NCS Clinical Decision-Making 2 — Questions and Answers
Question 1: A patient post-stroke presents with left-sided neglect and poor safety awareness during transfers. Which immediate intervention priority best reflects evidence-based clinical decision-making?
- Begin constraint-induced movement therapy to the left UE
- Address neglect with visual scanning training before progressing mobility (Correct answer)
- Discharge to home with caregiver education only
- Focus solely on strengthening the affected limb
Correct answer: Address neglect with visual scanning training before progressing mobility
Neglect and poor safety awareness must be addressed before advancing mobility tasks to prevent falls and injury.
Question 2: When interpreting an MRI report indicating a T2 hyperintense lesion in the posterior limb of the internal capsule, a neurologic PT should anticipate which primary functional deficit?
- Ipsilateral limb ataxia
- Contralateral spastic hemiplegia (Correct answer)
- Bilateral lower extremity weakness
- Expressive aphasia
Correct answer: Contralateral spastic hemiplegia
The posterior limb of the internal capsule carries the corticospinal tract, and a lesion there produces contralateral spastic hemiplegia.
Question 3: A patient with Guillain-Barré syndrome has an FVC of 18 mL/kg. What is the most appropriate clinical decision?
- Proceed with aggressive respiratory muscle strengthening exercises
- Continue ambulation training as tolerated
- Notify the physician immediately due to impending respiratory failure risk (Correct answer)
- Initiate incentive spirometry and discharge planning
Correct answer: Notify the physician immediately due to impending respiratory failure risk
An FVC below 20 mL/kg in GBS indicates critical risk for respiratory failure and requires urgent physician notification.
Question 4: A therapist uses the Fugl-Meyer Assessment to guide intervention for a patient 3 weeks post-ischemic stroke. This tool primarily informs decisions about which domain?
- Community participation and vocational return
- Degree of motor recovery and synergy pattern stage (Correct answer)
- Cognitive and perceptual function
- Cardiopulmonary endurance capacity
Correct answer: Degree of motor recovery and synergy pattern stage
The Fugl-Meyer Assessment measures motor recovery across the Brunnstrom stages of synergy, guiding movement-based intervention decisions.
Question 5: A patient with MS demonstrates heat sensitivity (Uhthoff's phenomenon) and has a therapy session scheduled during warm afternoon hours. The best clinical decision is to:
- Cancel the session and reschedule for evening
- Schedule the session in cooler morning hours and use cooling strategies (Correct answer)
- Increase session intensity to build heat tolerance
- Administer aquatic therapy in a heated pool
Correct answer: Schedule the session in cooler morning hours and use cooling strategies
Scheduling therapy in cooler conditions and using cooling vests or cold towels minimizes Uhthoff's phenomenon in MS patients.
Question 6: During gait analysis of a patient with Parkinson's disease, you note festination and freezing episodes. Which evidence-based cueing strategy should be prioritized?
- Verbal counting cadence without environmental cues
- External rhythmic auditory cueing (e.g., metronome) (Correct answer)
- Reducing walking speed to prevent falls
- Bilateral arm constraint to focus attention on legs
Correct answer: External rhythmic auditory cueing (e.g., metronome)
Rhythmic auditory stimulation (RAS) bypasses deficient internal rhythm generation in PD and has strong evidence for reducing freezing and festination.
Question 7: A patient recovering from a TBI scores 6 on the Rancho Los Amigos Scale. The therapist's clinical decision for this level should primarily focus on:
- Coma stimulation protocols and passive ROM only
- Vocational rehabilitation and community reintegration
- Managing confused-appropriate responses with structured, consistent routines (Correct answer)
- Independent ADL training in an unstructured environment
Correct answer: Managing confused-appropriate responses with structured, consistent routines
Rancho Level VI (Confused-Appropriate) patients benefit from structured, consistent routines that reduce confusion while beginning purposeful task training.
NCS Clinical Decision-Making 2
A patient post-stroke presents with left-sided neglect and poor safety awareness during transfers.
Which immediate intervention priority best reflects evidence-based clinical decision-making?