NPTE-PT Test Gait, Balance, and Orthotics Questions and Answers — Questions and Answers
Question 1: A physical therapist is evaluating a 76-year-old community-dwelling female with a history of two falls in the past year. The therapist wishes to quickly assess the patient's basic functional mobility and fall risk. The patient completes the Timed Up and Go (TUG) test in 15 seconds. Which of the following is the MOST accurate interpretation of this result?
- The patient's score is within the normal range for her age and indicates a low risk of falls.
- The patient's score indicates an increased risk for falls and warrants further balance assessment. (Correct answer)
- The patient requires a wheeled walker for all mobility to ensure safety.
- The patient's performance was too slow to be a valid measure of fall risk.
Correct answer: The patient's score indicates an increased risk for falls and warrants further balance assessment.
A score of 13.5 seconds or longer on the Timed Up and Go (TUG) test is widely cited as an indicator of increased fall risk in community-dwelling older adults. A time of 15 seconds clearly places the patient in this higher-risk category, necessitating further, more detailed balance and gait assessment to identify specific deficits that can be addressed in therapy.
Question 2: A patient recovering from a stroke presents with right-sided weakness. The examination reveals 2/5 strength in the ankle dorsiflexors and significant mediolateral instability at the ankle during weight-bearing. Which of the following ankle-foot orthoses (AFOs) is the MOST appropriate prescription for this patient?
- Posterior leaf spring AFO
- Articulating AFO with a plantar flexion stop
- Solid ankle AFO (Correct answer)
- Ground reaction AFO
Correct answer: Solid ankle AFO
A solid ankle AFO is the most appropriate choice because it provides maximum control in all three planes of motion (sagittal, frontal, and transverse). This is necessary to address both the severe dorsiflexion weakness (foot drop) and the significant mediolateral (frontal plane) instability. A posterior leaf spring only assists with dorsiflexion and offers minimal frontal plane control, while an articulating AFO allows for movement that may not be safe given the patient's instability.
Question 3: A physical therapist aims to specifically assess the contribution of the vestibular system to a patient's balance. According to the principles of the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB), which condition would MOST effectively isolate and challenge this system?
- Standing on a firm surface with eyes open
- Standing on a firm surface with eyes closed
- Standing on a foam surface with eyes open
- Standing on a foam surface with eyes closed (Correct answer)
Correct answer: Standing on a foam surface with eyes closed
To challenge the vestibular system, input from the visual and somatosensory systems must be removed or made unreliable. Standing on a foam surface makes somatosensory input from the feet and ankles unreliable. Closing the eyes removes visual input. Therefore, standing on a foam surface with eyes closed forces the patient to rely primarily on their vestibular system to maintain balance.
Question 4: During a gait analysis, a physical therapist observes a patient with painful right hip osteoarthritis. The therapist notes that the step length of the left leg is significantly shorter than the step length of the right leg. What is the MOST likely reason for this gait deviation?
- Weakness of the left hip flexors
- Weakness of the right gluteus medius
- A desire to decrease stance time on the painful right leg (Correct answer)
- Limited extension of the left hip
Correct answer: A desire to decrease stance time on the painful right leg
This gait pattern is known as an antalgic gait. The patient shortens the step length of the non-painful (left) leg to minimize the amount of time they must spend in the single-limb stance phase on the painful (right) leg. This is a compensatory strategy to reduce joint loading and pain on the affected side.
Question 5: A 55-year-old male presents with a chief complaint of sharp, stabbing pain at the medial aspect of his heel, which is most intense with his first steps in the morning. The physical therapist's examination reveals pes planus and excessive subtalar joint pronation during gait. Which of the following orthotic interventions would be MOST beneficial?
- A lateral forefoot post to encourage supination
- A cushioned heel lift to offload the Achilles tendon
- A full-length insert with medial longitudinal arch support and a medial heel post (Correct answer)
- A metatarsal pad placed just proximal to the metatarsal heads
Correct answer: A full-length insert with medial longitudinal arch support and a medial heel post
The patient's presentation is classic for plantar fasciitis, which is often exacerbated by pes planus (flat feet) and excessive pronation. A full-length orthotic with substantial medial longitudinal arch support will help to support the plantar fascia and reduce tensile stress. A medial heel post helps to control the excessive pronation at the subtalar joint, addressing the underlying biomechanical fault contributing to the condition.
Question 6: A patient with Parkinson's disease is being treated for gait deficits. The physical therapist observes short, shuffling steps and an involuntary acceleration of gait speed (festination). Which of the following verbal cues would be MOST effective to immediately improve gait safety and pattern?
- "Try to walk as fast as you can."
- "Look down at your feet while you walk."
- "Think about taking big steps." (Correct answer)
- "Keep your arms straight at your sides."
Correct answer: "Think about taking big steps."
Patients with Parkinson's disease often exhibit hypokinetic gait patterns, including reduced step length. External, attentional cues that focus on the result of the movement (e.g., "take big steps") are more effective than internal cues. This type of cue helps to bypass the automatic, but dysfunctional, motor pathways of the basal ganglia and engage more conscious, cortical control over the gait pattern, resulting in increased step length and improved stability.
NPTE-PT Test Gait, Balance, and Orthotics Questions and Answers
A physical therapist is evaluating a 76-year-old community-dwelling female with a history of two falls in the past year.
The therapist wishes to quickly assess the patient's basic functional mobility and fall risk.
The patient completes the Timed Up and Go (TUG) test in 15 seconds.
Which of the following is the MOST accurate interpretation of this result?