Parkinson's
An occupational therapist observes a client taking unusually small steps while walking and having difficulty initiating movement. Which Parkinson's disease symptom is MOST associated with these findings?
A. Chorea
B. Bradykinesia
C. Intention tremor
D. Dysmetria
Correct Answer: B. Bradykinesia
Rationale: Bradykinesia refers to slowness of movement and difficulty initiating movement. It is one of the cardinal features of Parkinson's disease and contributes to decreased arm swing, shuffling gait, and difficulty starting or stopping movement. Chorea is associated with Huntington's disease, while intention tremor and dysmetria are more commonly associated with cerebellar dysfunction.
An occupational therapist is developing a home program for a client with multiple sclerosis. Which recommendation should the therapist AVOID due to the potential for symptom exacerbation?
A. Using a cooling vest during outdoor activities
B. Taking frequent rest breaks during ADLs
C. Taking long hot showers to relax muscles
D. Scheduling demanding tasks during peak energy periods
Correct Answer: C. Taking long hot showers to relax muscles
Rationale: Heat sensitivity is common in multiple sclerosis and can temporarily worsen neurological symptoms such as fatigue, weakness, and visual disturbances. Clients are often encouraged to use cooling strategies and avoid excessive heat exposure.
A client with ALS is experiencing increasing difficulty with grasp and upper extremity strength. Which characteristic is MOST associated with ALS?
A. Progressive muscle weakness
B. Chorea
C. Bradykinesia
D. Demyelination
Correct Answer: A. Progressive muscle weakness
Rationale: ALS is a progressive neurodegenerative disease that affects upper and lower motor neurons, resulting in worsening muscle weakness, atrophy, and loss of functional abilities over time.
A client demonstrates involuntary, jerky, dance-like movements of the arms and legs. This movement pattern is known as:
A. Ataxia
B. Chorea
C. Bradykinesia
D. Spasticity
Correct Answer: B. Chorea
Rationale: Chorea consists of involuntary, irregular, dance-like movements and is a hallmark feature of Huntington's disease. Bradykinesia is associated with Parkinson's disease, while ataxia is associated with cerebellar dysfunction.
An occupational therapist is treating a client with a progressive neurological condition. Which intervention approach is MOST appropriate when the client's functional abilities begin to decline?
A. Focus exclusively on restoring lost function
B. Introduce compensatory strategies and adaptive equipment as needed
C. Discontinue therapy until the condition stabilizes
D. Increase task difficulty to promote recovery
Correct Answer: B. Introduce compensatory strategies and adaptive equipment as needed
Rationale: As progressive neurological conditions advance, OT intervention shifts toward compensation, adaptation, and maintaining participation. Adaptive equipment, environmental modifications, and compensatory strategies help maximize independence and quality of life despite declining function.
A client with Parkinson's disease frequently "freezes" when approaching doorways during functional mobility. Which intervention is MOST appropriate to improve mobility?
A. Encourage the client to walk faster through the doorway
B. Use visual floor markers or rhythmic auditory cues
C. Provide passive range of motion before walking
D. Restrict ambulation until symptoms improve
Correct Answer: B. Use visual floor markers or rhythmic auditory cues
Rationale: Clients with Parkinson's disease often benefit from external cueing strategies to overcome freezing episodes. Visual cues (such as floor tape) and auditory cues (such as counting or a metronome) can improve gait initiation and movement. Encouraging faster walking may increase fall risk, passive ROM does not directly address freezing, and restricting mobility can lead to further functional decline.
A client with multiple sclerosis reports that fatigue significantly interferes with ADL performance. Which occupational therapy intervention is MOST appropriate?
A. Encourage the client to complete all activities in one sitting
B. Schedule demanding tasks during periods of highest energy
C. Increase resistance training before ADLs
D. Eliminate rest breaks to improve endurance
Correct Answer: B. Schedule demanding tasks during periods of highest energy
Rationale: Fatigue is one of the most common symptoms of MS. Energy conservation strategies such as prioritizing activities, scheduling demanding tasks during peak energy periods, and incorporating rest breaks can improve occupational performance and participation.
Which body system is MOST commonly affected as ALS progresses and often contributes to mortality?
A. Visual system
B. Respiratory system
C. Gastrointestinal system
D. Auditory system
Correct Answer: B. Respiratory system
Rationale: Progressive respiratory muscle weakness is a major complication of ALS and is a common cause of death. Monitoring respiratory status and planning for future needs are important aspects of intervention.
A client with Guillain-Barré syndrome has experienced rapidly progressing weakness for the past several days. The weakness is continuing to worsen. Which stage of Guillain-Barré syndrome is the client MOST likely experiencing?
A. Plateau phase
B. Recovery phase
C. Acute (progressive) phase
D. Remission phase
Correct Answer: C. Acute (progressive) phase
Rationale: During the acute or progressive phase of Guillain-Barré syndrome, weakness continues to worsen and symptoms progress. This phase is followed by the plateau phase, where symptoms stabilize, and then the recovery phase, during which function gradually improves.
A client with a progressive neurological disease is still independent with ADLs but reports increasing difficulty completing tasks. What is the MOST appropriate OT focus at this stage?
A. Caregiver training for total assistance
B. Hospice and comfort measures
C. Maintaining function and introducing early compensatory strategies
D. Discontinuing therapy until further decline occurs
Correct Answer: C. Maintaining function and introducing early compensatory strategies
Rationale: Early-stage intervention focuses on maintaining independence, preserving function, and introducing compensatory strategies before significant decline occurs.
An occupational therapist is developing an intervention plan for a client with Parkinson's disease who demonstrates decreased movement amplitude during dressing, transfers, and mobility. Which intervention approach is MOST appropriate?
A. LSVT BIG
B. Constraint-Induced Movement Therapy (CIMT)
C. Neurodevelopmental Treatment (NDT)
D. Sensory Integration Therapy
Correct Answer: A. LSVT BIG
Rationale: LSVT BIG is an evidence-based intervention designed specifically for individuals with Parkinson's disease. It focuses on increasing movement amplitude through intensive, repetitive, large-amplitude movements to improve functional performance during daily activities. CIMT is primarily used following CVA, NDT is commonly associated with stroke and cerebral palsy, and Sensory Integration Therapy is primarily used in pediatrics.
A client with multiple sclerosis reports periods of symptom flare-ups followed by periods of recovery in which symptoms partially or completely resolve. This disease course is MOST characteristic of:
A. Primary progressive MS
B. Secondary progressive MS
C. Relapsing-remitting MS
D. Chronic progressive MS
Correct Answer: C. Relapsing-remitting MS
Rationale: Relapsing-remitting MS is the most common form of multiple sclerosis. It is characterized by exacerbations (relapses) followed by periods of recovery (remissions). Symptoms may partially or completely improve during remission periods.
A client with ALS reports increasing difficulty holding utensils and bringing food to the mouth due to upper extremity weakness. Which intervention is MOST appropriate?
A. Recommend complete caregiver feeding assistance immediately
B. Introduce adaptive feeding equipment to support independence
C. Begin resistive strengthening exercises for the upper extremities
D. Restrict oral intake
Correct Answer: B. Introduce adaptive feeding equipment to support independence
Rationale: As ALS progresses, occupational therapy focuses on compensatory strategies and adaptive equipment to maintain independence for as long as possible. Built-up utensils, universal cuffs, mobile arm supports, and other adaptive devices may help clients continue participating in self-feeding despite weakness.
An occupational therapist is treating a client with Guillain-Barré syndrome who is in the plateau phase of recovery. Muscle weakness has stabilized, but significant functional limitations remain. What should be the therapist's PRIMARY focus?
A. Aggressive strengthening to restore muscle function
B. Prevention of secondary complications and maintenance of function
C. Return-to-work training
D. High-level community mobility training
Correct Answer: B. Prevention of secondary complications and maintenance of function
Rationale: During the plateau phase of Guillain-Barré syndrome, symptoms have stabilized but recovery has not yet begun. Occupational therapy focuses on maintaining function, positioning, ROM, skin integrity, prevention of contractures, and minimizing secondary complications until recovery occurs.
A client with a progressive neurological disease is beginning to require increased assistance with ADLs. Which intervention should the occupational therapist prioritize?
A. Introduce adaptive equipment to maintain independence
B. Educate the caregiver on assistance techniques and future needs
C. Modify the environment to improve safety
D. Establish a strengthening program to restore prior function
Now we're getting somewhere.
Correct Answer: B. Educate the caregiver on assistance techniques and future needs
Rationale: As progressive diseases advance, caregiver education becomes increasingly important because assistance needs are expected to continue growing. While adaptive equipment and environmental modifications may also be appropriate, caregiver training helps prepare for future functional decline and supports long-term participation and safety.
During an evaluation, an occupational therapist passively moves a client's elbow and feels a ratchety, stop-and-go resistance throughout the range of motion. This type of rigidity is MOST characteristic of:
A. Lead-pipe rigidity
B. Cogwheel rigidity
C. Spasticity
D. Flaccidity
Correct Answer: B. Cogwheel rigidity
Rationale: Cogwheel rigidity is characterized by a ratchety, jerky resistance during passive movement and is commonly seen in Parkinson's disease. It results from rigidity combined with a resting tremor. Lead-pipe rigidity involves smooth, constant resistance throughout the range of motion. Spasticity is velocity-dependent increased muscle tone, while flaccidity is decreased muscle tone.
A client with multiple sclerosis reports eye pain, blurred vision, and decreased visual acuity in one eye. Which condition is MOST commonly associated with these symptoms?
A. Hemianopsia
B. Optic neuritis
C. Cataracts
D. Glaucoma
Correct Answer: B. Optic neuritis
Rationale: Optic neuritis is a common manifestation of multiple sclerosis caused by inflammation of the optic nerve. Symptoms often include eye pain, blurred vision, decreased visual acuity, and temporary vision loss. Hemianopsia is typically associated with CVA, while cataracts and glaucoma are not characteristic features of MS.
An occupational therapist is evaluating a client recently diagnosed with ALS who demonstrates mild upper extremity weakness but remains independent with ADLs. Which intervention is MOST appropriate at this stage?
A. Recommend complete caregiver assistance for all ADLs
B. Introduce energy conservation strategies and monitor functional changes
C. Prescribe a power wheelchair immediately
D. Focus solely on respiratory management
Correct Answer: B. Introduce energy conservation strategies and monitor functional changes
Rationale: During the early stages of ALS, occupational therapy focuses on maintaining independence, conserving energy, monitoring functional decline, and introducing compensatory strategies as needed. Full caregiver assistance and power mobility are typically not yet required.
In addition to choreiform movements, clients with Huntington's disease commonly experience which of the following?
A. Progressive cognitive decline and behavioral changes
B. Ascending paralysis and full recovery
C. Resting tremor and rigidity
D. Optic neuritis and diplopia
Correct Answer: A. Progressive cognitive decline and behavioral changes
Rationale: Huntington's disease is characterized by a triad of motor, cognitive, and behavioral symptoms. In addition to chorea, clients often experience impaired judgment, impulsivity, memory deficits, depression, and progressive cognitive decline. The other options are more characteristic of GBS, Parkinson's disease, and MS, respectively.
A client with a progressive neurological condition is experiencing increasing difficulty bringing food from the plate to the mouth due to severe upper extremity weakness. Which adaptive device is MOST appropriate?
A. Built-up utensils
B. Universal cuff
C. Mobile arm support
D. Weighted utensils
Correct Answer: C. Mobile arm support
Rationale: A mobile arm support assists individuals with significant proximal upper extremity weakness by supporting the weight of the arm during feeding. Built-up utensils, universal cuffs, and weighted utensils primarily address grasp or tremor-related difficulties and do not compensate for severe shoulder and elbow weakness.
A client with Parkinson's disease begins walking with increasingly rapid, short steps and appears unable to stop once movement has started. This gait pattern is known as:
A. Ataxic gait
B. Scissoring gait
C. Festinating gait
D. Steppage gait
Correct Answer: C. Festinating gait
Rationale: Festinating gait is characterized by short, accelerating steps that often cause the client to appear as though they are chasing their center of gravity. It is a common gait disturbance in Parkinson's disease and contributes to fall risk. Ataxic gait is associated with cerebellar dysfunction, scissoring gait is commonly seen in cerebral palsy, and steppage gait is associated with foot drop.
Multiple sclerosis is characterized by damage to the myelin sheath surrounding neurons in the central nervous system. This process is known as:
A. Demyelination
B. Axonal regeneration
C. Wallerian degeneration
D. Neuroplasticity
Correct Answer: A. Demyelination
Rationale: Multiple sclerosis is an autoimmune disease that causes demyelination of neurons in the central nervous system. Damage to the myelin sheath disrupts the efficient transmission of nerve impulses, resulting in symptoms such as fatigue, weakness, visual disturbances, impaired coordination, and sensory changes.
A client with end-stage ALS is dependent for all ADLs, uses a power wheelchair, and communicates through eye-gaze technology. Which occupational therapy intervention should be prioritized?
A. Increasing upper extremity strength through resistive exercise
B. Improving fine motor coordination for handwriting
C. Promoting comfort, positioning, and quality of life
D. Retraining independent dressing skills
Correct Answer: C. Promoting comfort, positioning, and quality of life
Rationale: In end-stage ALS, occupational therapy priorities shift from restoring function to maximizing comfort, quality of life, participation in meaningful activities, positioning, caregiver support, and prevention of secondary complications. Interventions should align with the client's goals and stage of disease progression.
An occupational therapist is evaluating a client with Huntington's disease who insists on continuing to cook independently despite worsening chorea, impulsivity, and poor judgment. Which intervention is MOST appropriate?
A. Encourage independent meal preparation to maintain autonomy
B. Recommend complete discontinuation of kitchen activities
C. Modify the environment and increase supervision during meal preparation
D. Focus on upper extremity strengthening to reduce choreiform movements
Correct Answer: C. Modify the environment and increase supervision during meal preparation
Rationale: Huntington's disease is associated with progressive motor, cognitive, and behavioral impairments. OT interventions should maximize participation while addressing safety through environmental modifications, task adaptations, and appropriate supervision. Complete restriction is unnecessarily limiting, while strengthening does not reduce chorea.
A client with an advanced progressive neurological condition is receiving hospice services and is dependent for all ADLs. Which occupational therapy intervention should be prioritized?
A. Educating caregivers on positioning techniques to maximize comfort
B. Recommending environmental modifications to reduce caregiver burden
C. Facilitating participation in meaningful activities identified by the client
D. Developing a restorative exercise program to improve strength
Correct Answer: A
Rationale: During hospice care, OT priorities focus on comfort, symptom management, caregiver support, and quality of life. Positioning is often the highest priority because it affects pain, skin integrity, comfort, and overall well-being. Meaningful activities and environmental modifications may also be appropriate, but comfort typically takes precedence.