PWR Client Assessment & Progress Monitoring 4 — Questions and Answers
Question 1: A PWR! client in Hoehn and Yahr Stage 3 is most likely to present with which characteristic during gait assessment?
- No gait abnormalities
- Mild postural instability but able to walk independently (Correct answer)
- Requires a wheelchair for mobility
- Unilateral tremor only with normal walking
Correct answer: Mild postural instability but able to walk independently
Stage 3 is characterized by mild to moderate bilateral disease with postural instability, but the client retains the ability to walk independently.
Question 2: When tracking freezing of gait (FOG) in a PWR! client, which assessment tool is most commonly used?
- Activities-Specific Balance Confidence Scale (ABC)
- Freezing of Gait Questionnaire (FOG-Q) (Correct answer)
- Barthel Index
- Dynamic Gait Index
Correct answer: Freezing of Gait Questionnaire (FOG-Q)
The Freezing of Gait Questionnaire is a validated patient-reported tool that quantifies FOG frequency and severity in daily life.
Question 3: A PWR! therapist uses the 6-Minute Walk Test (6MWT) with a client. A meaningful improvement in 6MWT distance is generally considered to be:
- 5 meters
- 14–25 meters (Correct answer)
- 50–100 meters
- Any change greater than 1 meter
Correct answer: 14–25 meters
Research supports a minimal clinically important difference of approximately 14–25 meters on the 6MWT for individuals with Parkinson's disease.
Question 4: Which cognitive assessment is most commonly used as a brief screen during PWR! intake to detect mild cognitive impairment?
- Trail Making Test Part B
- Montreal Cognitive Assessment (MoCA) (Correct answer)
- Wisconsin Card Sorting Test
- Stroop Color and Word Test
Correct answer: Montreal Cognitive Assessment (MoCA)
The MoCA is a brief, validated cognitive screening tool sensitive to the mild cognitive impairment commonly seen in Parkinson's disease.
Question 5: In PWR! progress documentation, a SOAP note's 'O' section would include:
- The client's complaint about pain
- Objective measurements like TUG time and gait speed (Correct answer)
- The therapist's interpretation of performance changes
- The plan for next session's exercises
Correct answer: Objective measurements like TUG time and gait speed
The 'O' (Objective) section of a SOAP note contains measurable, observable data such as standardized test results and performance metrics.
Question 6: A PWR! client scores 44/56 on the Berg Balance Scale at initial assessment and 48/56 at 6-week reassessment. How should the therapist interpret this change?
- Clinically meaningful improvement indicating reduced fall risk (Correct answer)
- Normal variability with no clinical significance
- Evidence of disease progression
- A result that requires repeating the test before drawing conclusions
Correct answer: Clinically meaningful improvement indicating reduced fall risk
A 4-point change on the Berg Balance Scale exceeds the minimal detectable change of approximately 3.3 points, indicating true improvement beyond measurement error.
Question 7: When assessing speech and voice in a PWR! client, which characteristic is most commonly associated with hypokinetic dysarthria in Parkinson's disease?
- Loud, rapid speech with normal rhythm
- Soft, monotone voice with reduced volume (Correct answer)
- Scanning speech with irregular rhythm
- High-pitched voice with frequent pitch breaks
Correct answer: Soft, monotone voice with reduced volume
Hypokinetic dysarthria in Parkinson's disease is characterized by soft volume, reduced pitch variability, and monotone speech due to rigidity and bradykinesia.
PWR Client Assessment & Progress Monitoring 4
A PWR! client in Hoehn and Yahr Stage 3 is most likely to present with which characteristic during gait assessment?