Treatment
Which of the following is a core outcome measure as identified by “A Core Set of Outcome Measures for Adults with Neurologic Conditions Undergoing Rehabilitation. A Clinical Practice Guideline?”
A) Berg Balance Assessment
B) Trunk Impairment Scale
C) Timed Up and Go
D) Orpington Prognositic Scale
A) Berg Balance Assessment
Sally is brought to the ED by her friend Tina after experiencing slurred speech and a loss of balance upon standing. The CT scan shows an ischemic stroke. What might be included in her medical management?
A) tPA
B) BP < 140/90mmHG
C) HOB > 30 degrees
D) Vitamin K via IV
A) tPA
You are treating a 16F s/p MVA diagnosed with severe DAI. She is currently exhibiting s/s consistent with LOCF level IV. All of the following should be included in your PT plan of care EXCEPT.
A. Transfer training
B. Treating the patient in a busy gym with many distractors to increase the complexity of the environment
C. Use of nighttime positioning devices to prevent loss of ROM
D. Gait training with an additional helper and AD as needed
B. Treating the patient in a busy gym with many distractors to increase the complexity of the environment
A patient has a 4-year history of MS. They report periods of worsening function, with some ability to recover and periods with no increase in symptoms. What type of MS do they have?
A. Clinically isolated syndrome
B. Primary progressive MS
C. Secondary progressive MS
D. Relapse remitting MS
D. Relapse remitting MS
When performing a supine to seated transfer with two people, it is most important to...
A. Talk to the patient’s family and explain what you are doing during the transfer.
B. Communicate with your fellow care provider to make sure patient and provider safety is maintained at all times.
C. Do the transfer as quickly as possible so that the patient does not become distressed.
D. Discourage the patient from assisting so that they do not get in the way while you are completing the transfer.
B. Communicate with your fellow care provider to make sure patient and provider safety is maintained at all times.
Which techniques below are examples of PNF therapeutic techniques?
A) Approximation and joint compression
B) Quick stretch
C) Alternating Isometrics
D) Deep pressure and prolonged cold
You are working with a patient who had a hemorrhagic stroke. You get the patient sitting on the edge of the bed and she tells you she has a new headache and experienced an episode of incontinence. What is your next course of action?
A) Try to stand
B) Work on only seated tasks today
C) Lay the patient in bed with HOB to 30 degrees and get the RN
D) Call a code
C) Lay the patient in bed with HOB to 30 degrees and get the RN
If a patient suffered a focal traumatic injury to the frontal lobe, what would be a likely presentation of deficits?
A. Lack of focus, irritability, personality changes
B. Difficulty with short and long-term memory
C. Vision changes
D. Difficulty with balance and equilibrium
A. Lack of focus, irritability, personality changes
Which of the following are appropriate exercise considerations for patients with MS?
A. Encouraging exercise in warm environments (>80 degrees)
B. Keep exercise activity minimal to prevent exacerbations
C. Gauging exercise based on patient presentation and current status
D. Encouraging at least 45 minutes of exercise a day
C. Gauging exercise based on patient presentation and current status
What postural control strategy is used to respond to small perturbations/LOB?
A. Suspensory
B. Ankle
C. Hip
D. Stepping
B. Ankle
You are treating a patient with a traumatic brain injury who begins to perseverate during treatment. In order to maximize effectiveness of your session, how should you respond?
A) Provide verbal cueing until the patient stops perseverating
B) Discontinue the session and try again tomorrow
C) Gently redirect the patient with a new activity and praise completion of the task
D) Discuss the topic the patient is perseverating on until they are no longer focused on it
C) Gently redirect the patient with a new activity and praise completion of the task
A patient incurred a right CVA 1 month ago and demonstrates moderate hypertonicity, especially in the left biceps. There is minimal active movement throughout the L UE, with ¼ inch subluxation of the shoulder. What initial treatment activity is the BEST choice for this patient?
A) Sitting, active shoulder protraction with extended elbow and shoulder flexed to 90 degrees
B) Sitting, weight bearing on extended UE with PT support to shoulder, weight shifting
C) Quadruped, rocking from side to side with fast perturbations on the left shoulder
D) Quick alternating isometrics in PNF D2 flexion pattern
B) Sitting, weight bearing on extended UE with PT support to shoulder, weight shifting
Choose the most appropriate pair of outcome measures to use when evaluating a patient who has recently emerged into a conscious state.
A. LOCF (Rancho Los Amigos Level of Cognitive Functioning Scale) and the Berg Balance Assessment
B. CRS-R (JFK Coma Recovery Scale – Revised) and the 6MWT (Six Minute Walk Test)
C. Glasgow Coma Scale and the QLAB (Quality of Life After Brain Injury Questionnaire)
D. ABC scale (Activities-Specific Balance Confidence Scale) and the HiMat Test (High Level Mobility Assessment Tool)
A. LOCF (Rancho Los Amigos Level of Cognitive Functioning Scale) and the Berg Balance Assessment
Fatigue can be a major component of patient management for patients with MS, what outcome measure is not effective in aiding in the management of fatigue?
A. MS Quality of Life Questionnaire
B. Visual Analog Scale for Fatigue
C. Modified Impact Fatigue Scale
D. Box and Blocks Test
D. Box and Blocks Test
You are working with a patient who is at LOCF VIII and generally requires only contact guard assist for safety. As you are walking, you notice he has ceased to participate in your conversation and his face looks ashen. His knees buckle and he begins to fall. What is the best PT response?
A. Encourage him to use a stepping strategy to regain his balance.
B. Step away so he does not land on you and you can catch/protect his head as he falls.
C. Bring your body in close to him and use your leg/body and the gait belt to maintain control of his body while lowering him to your knee.
D. Block his knees and keep one hand on the gait belt and one hand on his chest until pallor returns to normal and he resumes gait training.
C. Bring your body in close to him and use your leg/body and the gait belt to maintain control of his body while lowering him to your knee.
You are treating patient with secondary progressive MS. The patient has been experiencing increasing fatigue and difficulty meeting task demands of her daily life. She voices that she would like to be independent in her transfers in the least taxing way possible. The patient demonstrates hypertonia in LE> UE and R sided weakness. Which transfer intervention would be BEST for this patient?
A) SPT to R to encourage recovery and normalize movement
B) Squat pivot transfer to L with education on environmental modifications to aid in ease of transfer
C) Squat pivot transfer to R to encourage forced use of the involved extremities
D) Hoyer lift transfer to aid in energy conservation with aims of increasing independence in other areas of life
B) Squat pivot transfer to L with education on environmental modifications to aid in ease of transfer
You are treating a 65 yo female in an acute care hospital who experienced an ischemic MCA CVA 2 days ago. She arrived to the hospital within two hours of symptom onset and received tPA. On admission, NIHSS score of 11. She presents with R sided hemiparesis of UE> LE with no active finger extension and visuospatial deficits. Which of the following are negative prognostic factors for this patient?
A) NIHSS of 11
B) No active finger extension on day 2 post stroke
C) R sided hemiparesis
D) A and B
E) All of the above
B) No active finger extension on day 2 post stroke
You are treating 23 yo male in an IRF who experienced a severe HI during a MVA. He presents with normalized sleep-wake cycles and demonstrates a delayed, generalized response to stimulus. What will be the most appropriate intervention for this patient?
A) Rolling in the bed and dependent transfers supine to sit while asking the patient to participate and playing his favorite music
B) Educating the family on PROM of his extremities for ROM maintenance
C) Ordering and placing positioning devices in the bed to prevent contracture and skin breakdown
D) All of the above
D) All of the above
A. Impaired gag reflex during CN exam
B. Hyporeflexia with DTRs of the achilles
C. Cogwheel rigidity with PROM of elbow
D. Impaired force production in the LEs
D. Impaired force production in the LEs
What are two key events that must happen for the patient to attain mobility and perform swing limb advancement during gait?
A) Weight shift to the stance LE and trailing limb posture of the swing LE
B) Stability through the stance limb hip abductors and hip flexion through the swing limb
C) Terminal knee extension through the swing limb and hip extension through the stance limb
D) None of the above
A) Weight shift to the stance LE and trailing limb posture of the swing LE
Your patient experienced a R MCA CVA affecting the R corona radiata. When he goes to transfer sit> stand you notice that he demonstrates R hip abduction, L trunk lateral flexion, and overuse of the RUE on the bed rail resulting in leftward lean toward his hemiparetic side. When attempting to assist the patient into postural midline, the patient is resistive. Which intervention would be BEST to address the patients deficits during this transfer?
A) Continue to remind the patient to stand up tall and use your body weight to push him into postural midline when transitioning sit>stand
B) Practice seated balance tasks until he stops leaning to the left when he stands
C) Place a mirror in front of the patient for visual feedback during sit>stand transfers while asking the patient to keep his right shoulder against a wall throughout the movement
D) Place a mirror in front of the patient for visual feedback during sit>stand transfers while asking the patient to keep his left shoulder against a wall throughout the movement
C) Place a mirror in front of the patient for visual feedback during sit>stand transfers while asking the patient to keep his right shoulder against a wall throughout the movement
You are working with a 72 yo female in the outpatient setting who experienced a right sided MCA CVA. The patient presents with L foot drop, decreased weight shift to the L, decreased stride length, and decreased speed during gait. You are designing an intervention to target her impairments. Which of the following is likely to be the most effective?
A) Ambulating with a robotic exoskeleton
B) High intensity gait training
C) Circuit based strength training
D) Virtual reality based balance training
B) High intensity gait training
Your patient is a 35 yo female who experienced DAI during a fall off her bike. Prior to injury, she lived at home with her husband. She presents as LOCF VII and has a Berg Balance Score of 48/54. What will be an appropriate discharge recommendation for this patient?
A) Skilled nursing facility- the care burden on the husband will be too high
B) Home with the husband with 24/7 supervision
C) Home with the husband, with education for providing set up assistance for any complex tasks and only completing routine tasks when the husband is not home
D) Home with a home health aide to assist during mobility when the husband is not home
C) Home with the husband, with education for providing set up assistance for any complex tasks and only completing routine tasks when the husband is not home
Which of the following is a likely neurophysiologic basis for remission?
A. Gliosis
B. Demyelinated areas are filled with astrocytes
C. Increased density of sodium channels
C. Increased density of sodium channels
You are working with a patient on trunk control and sitting balance. They report unsteadiness sitting in the shower on their tub bench and on the toilet when performing bowel/hygiene tasks and would like to be able to complete those tasks without fear of LOB. Choose the most appropriate intervention.
A. Patient sits at edge of bed and PT uses manual cueing to help patient achieve proper alignment. PT tells pt, “this is what sitting should feel like”
B. Patient participates in a seated reaching task (up, down, and laterally) where objects are gradually moved further away in order to challenge pt’s balance and postural control outside of BOS.
C. Patient stands at bedside with their rolling walker and PT applies random perturbations to pt’s trunk to work on reactive postural control.
D. Patient practices maintaining postural stability while performing lateral trunk flexion and pelvic elevation while reaching underneath the buttock to mimic demands of pericare
D. Patient practices maintaining postural stability while performing lateral trunk flexion and pelvic elevation while reaching underneath the buttock to mimic demands of pericare