exam 1 practice questions pt.1

The zone of partial preservation (ZPP) is N/A if the spinal cord injury is…

Incomplete

What are the ADL expectations for an individual with C1-C4 spinal cord injury?

Independently directs care when assist is needed

Individuals with C1-C4 SCI can be independent in what type of mobility?

Use of a power wheelchair

What is the most important key muscle for individuals with C5 injury?

Biceps

What is the most important key muscle for individuals with C6 injury?

Extensor carpi radialis

What is the most important key muscle for individuals with C7 injury?

Triceps

In what level(s) of SCI does ambulation become possible (with assistance)

T1-T12, more caudal will need less assistance

What is the leading cause of death in SCI?

Pulmonary issues

All levels up to ___ will have decreased ability to cough

T10

What is the technique which uses the lips, tongue, and throat muscles to “gulp” air into the lungs?

Glossopharyngal breathing

How is autonomic dysreflexia defined?

Sudden increase in systolic blood pressure of at least 20 mmHg above the individual’s usual baseline

What are the common symptoms of autonomic dysreflexia?

HTN, bradycardia, headache, sweating, piloerection, flushed skin, blurred vision, constricted pupils, nasal congestion. Below the level of injury, the patient may have chills, feel clammy, cool or pale

What are some important things to do in AD management?

Stop activity, sit the patient up to 90 degrees, attempt to locate the noxious stimulus, monitor BP and pulse every 2-3 minutes, apply nitropaste if the patient has it

In individuals with injury at C6, when can we perform finger ROM?

Only when the wrist is in flexion, we want to preserve tenodesis

What can be done to manage orthostatic hypotension?

Monitor vitals with position changes, manage with slow progression to upright, compression (abdominal binders and/or ace wraps), hydration

Why are the first ~72 hours after SCI not the best time to do a neurologic examination on a patient?

Spinal shock and edema can impact results (flaccidity)

What timeframe is considered the period of greatest neurologic recovery?

0-6 months (most rapid in the first 3 months)

When does neurologic recovery largely plateau?

6-12 months after injury

What are the 3 largest prognostic indicators in SCI?

Initial severity, neurological level and injury pattern, age

What are the 3 most common complications in the first year of post-rehab discharge for patients with SCI?

UTI, autonomic dysreflexia, pressure ulcers

What 5 variables, assessed within the first 15 days post-injury, help predict independent walking 1-year post injury?

Age, quads strength (L3 myotome), gastroc strength (S1 myotome), Light touch at L3, Light touch at S1 (these factors assess whether the motor and sensory pathways needed for walking remain functional)

Which is the most common SCI syndrome?

Central cord syndrome

Central cord syndrome is more severe in which extremities?

More severe in upper extremities compared to lower extremities

Central cord syndrome typically presents in what type of pattern?

A cape distribution of sensory loss in the UE

What is the typical presentation of anterior cord syndrome?

Bilateral motor loss below the lesion, loss of pain and temperature sensation. Preservation of proprioception, vibration, deep pressure (because posterior column is preserved).

How does posterior cord syndrome typically present?

Loss of proprioception and vibration resulting in ataxic gait. Motor, pain, and temp are preserved.

What change in BP is required to be considered orthostatic hypotension?

Drop in 20 mmHg Systolic or 10 mmHg diastolic

What are the first things a PT should do in response to AD or OH?

AD: sit them up. OH: lay them down

If a patient is able to tolerate 20 minutes at ___ degrees of inclination with a tilt table, they will likely tolerate the cardiovascular demands of standing

70 degrees

What are the 2 key requirements (ROM-wise) for an individual to be able to participate in gait training?

Full hip extension ROM (for upright “parastance” balance) and no knee flexion/plantar flexion contractures

Which SCI level may benefit from an elbow extension splint?

C5 SCI to prevent biceps contracture

Most rapid improvements in UE function occur within the _____ day range. Recovery continues for _____ days.

50-100 ; 300

Which muscle being intact is a key prognostic indicator for independent manual wheelchair use?

Triceps

Peak heart rate in tetraplegia is typically…

100-120 bpm

What RPE range is appropriate for exercise in SCI?

13-17

What is a “multiple mononeuropathy”?

Also known as mononeuritis multiplex, it is a neuropathy with involvement of multiple nerves in an asymmetric pattern

If there is motor involvement with peripheral neuropathy, what part of the nerve is likely involved?

Axon

What is the most common cause of peripheral neuropathy?

Diabetes

Axonal pathology typically carries a _____ prognosis

worse

What are the 3 subtypes of diabetic neuropathy?

Distal symmetric polyneuropathy, diabetic autonomic neuropathy, diabetic amyotrophy

Which subtype is the most common type of diabetic neuropathy?

Distal symmetric polyneuropathy

How does Radiculoplexis Neuropathy (Diabetic Amyotrophy) typically present?

Severe unilateral low back, hip, or thigh pain with a rapid onset of (proximal) weakness and atrophy

What are the 3 subtypes of immune-mediated neuropathies?

Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy (CIDP), multifocal motor neuropathy

What is the primary difference between guillain-barre and CIDP?

In CIDP, autonomic nerves are typically spared.

What is the primary characteristic of multifocal motor neuropathy?

Motor nerves are affected exclusively

Which disease is considered a “hereditary neuropathy”?

Charcot-Marie-Tooth Disease

What is the gold standard treatment for charcot foot?

Total Contact Casting

What is the general shape of the legs in an individual with charcot marie tooth disease?

Inverted champagne bottle

How does charcot foot present during the acute phase?

Unilateral, localized swelling, warmth, redness, and joint effusion

What structural foot deformities are common in individuals with charcot marie tooth disease?

Severe high arches (pes cavus) and claw or hammer toes

Is multiple sclerosis a condition of the central nervous system or peripheral nervous system?

Central nervous system

What is something to look for to help determine whether toe drag in gait is due to ankle dorsiflexor weakness or hip flexor weakness?

With ankle dorsiflexor weakness, limb advance is preserved and there may be foot slap at initial contact. With hip flexor weakness, the thigh will have decreased advancement/shortened steps.

Which EDSS score is the hallmark of having severe disability?

EDSS 4.0

How should the exercise prescription be adjusted during a suspected relapse?

Modify or defer exercise. Do not progress exercises until the change is evaluated by an MD.

What is “smoldering” MS?

Chronically active lesions that continue to have neurodegeneration outside of acute relapses. Can cause gradual disability accumulation.

What are some important changes in the 2024 update to the McDonald criteria?

Optic nerve is added as a location for DIS, DIT is no longer mandatory

What is the benefit of using corticosteroids to treat MS?

Corticosteroids cannot stop an active relapse, however, they can slow the relapse

What is the EDSS score range for minimal-to-moderate disability?

EDSS 0-3.0

At what EDSS score does disability begin to impact the daily routine?

EDSS 5.0

Is MS typically symmetrical or asymmetrical?

Typically asymmetrical

An individual with MS walking with a stiff swing pattern, scissoring gait, reduced knee flexion, and increased co-contraction might indicate that their impairments are due to?

Spasticity or poor motor control

Polio leads to the destruction of which part of the nervous system?

Anterior horn cells in the spinal cord and motor nuclei in the brain stem

Motor recovery in Polio is influenced by what 3 factors?

The number of motor neurons that are able to recover and function again, the extent to which surviving motor neurons can sprout new axons to reconnect denervated muscle fibers (collateral sprouting), the amount of muscle hypertrophy

Post-polio syndrome is characterized by gradual onset of new or worsening…

Muscle weakness or atrophy, pain (often in previously affected areas), fatigue, functional decline

Is post-polio syndrome a recurrence of the polio virus?

No, it is distinct from the original poliomyelitis

What is the pathophysiology of PPS that occurs after an initial recovery from Poliovirus?

Previously recovered/enlarged motor units become metabolically overburdened and begin to fail, resulting in new muscle weakness, fatigue, and pain

What are the 5 factors associated with PPS development?

Age greater than 10 at initial infection, hospitalization during acute illness, ventilator dependency, paralytic involvement of all four extremities, rapid return of functional strength following extensive initial involvement

What are some of the 9 signs of PPS?

New muscular weakness, fatigue, pain, onset or aggravation of muscle atrophy, onset or aggravation of preexisting difficulties in daily activities, cold intolerance, sleep disorder, dysphagia or dysphonia, respiratory deficiency

When treating PPS, training should focus on…

Unaffected muscle groups and submaximal exercise

Strengthening should only be done for muscles with…

Full range of motion

We should not prescribe exercises for muscles with…

Less than antigravity muscle strength

Exercise should never cause…

Muscle soreness or prevent participation in daily activities due to fatigue