ASC Stroke Rehabilitation & Recovery 3 — Questions and Answers
Question 1: Constraint-induced movement therapy (CIMT) for upper extremity stroke recovery works primarily by:
- Forcing use of the paretic limb by restraining the unaffected limb (Correct answer)
- Providing electrical stimulation to paretic muscles
- Using mirror feedback to engage motor cortex
- Passively stretching the affected extremity
Correct answer: Forcing use of the paretic limb by restraining the unaffected limb
CIMT restrains the unaffected limb to overcome 'learned nonuse' and force repetitive practice with the paretic limb.
Question 2: Which brain plasticity mechanism underlies much of stroke motor recovery?
- Cortical reorganization and synaptogenesis (Correct answer)
- Regeneration of damaged axons
- Replacement of neurons by stem cells
- Increased myelination of surviving axons
Correct answer: Cortical reorganization and synaptogenesis
Cortical reorganization — where adjacent or contralateral areas assume functions of damaged regions — is the primary mechanism of stroke motor recovery.
Question 3: A post-stroke patient demonstrates pusher syndrome. This is best described as:
- Active pushing away from the paretic side while in sitting or standing (Correct answer)
- Falling toward the paretic side due to weakness
- Inability to perceive the vertical orientation
- Spastic hypertonicity causing lateral trunk lean
Correct answer: Active pushing away from the paretic side while in sitting or standing
Pusher syndrome involves active pushing toward the paretic side and resisting correction toward the midline, related to disturbed perception of body orientation.
Question 4: Post-stroke dysphagia evaluation should ideally begin with:
- A bedside swallow screening before any oral intake (Correct answer)
- Videofluoroscopic swallow study on day one
- Fiberoptic endoscopic evaluation of swallowing (FEES)
- Trial of thin liquids followed by observation for 24 hours
Correct answer: A bedside swallow screening before any oral intake
Clinical guidelines recommend a validated bedside swallow screen before any oral intake to identify aspiration risk.
Question 5: The '3-month plateau' concept in stroke recovery is best addressed by current evidence in which way?
- Recovery can continue beyond 3 months with intensive rehabilitation (Correct answer)
- Neurological recovery halts at 3 months post-stroke
- Rehabilitation is not beneficial after 3 months
- Spontaneous recovery ends at 3 months but function can still improve
Correct answer: Recovery can continue beyond 3 months with intensive rehabilitation
Modern evidence shows meaningful neurological and functional recovery can occur beyond 3 months with appropriate, intensive rehabilitation interventions.
Question 6: Which assessment tool measures stroke survivors' perceived quality of life and participation in activities?
- Stroke Impact Scale (SIS) (Correct answer)
- Berg Balance Scale
- Fugl-Meyer Assessment
- Modified Rankin Scale
Correct answer: Stroke Impact Scale (SIS)
The Stroke Impact Scale is a patient-reported outcome measure capturing eight domains of health and quality of life after stroke.
Question 7: Robot-assisted therapy for post-stroke upper extremity rehabilitation is most beneficial for patients who are:
- In the subacute phase with moderate to severe arm impairment (Correct answer)
- More than 5 years post-stroke with complete flaccid paralysis
- In the hyperacute phase within 6 hours of stroke onset
- Ambulatory with only mild arm weakness
Correct answer: In the subacute phase with moderate to severe arm impairment
Robot-assisted therapy shows greatest benefit in the subacute phase for patients with moderate-severe impairment who have some residual motor function.
ASC Stroke Rehabilitation & Recovery 3
Constraint-induced movement therapy (CIMT) for upper extremity stroke recovery works primarily by: