Basics
A patient presents with motor function that is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3. What ASIA scale rank is this patient?
C = Motor incomplete
ULTT3- name the nerve you are testing and the position of the UE
Radial Nerve
Shoulder =Depression,Medial rotation, Abduction (40*), and extension (25*)
Elbow = extension
Forearm = pronation
Wrist = Flexion & Ulnar deviation
Fingers = flexion
Cervical spine = Contralateral side flexion
A 28-year-old patient presents with progressive neurological symptoms, altered sensation, and muscle weakness. The patient reports that symptoms worsen with heat exposure. During cervical flexion, the patient experiences an electric-shock sensation traveling down the spine.
Which condition is the most likely diagnosis?
A. Amyotrophic lateral sclerosis (ALS)
B. Multiple sclerosis (MS)
C. Guillain-Barré syndrome (GBS)
D. Myasthenia gravis (MG)
B. Multiple sclerosis (MS)
MS involves progressive demyelination of neurons in the CNS.
Key clues: Uhthoff’s phenomenon (symptoms worsen with heat) and Lhermitte’s sign (electric-shock sensation with cervical flexion)
Sensation may be altered rather than completely lost.
A patient has expressive aphasia. What types of interventions would you do with this patient?
Treatment: Yes/No questions
A patient scores a 36 on the BERG exam. Is this patient a fall risk?
Yes- Max score 56, less than 45 indicates increased risk of falling.
A patient presents with spasticity. The physical therapist examines there is more marked increase in muscle tone through most of the ROM, but affected part(s) easily moved. What rank on the Modified Ashworth Scale for Grading Spasticity would this patient be?
2
Rhomboid Major and Minor is innervated by the Dorsal Scapular nerve. What nerve root(s) is the Dorsal scapular innervated by.
C5
A 45-year-old patient develops rapidly progressive, symmetrical muscle weakness following a recent infection. The weakness begins distally and progresses proximally. The patient also reports burning, tingling, and numbness in a glove-and-stocking distribution. Deep tendon reflexes are decreased.
Which condition is the most likely diagnosis?
A. Post-polio syndrome
B. Amyotrophic lateral sclerosis (ALS)
C. Guillain-Barré syndrome (GBS)
D. Parkinson’s disease
C. Guillain-Barré syndrome (GBS)
GBS is an acute inflammatory demyelinating polyradiculoneuropathy that can occur following an infection.
Key clues: Rapidly progressive, symmetrical weakness that progresses from distal to proximal, glove-and-stocking sensory loss, and decreased or absent reflexes.
A patient has pusher syndrome what types of interventions would you do this patient?
-Physical therapist sits at patient’s less involved side and instruct to lean over to them
-mirror therapy
-Do not attempt to passively push the patient into the correct alignment this will increase patient’s pushing
-shorter cane on strong side
What does the TUG exam assess?
Assess mobility and balance.
A patient wants to use PNF to improve self feeding on a patient. Which PNF technique would facilitate self feeding?
A. Contract relax
B. Slow reversal
C. Rythmic initiation
D. Hold relax
B. Slow reversal
Why--> Continuous flow: You actively contract a primary muscle group (agonist), and then immediately switch to contracting the opposing muscle group (antagonist) against the therapist's resistance.
Peroneus Tertius nerve innervation and action
Also known as Fibularis tertius
Nerve: Deep peroneal nerve
Action: DF and eversion
A 62-year-old patient presents with progressive muscle weakness, muscle fasciculations, and difficulty speaking and swallowing. The patient demonstrates signs of both upper and lower motor neuron involvement. Sensation remains intact, and the patient has developed cervical extensor weakness.
Which condition is the most likely diagnosis?
A. Multiple sclerosis (MS)
B. Myasthenia gravis (MG)
C. Amyotrophic lateral sclerosis (ALS)
D. Guillain-Barré syndrome (GBS)
C. Amyotrophic lateral sclerosis (ALS)
ALS involves progressive damage to both upper and lower motor neurons.
Key clues: Fasciculations, cervical extensor weakness, bulbar symptoms (difficulty speaking and swallowing), and preserved sensation.
A patient has UE flexion synergy. The PT decides to perform PROM exercises what position should the PT put the patient in?
The PT would want to move the patient out of the UE flexion synergy pattern
Patient presents to you spontaneous eye opening to speech, no motor response, and tends to use inappropriate words when talking. What glascow coma rank would the PT rank them?
A. Severe
B. Moderate
C. Mile
D. Not enough information is given to rank this patent on the Glascow Coma Scale.
A. Severe
spontaneous eye opening = 4
no motor response = 1
use inappropriate words = 3
Scores of 8 or less are classified as severe
Scores between 9 and 12 are defined as moderate
Scores of 13 to 15 are classified as mild
What foot position should the patient be in for an Achilles reflex test?
Foot should be held in slight passive dorsiflexion
What nerves are part of the posterior cord of the brachial plexus?
RATS:
Radial
Axillary
Thoracodorsal
Subscap (upper and lower)
A 35-year-old patient reports muscle weakness that worsens with repeated contractions but improves with rest. The patient initially developed ptosis and diplopia. Over time, the patient developed facial and proximal muscle weakness, followed by difficulty swallowing. Sensation remains intact.
Which condition is the most likely diagnosis, and what is the underlying mechanism?
Myasthenia gravis (MG)
MG is an autoimmune condition involving acetylcholine destruction at the neuromuscular junction, impairing muscle contraction.
Key clues: Muscle weakness worsens with repeated contraction and improves with rest, ptosis, diplopia, and progressive bulbar weakness. Sensation remains intact.
ALS interventions
• Focus on functional activities/ADLs and energy conservation initially and end stages
• Recommend soft foam collar for neck if weakness is present
• Maintain respiratory function, breathing exercises
• Avoid over fatiguing
•Take frequent breaks during activities, energy conservation techniques
Patient is in a heightened state of activity. Behavior is bizarre and nonpurposeful relative to the immediate environment. Does not discriminate among persons or objects; is unable to cooperate directly with treatment efforts. Verbalizations frequently are incoherent and/or inappropriate to the environment; confabulation may be present.
What Rancho Los Amigos Levels of Cognitive Functioning (LOCF) would this patient be classified as?
IV. Confused-Agitated
Can you describe all the stages of the Hoehn and Yahr Classification of Disability
I = Minimal or absent; unilateral if present.
II = Minimal bilateral or midline involvement. Balance not impaired.
III = Impaired righting reflexes.Unsteadiness when turning or rising from chair. Some activities are restricted, but patient can live independently and continue some forms of employment.
IV = All symptoms present and severe. Standing and walking possible only with assistance.
V = Confined to bed or wheelchair.
Increased Latency
A 52-year-old patient presents with a progressive neurological disorder characterized by involuntary, dance-like movements, grimacing, tongue protrusion, and mild personality changes. The patient has a family history of a similar condition. Over time, the patient develops worsening balance, cognitive decline, and difficulty swallowing.
Which condition is the most likely diagnosis?
Huntington’s disease
Huntington’s disease is an autosomal dominant disorder associated with a defect linked to chromosome 4 and the IT-15 gene.
Key clues: Involuntary choreic movements, grimacing, tongue protrusion, personality changes, and progressive cognitive deterioration.
A Parkinson's patient is currently taking Levodopa. When would be the best time to treat this patient?
One hour after dose
A patient is performing a sit-to-stand transfer. During the transfer, the PT is facilitating 75% of the effort in order to complete the sit-to-stand transfer. What FIM score would this patient have?
2 = Maximal assistance (patient performs 25% to 49% of the effort)
100-75 = 25 (the patient is only facilitating 25% of their own effort)