DPT Neurological Rehabilitation 5 — Questions and Answers
Question 1: A patient post-stroke demonstrates synergistic movement patterns in the upper extremity. During the Fugl-Meyer assessment, elbow flexion occurs automatically when the patient attempts shoulder abduction. Which stage of Brunnstrom recovery BEST describes this?
- Stage 3 — spasticity at peak with full flexion synergy (Correct answer)
- Stage 2 — spasticity beginning with minimal voluntary movement
- Stage 5 — relative independence from synergy patterns
- Stage 6 — near-normal coordination with mild incoordination
Correct answer: Stage 3 — spasticity at peak with full flexion synergy
Brunnstrom Stage 3 is characterized by peak spasticity and the ability to voluntarily produce limb synergies in their entirety, with strong coupling of synergy components.
Question 2: Which clinical test BEST differentiates a central cause from a peripheral cause of vertigo?
- Head Impulse Test (HIT) — a normal HIT with vertigo suggests a central etiology (Correct answer)
- Dix-Hallpike test — positive result always indicates central pathology
- Romberg test — falls to the right indicate a central lesion
- Fukuda stepping test — rotation greater than 30° confirms peripheral cause
Correct answer: Head Impulse Test (HIT) — a normal HIT with vertigo suggests a central etiology
A normal head impulse test (no corrective saccade) in a patient with acute vertigo and nystagmus is a red flag for central pathology, as peripheral lesions typically produce a catch-up saccade.
Question 3: A patient with incomplete cervical SCI demonstrates central cord syndrome. Which functional recovery pattern is MOST expected?
- Lower extremities recover before upper extremities, with hand function recovering last (Correct answer)
- Upper extremities recover fully before lower extremity function begins
- Bladder function recovers before lower extremity motor function
- Recovery occurs simultaneously in all extremities without a predictable pattern
Correct answer: Lower extremities recover before upper extremities, with hand function recovering last
In central cord syndrome, the cervical tracts are more centrally located; leg function (peripheral fibers) typically recovers first, while arm and hand function (central fibers) recover later or incompletely.
Question 4: Which sensory retraining technique is MOST appropriate for a patient with hypersensitivity (allodynia) following peripheral nerve repair?
- Desensitization using graded textures from least to most stimulating (Correct answer)
- Vibration at high frequency applied directly to the hypersensitive area daily
- Protective sensation training with monofilaments beginning at highest force
- Thermal biofeedback using cold stimulation to reduce nerve activity
Correct answer: Desensitization using graded textures from least to most stimulating
Desensitization using graded textures progressively habituates the nervous system to stimuli that were previously perceived as painful, reducing allodynia after nerve repair.
Question 5: A DPT is working with a patient post-TBI who demonstrates impaired dual-task performance. Which approach BEST addresses this deficit during functional training?
- Progressively add cognitive tasks (e.g., counting backwards) during motor activities (Correct answer)
- Train motor tasks in isolation until automatic before adding any cognitive load
- Avoid dual-task training as it increases fall risk without benefit
- Focus solely on cognitive rehabilitation and defer motor training
Correct answer: Progressively add cognitive tasks (e.g., counting backwards) during motor activities
Dual-task training that progressively combines motor and cognitive demands reflects real-world requirements and has evidence for improving performance in both domains after TBI.
Question 6: Which finding on clinical examination is MOST consistent with an upper motor neuron (UMN) lesion rather than a lower motor neuron (LMN) lesion?
- Hyperreflexia with clasp-knife spasticity and an extensor plantar response (Correct answer)
- Fasciculations with flaccid paralysis and absent deep tendon reflexes
- Muscle atrophy with diminished sensation in a dermatomal pattern
- Weakness limited to a single peripheral nerve distribution with normal tone
Correct answer: Hyperreflexia with clasp-knife spasticity and an extensor plantar response
UMN lesions above the anterior horn cell produce hyperreflexia, spasticity, and a positive Babinski sign (extensor plantar response), distinguishing them from flaccid LMN lesions.
Question 7: A patient with Huntington's disease presents with involuntary choreiform movements. Which movement strategy should be incorporated into gait training to improve safety?
- Use rhythmic cueing and slow the pace of movement to reduce amplitude of choreiform interference (Correct answer)
- Increase walking speed to outpace the involuntary movements
- Focus on strengthening only, as choreiform movements do not affect gait safety
- Avoid all ambulation training due to the unpredictable nature of chorea
Correct answer: Use rhythmic cueing and slow the pace of movement to reduce amplitude of choreiform interference
Rhythmic cueing and a controlled, slower pace reduce the functional impact of chorea during ambulation by imposing temporal structure on movement and minimizing interference with gait.
DPT Neurological Rehabilitation 5
A patient post-stroke demonstrates synergistic movement patterns in the upper extremity.
During the Fugl-Meyer assessment, elbow flexion occurs automatically when the patient attempts shoulder abduction.
Which stage of Brunnstrom recovery BEST describes this?