NCS Intervention Techniques 3 — Questions and Answers
Question 1: A patient with unilateral vestibular hypofunction has dizziness with horizontal head movement. Which instruction correctly describes a VOR x1 gaze stabilization exercise?
- Keep the head still and move a target card side to side while following it with the eyes
- Move the head side to side while maintaining visual focus on a stationary target (Correct answer)
- Move both the head and target simultaneously in the same direction
- Close the eyes and rotate the head to challenge the semicircular canals without visual input
Correct answer: Move the head side to side while maintaining visual focus on a stationary target
VOR x1 exercises require head movement while gaze remains fixed on a stationary target, promoting VOR adaptation to restore gaze stabilization during head movement.
Question 2: A patient with MS has significant lower extremity spasticity limiting functional mobility. Which approach is most appropriate as a first-line physical therapy intervention?
- Ice application for 20 minutes immediately before each exercise session
- Prolonged static stretching and positioning in patterns that inhibit the spastic muscles (Correct answer)
- Rapid, repetitive stretch to fatigue the stretch reflex over multiple sets
- High-intensity resistance training of the spastic muscles to improve voluntary control
Correct answer: Prolonged static stretching and positioning in patterns that inhibit the spastic muscles
Prolonged static stretching and anti-spasticity positioning are first-line PT interventions, reducing tonic stretch reflex activity and maintaining muscle extensibility.
Question 3: During aquatic therapy for a patient in the recovery phase of Guillain-Barré syndrome (3-/5 strength), which water temperature best supports rehabilitation?
- Cold water (< 25°C) to reduce metabolic demands and prevent overheating
- Thermoneutral water (33–36°C) to reduce muscle tone and minimize cardiovascular stress (Correct answer)
- Hot water (> 38°C) to maximize blood flow and promote muscle relaxation
- Room temperature water (28–30°C) to maximize buoyancy and minimize weight-bearing stress
Correct answer: Thermoneutral water (33–36°C) to reduce muscle tone and minimize cardiovascular stress
Thermoneutral water (33–36°C) minimizes cardiovascular demands and reduces muscle tone, making it most appropriate for patients with neuromuscular fatigue and potential autonomic instability in GBS.
Question 4: A patient with Huntington's disease has choreiform movements significantly affecting upper extremity function during ADLs. Which PT intervention strategy is most appropriate?
- Speed training to improve coordination through faster movement repetition
- Weighted wrist cuffs and task simplification to reduce movement variability (Correct answer)
- EMG biofeedback to increase patient awareness of involuntary muscle activity
- Progressive resistance training targeting the muscles producing choreiform movements
Correct answer: Weighted wrist cuffs and task simplification to reduce movement variability
Weighted cuffs dampen choreiform amplitude, and task simplification reduces attentional demands, together improving functional performance in Huntington's disease.
Question 5: When using the NDT/Bobath approach to facilitate knee extension during loading response in a patient with spastic hemiplegia, which handling strategy is most appropriate?
- Apply rapid stretch to the quadriceps muscle belly to trigger a facilitory stretch reflex
- Handle at the pelvis to facilitate weight shift onto the affected limb and normalize loading response (Correct answer)
- Apply progressive resistance to the knee extensors throughout full range to strengthen the muscle
- Use verbal cueing alone without manual facilitation to promote cortical motor control
Correct answer: Handle at the pelvis to facilitate weight shift onto the affected limb and normalize loading response
Pelvic facilitation and weight-shifting onto the affected side normalizes sensory input and activates appropriate knee extensor activity during loading response through postural alignment.
Question 6: A patient post-stroke develops shoulder-hand syndrome (CRPS Type I) in the affected upper extremity. Which intervention is most appropriate during the acute inflammatory phase?
- Aggressive passive ROM to maintain shoulder mobility and prevent adhesive capsulitis
- Active-assisted exercises with upper extremity elevation combined with TENS for pain modulation (Correct answer)
- Moist heat application to increase local circulation and reduce pain
- Resistive exercises targeting shoulder and hand muscles to reverse disuse atrophy
Correct answer: Active-assisted exercises with upper extremity elevation combined with TENS for pain modulation
Active-assisted exercises with elevation reduce edema via muscle pumping, while TENS provides pain modulation without aggravating the ongoing inflammatory response.
Question 7: During tilt table training for a patient with severe TBI who has been bedbound for 6 weeks, what finding requires immediate return to supine?
- Heart rate increase of 10 bpm above supine baseline with no symptoms
- Systolic blood pressure drop of 20 mmHg with concurrent dizziness and pallor (Correct answer)
- Respiratory rate increase of 4 breaths per minute from baseline
- Oxygen saturation decrease to 96% with no associated symptoms
Correct answer: Systolic blood pressure drop of 20 mmHg with concurrent dizziness and pallor
Orthostatic hypotension is defined as a systolic BP drop ≥20 mmHg accompanied by symptoms such as dizziness or pallor, requiring immediate return to supine to prevent syncope.
NCS Intervention Techniques 3
A patient with unilateral vestibular hypofunction has dizziness with horizontal head movement.
Which instruction correctly describes a VOR x1 gaze stabilization exercise?