Neuroanatomy
A PTA is performing the Rinne Test. Where should the PTA place the stem of the tuning fork and which CN is being tested?
Mastoid process ( CN VIII)
A patient with right hemisphere stroke insists that they can walk independently despite clear left-sided hemiplegia. What condition is this, and how might it affect your treatment approach?
This is anosognosia, a lack of awareness or denial of one’s deficits, commonly seen after right parietal lobe damage. This can increase fall risk and reduce cooperation with rehab
A 1-month-old child who is supine turns their head to the right. What is the expected extremity response in a typically developing child?
right upper extremity extension, left upper extremity flexion ( same pattern in lower extremities)
What is the MOST common diagnosis if the Physical Therapist Assistant observes a 10 year old boy attempt to move from the floor to a standing position by pushing downward on his legs with his hands to straighten his knees?
Duchenne's Muscular Dystrophy.
This is the Gower's Sign
A patient consistently overshoots or undershoots while reaching for an object during coordination testing. What type of dysfunction is this and where could the lesion be?
Dysmetria
This structure connects the two cerebral hemispheres and allows them to communicate.
corpus callosum
A PTA places common objects, one at a time, in a patient’s hand while the patient’s eyes are closed. The patient is unable to identify the object or it’s shape. What deficit does this patient present with?
astereognosis
What clinical signs might a PTA observe in a child with a persistent TLR?
It can impair the infant’s ability to develop antigravity motion (to flex against gravity in supine and to extend against gravity in prone). An exaggerated TLR affects the entire body and can prevent the child from reaching with the arms in the supine position or from pushing with the arms in the prone position to assist in coming to sit. (Pg 103 Neuro Interventions)
A physical therapist assistant is working with a 7 year old child with Down Syndrome. In the middle of the treatment session the child reports that his head hurts and he feels dizzy. Upon examination the child demonstrate hyperreflexia. What is the appropriate response of the PTA?
Call 911 as the child may have atlantoaxial dislocation
A PTA should report signs like coughing during meals, pocketing food, or prolonged chewing, which may indicate this condition that increases aspiration risk.
Which cranial nerve is responsible for this?
dysphagia
A patient reports numbness in the left 5th digit. Which spinal nerve root is MOST likely affected?
C8
Your patient demonstrates slow, effortful speech with mostly content words and appears frustrated when speaking. Comprehension is relatively intact. They also have difficulty with writing. What type of aphasia is this, and how should you modify your communication during treatment?
This is Broca’s aphasia (expressive aphasia), usually due to damage in the left frontal lobe. Patients understand language but have difficulty producing speech. Use yes/no questions, visual aids, gestures, and give the patient extra time to respond
This clinical presentation/condition would MOST likely have serial casting as an important intervention.
Hypertonic plantarflexors
Not for hypotonia or contractures. why?
A patient with slurred, poorly articulated speech and difficulty coordinating respiratory and oral muscles likely has this motor speech disorder.
What are possible causes of this?
Dysathria
CN 7, 9, 12 dysfunction
Bell's Palsy
Precentral gyrus ( tongue and face dysfunction)
You note your patient cannot feel pain or temperature on the left side of their body below the level of injury, but motor function is intact. This tract is likely damaged.
right spinothalamic tract
During a therapy session, your patient is unable to recognize a hairbrush by sight but can describe its shape and use it correctly when placed in their hand. What type of agnosia is this, and which brain region is likely affected?
This is visual agnosia, a condition in which the patient cannot recognize objects by sight despite having intact vision. Agnosias are usually due to a parietal lobe injury.
This describes a finding that would be MOST expected in a child with T8 spina bifida.
Deep Tendon Reflex of 3+ or 4+
UMN Lesions in the LEs
UEs would not be affected
A patient is unable to alternate between tapping their feet. They also cannot rapidly flip their palms face up/down during coordination testing. What would you call this dysfunction?
Dysdiadochokinesia
The PTA treats a patient who has a cerebellar lesion. These coordination impairments are expected to be observed with this condition. (Name the specific impairments)
Dysmetria (timing, force, extent, direction of limb movement, unable to reach target), nystagmus (gaze-evoked, eyes drift involuntarily to neutral), dysdiadochokinesia (inability to perform rapid alternating movements)
A patient is asked to demonstrate how to use a key, but the patient cannot perform the action on command, but later, they are observed unlocking a door automatically without difficulty. What impairment could this patient be presenting with?
ideomotor apraxia
This is the resting cervical position in a patient with left sided torticollis.
Left side-bend, Right rotation and flexion
Which of the following signs and symptoms is MOST consistent with Spinal Muscular Atrophy (SMA)?
Progressive weakness with eventual respiratory failure
You are testing the integrity of the S1 level by performing a DTR, which tendon are you testing?
What about L4?
Achilles DTR = S1
Patellar DTR = L4