NCS Patient Management 3 — Questions and Answers
Question 1: A neurologist's note documents 'hyperreflexia with sustained clonus at the ankle.' Which clinical implication is MOST relevant to the PT's plan of care?
- Upper motor neuron lesion pattern requiring spasticity management strategies (Correct answer)
- Lower motor neuron lesion requiring neuromuscular electrical stimulation
- Peripheral neuropathy requiring desensitization protocol
- Cerebellar dysfunction requiring balance retraining only
Correct answer: Upper motor neuron lesion pattern requiring spasticity management strategies
Hyperreflexia and sustained clonus are hallmark signs of an upper motor neuron lesion, indicating spasticity that must be addressed through positioning, stretching, and spasticity management in the plan of care.
Question 2: When applying the ICF model to a patient with stroke, which factor represents a 'participation restriction'?
- Right hemiplegia
- Inability to dorsiflex the ankle past neutral
- Unable to return to work as a teacher (Correct answer)
- Spastic gastrocnemius limiting gait
Correct answer: Unable to return to work as a teacher
Participation restrictions in the ICF model refer to problems in life situation involvement, such as the inability to fulfill the social role of employment.
Question 3: A 68-year-old patient with Guillain-Barré syndrome is in the plateau phase with 2/5 proximal lower extremity strength. Which therapy intensity is MOST appropriate?
- High-intensity resistance training to maximize neuroplasticity
- Passive ROM only to prevent contracture
- Low-to-moderate intensity activity with fatigue monitoring (Correct answer)
- Complete bed rest until full recovery
Correct answer: Low-to-moderate intensity activity with fatigue monitoring
During the GBS plateau phase, low-to-moderate intensity exercise with careful fatigue monitoring prevents deconditioning without risking exercise-induced exacerbation or overwork weakness.
Question 4: A patient with cerebellar ataxia is being trained in a new wheelchair-to-bed transfer. Which learning strategy is MOST consistent with motor learning principles for this population?
- Blocked practice in a single consistent environment
- Variable practice across multiple environments and conditions (Correct answer)
- Random practice schedule with contextual interference
- Massed practice with minimal rest intervals
Correct answer: Variable practice across multiple environments and conditions
Variable practice across environments promotes transfer and retention of motor skills in cerebellar ataxia patients who must generalize transfers to diverse real-world settings.
Question 5: A PT determines a patient with right MCA stroke is a falls risk. Which environmental modification has the HIGHEST evidence for inpatient fall prevention in this population?
- Placing the call light on the left side
- Bed exit alarms combined with staff response protocols (Correct answer)
- Lowering the bed to floor level during the night
- Applying non-slip socks only
Correct answer: Bed exit alarms combined with staff response protocols
Bed exit alarms combined with rapid staff response protocols have the strongest evidence for reducing inpatient falls in stroke units, especially for patients with impaired insight.
Question 6: A patient with TBI demonstrates confabulation and disorientation to time. According to the Rancho Los Amigos scale, which level BEST describes this presentation?
- Level III – Localized Response
- Level IV – Confused/Agitated
- Level V – Confused, Inappropriate, Non-Agitated (Correct answer)
- Level VI – Confused, Appropriate
Correct answer: Level V – Confused, Inappropriate, Non-Agitated
Level V is characterized by inconsistent responses, confusion without agitation, memory impairments, and confabulation, distinguishing it from the agitation of Level IV.
Question 7: A physical therapist is discharging a patient with progressive MS to home care. Which referral is MOST critical to ensure safe discharge?
- Outpatient aquatic therapy
- Home health PT with home safety evaluation (Correct answer)
- Community exercise class for neurological populations
- Vocational rehabilitation
Correct answer: Home health PT with home safety evaluation
A home health PT performing a home safety evaluation identifies environmental hazards and ensures equipment needs are met before the patient is fully independent in the home setting.
NCS Patient Management 3
A neurologist's note documents 'hyperreflexia with sustained clonus at the ankle.' Which clinical implication is MOST relevant to the PT's plan of care?