NCS Intervention Techniques 2 — Questions and Answers
Question 1: A patient post-stroke exhibits a strong elbow flexor synergy with minimal ability to isolate elbow extension. Which motor learning strategy should guide the initial intervention?
- Repetitive isolated elbow extension against maximal resistance
- Task-specific practice using movement patterns designed to break the synergy (Correct answer)
- Passive range of motion to maintain joint mobility while awaiting spontaneous recovery
- Strengthening of biceps to improve co-contraction stability at the elbow
Correct answer: Task-specific practice using movement patterns designed to break the synergy
Task-specific practice that incorporates synergy-breaking movement patterns leverages cortical plasticity and is the evidence-based approach for post-stroke upper extremity rehabilitation.
Question 2: When using functional electrical stimulation (FES) for foot drop in incomplete spinal cord injury, what is the optimal trigger for stimulation during ambulation?
- Continuous stimulation throughout the entire gait cycle
- A heel switch detecting heel-off to trigger dorsiflexion during swing phase (Correct answer)
- EMG activity from the quadriceps to coordinate knee and ankle movement
- Manual activation by the therapist at each step initiation
Correct answer: A heel switch detecting heel-off to trigger dorsiflexion during swing phase
A heel switch detecting heel-off provides phase-appropriate FES of the tibialis anterior during swing, mimicking normal gait neurophysiology.
Question 3: A patient with Parkinson's disease has festinating gait and reduced stride length. Which intervention has the strongest evidence for improving gait velocity and stride length?
- Treadmill training without any external cueing
- Rhythmic auditory stimulation (RAS) matched to a target cadence above baseline (Correct answer)
- Visual floor cueing with transverse lines placed 50 cm apart
- Nordic walking with bilateral poles to engage the upper extremities
Correct answer: Rhythmic auditory stimulation (RAS) matched to a target cadence above baseline
Rhythmic auditory stimulation provides an external temporal rhythm that bypasses defective internal timing circuits in Parkinson's disease, with robust evidence for improving cadence and stride length.
Question 4: When performing PNF using the 'hold-relax' technique to improve limited hip flexion, what is the correct sequence?
- Move to end range → isometric contraction of hip extensors → relax → move to new end range (Correct answer)
- Active movement → isometric contraction of hip flexors → relax → active movement to new range
- Passive stretch → isotonic contraction of hip flexors → relax → passive stretch to new range
- Isometric contraction of hip extensors → relax → isotonic contraction of hip flexors to new range
Correct answer: Move to end range → isometric contraction of hip extensors → relax → move to new end range
Hold-relax uses an isometric contraction of the limiting muscle (hip extensors) at end range, followed by relaxation, allowing the limb to move further into hip flexion.
Question 5: During body-weight supported treadmill training (BWSTT) for a patient with incomplete SCI who cannot step independently, what is the primary rationale for progressively reducing body weight support over the course of rehabilitation?
- To increase cardiovascular training intensity and improve aerobic capacity
- To increase proprioceptive loading and progressively challenge postural control and muscle activation (Correct answer)
- To reduce session costs by decreasing reliance on harness equipment
- To improve upper extremity coordination during parallel bar use
Correct answer: To increase proprioceptive loading and progressively challenge postural control and muscle activation
Progressive reduction of body weight support increases musculoskeletal loading and proprioceptive input, which are critical stimuli for activating spinal locomotor networks and driving neurological recovery.
Question 6: A patient with TBI cannot walk safely while performing a cognitive task. According to motor learning principles, what is the BEST initial approach?
- Practice dual tasks immediately to simulate real-world demands and force neural adaptation
- Master the primary motor task (walking) first, then systematically introduce cognitive challenges (Correct answer)
- Focus exclusively on cognitive rehabilitation until cognitive function normalizes
- Prescribe a walker permanently to reduce cognitive demands during ambulation
Correct answer: Master the primary motor task (walking) first, then systematically introduce cognitive challenges
Motor learning principles support establishing a stable, automatic single-task foundation before adding cognitive demands, particularly when the primary motor task is not yet automatic.
Question 7: When applying electrical stimulation to manage glenohumeral subluxation in a hemiplegic patient, which muscles are the primary targets to prevent inferior displacement?
- Anterior deltoid and biceps brachii
- Posterior deltoid and supraspinatus (Correct answer)
- Middle deltoid and infraspinatus
- Upper trapezius and serratus anterior
Correct answer: Posterior deltoid and supraspinatus
The posterior deltoid and supraspinatus are the primary passive stabilizers resisting inferior humeral displacement and are the optimal NMES targets in glenohumeral subluxation.
NCS Intervention Techniques 2
A patient post-stroke exhibits a strong elbow flexor synergy with minimal ability to isolate elbow extension.
Which motor learning strategy should guide the initial intervention?