SMS Neurological and Medical Conditions 1 — Questions and Answers
Question 1: What does an ASIA Impairment Scale grade 'A' indicate in a client with spinal cord injury?
- Incomplete injury with some motor function preserved below the level
- Complete injury with no sensory or motor function below the neurological level (Correct answer)
- Incomplete injury with sensory function only below the level
- Normal neurological function with minor deficits
Correct answer: Complete injury with no sensory or motor function below the neurological level
ASIA grade A indicates a complete SCI with absolutely no motor or sensory function preserved in the sacral segments S4–S5.
Question 2: A client with secondary progressive multiple sclerosis presents with increasing fatigue and lower extremity weakness. Which seating feature should be prioritized FIRST?
- Tilt-in-space functionality to manage fatigue and enable passive pressure relief (Correct answer)
- Custom contoured back support only
- Pressure relief cushion as the sole intervention
- Manual lightweight frame to encourage activity
Correct answer: Tilt-in-space functionality to manage fatigue and enable passive pressure relief
Tilt-in-space reduces the energy expenditure of active repositioning, directly addressing the fatigue that is a hallmark of progressive MS.
Question 3: A client with a C6 complete spinal cord injury typically has preserved function in which muscle group?
- Finger flexors and intrinsic hand muscles
- Wrist extensors (ECRL/ECRB) (Correct answer)
- Elbow extensors (triceps)
- Full grasp and release function
Correct answer: Wrist extensors (ECRL/ECRB)
The C6 myotome includes wrist extensors, which are critical for tenodesis grasp function and manual wheelchair propulsion with adaptations.
Question 4: Which spasticity pattern most commonly produces a windswept hip deformity in children with cerebral palsy?
- Symmetric hip adductor spasticity pulling both hips inward
- Asymmetric tone pulling one hip into adduction and the opposite into abduction (Correct answer)
- Isolated bilateral hip flexor spasticity
- Symmetric hip extensor spasticity
Correct answer: Asymmetric tone pulling one hip into adduction and the opposite into abduction
Windswept deformity results from asymmetric tone that forces both hips in opposite directions simultaneously, creating the characteristic 'swept' appearance.
Question 5: In late-stage ALS (amyotrophic lateral sclerosis), which wheelchair feature becomes MOST essential as the disease progresses?
- Rigid ultralight frame to maximize propulsion efficiency
- Power tilt and recline for passive positioning and pressure management (Correct answer)
- Standard sling seat for portability
- High-grip push rims to compensate for hand weakness
Correct answer: Power tilt and recline for passive positioning and pressure management
Progressive motor neuron loss in ALS eliminates the client's ability to independently reposition; power tilt and recline provide pressure relief and positioning that the client can no longer perform actively.
Question 6: A client with a T4 complete SCI is at risk for autonomic dysreflexia. Which seating-related trigger must be vigilantly monitored?
- Wheelchair cushion being too firm for comfort
- Seat pan width being slightly too wide
- Noxious stimuli from ill-fitting equipment causing undetected skin irritation or pressure below the injury level (Correct answer)
- Backrest height being set too high
Correct answer: Noxious stimuli from ill-fitting equipment causing undetected skin irritation or pressure below the injury level
Autonomic dysreflexia in injuries at or above T6 is triggered by noxious stimuli below the lesion that the client cannot feel, including pressure from poorly fitted seating or leg rests.
Question 7: Which GMFCS level describes a child with cerebral palsy who walks using a handheld mobility device but uses wheeled mobility for longer community distances?
- Level I
- Level II
- Level III (Correct answer)
- Level IV
Correct answer: Level III
GMFCS Level III children walk with handheld assistive devices and rely on wheeled mobility for community distances, reflecting limited but present ambulation capacity.
SMS Neurological and Medical Conditions 1
What does an ASIA Impairment Scale grade 'A' indicate in a client with spinal cord injury?