 164

Crossed extension reflex

1~2 months

Front 165

Infant reflex

( ) Reflex
1. Stimulus : displace the center of gravity by tilting or moving the support surface
2. Response
a. Curvature of the trunk toward the upward side along with extension and abduction of the extremities on that side.
b. Protective extension on the opposite side
3. Integrated

Back 165

Equilibrium Reactions

Persists

Front 166

Infant reflex

( ) Reflex
1. Stimulus : lift the child under the thorax in a prone position.
2. Response : first the head and then the back and legs will extend. If the head is then pushed into flexion, the extensor tone will disppear.
3. Integrated : ( ) months
4. Absent :

Back 166

Landau's Reflex

24months

strong flexor spasticity

Front 167

Infant reflex

( ) Reflex
1. Stimulus : Contact to the ball of foot under toes(plantar).
2. Response : rigid extension (cocontraction) of the lower extremities with
(1) ankel : (dorsi flexion / plantar flexion)
(2) Toes "clawing" and
(3) Hip : (internal / external) rotation.
3. Integrated : ( ) months.

Back 167

Positive Supporting Reaction.

Plantar flexion

Internal
6

Front 168

Infant reflex

( ) Reflex
1. Stimulus : displace the center of gravity outside the base of support.
2. Response
a. Arms or legs extend and abduct to support and to protect the body against falling.
b. Protective extension downward (parachute reaction) develops first, followed by forward, sideward and backward protective extension.
3. Onset
a. Arms : ( )~( ) months.
b. Legs : ( )~( ) months.
4. Integrated : ( ) months

Back 168

Protective extension reaction

a. 4~6
b. 6~9
Persist

Front 169

Developmental Behaviors

( ) Month
Can maintain quadruped, pivots on belly, prone extension position (pivot prone), assumes sitting from quadruped, trunk rotation in sitting and recognizes tone of voice.

Back 169

7 Months

Hint 169

Front 170

Developmental Behaviors

( ) month
Can prop up head and chest for a long time(pivot prone), head no longer lags in pull to-sitting sits with support, laughs out loud, rolls prone to side, suine to side, optical and labyrinthine head righting

Back 170

4 Month

Front 171

Developmental Behaviors

( ) Month
Belly crawls, quadruped creeping, side-sitting, pulls to stand through kneeling, cruises sideways, can stand alone, has, ( ) grasp with ghumb and forefinger, can transfer objects from one hand to the other, moves quadruped to sitting.

Back 171

8~9 Month

Pincer

Front 172

Developmental Behaviors

( ) month
can roll from prone to supine, head control in supported sitting, and weight shifting from one forearm to the other in prone.

Back 172

5 Month

Front 173

Developmental Behaviors

( ) Months
Can walk up and down stairs with assitance, ascends stairs with step-to-pattern, sits on asmall chair, begins to run more coordinated, jumps off bottm step, plays make-believe.

Back 173

18~20 Months

Front 174

Developmental Behaviors

( ) Month
Rolls from supine to prone, independent sitting, pulls to stand and prone on hands with elbows extended while weight shifting from hand to hand.

Back 174

6 Month

Front 175

Sul A 11
An appropriate fine motor behavior that should be established by 9 months of age would be the ability to:

1. Pick up a raisin with a fine pincer grasp.
2. Build a tower of four blocks.
3. Hold a cup by the handle while drinking.
4. Transfer objects from one hand to another.

Back 175

4
Transferring objects from one hand to another is a task developmentally appropriate for an 8- or 9-month-old.

Hint 175

INCORRECT CHOICES :
Using a fine pincer grasp and building a tower of four blocks are skills that develop later.
Holding a cup by the handle while drinking usually occurs by 12 months of age.

Front 176

Developmental Behaviors

( ) Month
Runs well, can go up stairs one at a time (reciprocal), active, restless, tantrums.

Back 176

24 Month

Front 177

Developmental Behaviors

( ) Month
Stands and begins to walk unassited, begins self-feeding, searches for hidden toys, plays patty-cake and peek-a-boo, imitates, reaches with supination, neat pincher grasp with release.

Back 177

10~15 months

Front 178

B1
A physical therapy plan of care for a child with spastic cerebral palsy who is 3 years old chronologically and cognitively but at a 6-month-old gross developmental level would include:

1. Reaching for a black and white object while in the supine position.
2. Reaching for a multicolored object while in an unsupported standing position.
3. Reaching for a multicolored object while in an unsupported, guarded sitting position.
4. Visually tracking a black and white object held 9 inches from his/her face.

Back 178

3
The appropriate task would include the 6-month-old gross developmental level activity of working on unsupported sitting.

Hint 178

INCORRECT CHOICES:
Standing and supine are not appropriate choices (too advanced or not advanced enough). The use of a multicolored object is more appropriate than a black and white object for a 3-year-old cognitive level.

Front 179

Scoring system used to evaluate the status of the newborn.

Back 179

APGAR

Front 180

APGAR

5 contesnts

Back 180

(1) Appearance (=Color)
(2) Pulse (=Heart rate)
(2) Grimace (=Activity)
(3) Muscle tone (=Reflex)
(5) Respiration

Front 181

APGAR Score

(1) Normal -
(2) Some care -
(3) Innediate care -

Back 181

(1) 7 or better

(2) 5~6

(3) less than 4

Hint 181

If the Apgar score remains below 3 at later times such as 10, 15, or 30 minutes, there is a risk that the child will suffer longer-term neurological damage.

Front 182

Brachial plexus injuryes
Upper = ( ) palsy
1. Occurs when the ( ) and ( ) nerve roots are stretched during the birth process.
2. Weakness - glenohumeral (abduction / adduction), (Internal / external) rotation, Elbow (flexion / extension), and (Pronation / Supination)
3. ( ) deformity
4. Not able to : ( ), ( ), ( )

Back 182

Erb's palsy

1. C5~C6
2. Abduction, external, flexion, supination
3. Waiter's tip
4. Hug a doll, Drink from a cup, Zipper a winter coat

Hint 182

Front 183

Brachial plexus injuryes
Lower = ( ) palsy
1. Occurs when the ( ) and ( ) nerve roots are stretched during the birth process.
2. The result is weakness of th and and wrist (flexors/extensors)
3. Deformity : ( )

Back 183

Klumpke's paralysis

1. C8~T1
2. flexors
3. Claw hand

Hint 183

Front 184

Sul A56
A newborn with Erb-Klumpke palsy is referred for physical therapy.
INITIALLY, the plan of care (POC) should include:

1. Partial immobilization of the limb across the abdomen followed by gentle ROM after immobilization.
2. Passive mobilization of the shoulder in overhead motions.
3. Age-appropriate task training of the upper extremity.
4. Splinting the shoulder in abduction and internal rotation

Back 184

1
Erb's palsy is a paralysis of the upper limb that typically results from a traction injury at birth causing a brachial plexus injury. Variations include Erb Duchenne (affecting C5-6 roots), whole arm palsy (affecting C5-T1 roots), and Erb-Klumpke (affecting the lower plexus nerve roots, C8 and T1). Partial immobilization of the limb across the abdomen followed by gentle ROM is the best choice for intial intervention.

Hint 184

INCORRECT CHOICES : Mobilization in overhead motions is contraindicated.
Splinting the shoulder in abduction leads to formation of abduction contractures and later hyperrnobility of the shoulder.
Age-appropriate task training can follow after the initial treatment.

Front 185

Premature Infant

The birth of an infant before ( ) week's gestation.

Back 185

37 weeks

Front 186

Cerebral palsy

Athetoid
1. Results from ( ) involvement
2. (Rapid/Slow), writhing, involumtary movements may affect the extremities.
3. Decreased muscle tone, poor functional stabiilty in (Proximal/Distal) joints, poor visual tracking, speech delay and oral-motor problems.

Back 186

1. Basal ganglia

2. Slow

3. Proximal

Front 187

Sul A 160
A patient suffered carbon monoxide poisoning from a work-related factory accident and is left with permanent damage to the basal ganglia. Intervention for this patient will need to address expected impairments of:

1. Motor paralysis with the use of free weights to increase strength.
2. Muscular spasms and hyperreflexia with the use of ice wraps.
3. Impaired sensory organization of balance with the use of standing balance platform training.
4. Motor planning with the use of guided and cued movement.

Back 187

4
The basal ganglia functions to convert general motor activity into specific, goal-directed action plans. Dysfunction results in problems with motor planning and scaling of movements and postures. Patients benefit from initial guided movement and task-specific training. Proprioceptive, tactile, and verbal cues can also be used prior to and during a task to enhance movement.

Hint 187

INCORRECT CHOICES:
The other listed deficits (choices) are not seen with basal ganglia disorders. Paralysis,hypertonicity, and hyperreflexia occur with upper motor neuron lesions (corticospinal tract involvement). Problems with sensory organization and selection can occur with traumatic brain injury, and stroke and in children with cerebral palsy, Down syndrome, and learning disabilities.

Front 188

Down Syndrome
1. A congenital chromosomal abnormality, resulting in an extra chromosome ( ).
2. (Hypo/Hyper tonia), decreased muscle force, congenital heart defects.
3. Forceful neck flexion and rotation activities should be limited due to : ( )

Back 188

1. 21

2. Hypo

3. atlantoaxial ligamentous laxity

Front 189

Sul A 153
An 18-month-old child with Down syndrome and moderate developmental delay is being treated at an Early Intervention Program.
Daily training activities that should be considered include:

1. Stimulation to postural extensors in sitting using rhythmic stabilization.
2. Locomotor training using body weight support and a motorized treadmill.
3. Holding and weight shifting in sitting and standing using tactile and verbal cueing.
4. Rolling activities, initiating movement with stretch and tracking resistance.

Back 189

3
Children with Down syndrome typically present with generalized hypotonicity. The low tone is best managed by weightbearing
activities in antigravity postures. Typical responses include widened base-of-support and cocontraction to gain
stability. Verbal cueing for redirection is generally the best form of feedback to use along with visually guided postural control.

Hint 189

INCORRECT CHOICES:
Proprioceptors are not in a high state of readiness and the child may be slow to respond to proprioceptive facilitation techniques
(i.e., stretch, resistance, rhythmic stabilization).
With developmental delay, this child is not ready for intensive locomotor training.

Front 190

Duchenne's Muscular Dystrophy

1. Genetic disease that affects (males / females).
2. Progressive weakness from (proximal / distal) to (proximal / distal) presenting in (boys/ girls) form ( ) to ( ) years old
3. ( ) gait pattern, toe walking, (lordosis/flat back).
4. Difficulty standing up : ( ) sign
5. Especial imbalance muscle : ( ), ( )

Back 190

1. males
2. proximal, distal, boys, 3~7
3. Wadding
4. Gower's

Front 191

A187
A 6-year-old boy has a diagnosis of Duchenne's muscular dystrophy with more than a third of lower extremity muscles graded less than 3/5. The child is still ambulatory with assistive devices for short distances.
The MOST appropriate activity to include in his POC would be:

1. Progressive resistance strength training at 80% maximum vital capacity.
2. 30 minutes of circuit training using resistance training and conditioning exercises.
3. Recreational physical activities such as swimming.
4. Wheelchair sports.

Back 191

3
Exercise at low to moderate intensities is the general rule for patients with muscular dystrophy. Because of the young age of this child, exercise should be fun. Recreational exercise (swimming) satisfies this requirement and should be helpful in maintaining functional level as long as possible. At 6 years of age, wheelchair confinement is not usual.

Hint 191

INCORRECT CHOICES:
Muscles with grades of 3 or less will not benefit from active or resistive exercise. Progressive resistance strength training (choice 1) and circuit training (choice 2) can be harmful at high intensities, producing overwork injury. Wheelchair sports (choice 4) is not applicable for a 6-year-old child.

Front 192

Myelomeningocele (= ' ')

- A defect in the vertebrae resulting in protrusion of the spinal cord and meniges

Back 192

spina bifida

Front 193

Charcot-Marie-Tooth Disease

1. A hereditary disorder of the ( ) muscle and (proximal/distal) (arms/legs) muscles.
2. Patient problems include foot drop and ( ) leg deformity.
3. Ankel : ( ) deformity.
4. Foot : ( ) toes

Back 193

1. peroneus, distal, legs
2. Stork
3. Equinovarus
4. Claw

Front 194

When your child does not reach their developmental milestones at the expected times. It is an ongoing major or minor delay in the process of development.

Back 194

Deveolomental delay

Front 195

"water on the brain"
Medical condition in which there is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain.
This may cause increased intracranial pressure inside the skull and progressive enlargement of the head, convulsion, tunnel vision, and mental disability.

Back 195

Hydrocephalus

Front 196

A 145
During a home visit, the mother of an 18-month-old child with developmental delay and an atrioventricular shunt for hydrocephalus tells the PT that her daughter vontited several times, was irritable, and is now lethargic.
The therapist's BEST course of action is to:

1. Call for emergency transportation and notify the pediatrician immediately.
2. Give the child a cold bath to try to rouse her.
3. Place the child in a side-lying position and monitor vital signs.
4. Have the mother give the child clear liquids because she vomited.

Back 196

1
These signs and symptoms could be the result of increased cerebral edema due to a clogged or infected shunt.
Medical attention should be obtained immediately to avoid damage to the brain.

Hint 196

INCORRECT CHOICES:
The other choices do not adequately respond to this emergency situation.

Front 197

Legg-Calve-Perthes Disease

1. Idiopathic aseptic necrosis of the ( ) epiphysis.
2. Usually unilater. Affecting mostly (boys/girls/both) between ( ) and ( ) years of age.

Back 197

1. femoral capital

2. boys, 5~10 years

Front 198

SCI Examination

Used to document sensory and motor impairments following SCI.

Back 198

ASIA scale

Front 199

ASIA SCALE

Grade 'B' :

Back 199

Incomplete.
Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5

Front 200

ASIA SCALE

Grade 'A' :

Back 200

Complete.
No sensory or motor function is preserved in the sacral segments S4-S5

Front 201

ASIA SCALE

Grade 'D' :

Back 201

Incomplete.
Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade greater than or equal to 3.

Front 202

ASIA SCALE

Grade 'C' :

Back 202

Incomplete.
Motor function is preserved below the neurological level, and more then half of key muscles below the neurological level have a muscle grade less then 3 (Grades 0-2).

Front 203

ASIA SCALE

Grade 'E' :

Back 203

Normal.
Sensory and motor functions are normal.

Front 204

Sul A7
An injury classified as American Spinal Injury Association (ASIA A) is a complete injury.
This lesion is below L1, making it a cauda equina injury (injury is to peripheral roots and nerves, a lower motor neuron injury).
Because regeneration is possible, some recovery of function can be expected.

1. A spastic or reflex bladder.
2. Some recovery of function because damage is to peripheral nerve roots.
3. Loss of motor function and pain and temperature sensation below the level of the lesion with light touch, proprioception, and position sense preserved.
4. Greater loss of upper extremity function than lower extremity function with early loss of pain and temperature sensation.

Back 204

2
A spinal cord lesion below L1 is a cauda equina lesion (injury to peripheral roots and nerves, lower motor neuron injury).
Because regeneration is possible, some recovery in function can be expected.

Hint 204

INCORRECT CHOICES:
A spastic or reflex bladder is associated with upper motor neuron injury. Other choices describe the deficits associated with anterior cord syndrome (choice 3) or central cord syndrome (choice 4).

Front 205

Spinal Cord Injury

( )
1. Temporary phenomenon that occurs after trauma to the spinal cord in which the cord ceases to function below the lesion.
2. Usually resoves within ( ) hours of injury with the return of the anal and bulabocavernosus reflexes.

Back 205

Spinal shock

24 hours

Front 206

Spinal Cord Injury

Designation of spinal level.
(1) Defined as the most (cranial/caudal) level of the spinal cord
(2) Muscles must have a grade of at least ( ) / 5 strength

Back 206

caudal

3+

Front 207

Spinal Cord Injury

( )
- Hemisection of the spinal cord, usually from stab or gunshot wounds

a. Ipsilateral
b. Contralateral

Back 207

Brown - S quard syndrome

Ipisilateral : weakness or motor paralysis, loss of proprioception, vibratory sense and two point discrimination, deceased reflexes, clonus and spasticity.

Contralateral : loss of pain and temperature

Front 208

Spinal Cord Injury

( ) cord.

(1) Loss of motor and loss of pain and temperature

(2) Related to flexion injuries of the cervical region.

Back 208

Anterior

Front 209

Spinal Cord Injury

( ) cord

(1) Most commonly occurs from hyperextension injuries with minor trauma to the cervical region.
(2) Affecting the (upper/lower) extremity sensation and motor functioning with normal lower extremity functioning.

Back 209

central

upper

Front 210

Spinal Cord Injury

Posterior cord

(1) Very rare with dificits of ( )

(2) An ataxic gait with a wide base of support may result.

Back 210

kinesthesia

Front 211

Spinal Cord Injury

Cauda Equina

(1) Injury below the ( ) segment that results in damage to the lumbar and sacral nerve roots.

(2) Regeneration ( possible / impossible )

Back 211

L1

Hint 211

Cauda equina syndrome

Serious neurologic condition in which damage to the cauda equina causes acute loss of function of the lumbar plexus, (nerve roots) of the spinal canal below the termination (conus medullaris) of the spinal cord. CES is a lower motor neuron lesion.



Signs and symptoms : Severe back pain, Saddle anesthesia, Bladder and bowel dysfunction, Achilles (ankle) reflex absent on both sides, Sexual dysfunction

Management : Bowel and bldder controle

Front 212

Spinal Cord Injury

( )
(1) Incomplete lesion in which the most centrally located sacral tracts are spared.

(2) Perianal sensation, rectal sphincter contraction, cutaneous innervation in the saddle area and active contraction of the sacrally innervated toe flexors are intact.

Back 212

Sacral sparing

Hint 212

Even though sensation is impaired in the thoracic and lumbar dermatomes below the level of the lesion. Sacral sparing may also include the preservation of motor function (voluntary external anal sphincter contraction) in the lowest sacral segments. Sacral sparing has been attributed to the idea that the sacral spinal pathways are not as likely as the other spinal pathways to become compressed after injury. The sparing of the sacral spinal pathways can be attributed to the lamination of fibers within the spinal cord.

Front 213

Spinal Cord Injury

Bowel and bladder continence
- Voluntary control of urination and defecation is lost after an injury to the sacral cord ( ) ~ ( )
(1) Autonomous or nonreflex (UMN / LMN) bladder - flaccid and can be emptied by increasing intraabdominal pressure or by manually compressing the lower abdomen.
(2) Reflex (UMN / LMN) bladders - empty in response to a certain level of filling pressure.

Back 213

S2 ~ S4

LMN

UMN

Front 214

Spinal Cord Injury

Thermoregulation

(1) Hyperthermia -

(2) Hypothermia -

Back 214

(1) Loss in sympathetic control of the sweat glands.

(2) Hypothalamus > peripheral vosodilation

Front 215

Spinal Cord Injury

Pressure relief over bony areas should take place every ( )~ ( ).

Back 215

15~20

Front 216

Spinal Cord Injury

- A medical emergency characterized by a sudden increase in blood pressure, bradycardia, a pounding headache, flushing, profuse sweating and anxiety.

Back 216

Autonomic dysreflexia

Hint 216

Potentially life threatening condition which can be considered a medical emergency requiring immediate attention. AD occurs most often in spinal cord-injured individuals with spinal lesions above the T6 spinal cord level, although it has been known to occur in patients with a lesion as low as T10.



Paroxysmal hypertension (the sudden onset of severe high blood pressure) associated with throbbing headaches, profuse sweating, nasal stuffiness, flushing of the skin above the level of the lesion, slow heart rate, anxiety, and sometimes by cognitive impairment.

Front 217

Sul A91
A patient is recovering from a complete SCI (ASIA A) with C5 tetraplegia. The PT is performing PROM exercises on the mat when the patient complains of a sudden pounding headache and double vision.
The therapist notices the patient is sweating excessively, and determines BP is 240/95. The therapist's BEST course of action is to:

1. Lay the patient down immediately, elevate the legs, and then call for a nurse.
2. Place the patient in a supported sitting position and continue to monitor BP before calling for help.
3. Sit the patient up, check/empty catheter bag, and then call for emergency medical assistance.
4. Lay the patient down, open the shirt, and monitor respiratory rate closely.

Back 217

3
The patient is exhibiting autonomic dysreflexia (an emergency situation).
The therapist should first sit the patient up and check for irritating or precipitating stimuli (e.g., a blocked catheter).
The next step is to call for emergency medical assistance.

Hint 217

INCORRECT CHOICES:
Placing the patient supine can aggravate the situation.
Continuing to monitor BP before calling for help causes an unnecessary delay in emergency services.

Front 218

Spinal Cord Injury

( )
- A decrease in blood pressure that occurs when a patient is moved from a horizontal position to a vertical one.

Back 218

Postural or orthostatic hypotension

Hint 218

Head rush or dizzy spell, is a form of hypotension in which a person's blood pressure suddenly falls when standing up or stretching. In medical terms, it is defined as a fall in systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg when a person assumes a standing position.

Orthostatic hypotension may cause accidental falls.

Front 219

Spinal Cord Injury

( )
Formation of new bone within muscles or other connective tissue below the lesion.

Back 219

Heterotopic bone formation

Hint 219

Heterotopic ossification of varying severity can be caused by surgery or trauma to the hips and legs. About every third patient who has total hip arthoplasty (joint replacement) or a severe fracture of the long bones of the lower leg will develop heterotopic ossification, is uncommonly symptomatic. Between 50% and 90% of patients who developed heterotopic ossification following a previous hip arthoplasty will develop additional heterotopic ossification.

Front 220

Spinal Cord Injury

C1~C3

(1) Breathing :
(2) Wheelchair :
(3) Wheelchair control :
(4) Wheelchair trunk control :

Back 220

(1) Portable ventilator or phrenic nerve stimulator

(2) Power "tilit-in-space"

(3) Mouth control

(4) Seatbelt

Front 221

Spinal Cord Injury

C4

(1) Key muscle :
(2) Breathing (cough) :
(3) Wheelchair control :

Back 221

(1) Diaphragm, trapezius

(2) Glossopharyngeal breathing

(3) Chin control

Front 222

Spinal Cord Injury

C5

(1) Key muscles : ( ), ( ), ( )
(2) Wheel chair :
(3) Cough technique :

Back 222

(1) Biceps, Supinator, Rhomboid

(2) Power with hand controls (joystick)

(3) Manual

Front 223

Spinal Cord Injury

Level ( )
- Capable of full use of upper extremities, impreoved trunk control, increased respiratory reserve.
- Key muscles : intercostals, long muscles of the back, intrinsic finger flexors.

Back 223

T1~T5

Front 224

Spinal Cord Injury

C7 : Key muscles
- (5)

Back 224

Extensor pollicis longus and brevis

Extrinsic finger extensors,

flexor carpi radialis

Triceps

Front 225

Spinal Cord Injury

Level ( )

Can become independent in self-care with equipment;

Transfers with a 'sliding board'

Back 225

C6

Front 226

Sul A97
A patient with complete C6 tetraplegia (ASIA A) should be instructed to initially transfer with a sliding board using:

1. Shoulder depressors and triceps, keeping the hands flexed to protect tenodesis grasp.
2. Pectoral muscles to stabilize the elbows in extension and scapular depressors to lift the trunk.
3. Shoulder extensors, external rotators, and anterior deltoid to position and lock the elbow.
4. Serratus anterior to elevate the trunk with elbow extensors stabilizing.

Back 226

3
The patient with complete C6 quadriplegia will lack triceps (elbow extensors) and should be taught to lock the elbow for push-up transfers by using shoulder external rotators and extensors to position the arm; the anterior deltoid locks the elbow by reverse actions (all of these muscles are functional) .

Hint 226

INCORRECT CHOICES :
Triceps are not functional in this patient. Pectoral muscles cannot be used to stabilize the elbows in extension.

Front 227

Spinal Cord Injury

T9~T12 Gait

Back 227

Independent swigh-to or through gait on level surfaces with bilateral KAFOs and a walker or forearm crutches.

Independent floor to wheelchair and tub transfers.

Independent household ambulators.

Front 228

Spinal Cord Injury

Level ( )

Capable of stron hip flexion and knee extension, weak knee flexion, improved trunk control.

Back 228

L4~L5

Front 229

Spinal Cord Injury

Level ( )

- Capable of jull use of all upper extremity muscle except intrinsics of the hand.
- Independent in living at home except for heavy work.

Back 229

C8

Front 230

Spinal Cord Injury

T6~T8 Gait

Back 230

Independent in swingto gait in parallel bars with bilateral KAFOs for short distances.

Supervision with walker and KAFOs in home.

Front 231

Spinal Cord Injury

T12~L3 Gait

Back 231

Independent swing-to, swing-thorugh or four-pint gait with bilateral KAFOs and forearm crutches on level surfaces and small elevations.

Independent home ambulators.

Can be 'community ambulators'

Front 232

A85
To prepare a patient with an incomplete T12 paraplegia, (ASIA A), for ambulation with crutches, the upper quadrant muscles that would be MOST important to strengthen include the:

1. Upper trapezius, rhomboids, and levator scapulae.
2. Deltoid, triceps, and wrist flexors.
3. Middle trapezius, latissimus dorsi, and triceps.
4. Lower trapezius, lati ssimus dorsi, and triceps.

Back 232

4
The upper quadrant muscles that are most important to strengthen for crutch gaits include the lower trapezius,latissimus dorsi, and triceps. Shoulder depression and elbow extension strength are crucial for successful crutch gait.

Hint 232

INCORRECT CHOICES:
The other choices include muscles not critical to swing-to or swing-through crutch gaits required by a patient with a complete SCI (ASIA A) at T12.

Front 233

Spinal Cord Injury

C6 : Key muscles
- ( 6 )

Back 233

Extensor carpi radialis,

Infraspinatus,

Latissimus dorsi,

Pectoralis major,

serratus anterior

teres minor

Front 234

Cerebral hemisphere

Primary motor cortex for voluntary muscle activation.

( ) lobe - ( )

Back 234

Frontal - Precentral

Front 235

Cerebral hemisphere

Controls emotions and judgments.

( ) lobe - ( )

Back 235

Frontal - Prefrontal

Front 236

Cerebral hemisphere

Controls motor aspects of speech

( ) lobe - ( )

Back 236

Frontal - Broca's

Hint 236

Frontal lobe of one hemisphere (usually the left) of the hominid brain with functions linked to speech production.

Brodmann's cytoarchitectonic map as areas 44 and 45

Expressive aphasia (= Broca's aphasia)
Typically able to comprehend words, and sentences with a simple syntactic structure (see above),
but are more or less unable to generate fluent speech

Front 237

Cerebral hemisphere

Primary sensory cortex for integraion of sensation.

( ) lobe - ( )

Back 237

Parietal - Postcentral gyrus

Hint 237

Lesions - Dysfunction in texture, size, and shape discrimination

agraphesthesia, astereognosia, hemihypesthesia, and loss of vibration, proprioception and fine touch

Front 238

Cerebral hemisphere

Recieves fibers conveying touch, proprioceptive, pain, and temperature sensations from opposite side of body.

( ) lobe

Back 238

Parietal lobe

Hint 238

Damage to the right hemisphere of this lobe results in the loss of imagery, visualization of spatial relationships and neglect of left-side space and left side of the body. Even drawings may be neglected on the left side. Damage to the left hemisphere of this lobe will result in problems in mathematics, long reading, writing, and understanding symbols.

Front 239

Cerebral hemisphere

Primary auditory cortex : receives / processes auditory stimuli.

( ) lobe

Back 239

Temporal lobe

Hint 239

Function
(1) Visual memories : The temporal lobe contains the hippocampus and plays a key role in the formation of explicit long-term memory modulated by the amygdala
(2) Processing sensory input : Auditory, Visual
(3) Language recognition : primary auditory cortex, Wernicke's area
(4) New memories : Hippocampi, which are essential for memory storage, therefore damage to this area can result in impairment in new memory formation leading to permanent or temporary anterograde amnesia.

Damage : Inability to connect the visual stimuli perceived to the visual processing and interpretation centers

Front 240

Cerebral hemisphere

Language comprehension.

( ) lobe - ( ) area

Back 240

Temporal - Wernicke's

Hint 240

Brodmann area 22

Understanding of written and spoken language

Destruction to Wernicke's area results in receptive, fluent aphasia

Front 241

Cerebral hemisphere

Primary visual cortex - receives / processes visual stimuli

Back 241

Occipital lobe

Hint 241

Primary visual cortex

Brodmann area 17

Front 242

Cerebral hemisphere

( )
Deep within lateral sulcus, associated with visceral functions.

Back 242

Insula

Front 243

Cerebral hemisphere

( )
Basic functions include feeding, aggression, emotions, and endocrine aspects of sexual response.

Back 243

Limbic system

Front 244

Cerebral hemisphere

Limbic system consists of ( ), ( ), ( ), ( ), anterior necleus of ( )

Back 244

Limbic lobe, hippocampal formation, amygdaloid nucleus, hypothalamus, thalamus

Front 245

Diencephaon

( )
Midline symmetrical structure of two halves, within the vertebrate brain, situated between the cerebral cortex and the midbrain. Some of its functions are the relaying of sensory and motor signals to the cerebral cortex, and the regulation of consciousness, sleep, and alertness. The thalamus surrounds the third ventricle. It is the main product of the embryonic diencephalon.

Back 245

Thalamus

Front 246

Diencephalon

( )
1. Link the nervous system to the endocrine system via the pituitary gland (hypophysis).
2. Responsible for certain metabolic processes and other activities of the autonomic nervous system
3. Controls body temperature, hunger, important aspects of parenting and attachment behaviors, thirst, fatigue, sleep, and circadian rhythms.

Back 246

Hypothalamus

Front 247

Diencephalon

( )
1. Secretion of melatonin by the pineal gland.
2. Regulation of motor pathways and emotions.
3. Wired with the limbic system and basal ganglia.

Back 247

Epithalamus

Front 248

Four motor symptoms are considered cardinal in Parkinson's Disease : ( )

Back 248

(1) Tremor (resting) : pill & rolling

(2) Bradykinesia (slowness of movement)

(3) Rigidity : Stiffness and resistance to limb movement caused by increased muscle tone, an excessive and continuous contraction of muscles

(4) Postural instability : secondarily to bone fractures

Hint 248

Front 249

Brainstem

( )
1. Function : eye movement, motor planning, reward-seeking, learning, and addiction
2. 'Parkinson's disease' is characterized by the death of dopaminergic neurons

Back 249

Substantia nigra

Front 250

A12
A patient with a 10-year history of Parkinson's disease (PD) has been taking levodopa (Sinemet) for the last 5 years. The patient presents with deteriorating function and is no longer able to walk independently due to constant and uncontrolled involuntary movements.
During the examination, the PT observes the patient is restless, with constant dancing, athetoid-like movements of his legs.
The therapist's BEST course of action is to:

1. Complete the treatment session, focusing specifically on documenting the effects of rigidity.
2. Document the observations and refer the patient back to the physician for possible medication adjustment.
3. Talk to the spouse to see if the patient is taking any drugs with hallucinogenic effects such as selegiline.
4. Examine for additional signs of chronic levodopa therapy such as dizziness and headache.

Back 250

2
Dyskinesias (involuntary movements) are caused by an adverse effect of prolonged use of dopamine.
Other changes include gastrointestinal disturbances (nausea, vomiting) and mental disturbances (restlessness, general overactivity, anxiety, or depression).
Medication adjustment may reduce some of these effects and improve function.

Hint 250

INCORRECT CHOICES:
Although the symptoms described in the other choices may also occur with pharmacological management of PD, they do not adequately explain the presence of adventitious or involuntary movements. Selegiline is used in early PD; itsmain adverse effects include nausea, dry mouth, dizziness, anxiety, and hallucinations. Failure to notify the physician of these documented adverse effects can jeopardize the patient's functional outcomes and safety.

Front 251

Sul A74
A patient with PD demonstrates a highly stereotyped gait pattern characterized by impoverished movement and a festinating gait.
The intervention that would be the MOST beneficial to use with this patient is:

1. Standing and reaching using a body weight support harness.
2. Braiding with light touch-down support of hands.
3. Locomotor training using a rolling walker.
4. Locomotor training using a motorized treadmill and body weight support harness.

Back 251

4
The patient with PD typically presents with postural deficits of forward head and trunk with hip and knee flexion contractures.
Gait is narrow-based and shuffling.
A festinating gait typically results from persistent forward posturing of the body near the forward limits of stability.
Task specific training using body weight support and treadmill training (BWSTT) is the best choice.

Hint 251

INCORRECT CHOICES:
A rolling walker is contraindicated because it would increase forward postural deformities and festinating gait.
Braiding is a complex gait activity that most likely exceeds this patient's abilities.
Standing and reaching with body weight support is an important lead-up activity.

Front 252

A174
A patient with an 8-year history of Parkinson's disease (PD) is referred for physical therapy. During the initial examination, the patient demonstrates significant rigidity, decreased PROM in both upper extremities in the typical distribution, and frequent episodes of akinesia.
The exercise intervention that BEST deals with these problems is:

1. Quadruped position, upper extremity PNF D2 flexion and extension.
2. Resistance training, free weights for shoulder flexors at 80% of one repetition maximum.
3. Modified plantigrade, isometric holding, stressing upper extremity shoulder flexion.
4. PNF bilateral symmetrical upper extremity D2 flexion patterns, rhythmic initiation.

Back 252

4
The patient with PD typically develops elbow flexion, shoulder adduction contractures of the upper extrerllities along with a flexed, stooped posture. Bilateral symmetrical upper extremity PNF D2F patterns encourage shoulder flexion and abduction with elbow extension and upper trunk extension (all needed motions).

Hint 252

INCORRECT CHOICES:
Both quadruped and modified plantigrade positions encourage postural flexion. The patient needs exercises to improve postural flexibility and AROM, not strength of shoulder flexors.

Front 253

Brainstem

( )
1. Nuclei that relay signals from the forebrain to the cerebellum
2. Sleep, respiration, swallowing, bladder control, hearing, equilibrium, taste, eye movement, facial expressions, facial sensation, and posture.
3. Pneumotaxic center, a nucleus that regulates the change from inspiration to expiration.
4. Implication : Sleep paralysis, and also plays a role in generating dreams.

Back 253

Pons

Front 254

Brainstem

( )
Connets the higher levels of the brain to the spinal cord, and is responsible for several functions of the autonomous nervous system.
(1) Respiration – chemoreceptors
(2) Cardiac center – sympathetic, parasympathetic nervous system
(3) Vasomotor center – baroreceptors
(4) Reflex centers of vomiting, coughing, sneezing, and swallowing. These reflexes can be classified as "bulbar reflexes", including the pharyngeal reflex, the swallowing reflex (also known as the palatal reflex), and the masseter reflex

Back 254

Medulla Oblangata

Front 255

( )

In the carotid and aortic bodies monitor blood oxygen, carbondioxide and pH.

Back 255

Chemoreceptors

Front 256

Cerebellum

( )
- Connects with vestibular system and is concerned with equilibrium and regulation of muscle tone;
Helps coordinate vestibulo-ocular reflex.

Back 256

Archicerebellum

Front 257

Cerebellum

( )
1. Receives input from proprioceptive pathways and is concerend with modifiying muscle tone and synergistic actions of muscles.
- It is important in maintenance of posture and volunatary movement control.

Back 257

Paleocerebellum

Front 258

Cerebellum

( )
1. Receives input from corticopontocerebellar tracts and olivocerebellar fibers;
- It is concerned with the sooth coordination of voluntary movements;
- Ensures accurate force, direction, and extent of movement.
- Important for motor learning, sequencing of movements, and visually trigered movements.
- May have a role in assisting cognitive function and mental imagery.

Back 258

Neocerebellum

Front 259

Spinal cord

Anterior horn
(Afferent / Efferent) (Sensory / Motor) Neurons.
- (Alpha / Gamma) effect muscle spindle
- (Alpha / Gamma) effect muscle.

Back 259

Effernt

Motor

Gamma

Alpha

Front 260

Spinal cord

Posterior horn
(Afferent / Efferent) (Sensory / Motor) Neurons.

Back 260

Afferent

Sensory

Front 261

Spinal cord

( )
- Convey sensatons of proprioception, vibration, and tactile discrimination:
( ) - upper extremity tracts, laterally located
( ) - lower extremity tracts, medially located

Back 261

Dorsal columns / Medial lemniscal system

fasciculus cuneatus

fasciculus gracilis

Front 262

Spinal cord

Ascendig fiber systems (sensory pathways)

4 :

Back 262

(1) Dorsla columns / Medial lemniscal system

(2) Spinothalamic tracts

(3) Spinocerebellar tracts

(4) Spinoreticular tracts

Front 263

Spinal cord

( ) tracts
- convey sensations of pain and temperature(lateral), and crude touch(anterior)

Back 263

Spinothalamic tracts

Front 264

Spinal cord

( ) tracts
- Convey proprioeption information from muscle spindles, Golgi tendon organs, and touch and -pressure receptors to cerebellum for control of voluntary movement.

Back 264

Spinocerebellar tracts

Front 265

Spinal cord

( ) tracts
- Convey deep and chronic pain to reticular formation of brainstem via diffuse, polysynaptic pathways.

Back 265

Spinoreticular tracts

Front 266

A 132
During a sensory examination, a patient complains of a dull, aching pain and is not able to discriminate a stimulus as sharp or dull. Two-point discrimination is absent.
Based on these findings, the pathway that is intact is the:

1. Lateral spinothalamic tract.
2. Dorsal columns / neospinothalamic systems.
3. Fasciculus gracilis/medial lemniscus.
4. Anterior spinothalamic tract.

Back 266

4
Sensations interpreted as dull, aching pain travel in the anterior (paleo)spinothalamic tract.

Hint 266

INCORRECT CHOICES : Discriminative fast pain is carried in the lateral (neo)spinothalamic tract.
Discriminative touch is carried in the proprioceptive pathways (fasciculus gracilis/cuneatus, medial lemniscus).

Front 267

Spinal cord

Descending fiber systems (motor pathways)

5 :

Back 267

(1) Corticospinal tracts

(2) Vestibulospinal tracts

(3) Rubrospinal tracts

(4) Reticulospinal tracts

(5) Tectospinal tracts

Front 268

Spinal cord

(1) Important for voluntary motor control
(2) Primary motor coretx, decscend in brainstem, cross in medulla (pyramidal decussation(. via lateral corticospinal tract to ventral gray matter;

Back 268

Corticospinal tracts

Front 269

Spinal cord

(1) Important for control of muscle tone, antigravity muscles, and postural reflexes.
(2) Arise from vestibulr nucleus and cescend to spinal cord in lateral (uncrossed( and medial (crossed and uncrossed( vestibulospinal tracts

Back 269

Vestibulospinal tracts

Front 270

Spinal cord

( )
One of several major motor control pathways. It is smaller and has fewer axons than the corticospinal tract, suggesting that it is less important in motor control.

Back 270

Rubrospinal

Front 271

Spinal cord

( )
Extrapyramidal motor tract that descends from the reticular formation in two tracts to act on the motor neurons supplying the trunk and proximal limb muscles. It is involved mainly in locomotion and postural control, although it does have other effects as well.
1. Integrates information from the motor systems to coordinate automatic movements of locomotion and posture
2. Facilitates and inhibits voluntary movement; influences muscle tone
3. Mediates autonomic functions
4. Modulates pain impulses
5. Influences blood flow to lateral geniculate nucleus of the thalamus.

Back 271

Reticulospinal system

Front 272

Spinal cord

( )
1. Coordinates head and eye movements
2. Mediate reflex postural movements of the head in response to visual and auditory stimuli.

Back 272

Tectospinal tract

Front 273

Brain blood supply

( )
One of the three major paired arteries that supply blood to the cerebrum. The MCA arises from the internal carotid and continues into the lateral sulcus where it then branches and projects to many parts of the lateral cerebral cortex. It also supplies blood to the anterior temporal lobes and the insular cortices.

Back 273

Middle cerebral artery (MCA)

Front 274

Brain blood supply

( )
One of a pair of arteries on the brain that supplies oxygenated blood to most medial portions of the frontal lobes and superior medial parietal lobes. The two anterior cerebral arteries arise from the internal carotid artery and are part of the Circle of Willis.

Back 274

Anterior cerebral artery (ACA)

Front 275

Brain blood supply

( ) blood supply to the posterior portion of the brain, including the occipital lobes, cerebellum and brainstem. It is supplied by the following arteries:

Back 275

PICA

Front 276

Brain blood supply

( )
One of a pair of blood vessels that supply oxygenated blood to the posterior aspect of the brain (occipital lobe) in human anatomy. It arises near the intersection of the posterior communicating artery and the basilar artery and connects with the ipsilateral middle cerebral artery (MCA) and internal carotid artery via the posterior communicating artery.

Back 276

Posterior cerebral artery (PCA)

Front 277

A49
A patient is unable to bring her foot up on the next step during a training session on stair climbing.
The PT's BEST course of action to promote learning of this task is to have the patient practice:

1. Marching in place in the parallel bars.
2. Standing up from half-kneeling.
3. Step-ups onto a low step while in the parallel bars.
4. Balance on the stairs while the therapist passively brings the foot up.

Back 277

3
Active task-specific practice of stepping using a low step represents the best choice to ensure motor learning.

Hint 277

INCORRECT CHOICES:
Passively bringing the foot up does not promote active learning.
Marching in place and balance on stairs are appropriate lead-up skills to stair climbing but are not task-specific practice.

Front 278

CRANIAL NERVE

Test sense of smell on each side: use common, nonirritating odors; close off other nostril.

Q1. Nerve?

Q2. Function?

Back 278

A1. Olfactory

A2. Smell

Q1. Dysfuction : ( )

Hint 278

A1. Anosmia (inability to detect smells), seen with frontal lobe lesions

Front 279

CRANIAL NERVE

Vision

Q1. Nerve?

Q2. Test?

Back 279

A1. Optic

A2. Test visual acuity
Central: Snellen eye chart; test each eye separately by covering other eye; test at distance of 20 feet.
Visual fields: test peripheral vision by confrontation.

Q. Possible : ( )

Hint 279

A. Visual field defects: (homonymous hemi anopsia)

Front 280

CRANIAL NERVE

Occulomotor

Q. Function? (2)

Back 280

A1. Somatic Motor (eyelid and eyeball movement)
Visceral Motor Levator palpebrae, superioris, superior, medial & inferior recti muscles

A2. Parasympathetic to ciliary & pupillary constrictor muscles

Q. Test - Damage? (A2)

Hint 280

A1. Test pupillary reactions (constriction) by shining light in eye;
if abnormal, test near reaction
- Absence of pupillary constriction

A2. Test pupillary size/shape
- Anisocoria (unequal pupils);
Horner's syndrome, CN III paralysis

Front 281

CRANIAL NERVE

Trochlear Nerve

Q1. Function ?

Q2. Muscle Action ?

Back 281

A. Turn eye downward and laterally
(innervates 'superior oblique')

Origin :As above
Insertion : Superior, lateral surface of eyeball
Action : Eye rolls, looks down and to the side

Q. Dysfuction ?

Hint 281

A. Rotation of the eyeball upward and outward

Front 282

CRANIAL NERVE

Trigeminal Nerve

Q1. Sensory -

Q2. Motor -

Back 282

A1. Face, cornea
-> Q1. Test - (1) Face, (2) Cornea

A2. Tempral and masseter muscles
-> Q2. Test -

Hint 282

A1.
(1) Face : Test pain, light touch sensations: forehead, cheeks, jaw (eyes closed)
(2) Cornea : Test corneal reflex: touch lightly with wisp of cotton

Q2. Palpate muscles; have patient clench teeth, hold against resistance.

Front 283

Cranial Nerve

Abducens

Q1. Function -

Q2. Test -

Back 283

A1. Turns eye laterally

A2. Observe position of eye ;
Test pursuit eye movement

Front 284

Cranial Nerve

Facial Nerve

Q1. Function -

Q2. Examination -

Back 284

A1. Facial expression

A2. Test motor function facial muscles:
raise eye, brows, frown, show teeth, smile, close eyes tightly, puff out both cheeks

Q. Abnormal Nerve findings -

Front 285

Cranial Nerve

Vestibulocochlear Nerve

Q1. Function - (1), (2)

Q2. Test

Back 285

A1.
(1) Vestibular function
(2) Cochlear function

A2.
(1) Test balance: vestibulospinal function
(2) Test auditory acuity

Front 286

Cranial Nerve

Glossopharyngeal Nerve

Q1. Motor function - (1), (2)

Q2. Sensory function - (1), (2), (3)

Back 286

A1.
(1) Brancial motor - stylopharyngeus muscle
(2) Visceral motor - Parasympathetic innervation of the smooth muscle and glands of the pharynx, larynx, and viscera of the thorax and abdomen.

A2.
(1) Visceral sensory - Carries visceral sensory information from the carotid sinus and body.
(2) General sensory - Provides general sensory information from the skin of the external ear, internal surface of the tympanic membrane, upper pharynx, and the posterior one-third of the tongue.
(3) Special sensory - Provides taste sensation from the posterior one-third of the tongue.

Front 287

Cranial Nerve

Vagus

Q1. Motor function - (1), (2)

Q2. Sensory function - (1), (2)

Back 287

A1.
(1) Branchial Motor - Muscles pharynx & larynx
(2) Visceral Motor - Parasympathetic to neck, thorax, & abdomen

A2.
(1) Visceral Sensor - Sensory from pharynx, larynx & viscera
(2) Special Sensory - Sensory from external ear

Front 288

Cranial Nerve

Spinal Accessory

Q. Function -

Back 288

A. Branchiaal Motor -
Trapezius & sternocleidomastoid muscles

Front 289

Cranial Nerve

Hypoglossal

Q. Function -

Back 289

A. Tongue muscles except palatoglossal

Front 290

A161
A patient presents with problems with swallowing. When the PT tests for phonation by having the patient say HAH" with the mouth open, there is deviation of the uvula to one side. The therapist then tests for function of the gag reflex and notices decreased response to stimulation.
These findings suggest involvement of the:

1. Vagus nerve.
2. Trigeminal nerve.
3. Facial nerve.
4. Hypoglossal nerve.

Back 290

1

These are the tests to examine vagus nerve (CN X) function.

Hint 290

INCORRECT CHOICES:
The trigeminal nerve (CN V) has both sensory and motor components. Sensory tests include pain & light touch to forehead, checks, jaw along with light touch (cotton wisp) to cornea. Motor function involves testing the temporal and masseter muscle (patient clenches teeth and holds against resistance). The facial nerve (CN 7) is tested using motor tests: raise eyebrows, frown, show teeth, smile, close eyes tightly, and puff out both cheeks. The hypoglossal nerve (CN 12) is testing using motor tests: tongue movements.

Front 291

B20
A patient incurred a right CVA I month ago and demonstrates moderate spasticity in the left upper extremity (predominantly increased flexor tone). The major problem at this time is a lack of voluntary movement control. There is minimal active movement with 1/4-inch subluxation of the shoulder.
The initial treatment activity of GREATEST BENEFIT is:

1. Sitting, weight-bearing on extended left upper extremtiy, weight-shifting.
2. PNF D2 flexion pattern, left upper extremity.
3. Quadruped, rocking from side to side.
4. Sitting, left active shoulder protraction with extended elbow and shoulder flexed to 90 degrees.

Back 291

1
Sitting, weight-bearing, and rocking on an extended left upper extremity will help to decrease the flexor tone. It also provides joint compression (approximation) at the shoulder, which will help maintain shoulder position and stimulate stabilizing muscles.

Hint 291

INCORRECT CHOICES:
Quadruped is too strenuous for this patient at this time (maximum weight-bearing on a weak, unstable upper extremity). The other two activities demand more voluntary control than this patient currently demonstrates.