Gait+
orthotics
orthotics
Upper Extremity
Acute Care
Stroke Assessment
Misc.
100
During the Initial Contact phase of paretic gait, initial contact made on the forefoot or flat foot forces the tibia backward during loading response, producing this specific joint deviation at the knee
what is hyperextension?
100
To prevent subacromial tissue damage and hemiplegic shoulder pain, a physical therapist must never passively move a paretic shoulder beyond 90° of flexion or abduction unless the scapula is performing this movement and the humerus is positioned in this orientation
What is upward rotation and external rotation?
100
Before sitting or mobilizing a patient in the Neuro ICU who has this temporary drainage and monitoring line installed in their lateral ventricles, a therapist must ensure it is clamped by medical order to prevent rapid, uncontrolled drainage of cerebrospinal fluid (CSF).
what is external ventricular drain?
EVD- temporary pressure-gradient catheter inserted into the frontal horn of the lateral ventricle of the brain. It is primarily encountered in acute care with patients recovering from subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH)
100
A patient has a 6MWT distance of 300 meters.
What does this suggest regarding community walking?
patient is a full/unlimited community ambulator
100
According to post-stroke cardiovascular guidelines, commencing physical activity or exercise is contraindicated if a patient's resting blood pressure exceeds this specific systolic and diastolic threshold.
What is >200 mmHg SBP and >110 mmHg DBP?
200
A 62-year-old stroke survivor in outpatient PT completes a 10-Meter Walk Test with a comfortable gait speed of 0.20 m/s. According to Perry’s Functional Walking Categories, this patient is classified under this functional ambulation category?
What is a household walker (or limited household walker)?
(Slide 46 of Gait Retraining Post-Stroke)
200
List 3/5 risk factors for hemiplegic shoulder pain
little to no active movement, sensory loss, does not recognize limb as their own, scapular misalignment, loss of PROM of shoulder flexion/abduction <90 degrees and external rotation <60 degrees
200
In a resting adult in acute neurological care, normal Intracranial Pressure (ICP) ranges between these two values in mmHg.
What is 5 to 15 mmHg?
200
On the National Institutes of Health Stroke Scale (NIHSS), a total score falling strictly within this numerical score range indicates moderate stroke severity and serves as a primary clinical predictor that the patient will be discharged to where?
What is 6-13 and Inpatient Rehabilitation Facility?
200
A patient learns a compensatory strategy that makes a task easier but prevents them from practicing a more neurologically effective movement.
Which neuroplasticity principle describes this problem?
what is interference?
300
While a Solid Ankle AFO successfully stops foot posturing and provides strong distal stability in stance, its primary biomechanical drawback is that it completely blocks ankle mobility and prevents this necessary anterior movement of the lower leg during midstance
What is forward tibial translation?
300
List 3/5 causes for glenohumeral joint subluxation
flaccid /weak rotator cuff muscles- deprives the joint of natural muscular alignment and hold
Overstretched glenohumeral capsule- without active support, gravity continuously pulls down on the heavy arm therefore overstretching the joint capsule
Improper bed positioning: poor alignment can place mechanical strain on the joint
Lack of support when upright: gravity pulls the humeral head out of the socket
Pulling on the paretic arm during transfers/bed mobility/gait
300
You and your CI are treating a 64-year-old patient 18 hours post-ischemic stroke. The patient is medically stable,
Your CI proposes scheduling a single 50-minute continuous out-of-bed rehabilitation session once per day to "maximize therapy dose and motor learning."
Based on the evidence from the AVERT trial, what should you recommend the frequency and duration of the session be?
Shorter, more frequent out-of-bed sessions (10-15 minutes, 3-4x/day)
The AVERT trial suggests that shorter, more frequent out-of-bed sessions throughout the day improve the odds of favorable outcomes and reduce the odds of death.
300
Beyond synergy contamination, MMT results post-stroke are frequently confounded by these velocity-dependent and involuntary neuromuscular abnormalities that alter joint resistance.
What are spasticity, altered muscle tone, or muscle co-contraction?
300
To effectively improve cardiorespiratory fitness post-stroke, continuous aerobic exercise using large muscle groups must be performed for at least 20 minutes at an intensity of at least this percentage of Heart Rate Reserve (HRR).
What is 40%?
Guidelines recommend 40-70% of HRR to improve cardiorespiratory fitness in this population.
400
During weight acceptance in stance phase, a therapist observes a patient's paretic knee snap backward into knee hyperextension (extension thrust). Biomechanical analysis reveals the patient makes Initial Contact with their forefoot rather than a heel strike. This specific ankle impairment is forcing the tibia backward and driving the knee extension thrust.
What is excessive plantarflexion, plantarflexion contracture, or lack of dorsiflexion ROM?
400
What are the three principles of motor learning that are integral to a CIMT protocol?
What is extensive challenged practice, active participation, and meaningful goals?
Extensive challenged practice- task demands should be continually elevated as skill improves to ensure that the nervous system actively solves motor problems instead of just going through the motions
Active participation- the patient needs to move their limb for cortical pathways to be reformed
Meaningful goals- movement must be functionally relevant/personal to the patient for long-term memory consolidation and can be transferred to real life
400
This progressive protocol moves Neuro ICU patients stepwise from HOB 45° to sitting at the edge of the bed, stand-pivot transfers, and hallway ambulation up to 150 feet.
What is the Progressive Upright Mobility Protocol (PUMP)?
400
During a bed-to-chair transfer, a patient completes 100% of the physical effort while the physical therapist provides verbal safety cues and keeps a light steadying hand on the patient's waist. Under the IRF-PAI 6-point scale, this performance is assigned this specific numerical score.
What is a score of 4 (Supervision / Touching Assistance / Contact Guard)?
400
While men post-stroke tend to exhibit "typical" acute symptoms such as slurred speech and facial droop, women are significantly more likely to present with what atypical symptoms?
What is urinary incontinence, diplopia, dysphagia, and confusion/altered mental status?
500
During gait observation, a physical therapist notes that a patient fails to achieve a heel rise in terminal stance and cannot advance body weight onto the forefoot, forcing a shortened step length on the non-paretic limb. Rather than simple gastrocnemius weakness, the PT identifies this specific foot impairment as the underlying cause.
What are clawed toes (or toe flexor spasticity)?
500
A 52-year-old male 4 months post-MCA stroke presents to outpatient PT. On examination of his paretic right upper extremity, he demonstrates:
- 35° active shoulder flexion and 35° active shoulder abduction against gravity.
- 25° active elbow extension in gravity-reduced position.
- 12° active wrist extension.
- 12° active thumb abduction and 12° active extension in digits 2 and 3.
Is this patient eligible for Constraint-Induced Movement Therapy (CIMT), and if so, under which criteria threshold?
Yes, he meets the "low function" CIMT motor criteria:
- 10 degrees wrist extension
- 10 degrees active thumb extension/abduction
- 10 degrees active extension in at least 2 other digits
- as well as 30 degrees active shoulder flexion/abduction and 20 degrees elbow extension
500
A 54-year-old female is admitted to the Neuro ICU after experiencing a sudden, severe "worst headache of her life," followed by vomiting and a rapid drop in level of consciousness. A CT scan confirms a Subarachnoid Hemorrhage (SAH) secondary to an aneurysm rupture. While acute care physical therapy for an uncomplicated ischemic stroke often initiates out-of-bed mobilization within 18–24 hours, the acute care PT knows this SAH patient requires an extended Neuro ICU stay of 14+ days due to a heightened risk of re-bleeding and this delayed vascular complication
What is cerebral vasospasm?
An aneurysmal SAH requires a minimum of 14 days of intensive monitoring because peak risk for cerebral vasospasm occurs between days 4 and 14 post-event, drastically reducing cerebral blood flow and risking secondary delayed ischemic deficits.
500
Under the PREP (Predict Responding to Exercise and Physical Therapy) Algorithm, when a patient presents on Day 3 post-stroke with a SAFE score of less than 5, Transcranial Magnetic Stimulation (TMS) is used to test for Motor Evoked Potentials (MEPs). If a motor evoked potential is detected (MEP+), the patient is routed into this specific upper extremity outcome pathway.
What is good?
500
Under Kleim and Jones's 7th principle ("Salience Matters"), task practice must be functionally relevant and meaningful to the patient to drive cortical reorganization, which relies on the active engagement of this specific neurotransmitter system.
What is the cholinergic system?