NCS Stroke Rehabilitation 3 — Questions and Answers
Question 1: Constraint-Induced Movement Therapy (CIMT) is BEST indicated for which post-stroke patient profile?
- Flaccid hemiplegia with no active wrist extension
- At least 10° active wrist extension and 10° active finger extension in affected hand (Correct answer)
- Complete paralysis of the affected upper extremity
- Severe cognitive impairment limiting task follow-through
Correct answer: At least 10° active wrist extension and 10° active finger extension in affected hand
CIMT criteria require a minimum of 10° active wrist extension and 10° active finger extension in the affected hand to achieve meaningful functional gains.
Question 2: Which neuroplasticity principle is MOST directly exploited by task-specific training in stroke rehabilitation?
- Use it or lose it
- Use-dependent cortical reorganization (Correct answer)
- Cross-education
- Diaschisis resolution
Correct answer: Use-dependent cortical reorganization
Repetitive task-specific practice drives use-dependent cortical reorganization, expanding the cortical representation of trained movements.
Question 3: Body-weight-supported treadmill training (BWSTT) for gait rehabilitation after stroke primarily works by facilitating which mechanism?
- Reducing cardiovascular demand
- Activating central pattern generators in the lumbar spinal cord (Correct answer)
- Strengthening hip flexors through loaded stepping
- Improving cerebellar coordination via visual feedback
Correct answer: Activating central pattern generators in the lumbar spinal cord
BWSTT unloads body weight to allow repetitive stepping, activating central pattern generators (CPGs) in the lumbar spinal cord to retrain locomotor patterns.
Question 4: A patient 3 months post-stroke has a flaccid affected lower extremity. Which intervention is MOST appropriate to facilitate early stance stability?
- Knee immobilizer during ambulation
- Ankle-foot orthosis (AFO) with rigid footplate
- Functional electrical stimulation (FES) to quadriceps during stance (Correct answer)
- Hamstring strengthening exercises
Correct answer: Functional electrical stimulation (FES) to quadriceps during stance
FES applied to the quadriceps during the stance phase provides active muscle contraction to support knee stability when the muscle is flaccid.
Question 5: Mirror therapy for post-stroke upper extremity rehabilitation works primarily through which mechanism?
- Activating the motor cortex via visual illusion of affected limb movement (Correct answer)
- Increasing afferent proprioceptive input to the sensory cortex
- Strengthening the unaffected limb through cross-education
- Reducing spasticity through reciprocal inhibition
Correct answer: Activating the motor cortex via visual illusion of affected limb movement
Mirror therapy creates a visual illusion that the affected limb is moving, activating mirror neurons and motor cortex regions associated with the paretic limb.
Question 6: Mental practice (motor imagery) combined with physical practice has evidence for post-stroke upper extremity recovery PRIMARILY because it activates which neural substrate?
- Cerebellum via internal forward models
- Overlapping cortical motor networks used during actual movement (Correct answer)
- Basal ganglia reward pathways
- Reticulospinal tracts for postural tone
Correct answer: Overlapping cortical motor networks used during actual movement
Mental practice activates overlapping cortical motor networks used during actual movement execution, enhancing neuroplasticity when combined with physical practice.
Question 7: When using the Task-Oriented Approach in stroke rehabilitation, the therapist's primary role is to:
- Facilitate normal movement patterns through hands-on techniques
- Provide an optimal environment for the patient to solve motor problems (Correct answer)
- Stretch spastic muscles before functional tasks
- Guide limb placement to reduce compensatory strategies
Correct answer: Provide an optimal environment for the patient to solve motor problems
In the Task-Oriented Approach, the therapist structures the task and environment to encourage active problem-solving and self-directed motor learning.
NCS Stroke Rehabilitation 3
Constraint-Induced Movement Therapy (CIMT) is BEST indicated for which post-stroke patient profile?