Ptha 2431 - Management Of Neurological Disorders - Martin And Kessler Book And Miele Lecture - Exam 4

Front 1

How many new spinal cord injuries occur every year? ***

Back 1

11,000

Front 2

How many in the U.S. are living with SCI? ***

Back 2

243,000

Front 3

Who are the most typical victims of SCI? ***

Back 3

- between ages of 16 – 30 years old

- male (81%)

Front 4

What are the most common causes of SCI? ***

Back 4

- MVA (40.9%)
- falls (22.4%)
- acts of violence (21.6%)
- sports-related (7.5%)

Front 5

What additional follow-on care will most SCI patients need? ***

Back 5

- psychological assistance for guilt, depression, etc.

Front 6

How many pairs of spinal nerves do humans have? ***

Back 6

31 pairs

Front 7

How are the spinal nerves numbered? ***

Back 7

- C1 – C8 – cervical (exit the spinal column from above the vertebrae, except C8 goes below C7)
- T1 – T12 – thoracic (exit the spinal column from below the vertebrae)
- L1 – L5 – lumbar (exit the spinal column from below the vertebrae)
- S1-S4,S5 – sacral

Front 8

At what points in the spinal cord are injuries the most common? Why? ***

Back 8

- C1
- C2
- C5 – C7
- T12 – L2

- these are the regions of increased spinal mobility

Front 9

Differentiate a “high-level SCI” from a “high-level patient.” ***

Back 9

- a “high-level SCI” means the injury is higher up and the patient will have less function

- a “high-level patient” has more function

Front 10

How are SCI injuries named? ***

Back 10

by an alphanumeric sequence:

- an alpha character representing the first vertebral segment involved (i.e., C, T, L, or S)

- a number representing the last spinal nerve segment with innervation

e.g., a cervical vertebra injury in which the patient still has biceps function = SCI C5

Front 11

What is quadriplegia? ***

Back 11

- a patient with a cervical vertebra (C) injury

- quadriplegia means cervical level, the patient may or may not have use of arms

- this is the old term—the new term is “tetraplegia”

Front 12

What is the “new” term for quadriplegia? ***

Back 12

tetraplegia

Front 13

What is tetraplegia? ***

Back 13

- term adopted in place of quadriplegia per the American Spinal Injury Association (ASIA)

- associated with Cervical injuries: impairments to UE, LE, trunk and pelvic organs

Front 14

What is paraplegia? ***

Back 14

- refers to thoracic spine injuries

- typically sparing of UE, impairments to LE, trunk and pelvic organs

Front 15

What is the neurologic level with respect to naming an SCI? ***

Back 15

most caudal segment of the spinal cord with normal sensory and motor function on both sides of the body

Front 16

What is normal muscle function with respect to naming an SCI? ***

Back 16

lowest key muscle with a MMT of fair, provided muscle above this level are good to normal

Front 17

What is a zone of partial preservation with respect to naming an SCI? ***

Back 17

most caudal segment with some sensory and/or motor function. (only applicable to complete injuries)

Front 18

To which type of SCI does the zone of partial preservation apply? ***

Back 18

only to compete SCIs

Front 19

ASIA identification of key muscles that can provide greatest functional improvements: C5 (Table 12-1, P. 380). ***

Back 19

elbow flexors

Front 20

ASIA identification of key muscles that can provide greatest functional improvements: C6 (Table 12-1, P. 380). ***

Back 20

wrist extensors

Front 21

ASIA identification of key muscles that can provide greatest functional improvements: C7 (Table 12-1, P. 380). ***

Back 21

elbow extensors

Front 22

ASIA identification of key muscles that can provide greatest functional improvements: C8 (Table 12-1, P. 380). ***

Back 22

finger flexors

Front 23

ASIA identification of key muscles that can provide greatest functional improvements: T1 (Table 12-1, P. 380). ***

Back 23

finger abductors

Front 24

ASIA identification of key muscles that can provide greatest functional improvements: L2 (Table 12-1, P. 380). ***

Back 24

hip flexors

Front 25

ASIA identification of key muscles that can provide greatest functional improvements: L3 (Table 12-1, P. 380). ***

Back 25

knee extensors

Front 26

ASIA identification of key muscles that can provide greatest functional improvements: L4 (Table 12-1, P. 380). ***

Back 26

ankle dorsiflexors

Front 27

ASIA identification of key muscles that can provide greatest functional improvements: L5 (Table 12-1, P. 380). ***

Back 27

big toe extensors

Front 28

ASIA identification of key muscles that can provide greatest functional improvements: S1 (Table 12-1, P. 380). ***

Back 28

ankle plantar flexors

Front 29

Key muscles by segmental innervation: C1 – C2 (Table 12-4, P. 389).

Back 29

- facial muscles
- partial SCM
- capital muscles

Front 30

Key muscles by segmental innervation: C3 (Table 12-4, P. 389).

Back 30

- SCM
- partial diaphragm
- upper trapezius

Front 31

Key muscles by segmental innervation: C4 (Table 12-4, P. 389).

Back 31

- diaphragmatic
- partial deltoid
- SCM
- upper trapezius

Front 32

Key muscles by segmental innervation: C5 (Table 12-4, P. 389).

Back 32

- deltoid
- biceps
- rhomboids
- brachioradialis
- teres minor
- infraspinatus
- serratus anterior

Front 33

Key muscles by segmental innervation: C6 (Table 12-4, P. 389).

Back 33

- extensor carpi radialis
- pectoralis major (clavicular portion)
- teres major
- supinator
- serratus anterior
- weak pronator

Front 34

Key muscles by segmental innervation: C7 (Table 12-4, P. 389).

Back 34

- triceps
- flexor carpi radialis
- latissimus
- pronator teres

Front 35

Key muscles by segmental innervation: C8 (Table 12-4, P. 389).

Back 35

- flexor carpi ulnaris
- extensor carpi ulnaris
- patient may have some hand intrinsics

Front 36

Key muscles by segmental innervation: T1 – T8 (Table 12-4, P. 389).

Back 36

- hand intrinsics
- top half of the intercostals
- pectoralis major (sternal portion)

Front 37

Key muscles by segmental innervation: T7 – T9 (Table 12-4, P. 389).

Back 37

- upper abdominals

Front 38

Key muscles by segmental innervation: T9 – T12 (Table 12-4, P. 389)

Back 38

lower abdominals

Front 39

Key muscles by segmental innervation: T12 (Table 12-4, P. 389).

Back 39

- lower abdominals
- weak quadratus lumborum

Front 40

Key muscles by segmental innervation: L2 (Table 12-4, P. 389).

Back 40

- iliopsoas
- weak sartorius
- weak adductors
- weak rectus femoris

Front 41

Key muscles by segmental innervation: L3 (Table 12-4, P. 389).

Back 41

- sartorius
- rectus femoris
- adductors

Front 42

Key muscles by segmental innervation: L4 (Table 12-4, P. 389).

Back 42

- gluteus medius
- tensor fascia latae
- hamstrings
- tibialis anterior

Front 43

Key muscles by segmental innervation: L5 (Table 12-4, P. 389).

Back 43

- weak gluteus maximus
- long toe extensors
- tibialis posterior

Front 44

Key muscles by segmental innervation: S1 (Table 12-4, P. 389).

Back 44

- gluteus maximus
- ankle plantar flexors (gastrocnemius, soleus)

Front 45

Key muscles by segmental innervation: S2 (Table 12-4, P. 389).

Back 45

- anal sphincter

Front 46

What are some of the mechanisms of injury for SCI? ***

Back 46

- traumatic impact
- vertebral subluxation
- compression fractures
- hyperextension/hyperflexion

Front 47

What is the worst mechanism of injury for an SCI? ***

Back 47

twisting and flexing, especially in conjunction with a traumatic blow

Front 48

What is the most common type of cervical SCI? What is the most frequent cause? ***

Back 48

- flexion and rotation injury
- posterior spinal ligaments rupture and upper vertebra is displaced over lower vertebra
- rupture of intervertebral disc and, in severe cases, anterior longitudinal ligament can occur
- transection of SC is often associated with this type of injury

- rear-end MVA

Front 49

Besides the flexion and rotation injury, what other cervical SCIs are common? How do they typically occur? ***

Back 49

- hyperflexion
--- hyperflexion force causes anterior compression fracture of vertebral body and stretching of the posterior longitudinal ligaments (but they remain intact)
--- may sever anterior spinal artery and cause incomplete anterior cord syndrome.
--- frequently caused by head on collision or blow to back of head

- hyperextension
--- common in older adults
--- frequently caused by chin striking stationary object (e.g., a stair or table in a fall)
--- force ruptures the anterior longitudinal ligament and compresses and ruptures intervertebral disc
--- SC may be compressed between ligamentum flavum and vertebral body, causing central cord injury

- compression injuries (cervical or lumbar spine)
--- result from vertical compressive forces
--- traumatic (e.g., diving accidents, falls from height)
--- due to disease (e.g., osteoporosis, osteoarthritis, RA)

Front 50

What are the two general categories of SCI? ***

Back 50

- complete

- incomplete

Front 51

What constitutes a complete SCI? ***

Back 51

- sensory and motor lost below level of injury
- sensory and motor lost in S4 and S5 (perianal)
- usually result of complete cord transection, compression, or vascular impairment

Front 52

What constitutes an incomplete SCI? ***

Back 52

- some remaining motor and/or sensory below level of lesion
- must have perianal sensation
- clinical picture variable and unpredictable

Front 53

What are the four types of incomplete SCI? ***

Back 53

- Brown-Sequard syndrome (loss of R/L hemisphere)
- anterior cord syndrome
- central cord syndrome
- dorsal column syndrome

Front 54

What pathologic changes may be noted as sequelae to SCI? ***

Back 54

- hemorrhage into gray matter
- edema within white matter
- necrosis
- myelin sheaths disintegrate, axons shrink

- 24 to 48 hours s/p SCI injury may ascend 1 to 2 levels
- spinal shock: period of flaccidity, areflexia, loss of B & B, autonomic deficits,

- decreased arterial blood pressure, poor temperature regulation below injury level
- reflex activity below lesion level returns after spinal shock subsides

Front 55

What are some complications commonly noted as sequelae to SCI? ***

Back 55

- autonomic dysreflexia/hyperreflexia (above T6) – can be life-threatening!!
- postural hypotension

- pain
- contractures

- pressure ulcers
- DVT (since skeletal mm pump is gone)

- respiratory compromise
--- diaphragm: innervated by phrenic nerve C3-C5 primary muscle of inspiration
--- external intercostals: assist with inspiration (innervated segments begin T1, lift the ribs)
--- abdominals: T7-T11, aide with forceful expiration (coughing)

- heterotopic ossification (myositis ossificans)
- osteoporosis & renal calculi (due to lack of WB, breakdown of bone)

Front 56

What interventions are used to address reduced respiratory function? ***

Back 56

- early acclimation to upright
- abdominal corsets and binders

- assisted cough techniques
- diaphragmatic strengthening
- incentive spirometry

Front 57

How is the bladder affected by SCI? ***

Back 57

- bladder innervated S2-S4

- during spinal shock the bladder is flaccid

Front 58

How does SCI above S2 affect bladder function? ***

Back 58

- cause spastic or reflex bladder
- bladder auto-empties when full

- suprapubic cutaneous stimulation techniques can assist voiding

Front 59

How does SCI to cauda equina or conus medullaris affect bladder function? ***

Back 59

- nonreflexive or flaccid bladder

- manual emptying required

Front 60

What interventions may be used to allow an SCI patient to remain catheter-free? ***

Back 60

- timed voiding
- manual stimulation

- bladder and bowel training are important parts of rehabilitation
- therapies should not be scheduled during times designated for these activities

Front 61

Upon what factors do functional outcomes post-SCI depend? ***

Back 61

- type of injury
- level of injury

- pre-injury health
- body build & flexibility (motor memory is better if patient was fit beforehand)

- age
- motivation
- preexisting personality

- support systems
- financial situation

Front 62

What factors determine an SCI patient’s functional potential? ***

Back 62

- level of injury (functional potential increases with each successive motor level)

- strength (muscle must be at least fair 3/5 for functional use)

(of course, incomplete SCI are variable)

Front 63

What physical therapy acute interventions are performed with/on patients with SCI? ***

Back 63

- prevent contractures (PROM—ensure you palpate the muscle so you don’t overstretch; if cervical instability, do not take shoulder past 90 degrees flexion or abduction; if lumbar instability, do not take hip past 90 degrees flexion or abduction)

- improvement of muscle and respiratory function

- acclimation of patient to upright position

- prevent secondary complications (DU, DVT, nosocomial infection, etc.)

Front 64

What are the physical therapy goals for inpatient rehabilitation with SCI patients? ***

Back 64

- after patient is medically stable
- focus is on functional recovery (you are there to teach them to achieve their maximum possible potential; help through the grief process, etc)

PT Goals:

- independence in skin inspection and pressure relief (e.g., how to use mirror for ischial tuberosities)
- increase strength of key muscle groups
- increased passive range of motion of HSs and shoulder extensors
- increased vital capacity

- increased tolerance to upright positioning
- independence in transfers (or directing a caregiver)
- independence in bed and mat mobility (or directing a caregiver)
- independence in WC on level surfaces

- independence in operating vehicle
- return, to home, school, work
- independence in HEP (will need lifelong HEP)
- patient and family education

Front 65

What types of mat activities are conducted with SCI patients? ***

Back 65

- rolling supine to prone (and back)
- prone position strengthening (especially to scapulae, shoulders)

- supine to supine on elbows
- supine on elbows to long sit
- push-up in long sit

Front 66

What types of transfers are done with patients with SCI? ***

Back 66

- two-person lift
- airlift (especially if risk of triggering spasticity by touching feet to floor)

- advanced WC techniques (e.g., tall kneel to get into chair)

Front 67

What is Parkinson’s disease? ***

Back 67

Chronic progressive neurologic condition affecting the motor system

Front 68

What is the classic triad of Parkinson’s Disease? ***

Back 68

- bradykinesia
- rigidity
- tremor

Front 69

What causes Parkinson’s disease? ***

Back 69

decrease in dopamine, a neurotransmitter stored in substantia nigra

Front 70

What is one of the three most common movement disorders in the U.S.? ***

Back 70

Parkinson’s disease

Front 71

What is the most common age of onset for Parkinson’s disease? ***

Back 71

ages 50 - 79

Front 72

What is bradykinesia? ***

Back 72

slow movement

Front 73

What are the common effects of bradykinesia? ***

Back 73

- affects ADLs
- poor speech due to slow oral movement
- micrographia – writing small, possibly for better control
- akinesia: inability to initiate movement

tend to adopt fixed forward-flexed posture, loss of ability to extend against gravity

Front 74

What is micrographia? ***

Back 74

- writing small, possibly for better control

Front 75

What is akinesia? ***

Back 75

- inability to initiate movement

Front 76

What areas are most commonly affected by rigidity? ***

Back 76

- trunk
- extremities
- frequently loss of normal arm swing
- loss of respiratory function

-loss of postural tone

Front 77

What is rigidity? ***

Back 77

- resistance to passive movement regardless of speed

Front 78

What are the two types of rigidity? ***

Back 78

- lead-pipe: constant resistance to passive limb movement in any direction regardless of speed

- cogwheel: lead-pipe rigidity plus tremor (results in a “catch” and the tremor “lets go”

Front 79

What frequently happens when breathing is impaired? ***

Back 79

- fatigue

- trunk rigidity impairs breathing by restricting chest wall motion
- increases energy expenditure leading to fatigue

Front 80

What is often the first sign of Parkinson’s Disease? ***

Back 80

tremor

Front 81

What type of tremor is associated with Parkinson’s Disease? ***

Back 81

- resting tremor, not intention tremor

- hand tremor 4 to 7 beats per second

- may be oral or affect postural muscles

- may progress from unilateral involvement to all four extremities
- rarely interferes with ADLs

Front 82

How does postural instability manifest in the Parkinson’s patient? ***

Back 82

- loss of postural extension and response to postural disturbances leads to increased fall risk (ankle strategy, hip strategy, stepping strategy)

- fall potential increases as disease progresses (as trunk tightens, posture increasingly flexed, etc.)

- result from inability to distinguish self-movement from movement of the environment

- increasingly dependent on visual cues for postural adjustment and cannot make use of vestibular input

Front 83

What are some other typical signs and symptoms of Parkinson’s Disease? ***

Back 83

- flexed posture
- festinating gait
- freezing episodes (especially in doorways)
- fatigue

- masked face
- dysphagia

Front 84

What role does PT play in treatment of patients with Parkinson’s Disease? ***

Back 84

- we are not long-term treatment; will see them, teach them coping and conditioning strategies, but insurance won’t pay for long-term PT for a disease that is only going to progressively worsen

- beneficial adjunct to medication

- stride length affected, we can teach strategies for improving movement
- use of visual and auditory cues during movement for gait hypokinesia
(examples: cones, verbal cueing to increase step length, walking toward mirror, treadmill tng)
- alternative walking patterns: side stepping, braiding, backwards—good for geriatrics!!

- task part training versus component helpful in general (akinesia prevents patient from complying with “stand up”; task needs to be broken down to “scoot forward in your chair,” “put your nose over your toes,” etc.)
- cognitive coaching to initiate movement – they have to think through movement that previously was automatic (e.g., for sit-to-stand, “move head forward and up”)
- exercises may include sit-to-stand, reaching, grasping, manipulating objects, buttoning, folding (fine motor skills normally the domain of OT) Don’t stop wearing button-down shirts! Trunk rotation for shirt don/doff


prevent secondary complications:
- deconditioning
- loss of extension and rotation – teach trunk rotation—supine/relaxing!!

education:
- importance of good posture, daily walking, and sustained activity
- that it’s OK to struggle—family should not do everything for patient

Front 85

What is “freezing” when associated with Parkinson’s Disease? ***

Back 85

- patient becomes unable to initiate movement

- typical in narrow spaces (doorways, turning corners, etc.)

Front 86

How do we teach Parkinson’s patients to cope with/overcome freezing episodes? ***

Back 86

- break freeze by focusing on alternative task (e.g., toss a penny on the floor and pick it up—if balance is good!, kick a box, marks on floor may help)

- early strengthening of extensors and trunk rotation
- relaxation: deep breathing, trunk rotating and rocking

Front 87

What is Multiple Sclerosis? ***

Back 87

- a wide spectrum, chronic and debilitating disease that

- results from demyelination of CNS

Front 88

Who are the typical MS patients? ***

Back 88

- onset usually between the ages of 20-40

- females 2X greater incidence

Front 89

What are the typical signs and symptoms of MS? ***

Back 89

- paresthesias—usually first sign, muscle weakness, clumsiness, fatigue

- neurologic problems: weakness, spasticity, ataxia

- Charcot’s triad—intention tremor, nystagmus, scanning speech (ataxic dysarthria—halting w/breaks in wrong places)

Front 90

What is Charcot’s triad? ****

Back 90

- associated with MS

- intention tremor
- nystagmus
- scanning speech (a.k.a. ataxic dysarthria—halt ingwith breaksin wrongpla ces)

Front 91

What role does PT play in treatment of patients with Multiple Sclerosis? ***

Back 91

- we are not long-term treatment; will see them, teach them coping and conditioning strategies, but insurance won’t pay for long-term PT for a disease that is only going to progressively worsen

- minimize progression
- maintain optimum level of function
- maintain respiratory function

- prevent or decrease secondary complications

- treatment: aerobic conditioning (low intensity, cool environment), slow, static stretching

Front 92

What is the most common cause of acute generalized weakness? ***

Back 92

Guillain-Barre Disease

Front 93

What is Guillain-Barre Disease? ***

Back 93

- represents broad group of demyelinating inflammatory polyradiculoneuropathies
- symmetrical ascending progressive loss of motor function that begins distally and progresses proximally

- occurs in all age groups
- most common cause of acute generalized weakness
- possibly related to the Epstein-Barr virus

Front 94

What role does PT play in treatment of patients with Guillain-Barre disease? (Three phases) ***

Back 94

acute
- gentle ROM
- positioning

plateau phase (viral in nature, so must run its course)
- acclimation to upright position (hospital bed, tilt table, standing frame)
- ROM (avoid overexertion)

recovery phase (usually the point where we see them)
- generally 2 to 4 wks after plateau
- strengthening (must be 3/5 for strengthening, i.e., able to work against gravity)
- functional activities

Front 95

What precautions need to be taken when working with a Guillain-Barre patient? ***

Back 95

- avoid fatigue
- avoid overexertion
- avoid eccentric contractions (they place the greatest stress on nerves)

- 3/5 muscle strength needed (able to work against gravity) prior to active strengthening

- overwork weakness: overworking partially denervated muscle produces profound decrease in that muscle's ability to demonstrate strength and endurance

Front 96

What is overwork weakness and what are its signs and symptoms? ***

Back 96

- overwork weakness: overworking partially denervated muscle produces profound decrease in that muscle's ability to demonstrate strength and endurance

- delayed onset of muscle soreness
- gets worse one to five days after exercise (long after “normal” DOMS)

- reduction in maximum muscle force

(*active strengthening requires muscle strength of 3/5; training of muscles 2/5 should be done in gravity eliminated position)

Front 97

What is Postpolio Syndrome? ****

Back 97

- viral infection of anterior horn cells causing muscle weakness or paralysis

- experienced by 20 – 40% of individuals surviving poliomyelitis
- occurs decades after initial disease

loss of giant motor units (overwork weakness, age-related changes)
- these units are regrown and substitute for ones destroyed by polio
- as such, they are more susceptible to overwork and age related changes

Front 98

What are the signs and symptoms of Postpolio Syndrome? ***

Back 98

clinical features
- fatigue
- new weakness
- pain: both muscle and joint

Front 99

What role does PT play in treatment of patients with Postpolio Syndrome? ***

Back 99

helps the patient to:
- avoid fatigue
- ambulate safely
- achieve optimum function

Front 100

What are the protocols for nonfatiguing exercise? ***

Back 100

- understand cause of the fatigue

- when fatigue is a contraindication for exercise
--- target heart rate 60-70% of max
--- duration of 15-30 mins TIW (3X per week) for aerobic exercise
--- nonfatiguing strengthening 3-5X per week

- fatigue should be avoided with MS, Guillain-Barre and Postpolio Syndrome!

Front 101

Which of the following has been shown to be associated with an increased risk for falls? ***

a. taking less than 4 medications
b. a history of previous falls
c. home exercise programs
d. a high score on the DGI (dynamic gait index)

Back 101

b. a history of previous falls

Front 102

A patient presents with pathology restricted to a peripheral nerve injury distally in one upper extremity. Is this patient at increased risk for loss of balance? ***

a. yes, peripheral nerve injury affects strength, and an intact motor system is necessary for normal postural control.
b. no, the impairments are restricted to the distal upper extremity, which is minimally involved in normal postural control.
c. yes, the peripheral nerve injury affects sensation, and an intact sensory system is necessary for normal postural control.
d. no, pathologies that affect central systems have more influence on normal postural control than those affecting peripheral systems.

Back 102

b. no, the impairments are restricted to the distal upper extremity, which is minimally involved in normal postural control.

Front 103

Which of the following best describes the prognosis for a patient with permanent bilateral vestibular loss? ***

a. because of the importance of the vestibular system in balance, the patient will need to be supported when upright.
b. after an initial period of disability, the patient will adapt sufficiently to rely on other sensory systems for balance information when upright.
c. one of the other sensory systems will take over the role of the vestibular system inmediating conflicting information during balance activities.
d. the patient will no longer be able to keep the head oriented or turn appropriately for auditory input.

Back 103

b. after an initial period of disability, the patient will adapt sufficiently to rely on other sensory systems for balance information when upright.

Front 104

The Hallpike-Dix maneuver would be an appropriate part of the physical therapy examination of someone with which of the following complaints? ***

a. vertigo and nausea, lasting seconds when turning over in bed
b. lightheadedness lasting seconds when moving from sit to stand
c. vertigo, lasting hours, along with tinnitus and hearing loss
d. vertigo, oscillopsia, disequilibrium, persistent sensory loss

Back 104

a. vertigo and nausea, lasting seconds when turning over in bed

Front 105

Which of the following is NOT part of both the Berg Balance Scale (BBS) and Tinetti’s Performance Oriented Mobility Assessment (POMA)? ***

a. an assessment of standing balance.
b. an analysis of gait.
c. developed for older adults.
d. an indication of falling risk.

Back 105

b. an analysis of gait.

Front 106

A patient has fallen twice recently: Once when carrying a large box upstairs and once when trying to get to the bathroom at night without turning on the light. A Romberg test is positive and the therapist determines that the patient’s balance dysfunction is due to sensory deficits and reliance on vision to compensate. How will you help the patient be safer? ***

a. have her strengthen her lower extremities.
b. instruct her to keep a night light on.
c. practice walking with eyes closed.
d. instruct her to use a walker for community ambulation.

Back 106

b. instruct her to keep a night light on.

Front 107

Appropriate physical therapy intervention to decrease standing loss of balance in a patient who has hemiparesis following a stroke would best incorporate which of the following? ***

a. facilitation to improve strength and timing of symmetrical ankle and hip strategies.
b. exercises to habituate response to head turning.
c. facilitation on the paretic side in sitting while patient shifts weight to the nonparetic side.
d. practice the Clinical Test of Sensory Integration and Balance (CTSIB) several times.

Back 107

a. facilitation to improve strength and timing of symmetrical ankle and hip strategies.

Front 108

Appropriate physical therapy intervention to decrease dizziness in a patient with benign paroxysmal peripheral vertigo (BPPV) would best incorporate having the patient do which of the following? ***

a. habituate responses by practicing the rotary chair test.
b. roll over several times in bed to get the otoconia to reposition themselves.
c. practice switching gaze from objects to the right and then to the left for improved control without dizziness.
d. perform the Brandt-Daroff exercises.

Back 108

d. perform the Brandt-Daroff exercises.

Front 109

On examination, a 7-month-old female was observed performing motor tasks typically seen in 3-month-olds. Aylward would classify the 7-month-old’s performance as which of the following? ***

a. delayed
b. dissociated
c. deviant
d. atypical movements

Back 109

a. delayed

Front 110

The differences noted in the timing and rate of development among children is explained by which of the following? ***

a. cultural influences
b. gender
c. practice of skills
d. all of the above
e. a and b only

Back 110

d. all of the above

Front 111

Development is divided into segments, including childhood, adolescence, and adulthood. Adolescence is classified by which of the following? ***

a. age
b. Tanner stage
c. age and gender
d. age and Tanner stage

Back 111

d. age and Tanner stage

Front 112

An example of a norm-referenced test is which of the following? ***

a. GMFM-66
b. GMFM-88
c. PEDI
d. Hawaii Early Learning Profile

Back 112

c. PEDI

Front 113

The AIMS would be classified as which of the following? ***

a. a norm-referenced and impairment measure
b. a criterion-referenced and participation measure
c. a criterion-referenced and body structure/body function measure
d. a norm-referenced and activities measure

Back 113

d. a norm-referenced and activities measure

Front 114

Which of the following combination of tests and measures includes information at the levels of each of the following levels of the ICF model: body structure and function; activity; and participation? ***

a. muscle strength and joint ROM
b. GMFM-66 and HELP
c. muscle strength and PEDI
d. PEDI and GMFM-66

Back 114

c. muscle strength and PEDI

Front 115

A 10-year-old boy with cerebral palsy has been examined and evaluated by a physical therapist. Her examination notes that the sum of the triceps and subscapular skinfold thickness for this child is 40 mm. This measure is a reflection of which of the following? ***

a. strength
b. skeletal growth and maturity
c. flexibility
d. body fat percentage

Back 115

d. body fat percentage

Front 116

All of the following statements about the development of strength in children and adolescents are true EXCEPT which of the following? ***

a. multiple factors contribute to the development of strength, including gender, age, body size and type, muscle cross-sectional area, and proportion of fiber type.
b. In girls, strength increases linearly until puberty and then increases sharply during adolescence due to hormonal influences.
c. changes in muscle function follow changes in muscle size, but qualitative changes also result from neural influences.
d. gender differences in strength are evident in children as young as 3 years old, with boys demonstrating greater strength than girls.

Back 116

b. In girls, strength increases linearly until puberty and then increases sharply during adolescence due to hormonal influences.

Front 117

A child is described as having athetoid cerebral palsy. Which of the following descriptions is most likely to describe his presentation? ***

a. increased resistance to fast passive movement of his extremities.
b. impaired volitional activity encompassing slow, irregular, and writhing movements of the extremities, face, and neck that are perceived as uncontrolled and purposeless.
c. wide-based gait with poor foot placement.
d. reduced resistance to fast passive movement of his extremities. Generally “floppy” appearing.

Back 117

b. impaired volitional activity encompassing slow, irregular, and writhing movements of the extremities, face, and neck that are perceived as uncontrolled and purposeless.

Front 118

An example of an activity-focused intervention is which of the following? ***

a. ROM
b. strength training
c. stair climbing
d. aerobic conditioning

Back 118

c. stair climbing

Front 119

Botulinum toxin injections are used in children with CP for which of the following? ***

a. to strengthen muscles
b. to alter bony abnormalities
c. to lengthen muscles
d. to reduce spasticity

Back 119

d. to reduce spasticity

Front 120

The clinical manifestations of CP: ***

a. often change over time
b. are progressive because of increasing damage to the central nervous system
c. are acute and generally resolve within 3-4 years
d. remain static (unchanging)

Back 120

a. often change over time

Front 121

Clinical neurological findings of abnormal consciousness, altered tone and reflexes, feeding and respiration difficulties, and/or seizures seen in early infancy is termed which of the following? ***

a. CP
b. myelomeningocele
c. acute hypoxia
d. neonatal encephalopathy

Back 121

d. neonatal encephalopathy

Front 122

A premature birth is defined as which of the following? ***

a. less than 35 weeks gestation, weighing less than 2500 gm
b. less than 35 weeks gestation
c. less than 37 weeks gestation
d. less than 40 weeks gestation, weighing less than 2500 gm

Back 122

c. less than 37 weeks gestation

Front 123

A child with the diagnosis of diplegic CP is likely to present with which of the following patterns of involvement? ***

a. involvement of one side of the body (right or left)
b. uncontrolled movements of all extremities
c. involvement of the entire body but with the lower extremities more involved than the upper extremities
d. about equal involvement of all four extremities

Back 123

c. involvement of the entire body but with the lower extremities more involved than the upper extremities

Front 124

The Gross Motor Function Classification System (GMFCS) classifies which of the following? ***

a. topographical distribution of a movement disorder
b. clinical type of CP
c. functional ability of a child with CP
d. degree of spasticity

Back 124

c. functional ability of a child with CP

Front 125

Selective dorsal rhizotomy is used in children with CP for the purpose of which of the following? ***

a. strengthening muscles
b. altering bony abnormalities
c. lengthening muscles
d. reducing spasticity

Back 125

d. reducing spasticity

Front 126

Congenital malformations of the spine and spinal cord, including anomalies of the skin, muscles, vertebrae, meninges, and nervous tissues, is a condition termed which of the following? ***

a. spinal dysraphism
b. cerebral palsy
c. neonatal encephalopathy
d. Chiari II malformation

Back 126

a. spinal dysraphism

Front 127

An example of an open spinal dysraphism is which of the following? ***

a. tethered cord syndrome
b. lipomyeloschisis
c. myelomeningocele
d. lipomyelomeningocele

Back 127

c. myelomeningocele

Front 128

Impairments often associated with myelomeningocele may include all of the following EXCEPT: ***

a. paralysis
b. musculoskeletal deformities
c. spastic hemiplegia CP
d. cognitive delays

Back 128

c. spastic hemiplegia CP

Front 129

A patient with a middle cerebral artery stroke will most likely present with which of the following? ***

a. ipsilateral paralysis and sensory loss; more involvement of the upper extremity than the lower
b. ipsilateral paralysis and sensory loss; more involvement of the lower extremity than the upper
c. contralateral paralysis and sensory loss; more involvement of the upper extremity than the lower
d. contralateral paralysis and sensory loss; more involvement of the lower extremity than the upper

Back 129

c. contralateral paralysis and sensory loss; more involvement of the upper extremity than the lower

Front 130

A patient who has intact vision in all visual fields but seems NOT to attend to things or people on his left would be described as having which of the following? ***

a. left homonymous hemianopsia
b. left side neglect
c. left hemiplegia
d. left hemianesthesia

Back 130

b. left side neglect

Front 131

An individual with muscle tone of the left bicep, wrist, and finger flexors graded as 2 on the Modified Ashworth Scale would exhibit which of the following in the left upper extremity: ***

a. minimal resistance to movement at the end ranges of elbow and wrist extension
b. increased muscle tone through most of the range but the upper extremity could be easily straightened
c. rigid flexion of the elbow, wrist, and fingers
d. flaccidity

Back 131

b. increased muscle tone through most of the range but the upper extremity could be easily straightened

Front 132

Which of the following techniques would be most appropriate for facilitating initiation of movement in a paretic upper extremity? ***

a. slow reversals
b. alternating isometrics
c. rhythmic initiation
d. agonistic reversals

Back 132

c. rhythmic initiation

Front 133

Which of the following is NOT associated with both traumatic brain injury and stroke? ***

a. clinical presentation varies in severity.
b. brain damage can be from hemorrhage.
c. diffuse area of injury.
d. abnormal synergy patterns.

Back 133

c. diffuse area of injury.

Front 134

Based on Gentile’s taxonomy, which of the following is the most difficult task? ***

a. getting keys from your pocket while walking in a crowd of people.
b. standing in the physical therapy gym while leaning on a wall for support.
c. ambulating on a treadmill.
d. sitting at a table to practice writing with a fat pen, thin pencil, and a felt-tip marker.

Back 134

a. getting keys from your pocket while walking in a crowd of people.

Front 135

Which of the following feedback and practice paradigms is most effective for promoting motor learning? ***

a. practice one task repeatedly with feedback given every trial.
b. practice one task repeatedly with feedback given every other trial.
c. practice a variety of tasks with feedback given every trial.
d. practice a variety of tasks with feedback given every other trial.

Back 135

d. practice a variety of tasks with feedback given every other trial.

Front 136

Which of the following impairments would you most expect to be reported in the examination of a patient with Parkinson’s disease? ***

a. weak quadriceps muscles
b. reduced arm swing and trunk rotation during gait
c. reduced upper extremity sensation
d. reduced lower extremity sensation

Back 136

b. reduced arm swing and trunk rotation during gait

Front 137

The general physical therapy management of a patient with Parkinson’s disease would be best described by which of the following statements? ***

a. physical therapy is needed because it can alter the disease process
b. physical therapy is needed to help the patient optimize movement skills
c. physical therapy is needed to assist with the prevention of secondary complications
d. b and c

Back 137

d. b and c

Front 138

The physical therapy examination of Mrs. S, a 60-year-old woman with midstage Parkinson’s disease, reveals the following: Grade 4/5 strength in the lower extremities, 10-degree bilateral hip flexion contractures, and exaggerated forward-standing posture. Mrs. S reports balance problems and states she requires physical assistance from her husband to ambulate on any level surfaces. The most important activity to initially include in Mrs. S’s home program is which of the following? ***

a. exercises in prone lying
b. lower extremity resistive exercises with weights
c. progressive relaxation exercises
d. postural awareness and balance exercises in standing

Back 138

d. postural awareness and balance exercises in standing

Front 139

JL is a patient with multiple sclerosis. He has bilateral hamstring and gastrocnemius spasticity graded as 3 on the Modified Ashworth scale. JL complains of being tired during the exercise program you have developed for him. On his next scheduled treatment day, you would do which of the following? ***

a. continue with the treatment plan but change JL’s treatment time to the late afternoon
b. continue with your prescribed exercise program but have JL exercise in a warmer room
c. provide JL with relaxation strategies and reduce the exercise intensity
d. take JL to the pool, as temperatures greater than 90 degrees will be beneficial for JL

Back 139

c. provide JL with relaxation strategies and reduce the exercise intensity

Front 140

Robert is a 32-year-old man with ALS. He reports that before his diagnosis he played recreational sports on the weekends and jogged 2 miles daily. His right toes have been catching on the floor when he walks quickly, and he has occasional mild cramping in his calf muscles. Otherwise, he has no complaints. On physical examination his right dorsiflexion strength is 3/5. In addition, his lower extremity tone bilaterally is graded 1 on the Modified Ashworth Scale.
Initial exercises for Robert would focus on which of the following? ***

a. PROM to the right foot and ankle
b. eliminating any resistive exercises
c. strengthening the right tibialis anterior
d. low intensity general conditioning exercises

Back 140

c. strengthening the right tibialis anterior

Front 141

Which of the following would indicate that Robert’s therapy plan should be modified? ***

a. grade 0/5 dorsiflexion strength when his lower extremities are reevaluated.
b. increased incidence of calf cramping.
c. Increased tripping.
d. all of the above.

Back 141

d. all of the above.

Front 142

Which of the following is an appropriate outcome measure to assess improvements related to physical therapy intervention (outpatient setting) for patients with Parkinson’s disease? ***

a. Hoehn and Yahr Scale
b. Berg Balance Scale (BBS)
c. Mini Mental Status Examination (MMSE)
d. Functional Independence Measure (FIM)

Back 142

b. Berg Balance Scale (BBS)

Front 143

Which of the following is NOT a common characteristic of Huntington’s disease? ***

a. spasticity
b. dystonia
c. chorea
d. bradykinesia

Back 143

a. spasticity

Front 144

What is the approximate maximum expected rate of peripheral nerve regeneration? ***

a. 1 mm per day
b. 1 cm per day
c. 1 m per day
d. 1 cm per month

Back 144

b. 1 cm per day

Front 145

Which degree of nerve injury requires surgical repair to join proximal and distal stumps of transected nerve? ***

a. axonotmesis
b. neurapraxia
c. neurotmesis

Back 145

c. neurotmesis

Front 146

Typical examination findings for a patient with peripheral neuropathy include all of the following EXCEPT: ***

a. muscle weakness
b. muscle atrophy
c. diminished sensation
d. increased reflexes

Back 146

d. increased reflexes

Front 147

In what sequence does return of sensation typically occur? ***

a. protective sensation, light touch, discriminative touch
b. light touch, discriminative touch, protective sensation
c. discriminative touch, protective sensation, light touch
d. protective sensation, light touch, discriminative touch

Back 147

d. protective sensation, light touch, discriminative touch

Front 148

A patient with a surgical nerve repair was examined by the physical therapist. The plan of care includes nerve mobilization. Which of the following is consistent with this plan of care? ***

a. application of neuromuscular electrical stimulation to denervated muscle
b. application of nerve gliding techniques
c. application of an ice pack over the postsurgical incision to reduce edema
d. immobilization of one or more joints over which the repaired nerve crosses

Back 148

b. application of nerve gliding techniques

Front 149

Which of the following tests would NOT be expected to reproduce the patient’s symptoms in a patient with a peripheral nerve injury? ***

a. upper limb neural tension test
b. deep tendon reflex
c. Tinel’s
d. Phalen’s

Back 149

b. deep tendon reflex

Front 150

With peripheral nerve injury the deep tendon reflexes will be: ***

a. hyporeactive
b. hyperreactive
c. normoreactive
d. none of the above

Back 150

a. hyporeactive

Front 151

Which of the following is NOT a mechanism of peripheral nerve injury? ***

a. radiation
b. stretch
c. compression
d. toxins
e. inadequate blood supply
f. disuse

Back 151

f. disuse

Front 152

Polyneuropathies are which of the following? ***

a. peripheral neuropathies that affect multiple nerves
b. peripheral neuropathies that affect a single nerve
c. central cord neuropathies that affect multiple nerves
d. central cord neuropathies that affect a single nerve

Back 152

a. peripheral neuropathies that affect multiple nerves

Front 153

Polyneuropathy is generally which of the following? ***

a. unilateral and symmetrical
b. bilateral and asymmetrical
c. bilateral and symmetrical
d. unilateral and asymmetrical

Back 153

c. bilateral and symmetrical

Front 154

Diabetic neuropathies: ***

a. generally do not follow a length-dependent pattern of distribution.
b. are generally mononeuropathies.
c. are considered acquired demyelinating polyneuropathies.
d. generally present with sensory motor signs and symptoms.

Back 154

d. generally present with sensory motor signs and symptoms.

Front 155

A peripheral nervous system dysfunction of the spinal roots is which of the following? ***

a. polyradiculoneuropathy
b. polyradiculopathy
c. mononeuropathy multiplex
d. none of the above
e. all of the above

Back 155

b. polyradiculopathy

Front 156

Patients with Charcot-Marie-Tooth syndrome typically present with which of the following? ***

a. distal muscle weakness
b. EMG abnormalities
c. a gradual onset of signs and symptoms
d. all of the above
e. none of the above

Back 156

d. all of the above

Front 157

Typical examination findings in patients with polyneuropathies are which of the following? ***

a. unilateral decrease or loss of reflexes
b. distal decrease or loss of reflexes
c. changes in proximal but not distal reflexes
d. all of the above

Back 157

b. distal decrease or loss of reflexes

Front 158

Transcutaneous electrical nerve stimulation (TENS) may help control neuropathic pain by which of the following mechanisms? ***

a. stimulating A-beta sensory fibers
b. stimulating nerve growth
c. stimulating C fibers
d. stimulating muscle fibers

Back 158

a. stimulating A-beta sensory fibers

Front 159

Ankle foot orthoses may be used by people with polyneuropathies: ***

a. to prevent contracture
b. to reduce risk of falls
c. to improve sensation
d. a and b
e. a, b, and c

Back 159

d. a and b

Front 160

Which of the following is NOT associated with slowed nerve conduction velocity? ***

a. increased age
b. decreased limb temperatures
c. increased limb temperatures
d. demyelination

Back 160

c. increased limb temperatures

Front 161

Juan sustained a fracture of his C5 vertebra in a motorcycle accident. Upon examination the physical therapist finds that he has 5/5 (normal) strength in biceps bilaterally, 4/5 wrist extension on the left, and 5/5 wrist extension on the right. He has 0/5 triceps strength bilaterally and no other active movement below this level. He has normal sensation through the C6 dermatome and partial preservation of light touch and pinprick in the C7 through the sacral dermatomes. Based on the examination and evaluation the therapist classifies Juan’s injury as a C6, incomplete, ASIA C.

You are working on bed mobility with Juan in the rehabilitation gym when he begins to complain of a headache and dizziness. You take a closer look and notice that he is flushed and sweating out of proportion to his level of exertion. You conclude that Juan may be suffering from which of the following? ***

a. spinal shock
b. heterotopic ossification
c. autonomic dysreflexia
d. pulmonary embolus

Back 161

c. autonomic dysreflexia

Front 162

What would you do in response to this finding? ***

a. check for any cause of discomfort in the patient such as a tight belt or kinked urinary catheter
b. immediately activate the emergency medical response system
c. continue with the prior mobility activities and encourage Juan to breathe deeply and relax
d. stop the bed mobility activities and work on sitting balance

Back 162

a. check for any cause of discomfort in the patient such as a tight belt or kinked urinary catheter

Front 163

During his stay in acute care, Juan is at increased risk for all of the following medical complications EXCEPT: ***

a. pressure ulcers
b. deep vein thrombosis
c. atelectasis
d. subarachnoid hemorrhage

Back 163

d. subarachnoid hemorrhage

Front 164

The most likely technique that Juan will use for performing regular pressure relief will be which of the following? ***

a. using a tilt or recline wheelchair for position changes
b. push-up technique
c. transferring out of his chair and lying prone for 5 minutes
d. side-to side leans using wrist extension to hook on the wheelchair push handle

Back 164

a. using a tilt or recline wheelchair for position changes

Front 165

Paul has incomplete T10 paraplegia, classified as ASIA C, as the result of a stab wound. He is nearing the end of his inpatient rehabilitation stay and is preparing for the transition to home. The most likely technique that Paul will use for performing regular pressure relief will be which of the following? ***

a. using a tilt or recline wheelchair for position changes
b. push-up technique
c. transferring out of his chair and lying prone for 5 minutes
d. side-to-side leans using wrist extension to hook on the wheelchair push handle

Back 165

b. push-up technique

Front 166

Paul is trying to learn to go up a curb in his wheelchair. In order to do this skill successfully, it is critical that he do which of the following? ***

a. have good timing and good command of the wheelie skill.
b. have exceptional upper extremity strength and normal upper extremity motor control.
c. be able to use his preserved lower extremity function enough to at least assist during the technique with pelvic and lower extremity control.
d. have a specially modified wheelchair designed to assist with this type of mobility.

Back 166

a. have good timing and good command of the wheelie skill.

Front 167

During therapy, muscle strength training for Paul will be focused on which of the following areas? ***

a. hand and wrist
b. trunk
c. lower extremities
d. shoulders and scapulae

Back 167

d. shoulders and scapulae

Front 168

During the days when he is not at therapy, Paul will be at home alone during the daytime hours when he is performing his home exercise program. Knowing this, recommendations for Paul’s home program are most likely to include which of the following? ***

a. practicing performing wheelies, repetitions of floor transfers, and propelling his wheelchair up and down curbs and around obstacles in the neighborhood.
b. lower extremity strengthening exercises, standing at a counter, performing squats in a very limited ROM.
c. biceps curls with increasing resistance, repeated sit to stand, and practicing floor transfers.
d. self-ROM exercises and propelling his wheelchair for gradually longer and faster trips around the neighborhood

Back 168

d. self-ROM exercises and propelling his wheelchair for gradually longer and faster trips around the neighborhood

Front 169

Paul’s wheelchair may need to be equipped at this time with which of the following? ***

a. a reclining back
b. plastic-coated push rims
c. anti-tip devices
d. power elevating leg rests

Back 169

c. anti-tip devices

Front 170

What is the significance of the cranial nerve nuclei and their relationship to the ascending reticular activating system (ARAS) in the brainstem for patients with disorders of consciousness? ***

a. cranial nerve nuclei are located throughout the ARAS and if intact may lead to a worse prognosis for recovery from coma.
b. cranial nerve nuclei are located above the ARAS and if intact may lead to a better prognosis for recovery from coma.
c. cranial nerve nuclei are located throughout the ARAS and if intact may lead to a better prognosis for recovery from coma.
d. there is no relationship between cranial nerve nuclei and the ARAS in the brainstem.

Back 170

c. cranial nerve nuclei are located throughout the ARAS and if intact may lead to a better prognosis for recovery from coma.

Front 171

In thinking of consciousness as requiring both awareness and arousal, which of the following statements is true? ***

a. you cannot have awareness without arousal.
b. you cannot have arousal without awareness.
c. the reticular activating system is responsible for the awareness component of consciousness.
d. a person in a coma is arousable but not aware.

Back 171

a. you cannot have awareness without arousal.

Front 172

Which of the following are reflexive movements? ***

a. eyes closing in response to bright lights
b. turning toward a loud noise
c. pulling away from a noxious stimulus to the fingers
d. blinking in response to touching the cornea

Back 172

d. blinking in response to touching the cornea

Front 173

Which of the following treatment interventions for patients with disorders of consciousness is supported by the current evidence in the research literature? ***

a. passive ROM to reduce the incidence of heterotopic ossification.
b. stretching soft tissues for an appropriate length of time to decrease contracture formation and reduce spasticity.
c. sensory stimulation programs to stimulate arousal and higher behavioral responses.
d. casting to improve passive ROM

Back 173

d. casting to improve passive ROM

Front 174

Which of the following is FALSE regarding the Glasgow Coma Scale (GCS)? ***

a. the GCS is the most widely used coma scale.
b. the scale consists of three categories: eye opening, best motor response, best verbal response.
c. the lowest possible total score is 0, indicating coma.
d. a total score of 12 or more indicates minor injury.
e. all of the above are true.

Back 174

c. the lowest possible total score is 0, indicating coma.

Front 175

Which of the following is FALSE? ***

a. the state of coma rarely lasts beyond 14 days, with the patient dying or transitioning to a vegetative state within that time frame.
b. patients in a vegetative state are always in a state of coma initially.
c. patients in a minimally conscious state must demonstrate some degree of awareness.
d. all of the above are true.

Back 175

b. patients in a vegetative state are always in a state of coma initially.

Front 176

Disorders of consciousness may result from which of the following? ***

a. trauma
b. tumor
c. stroke
d. cerebral anoxia
e. all of the above

Back 176

e. all of the above

Front 177

During the first week of bed rest, skeletal muscle decreases by what percent? ***

a. 0.5%
b. 0.5% to 1%
c. 1% to 1.5%
d. 1.5% to 2%

Back 177

c. 1% to 1.5%

Front 178

Positioning protocols are developed for patients with disorders of consciousness to: ***

a. avoid development of pressure ulcers
b. mobilize lung secretions
c. both a and b
d. none of the above

Back 178

c. both a and b

Front 179

What types of patients can benefit from aquatic therapy? ***

Back 179

those with
- back surgery/injury
- cervical/shoulder/wrist/hand/hip/knee/ankle injuries
- multiple sclerosis
- repetitive stress disorders
- chronic fatigue syndrome
- arthritis
- amputations
- neurological issues: stroke/Parkinson’s disease/head injuries
- respiratory issues (e.g, COPD)

Front 180

What are the contraindications for aquatic therapy? ***

Back 180

- open wounds
- active infections
- fever
- diarrhea (must be symptom-free for 48 hours before entering pool)
- incontinence

Front 181

What is the ideal water temperature for aquatic therapy with patients performing aerobic training? ***

Back 181

85 – 88 degrees

Front 182

What is the ideal water temperature for aquatic therapy with patients having multiple sclerosis? ***

Back 182

88 – 90 degrees

Front 183

What is the ideal water temperature for aquatic therapy with patients having arthritis or fibromyalgia? ***

Back 183

90 – 92 degrees

Front 184

What is the center of buoyancy of a human in the water? ***

Back 184

around T4

Front 185

What are some precautions for aqua therapy with diabetic patients? ***

Back 185

- patients should wear water shoes to protect feet

- patients should bring a snack and water for before and after treatment; aquatic therapy decreases blood sugar

Front 186

What are the weight-bearing levels for aquatic activities? ***

Back 186

- waist deep = 50%
- chest deep = 25%
- neck deep = 10%

Front 187

What should all patients do before aquatic therapy? ***

Back 187

- shower
- wear water shoes
- have blood pressure, heart rate, and oxygen saturation checked

Front 188

What effects does the hydrostatic pressure of the water have on patients? ***

Back 188

- decreases blood pressure
- reduces edema

- makes it more difficult to breath, especially for patients with respiratory issues

Front 189

What should be avoided for patients with back issues during aquatic therapy? ***

Back 189

- large hip abduction movements

Front 190

When should forward warm-up walking be avoided? What other move can substitute? ***

Back 190

- if patients are unable to maintain good upright posture
(tendency when walking in water is to lean forward)

- have them walk backwards instead

Front 191

How is heart rate affected by being in the water? ***

Back 191

- heart rate is 17 beats lower in the water

Front 192

What is the most common cause of acute paralysis in adults? ***

Back 192

Guillain-Barre

Front 193

What is one of the three most common movement disorders seen in the U.S.? ***

Back 193

Parkinson disease

Front 194

What is the most pervasive symptom seen in all the neurologic disorders discussed? ***

Back 194

- fatigue

- it impacts all aspects of the care and management of the individuals with these disorders

Front 195

Give several interventions that could be used to improve LE extensibility in a person with MS who exhibits increased LE tone. ***

Back 195

- slow stretching of muscles that exhibit increased tone can improve extensibility
- using weight-bearing positions is good for prolonged stretch, such as standing in a modified plantigrade posture, and weight bearing on the LEs and UEs
- the LEs can be in a step-stance position to allow a heel cord and hamstring stretch to the back leg
- doorway stretches can be used for the hamstrings, or the person can long sit with one leg on the mat table and the other on the floor

Front 196

Identify three factors that could lead to inactivity and deconditioning in a person with PPS. ***

Back 196

- fatigue
- pain
- weakness

Front 197

List signs and symptoms of overuse weakness. ***

Back 197

- delayed onset of muscle soreness, which gets worse 1-5 days after exercising

- reduction in the maximum amount of force the muscle is able to generate

Front 198

What is the most prevalent type of MS? ***

Back 198

relapsing and remitting

Front 199

How long can a person with PD usually benefit from taking L-dopa? ***

Back 199

- the medication usually works for only about 5-7 years before its benefits are no longer evident

- thus there comes a question of when to begin using it; most start at the point that PD symptoms become problematic for ADLs and quality of life

- dyskinetic movements result from prolonged use of L-dopa, and are most common at peak effect of the medication; many accept this side effect as tolerable in favor of the medicine’s effects

Front 200

Describe strategies to use when a person with PD freezes. ***

Back 200

- having the person change the movement pattern (march, kick a box, stop and pick up a penny)

- avoiding narrow spaces may be another strategy if freezing tends to occur going through doorways

Front 201

Who should use a nonfatiguing exercise protocol? ***

Back 201

- anyone who experiences fatigue as part of a disease process or disorder

- includes individuals with MS, Guillain-Barre, and post-polio

- the fatigue in individuals with Parkinson disease responds best to aerobic activity as the fatigue is often a result of slowed movement and decreased activity

Front 202

What are three exercise guidelines for a patient with GBS? ***

Back 202

- avoid overwork
- avoid eccentric contractions
- wait until the limb can be moved against gravity before stressing the muscle with active exercise

Front 203

List the four most common causes of SCIs. ***

Back 203

- MVA
- acts of violence
- falls
- sports-related

Front 204

Differentiate between a complete SCI and an incomplete SCI. ***

Back 204

- complete injury – sensory and motor function absent below the level of injury and in the S4 and S5 sacral segments

- incomplete injury – characterized by presence of some motor or sensory function below level of injury and in the lowest sacral segments; perianal sensation must be present for an injury to be classified as incomplete

Front 205

What are the characteristics of spinal shock? ***

Back 205

- flaccidity
- areflexia
- loss of bowel and bladder function
- autonomic deficits including decreased blood pressure and poor temperature regulation

Front 206

What is autonomic dysreflexia? Describe the clinical manifestations of a patient experiencing this condition. ***

Back 206

- pathological autonomic reflex that can occur in patients with injuries above the T6 level

- a noxious stimulus causes autonomic stimulation, vasoconstriction, and rapid increase in BP

- signs and symptoms can include hypertension, severe and pounding headache, profuse sweating, flushing above the injury, constricted pupils, goose bumps, blurred vision, and runny nose

Front 207

What is the functional potential of a patient with C7 tetraplegia? ***

Back 207

to live independently

Front 208

List three physical therapy interventions that will improve pulmonary function. ***

Back 208

- diaphragm strengthening
- instruction in glossopharyngeal breathing
- incentive spirometry
- postural drainage
- instruction in assistive cough techniques

Front 209

List the three primary goals of physical therapy intervention during the acute care phase of rehabilitation. ***

Back 209

- to prevent joint contractures and deformities
- to maximize muscular and respiratory function
- to acclimate patient to upright position

Front 210

Discuss a typical mat exercise program for a patient with C6 tetraplegia. ***

Back 210

- PROM to LEs
- UE strengthening to innervated musculature
- diaphragm strengthening
- assistive cough techniques

- rolling supine to prone
- transitioning from prone to prone on elbows
- transferring from supine to long sitting
- long-sitting activities with elbows anatomically locked

- increasing patient’s tolerance to upright
- instruction in pressure relief
- instruction in wheelchair propulsion

Front 211

What is the most functional type of wheelchair-to-mat transfer for a patient with C7 tetraplegia? ***

Back 211

- should be able to perform lateral transfer independently without a sliding board

Front 212

List the benefits of a therapeutic pool program. ***

Back 212

assists in
- decreasing abnormal muscle tone
- increasing muscle strength
- increasing ROM
- improving pulmonary function

- also allow standing and weight bearing and the ability to exercise weak muscles more easily

Front 213

Discuss the gait training sequence for a patient with paraplegia who will be using orthoses. ***

Back 213

- ideally they begin in the parallel bars
- find the balance point
- work on weight shifting
- pushups on the bars
- learn to jackknife

- start taking steps; swing-to or swing-through
- practice sit-to-stand and stand-to-sit

Front 214

Describe important areas for patient and family teaching for a patient with SCI. ***

Back 214

- instruction in patient transfers and ROM exercises

- knowledge about patient’s injury, potential complications, precautions, and likely functional outcomes

Front 215

Describe the clinical manifestations of a subdural hematoma. ***

Back 215

- develops between the dura and the arachnoid
- patient’s findings can fluctuate and are similar to those seen post-CVA

patients can experience
- decreased consciousness,
- ipsilateral pupil dilation
- contralateral hemiparesis

Front 216

What are some signs and symptoms of increased ICP? ***

Back 216

- decreased responsiveness
- impaired consciousness

- severe headache
- vomiting
- irritability

- papilledema
- increase in BP
- increase in HR

Front 217

Differentiate between a patient in a coma and a patient in a persistent vegetative state. ***

Back 217

- patient in a coma is neither aroused nor responsive to what is occurring internal or within the external environment; eyes remain closed and no distinction in sleep/wake cycles

- patient in persistent vegetative state has a return of brainstem reflexes and sleep/wake cycles; if person remains unaware of his/her internal needs or external environment for a year or longer he/she is said to be in a persistent vegetative state

Front 218

List four goals of acute physical therapy intervention for the patient with a TBI. ***

Back 218

- increasing patient’s level of arousal
- improving or preventing loss of function
- preventing secondary complications
- educating patient and family

Front 219

Define the ten stages within the Rancho Los Amigos Scale of Cognitive Functioning. ***

Back 219

I – no response
II – generalized response
III – localized response

IV – confused, agitated
V – confused, inappropriate
VI – confused. appropriate
VII – automatic, appropriate

VIII – purposeful and appropriate, SBA
IX – purposeful and appropriate, SBAOR
X – purposeful and appropriate, mod I

Front 220

Discuss the benefits of hand-over-hand modeling for patients with decreased cognitive functioning. ***

Back 220

- can assist patients in relearning automatic functional activities

- during completion of a meaningful functional task, patient receives proprioceptive and kinesthetic feedback from the clinician

Front 221

How may the physical environment affect the patient’s response to intervention? ***

Back 221

- too much sensory stimulation (lights, sounds, number of people) may overstimulate the patient and cause him/her to become distracted or agitated

Front 222

A patient is exhibiting significant disorientation and attention deficits. How could the PTA intervene to assist the patient in therapy? ***

Back 222

- for patients who are disoriented, use of a script or memory book can help fill in missing information about him/herself

- simple verbal instructions, redirection to the task, preparing a number of different treatment activities can be used with patients having attention deficits

Front 223

A patient becomes easily agitated and frustrated during therapy. At times, he can escalate into a full crisis. What can the PTA do to minimize these episodes? What should the PTA do if a crisis should occur? ***

Back 223

- patients who are disoriented can become agitated and may exhibit aggressive behaviors
- reorienting the patient may assist in calming him

- if the patient is overstimulated, clinician should try to remove the stimulus or remove the patient from the environment

- if the patient’s condition escalates to a crisis situation, the clinician’s primary concern is to protect the patient from harming himself or others

Front 224

A patient who has had a TBI possesses good motor skills. He is able to walk independently without an assistive device and is able to transfer independently. The patient does exhibit occasional losses of balance. The patient’s cognitive abilities are more seriously impaired. He is disoriented and has memory deficits. Identify four treatment activities for this patient that incorporate physical and cognitive components. ***

Back 224

- counting the number of completed repetitions of an exercise
- using a map or route-finding techniques
- throwing and catching in a sitting or standing position
- completing an obstacle course
- going on community outings

Front 225

Describe the major impairments seen in patients who have had CVAs. ***

Back 225

- motor impairments (flaccidity, spasticity, presence of synergies, paresis, apraxia)
- sensory impairments
- communication impairments

- orofacial deficits
- respiratory dysfunction
- bowel and bladder dysfunction
- functional limitations

Front 226

What are risk factors for the development of a CVA? ***

Back 226

- hypertension
- heart disease
- hyperlipidemia

- smoking
- alcohol consumption
- physical inactivity
- obesity
- age

- prior history of CVA or TIA
- gender (male)
- race (African American)

Front 227

Describe the upper and lower extremity flexion and extension synergy patterns. ***

Back 227

UE flexion synergy pattern
- scapular retraction and elevation or hyperextension
- shoulder abduction with ER
- elbow flexion
- forearm supination
- wrist and finger flexion

UE extension synergy pattern
- scapular protraction
- shoulder adduction with IR
- elbow extension
- forearm pronation
- wrist and finger flexion

LE flexion synergy pattern
- hip flexion
- hip abduction and ER
- knee flexion
- ankle DF and inversion
- extension of toes (it said dorsiflexion of toes)

LE extension synergy pattern
- hip extension
- hip adduction and IR
- knee extension
- ankle PF and inversion
- flexion of toes (it said plantar flexion of toes)

Front 228

Discuss the benefits of patient positioning. ***

Back 228

proper positioning out of synergy patterns assists in
- stimulating motor function
- increasing sensory awareness
- improving respiratory and oromotor function
- maintaining normal ROM
- decreasing risk of deformities and pressure ulcers

Front 229

The acute care PT management of a patient who has had a CVA should include what? ***

Back 229

- cardiopulmonary retraining (diaphragm strengthening)
- motor relearning exercises for UE and LE
- encouraging use of involved extremities

- positioning
- bed mobility exercises (bridging, scapular mobilization)
- rolling activities
- transfers

Front 230

The basic philosophical principles regarding the neurodevelopmental treatment approach include what? ***

Back 230

- to inhibit abnormal postural reflexes and movement patterns

- to facilitate normal functional movement

Front 231

What are appropriate physical therapy interventions to be performed with the patient in sitting? ***

Back 231

- posture correction
- maintenance of a neutral pelvic tilt

- weight bearing on involved UE and hand
- weight-shifting activities

- alternating isometrics and rhythmic stabilization
- performance of functional tasks such as reaching and ADLs

Front 232

Describe the gait training sequence for patients after acute CVA. ***

Back 232

patient must be able to
- stand and bear weight equally on both LEs
- maintain upright, erect posture
- shift weight in standing in order to advance first the uninvolved LE, then the involved LE

- once patient is able to step forward and back with either leg, several steps may be put together

Front 233

Name four advanced dynamic standing balance exercises. ***

Back 233

- marching in place
- side stepping
- braiding
- walking backward

- walking outside on uneven surfaces
- walking on a balance beam
- tandem walking
- throwing and catching

Front 234

What environmental factors must be considered when preparing the patient for discharge to home? ***

Back 234

- type of dwelling
- type of entrance
- interior accessibility
- type of carpeting present
- patient’s access to transportation

Front 235

Define the term “appropriate resistance” according to the PNF approach. ***

Back 235

- the amount of force or pressure that allows optimal patient response, depending on the type of muscle contraction desired

- if goal is isotonic movement, appropriate resistance would be the maximal amount of force that allows smooth, coordinated movement through the range determined by the clinician

- if goal is isometric contraction, appropriate resistance would be the amount of force that maximally challenges the patient while allowing him/her to maintain the chosen position

Front 236

What is irradiation? ***

Back 236

- a phenomenon through which relatively strong muscles reinforce or promote additional motor recruitment in associated weaker muscles

- patterns of irradiation/overflow are not completely predictable, but the most consistent results generally occur in synergists or muscles within a specific PNF or functional pattern

Front 237

What two PNF techniques are frequently applied to increase stability? ***

Back 237

- Alternating Isometrics and

- Rhythmic Stabilization

Front 238

A patient has weakness in the right gluteals. Identify activities to strengthen these muscles eccentrically. What PNF technique is most appropriate to address an eccentric deficit? ***

Back 238

- bridging
- tall kneeling to heel sitting
- mini squats
- stand-to-sit movements

- Agonist Reversal

Front 239

Hamstring shortness is limiting a patient’s ability to sit with the knees extended (long sitting position.) What PNF technique promotes lengthening of this muscle group. ***

Back 239

- Hold Relax is an effective technique to increase hamstring length

- Contract Relax with emphasis on hip components may also be effective

- techniques such as Slow Reversal are then used directly after stretching to encourage active or resistive movement through the newly acquired range