Neuromuscular Practice I: Exam 1

Rancho level I

no response, total assistance

Rancho level II

generalized response = same response regardless of stimulation

Rancho level III

localized response= responses begin to correlate with type of stimulation

Rancho level IV

confused- agitated = unable to cooperate with treatment efforts

Rancho level V

confused-inappropriate= able to respond to simple commands fairly consistently

Rancho level VI

confused-appropriate= consistently follows simple directions

Rancho level VII

autonomic appropriate= carry over learning, but overestimates abilities

Rancho level VIII

Purposeful-appropriate= oriented to person, place and time and independently attends tasks in distracting environments

Assess higher-level balance needed for vocational and

social activities.

Community Balance and Mobility Scale (CB&M) and High-Level Mobility

Assessment Tool (HiMAT)

identifies patterns of recovery for people with brain injury. The scale describes behavioral characteristics and cognitive deficits associated with brain injury.

Rancho Levels of Cognitive Functioning (RLCF)

Observes attention-related behaviors.

Moss Attention Rating Scale (MARS

Assess reintegration into home, work,

and social roles.

Community Integration Questionnaire (CIQ)

Evaluates emotional and cognitive well-being.

Quality of Life After Brain Injury

Assesses the impact of dizziness on daily life.

Dizziness Handicap Inventory (DHI

a self-efficacy measure used to assess an individual's perception of balance ability when standing or walking balance is challenged. It uses a scale from 1 to 10, with 1 representing complete stability and 10 indicating feeling like you are about to fall.

Rate of Perceived Stability

assesses how well a patient uses their balance systems (somatosensory, visual, and vestibular) under various conditions

mCTSIB

a form of posturography that is designed to assess quantitatively an individual's ability to use visual, proprioceptive and vestibular cues to maintain postural stability in stance

Sensory Organization Test:

It aims to target and identify 6 different balance control systems so that specific rehabilitation approaches can be designed for different balance deficits.

Mini-BEST

difficulty finding or maintaining bodies COM inside of BOS . Practice maintaining alignment in sitting or standing while using augmented sensory feedback during various BOS conditions. E.g mirror, manual cues, force plate, VR, Unilateral stance, sitting crossing legs.

SSPC- Postural movement strategies

difficulty integrating sensory information for balance, even in static conditions. Work on maintaining static body position while varying availability of 1 or more sense of orientation. E.g: sunglasses, eyes closed (visual) , compliant surface, foam (somatosensory), perform activities w/ head nods (vestibular)

SSPC- sensory processing

difficulty w perceived balance ability. Challenge them outside confidence level by reducing UE support or altering LE BOS + work on self-efficacy strategies.

SSPC- balance confidence

perceptual difficulty with orienting themselves in relation to the line of gravity. Practice achieving midline sitting or standing w/ environmental queues. E.g. Standing w/ back against wall, hemiparetic side against wall, verbal and visual cues to achieve midline

SSPC-verticality

maintain balance in a steady state but not w/ movement. Practice tasks that require dynamic control of COM. e.g Add UE and LE movement to functional task (kicking, reaching etc..) stepping over obstacles, gait with turns

APC- postural movement strategies

difficulty integrating sensory information for balance w/ more dynamic activities eg marching with eyes closed, reaching on compliant surface, walking with head turns.

APC- sensory integration

difficulty w perceived balance ability w/ dynamic movement. eg Tai chi, other dynamic balance exercises.

APC- balance confidence

difficulty with secondary motor or cognitive tasks. Practice single conditions and then add dual tasks.

APC-Executive function/multi task ability

difficulty performing tasks with unexpected perturbation. Practice tasks requiring recovery of balance after unexpected perturbation.

RPC- postural movement strategies

changing availability of sensory information. E.g external: perturbations on a compliant surface. Internal: marching with eyes closed, tandem standing with head turns (w/ unexpected perturbations)

RPC- sensory integration

What are the key steps in patient/client management?

1. Exam of pt

2. Eval of data and ID of problems

3. Determination of PT Dx

4. Determination of Px & POC

5. Implementation of POC

6. Reexam of pt and eval of Tx outcomes

What is an impairment?

Any problem someone may have in body fn or structure.

What is an activity limitation?

Difficulties executing task/action (e.g. cognitive & learning, communication, functional mobility skills, & ADLs)

e.g. difficulty with bathing and dressing (Max A) and eating (Min A)

What is a participation restriction?

Problems regarding involvement in life situations and societal interactions (e.g. home management, work (job/school/play), community, & leisure)

e.g. unable to return to work as a computer programmer; unable to drive to work or community activities; unable to live at home independently

What are the direct impairments?

A patient presents to outpatient physical therapy 6 weeks following a stroke. The history, systems review, and examination reveal that the patient (age 56) is unable to live independently at home and is unable to drive or return to work as a computer programmer. He has sensory loss, paresis, dyspraxia, and hemianopsia. The patient also presents with decreased vital capacity and endurance, disuse atrophy and weakness, and right finger flexor contracture, as well as balance and gait deficits. The patient has difficulty transferring independently requiring maximum assistance, requires supervision with wheelchair mobility, and is unable to walk. The patient also requires maximum assistance in bathing and dressing, with minimum assistance in eating. Match the following patient conditions to the appropriate category.

Sensory loss & paresis

Dyspraxia and hemianopsia

What are the indirect impairments?

A patient presents to outpatient physical therapy 6 weeks following a stroke. The history, systems review, and examination reveal that the patient (age 56) is unable to live independently at home and is unable to drive or return to work as a computer programmer. He has sensory loss, paresis, dyspraxia, and hemianopsia. The patient also presents with decreased vital capacity and endurance, disuse atrophy and weakness, and right finger flexor contracture, as well as balance and gait deficits. The patient has difficulty transferring independently requiring maximum assistance, requires supervision with wheelchair mobility, and is unable to walk. The patient also requires maximum assistance in bathing and dressing, with minimum assistance in eating. Match the following patient conditions to the appropriate category.

Contracture

Decreased vital capacity and endurance, disuse atrophy and weakness

What are the composite impairments?

A patient presents to outpatient physical therapy 6 weeks following a stroke. The history, systems review, and examination reveal that the patient (age 56) is unable to live independently at home and is unable to drive or return to work as a computer programmer. He has sensory loss, paresis, dyspraxia, and hemianopsia. The patient also presents with decreased vital capacity and endurance, disuse atrophy and weakness, and right finger flexor contracture, as well as balance and gait deficits. The patient has difficulty transferring independently requiring maximum assistance, requires supervision with wheelchair mobility, and is unable to walk. The patient also requires maximum assistance in bathing and dressing, with minimum assistance in eating. Match the following patient conditions to the appropriate category.

Balance and gait deficits

What is a restorative intervention?

Interventions directed toward remediating or improving the pt's status in terms of impairments, activity limitations, participation restrictions, & recovery of fn. Involved body segments are targeted for intervention.

What is a compensatory intervention?

Interventions directed toward promoting optimal function using residual abilities. The activity/task or environment is adapted/changed to achieve fn. Uninvolved segments are targeted for intervention.

Autonomous stage

Stage where motor performance is largely automatic. There is only a minimal level of attention. The spatial and temporal components of movement are becoming highly organized, and the learner is capable of coordinated motor patterns. Movements are largely error-free with little interference from environmental distractions.

Cognitive stage

Stage where the individual develops an overall understanding of the skill, requires a high level of cognitive processing and trial-and-error practice with frequent errors.

Associative stage

Stage where refinement of the motor pattern is achieved through continued practice. Spatial and temporal aspects become organized as the movement develops into a coordinated pattern. As performance improves, there is greater consistency and fewer errors and extraneous movements. The learner is now concentrating on how to do the movement rather than on what to do.

What training strategies are appropriate for someone in the autonomous stage?

Stage where the learner can perform the task in a changing, unpredictable environment. The therapist guides learning by providing appropriate feedback and structuring the practice.

What training strategies are appropriate for someone in the cognitive stage?

Stage where large improvements in performance can be readily observed, the learner relies heavily on vision to guide early learning and movement. The therapist guides learning by providing appropriate feedback and structuring the practice. A stable environment free from distractors optimizes learning during this initial stage.

What training strategies are appropriate for someone in the associative stage?

Stage where proprioceptive cues become increasingly important, while dependence on visual cues decreases. The therapist guides learning by varying the challenge (altering the task, the practice schedule, the amount and type of feedback, and the environment).

Neural plasticity

ability of the brain to change and repair itself. mechanisms: neuroanatomical, neurochemical, and neuroreceptive changes

What are examples of neuroanatomical changes related to neural plasticity?

Nerve growth (neural regeneration)

Regenerative synaptogenesis refers to sprouting of the injured axons to innervate (reclaim) previously innervated synapses.

Reactive synaptogenesis (collateral sprouting) refers to the reclaiming of synaptic sites of the injured axon by dendritic fibers from neighboring axons.

What is a neurochemical change related to neural plasticity?

Neurotransmitter release and receptor sensitivity are improved (synaptic plasticity).

What is a neuroreceptive change related to neural plasticity?

Changes in synaptic strength, known as long-term potentiation, firm up neuronal connections and serve as a basis for all memory and learning

How would you use this neuroplasticity principle in PT? Focus on active practice of motor skills "Use it or lose it"

Engage the patient in active practice of specific goal directed activities that are functionally relevant and important to the individual; failure to drive specific brain functions can lead to functional degradation.

How would you describe this neuroplasticity principle in PT? Repetition matters

Focus on sufficient repetition to stimulate brain reorganization

How would you describe this neuroplasticity principle in PT? Specificity matters

The nature of the training experience dictates the nature of the plasticity.

How would you use this neuroplasticity principle in PT? Intensity matters

Focus on sufficient intensity of training to stimulate brain reorganization, carefully matching the dynamic and changing needs of the patient.

How would you describe this neuroplasticity principle in PT? Timing matters

Different forms of plasticity occur at different times during training; very early training may be detrimental in some cases of neural injury; delayed or absent training can limit recovery and can result in neural degradation and "learned nonuse."

How would you describe this neuroplasticity principle in PT? Age matters

Training-induced plasticity occurs more readily in younger brains; plasticity and experience-dependent brain changes in older adults may be slower and less demonstrable

How would you use this neuroplasticity principle in PT? Transference "Use it and shape it to the patient's ability"

Continually challenge the patient's movement capability with acquisition of new skills to ensure continued learning; progressively modify skills to ensure transference and achieve functional outcomes

How would you use this neuroplasticity principle in PT? Reinforce selection of important stimuli

Reinforce behaviorally important stimuli to enhance skill learning; create the best possible environment for learning.

How would you use this neuroplasticity principle in PT? Enhance attention and feedback

Actively engage the patient in evaluating goal-achievement and in making accurate adjustments of motor skills based on appropriate use of feedback.

What are the basic principles of task-oriented training?

• Task practice using the involved body segments

• Practice specific functional tasks in varying environments, progressing to real-life environments

• Use a sufficient level of practice and intensity to drive recovery

• Practice adapting tasks and transfer of skills to other similar skills

Which principles of neuroplasticity do the basic principles of task-oriented training relate to?

• Task practice using the involved body segments- use it or lose it

• Practice specific functional tasks in varying environments, progressing to real-life environments - specificity of training

• Use a sufficient level of practice and intensity to drive recovery- repetition and intensity matter

• Practice adapting tasks and transfer of skills to other similar skills- transference

Which of the following descriptions best describes the "Transference" principle of neuroplasticity?

A Plasticity in response to one experience can interfere with the acquisition of other behaviors.

B Continually challenge the patient's movement capability with the acquisition of new skills and progressively modify skills to achieve functional outcomes

C The nature of the training experience dictates the nature of the plasticity.

D Reinforce behaviorally important stimuli to enhance skill learning

B - Transference is the ability of the nervous system to apply learning from one task to another. Challenging patients to acquire new skills and modifying those skills can promote transference to functional tasks.

Which one of the following best describes the FIRST step that a physical therapist should take when integrating best evidence into clinical practice?

A Identify the best evidence on the most successful interventions for the patient's diagnosis.

B Critically appraise the evidence for its validity, level of evidence, and applicability.

C Identify a clinically relevant question to research that is important for the patient.

D Integrate the best evidence into clinical decision-making after discussing it with the patient.

C - The importance of starting with a clinically relevant question that integrates patient values is commonly overlooked, even though it is necessary for integrating best evidence into clinical practice.

Which of the following interventions are best matched with the intervention category?

A Compensatory- Neurofacilitation Interventions

B Augmented- Isolated muscle strengthening

C Restorative- Activity-Based Interventions

D Impairment Specific- Teaching use of assistive devices

C - Restorative interventions focus on restoring function to impaired areas through activity-based interventions. These interventions are aimed at enhancing motor learning and neural plasticity in affected areas.

During gait training, the patient uses sensory cues and the therapist provides verbal and tactile cues during different segments of the training. Which of the following BEST describes this type of feedback?

A Variable feedback

B Delayed feedback

C Bandwidth feedback

D Faded feedback

A - Variable feedback involves varying the type or timing of feedback provided to enhance the patient's learning and performance. This approach helps generalize skills to different contexts and improve adaptability.

A patient who sustained a left cerebrovascular accident 6 weeks ago has been working on the task of window washing in therapy. The patient demonstrates the ability to complete the task consistently and with few errors. The patient is occasionally distracted when someone speaks on the overhead pager. Which of the following BEST describes the patient's stage of motor learning?

A Cognitive

B Autonomous

C Associative

D Psychomotor

C - In the associative stage of motor learning, the individual has learned the basics of the task and can perform it consistently but may still make some errors and be distracted by external stimuli.

A patient with acute stroke presents with comorbid diagnoses of diabetes mellitus and hypertension. In what domain of the International Classification of Functioning, Disability, and Health (ICF) model would the comorbid factors be classified?

A Personal factors

B Body function and structure impairment

C Activity limitations

D Environmental factors

A - Personal factors, such as the patient's comorbid diagnoses of diabetes mellitus and hypertension, are classified in the ICF model as factors that influence a person's health condition and can affect their functioning and disability.

For a patient in the associative stage of motor learning, what type of practice schedule would be best to improve motor learning?

A Variable practice

B Blocked practice

C Distributed practice

D Constant practice

A - Patients in the associative stage benefit from variable practice because it allows them to adapt to different variations of the task, promoting better retention and transfer of learned skills.

What is the MOST appropriate classification of patient impairments that are the result of inactivity following a stroke?

A Direct impairments

B Composite impairments

C Indirect impairments

D Comprehensive impairments

C - Indirect impairments result from disuse or inactivity and are caused by changes in other body systems or structures due to lack of movement. Direct impairments, on the other hand, result directly from the stroke itself. Inactivity following a stroke can cause indirect impairments such as muscle weakness, decreased range of motion, and decreased endurance. Therefore, the MOST appropriate classification for the impairments resulting from inactivity following a stroke is indirect impairments.

What clinical presentation should a physical therapist hypothesize based on a patient's diagnosis of a right middle cerebral artery stroke?

A Cautious behavior and left hemiparesis with more upper extremity involvement than lower extremity

B Depression and left hemiparesis with more lower extremity involvement than upper extremity

C Aphasia and poor judgment

D Impulsive behavior and left hemiparesis with more upper extremity involvement than lower extremity

D - Damage to the middle cerebral artery can result in hemiparesis, which is weakness or paralysis of one side of the body. In right middle cerebral artery stroke, the left side of the body is affected, with more involvement of the upper extremity. Additionally, impulsive behavior can be a clinical manifestation of right middle cerebral artery stroke due to its location in the brain.

Upon examination, it is noted that a patient appears to understand the physical therapist's questions but hesitates and is slow when answering. Based on this presentation, what is the MOST likely location of the lesion and what is the impairment noted?

A Broca's area with fluent aphasia

B Wernicke's area, receptive aphasia

C Wernicke's area, expressive aphasia

D Broca's area with nonfluent aphasia

D - Disorders of speech and language occur when lesions affect the cortex of the dominant area of the brain, typically the left hemisphere. Nonfluent aphasia, or expressive aphasia, occurs secondary to lesions to Broca’s area and presents with slow and hesitant speech, limited vocabulary, and impaired syntax. Although speech production is labored or completely lost, comprehension is left intact. 

Which of the following clinical presentations is most characteristic of a vertebrobasilar artery infarct?

A Tetraplegia, diplopia, and bulbar paralysis

B Contralateral homonymous hemianopsia and amnesia

C Fluent aphasia, contralateral hemiparesis, and hemianesthesia

D Contralateral hemiparesis with upper extremity more involved than lower extremity

A Tetraplegia, diplopia, and bulbar paralysis

Which of the following is the most appropriate rehabilitation setting for a patient with moderate to severe activity limitations following a stroke, who can tolerate three hours of therapy per day?

A Inpatient rehabilitation facility

B Home health therapy

C Acute care hospital

D Skilled nursing facility

A - Inpatient rehabilitation is for patients who can tolerate intensive therapy (at least two disciplines, three hours per day, five to six days per week).

A physical therapist assesses muscle tone in the right arm of a patient post-stroke. When moving the patient's elbow into flexion and extension, the therapist feels resistance that increases with faster movements. What is the MOST likely impairment?

A Rigidity

B Hypotonia

C Flaccidity

D Spasticity

D - Spasticity is velocity-dependent resistance to passive movement, which is characteristic of upper motor neuron lesions, such as those seen in stroke. Rigidity is not velocitydependent, while hypotonia and flaccidity are characterized by decreased resistance.

Which of the following is most likely to result in scissoring gait in patients after a stroke? 

A Dorsiflexion weakness

B Quadriceps weakness 

C Lower extremity extensor synergy 

D Lower extremity flexor synergy

C - The lower extremity extensor synergy includes hip adduction, knee extension, and plantarflexion, contributing to scissoring gait which is represented by excessive hip adduction a narrow base of support, and steps that cross over midline. 

A 72-year-old patient with right hemiparesis post-stroke demonstrates 3/5 strength in the right quadriceps during manual muscle testing (MMT) and difficulty with sit to stand. Which activity would BEST improve performance on this task, appropriate for his current strength?

A Ambulating with a walker on a level surface

B Ascending stairs with a reciprocal gait pattern

C Repeated standing from sitting on an elevated surface

D Maintaining a single-leg stance on the affected side

C - A muscle grade of 3/5 indicates the ability to move against gravity but not resist additional force. Standing with arm support matches this functional ability, while activities like single-leg stance or reciprocal stair climbing require greater strength.

A patient post-stroke demonstrates a strong synergy during voluntary movement of the affected upper extremity. During testing, the patient flexes the elbow and wrist whenever they attempt shoulder flexion. What is the MOST likely explanation for this finding?

A Poor understanding of the movement task

B Spasticity in the elbow and wrist flexors

C Abnormal recruitment of muscles due to motor control deficits

D Compensation due to weakness in the shoulder flexors

C - Synergies are common after stroke due to impaired motor control and inability to isolate movements. Although patients often have spasticity in muscle groups involved in involuntary muscle synergies, spasticity is an increase in muscle tone with passive muscle elongation rather than active movement.

A 60-year-old patient with left hemiparesis after a right MCA stroke is learning to walk again. The physical therapist observes foot drop during the swing phase of gait. Which of the following is MOST appropriate to address this impairment?

A Stretching the plantar flexors on the affected lower extremity

B Performing weight-bearing activities on the affected lower extremity

C Strengthening the hip flexors on the affected lower extremity

D Fitting the patient for an ankle-foot orthosis (AFO) on the affected lower extremity

D - Foot drop during swing phase is due to weakness in the dorsiflexors. An AFO is a common orthotic device for patients with foot drop as it supports the ankle in dorsiflexion, promotes a safer gait pattern, and reduces compensatory strategies. While strengthening (option C) and weight-bearing (option B) are valuable long-term strategies, they do not provide immediate functional improvement like an AFO. Stretching plantar flexors (option D) may reduce tightness but does not directly address foot drop.

Which of the following early interventions is MOST appropriate for a patient diagnosed with an ischemic stroke within 3 hours of symptom onset? 

A Administration of tissue plasminogen activator (tPA)

B Aspirin therapy 

C Induced hypothermia 

D Immediate surgical intervention 

A

Which of the following interventions BEST exemplifies repetitive task-specific training

A Weight-supported treadmill training with no active involvement

B Passive range of motion exercises for the upper extremity

C Repeated practice of reaching for objects placed on a shelf

D Isolated strengthening of the deltoid muscles using weights

C - Repetitive task-specific training involves practicing a meaningful functional activity, such as reaching for objects, rather than isolated strengthening exercises.

A therapist incorporates mirror therapy into task-specific training for a patient post-stroke. What is the PRIMARY goal of this intervention?

A Reduce spasticity in the affected extremity

B Improve visual feedback and motor learning of the affected extremity

C Strengthen the unaffected extremity

D Increase proprioception of the trunk

B - Mirror therapy provides visual feedback to enhance motor learning and functional use of the affected limb.

On an interprofessional healthcare team, which health professional is most likely primarily managing the assessment and treatment of dressing and self-care for a patient with a traumatic brain injury?

A Speech-Language Pathologist

B Physician

C Occupational Therapist

D Physical Therapist

C - Occupational therapists specialize in addressing activities of daily living, including dressing and self-care, making them the most likely health professional to manage these aspects of care for a patient with a traumatic brain injury.

A patient is having difficulty with sit to stand from soft surfaces. Which of the following is the best intervention to help the patient with their performance of sit to stand?

A Repetitions of sit to stand from a balance disc

B Repetitions of partial lunges

C Repetitions of forward weight shifting in sitting

D Repetitions of sit to stand from a high surface

A -The patient is having difficulty with sit to stand from soft surfaces, which may be due to decreased lower extremity strength or difficulty maintaining balance on a soft surface. Repetitions of stand to sit from a bed, couch, or on a balance disc can help improve lower extremity strength and balance control, which will translate to better performance of sit to stand on soft surfaces.

Which of the following represents abnormally high intracranial pressure?

'

A 15 mm Hg

B 17 mm Hg

C 5 mm Hg

D 20 mm Hg

D - Normal intracranial pressure is around 7-15 mmHg, intracranial pressure above 20mmHg would be considered a contraindication to PT interventions unless otherwise approved by the physician. Medical management including surgical decompression may be needed if ICP levels stay elevated despite pharmacological management. Never invert a patient with an elevated ICP.

A young adult who is comatose (Glasgow Coma Scale score of 3) is transferred to a longterm care facility. On initial examination, the therapist observes that the patient is demonstrating decorticate posturing. Which limb or body position is indicative of this?

A The upper extremities in flexion and lower extremities in extension

B All four limbs in extension

C Extreme hyperextension of the neck and spine with both lower extremities flexed and the heels touching the buttocks

D All four limbs in flexion

A - Decorticate posturing is characterized by upper extremities in flexion and lower extremities in extension. Decerebrate posturing is characterized by upper and lower extremities in extension. Both indicate damage to the cerebral hemisphere or corticospinal tract

A physical therapist is working with a patient with traumatic brain injury in an outpatient

setting 8 weeks after brain injury. The patient is now oriented to person and place and is

independently able to practice his half hour exercise routine in a non-distracting

environment. He requires minimal reminders to perform his daily routine to make his bed,

perform activities of daily living, and write his ‘to do' list. He still insists that he is currently

capable of returning to his previous job as a manager and is often frustrated with

explanations indicating that he is not yet ready to return to his work place.

Which Rancho Los Amigos Cognitive Level best represents the patient's presentation?

A Level V (5)

B Level VI (6)

C Level VII (7)

D Level VIII (8)

C - Level VII (7) is characterized by the patient being oriented to person, place, and time, but still exhibiting difficulties with abstract reasoning, judgment, and problem-solving. Patients in this level can perform daily routines and may exhibit a decreased ability to cope with stress, which could explain the patient's frustration with not being able to return to work.

A patient with a closed head injury is at a level 4 on the Rancho Los Amigos Cognitive scale. The patient can ambulate with minimal assistance 100' on level surfaces without an assistive device. The patient becomes agitated and combative with excessive external stimulation. What environment would be MOST appropriate when working with this patient?

A Quiet, closed environment in a therapy gym with one or two other patients and therapists

B Quiet, closed environment in the patient's room with the therapist and patient only

C Quiet, open environment in a hospital courtyard in an open environment with many other patients and therapists

D Busy, open environment in a grocery store or other open community re-integration setting with therapist and patient only

A - Patients in Level 4 of the Rancho Los Amigos Cognitive Scale are often confused and agitated and have difficulty processing environmental stimuli. A quiet and controlled environment with minimal distractions is the most appropriate setting for therapy. A closed gym with one or two other patients and therapists would provide an optimal environment for the patient to work on therapy goals. Having a couple of people around in a controlled environment can also be safer than being alone with an agitated patient.

Which of the following outcome measures would BEST ASSESS elements of home/social integration and productive activities for individuals with brain injury?

A Community Integration Questionnaire

B Community Balance and Mobility Scale

C Rancho Levels of Cognitive Functioning

D High Level Mobility Assessment Tool (HiMAT)

A - The Community Integration Questionnaire (CIQ) is a widely used outcome measure that assesses an individual's ability to reintegrate into home and social activities, as well as their level of participation in productive activities after a brain injury. It is a comprehensive tool that evaluates various domains of community integration, making it the best option among the given outcome measures.

Which of the following spasticity management approaches is a pharmacological approach designed to release small amounts of medication into the space around the spinal column?

A Botox injections

B Intrathecal Baclofen Pump

C Oral Baclofen

D Oral benzodiazepines

B - The Intrathecal Baclofen Pump is a pharmacological approach used to manage spasticity. It is a device that is implanted in the body and delivers small amounts of Baclofen directly into the space around the spinal column through a catheter. This method of delivery allows for a more targeted and controlled release of the medication, which can be especially helpful for individuals with severe spasticity who may not respond well to other treatments. Botox injections are another common approach for managing spasticity, but they involve injecting Botox directly into the affected muscles, rather than into the spinal column. Oral Baclofen and oral benzodiazepines are also pharmacological approaches, but they are taken orally rather than delivered through an implant.

What is the MOST likely classification of the altered state of consciousness for a patient with traumatic brain injury who presents with sleep/wake cycles present but no awareness of surroundings even if they are able to open their eyes?

A Unresponsive wakefulness (vegetative) state

B Minimally conscious state

C Comatose state

D Neurogenic reserve state

A - The described symptoms match the criteria for unresponsive wakefulness (vegetative) state, where patients have sleep/wake cycles and may open their eyes, but show no signs of awareness of their surroundings.

Which of the following is an example of a portable immersive virtual reality system?

A Wearable goggles with visual stimulus presented within goggles and motion can be detected through gloves or wearable sensors if available

B Large TV with wraparound viewing on a responsive footplate

C Treadmill in a visually surrounded room or space with cameras with tracking capabilities

D Video game system like Microsoft Kinect or Nintendo WiiFit with a TV with responsive gaming system

A - Wearable goggles with visual stimulus presented within the goggles and motion detection through gloves or wearable sensors would create a fully immersive virtual reality experience that could be taken anywhere.

A patient presents with severe loss of proprioceptive function in bilateral lower extremities and has had multiple falls due to an inability to recover from even small losses of balance or perturbations. Based on the given information, which of the following would be an appropriate Movement System Diagnosis?

A Deficit in Reactive Postural Control- Sensory Processing

B Deficit in Anticipatory Postural Control- Sensory Processing

C Deficit in Reactive Postural Control- Postural Movement Strategies

D Deficit in Anticipatory Postural Control- Postural Movement Strategies

B - Deficit in Reactive Postural Control- Sensory Processing is the correct response because the patient's falls are due to an inability to recover from small losses of balance or perturbations, which indicates a deficit in reactive postural control. Reactive postural control is the ability to make quick adjustments to maintain balance in response to unexpected perturbations, and this type of deficit is often associated with impairments in sensory processing. Anticipatory postural control, on the other hand, refers to the ability to activate postural muscles in anticipation of expected perturbations, and deficits in this type of control are often associated with impairments in postural movement strategies.

Which of the following interventions would target improving the use of somatosensory input for balance?

A Standing on an airex pad in a well-lit room in a challenging position

B Standing on a firm surface with eyes closed in a challenging position

C Standing on a firm surface with gaze stabilization in a challenging position

D Standing on an airex pad with head turns in a challenging position

B - standing on a firm surface with eyes closed in a challenging position would require an individual to rely more on somatosensory input for balance. When the eyes are closed, the visual system cannot contribute to balance control, and therefore the individual must rely more on the somatosensory and vestibular systems to maintain balance.

A patient with a traumatic brain injury (TBI) opens their eyes in response to verbal stimuli, localizes pain, and is confused when speaking. What is their Glasgow Coma Scale (GCS) score?

A 10

B 12

C 9

D 11

B - The Glasgow Coma Scale (GCS) scores based on eye opening, motor response, and verbal response. Eye opening to verbal = 3 Localizing pain = 5 Confused speech = 4 Total = 12, indicating moderate TBI

Which outcome measure is BEST for assessing functional mobility in a patient with a brain injury?

A Babinski Reflex Test

B Glasgow Coma Scale (GCS)

C Rancho Los Amigos Scale

D Functional Independence Measure (FIM)

D - The FIM assesses functional mobility in TBI patients by evaluating ADLs, transfers, and locomotion.

A patient with a brain injury has been immobile for several weeks. Which factor increases their risk for contracture development?

A Prolonged spasticity without range of motion exercises

B Short-term immobilization for less than 24 hours

C Low muscle tone in all extremities

D Active participation in daily therapy

A - Contractures occur due to spasticity, prolonged immobility, and lack of stretching.

A patient with a brain injury has difficulty initiating rolling in bed. What task-specific training technique is MOST appropriate?

A Practicing segmental rolling with verbal and tactile cues

B Strengthening trunk extensors in a prone position

C Using a draw sheet for dependent rolling

D Passive range of motion for trunk rotation

A - Breaking down rolling into segments and providing cues helps improve motor control and initiation of movement, making rolling easier.

A patient with a brain injury has difficulty maneuvering a wheelchair. Which intervention BEST promotes task-specific training?

A Practicing wheelchair propulsion over different surfaces

B Strengthening the shoulder muscles with free weights

C Static sitting balance training

D Passive stretching of tight elbow flexors

A - Practicing propulsion on various surfaces enhances strength, control, and adaptability in wheelchair mobility

Which balance assessment is MOST appropriate for a patient with a brain injury who is ambulatory but experiencing falls?

A Rancho Los Amigos Scale

B Glasgow Coma Scale

C Berg Balance Scale

D Functional Reach Test

C - The Berg Balance Scale (BBS) assesses fall risk in ambulatory patients with balance deficits.

A physical therapist is working with a patient who had a brain injury 1 year ago in an outpatient setting. The therapist decides after medical clearance to implement a high-intensity gait training program. The patient is not on beta blockers. Which of the following heart rate reserve (HRR) targets is most appropriate to target?

A 70-80% HRR

B 50-60% HRR

C 40-50% HRR

D 60-70% HRR

A

A patient with a traumatic brain injury is at a Rancho Los Amigos Cognitive Level VIII and can ambulate with independence long distances and has started running short distances with supervision assistance. The patient's goal is to return to playing on a soccer team. Which of the following characteristics may be a barrier to reaching this goal based on this patient's Rancho VIII Cognitive Function Level?

A Inability to carryover learning of familiar activities

B Low frustration tolerance with challenging activities

C Agitated/combative response to education from therapist or coach

D Inability to selectively attend to a task in a quiet environment

B

What 2 things should clinicians perform according to the CPG to improve locomotor function following chronic stroke, incomplete SCI, and brain injury?

• Walking training at moderate to high aerobic intensities (up to 85% HR max)

• Walking training with VR

What 3 things clinicians may consider according to the CPG to improve locomotor function following chronic stroke, incomplete SCI, and brain injury?

• Strength training at >70% 1 rep max

• Circuit training, cycling, or recumbent stepping (up to 85% HR max)

• Balance training with VR