DPT Neurological Rehabilitation 4 — Questions and Answers
Question 1: A patient with T10 complete spinal cord injury is beginning ambulation training. Which assistive device and orthotic combination is MOST appropriate for therapeutic ambulation?
- Reciprocating gait orthosis (RGO) with a walker or forearm crutches (Correct answer)
- Ankle-foot orthoses only with a standard cane
- Knee-ankle-foot orthoses with no assistive device
- Bilateral hip orthoses without lower extremity bracing
Correct answer: Reciprocating gait orthosis (RGO) with a walker or forearm crutches
T10 complete SCI patients lack lower extremity motor function and require a reciprocating gait orthosis (RGO) with an appropriate assistive device to achieve therapeutic ambulation.
Question 2: Which mechanism BEST explains why constraint-induced movement therapy (CIMT) improves upper extremity function after stroke?
- Forced use of the affected limb counters learned non-use and promotes cortical reorganization (Correct answer)
- Constraint of the unaffected limb reduces mirror movements
- Immobilization of the affected limb allows spontaneous recovery
- Restraint prevents compensatory movements that could cause injury
Correct answer: Forced use of the affected limb counters learned non-use and promotes cortical reorganization
CIMT overcomes learned non-use — where patients habitually avoid using the affected limb — while intense massed practice drives cortical reorganization of the motor cortex.
Question 3: A patient with vestibular hypofunction secondary to acoustic neuroma resection reports oscillopsia during walking. Which intervention DIRECTLY addresses this symptom?
- Gaze stabilization exercises using the vestibulo-ocular reflex (VOR) x1 protocol (Correct answer)
- Canalith repositioning maneuver (Epley)
- Optokinetic stimulation for BPPV
- Balance retraining on foam with eyes closed only
Correct answer: Gaze stabilization exercises using the vestibulo-ocular reflex (VOR) x1 protocol
Oscillopsia from vestibular hypofunction reflects VOR impairment; gaze stabilization exercises using the VOR x1 protocol promote central adaptation and substitution to reduce image blur during head movement.
Question 4: During a functional mobility assessment, a patient with ALS demonstrates difficulty with transfers but retains adequate upper extremity strength. Which adaptive strategy should be prioritized FIRST?
- Teach sliding board transfers to preserve independence while reducing fall risk (Correct answer)
- Initiate total assist transfers to conserve energy for disease progression
- Prescribe a power wheelchair before manual options are exhausted
- Focus exclusively on strengthening to delay functional decline
Correct answer: Teach sliding board transfers to preserve independence while reducing fall risk
Sliding board transfers allow patients with adequate upper extremity function to maintain transfer independence safely, preserving autonomy while adapting to motor decline.
Question 5: Which finding during gait analysis MOST suggests hypertonicity of the plantar flexors (spastic equinus) as the cause of a patient's reduced step length?
- Premature heel rise and excessive plantar flexion during mid-stance (Correct answer)
- Excessive dorsiflexion during mid-stance with lateral trunk lean
- Hip hiking during swing phase without ankle involvement
- Circumduction gait with intact heel strike
Correct answer: Premature heel rise and excessive plantar flexion during mid-stance
Spastic equinus causes premature heel rise during stance and limits forward tibial progression, resulting in reduced step length due to restricted ankle mobility.
Question 6: A patient with right hemisphere stroke demonstrates anosognosia. How does this MOST affect the PT examination?
- The patient may deny deficits and resist therapy, requiring careful safety monitoring (Correct answer)
- The patient will over-report symptoms, making objective testing unreliable
- Anosognosia primarily affects sensory testing rather than motor assessment
- The condition resolves within 48 hours and does not impact examination strategy
Correct answer: The patient may deny deficits and resist therapy, requiring careful safety monitoring
Anosognosia is unawareness of one's own deficits; patients may deny weakness or paralysis, resist compensatory strategies, and place themselves at safety risk without appropriate supervision.
Question 7: Which primary neurotransmitter deficit is responsible for the motor symptoms of Parkinson's disease and directly informs pharmacological and rehabilitation management?
- Dopamine deficit in the nigrostriatal pathway (Correct answer)
- Acetylcholine excess in the basal ganglia
- Serotonin deficiency in the raphe nuclei
- GABA reduction in the cerebellum
Correct answer: Dopamine deficit in the nigrostriatal pathway
Parkinson's disease results from dopaminergic neuron loss in the substantia nigra pars compacta, depleting dopamine in the striatum and disrupting the motor control loop.
DPT Neurological Rehabilitation 4
A patient with T10 complete spinal cord injury is beginning ambulation training.
Which assistive device and orthotic combination is MOST appropriate for therapeutic ambulation?