SMS Neurological and Medical Conditions 2 — Questions and Answers
Question 1: A teenager with Duchenne muscular dystrophy (DMD) transitions to full-time wheelchair use. Which postural complication is MOST commonly observed?
- Excessive lumbar lordosis and anterior pelvic tilt
- Hip extension contractures limiting seating tolerance
- Progressive thoracic scoliosis with pelvic obliquity due to trunk muscle weakness (Correct answer)
- Cervical kyphosis and forward head posture
Correct answer: Progressive thoracic scoliosis with pelvic obliquity due to trunk muscle weakness
Loss of ambulation in DMD removes the spine-straightening effect of weight-bearing, and progressive trunk muscle weakness leads to scoliosis with pelvic obliquity.
Question 2: A child with myelomeningocele at the L4 level would MOST likely have which functional lower extremity ability?
- No lower extremity movement; complete flaccid paralysis
- Hip flexion only with no distal control
- Knee extension via intact quadriceps with potential for AFO-assisted ambulation (Correct answer)
- Full lower extremity strength and normal gait
Correct answer: Knee extension via intact quadriceps with potential for AFO-assisted ambulation
The L4 myotome includes tibialis anterior and quadriceps; preservation of these muscles allows knee extension and potential for household or limited community ambulation with AFOs.
Question 3: Which seated posture is MOST characteristic of a client with Parkinson's disease?
- Posterior pelvic tilt with thoracic kyphosis and forward head position (Correct answer)
- Anterior pelvic tilt with exaggerated lumbar lordosis
- Lateral trunk lean with fixed scoliosis
- Neutral pelvic alignment with flat thoracic spine
Correct answer: Posterior pelvic tilt with thoracic kyphosis and forward head position
Rigidity and bradykinesia in Parkinson's disease produce a characteristic flexed, stooped posture manifesting as posterior pelvic tilt, thoracic kyphosis, and forward head when seated.
Question 4: Following a left CVA resulting in right hemiplegia, which seating intervention is MOST critical for the affected upper extremity?
- Elevating leg rests to reduce lower extremity edema
- Lap tray or arm trough to prevent shoulder subluxation and dependent edema (Correct answer)
- High back support to manage lateral trunk lean
- Anti-tip devices for wheelchair safety
Correct answer: Lap tray or arm trough to prevent shoulder subluxation and dependent edema
Flaccid hemiplegia leaves the shoulder unsupported, making subluxation and dependent edema major risks; a lap tray or arm trough provides essential support for the affected extremity.
Question 5: A client with hereditary spastic paraplegia demonstrates a scissoring lower extremity pattern in sitting. Which seating intervention MOST directly addresses this pattern?
- Hip abduction positioning component to counteract the adductor tone (Correct answer)
- Padded lateral trunk supports
- Anterior chest strap for trunk stability
- Reclined backrest angle to reduce hip flexion
Correct answer: Hip abduction positioning component to counteract the adductor tone
Hereditary spastic paraplegia produces symmetric hip adductor spasticity causing scissoring; a hip abduction component mechanically counteracts this pattern to maintain proper pelvic and lower extremity alignment.
Question 6: A client with incomplete SCI (ASIA C classification) has preserved but weak lower extremity motor function. What should guide equipment selection?
- Prescribe the most durable power wheelchair to ensure long-term use
- Select equipment that supports current function while remaining adaptable to potential changes in functional status (Correct answer)
- Focus exclusively on pressure relief and ignore propulsion options
- Provide a standard manual wheelchair without modifications
Correct answer: Select equipment that supports current function while remaining adaptable to potential changes in functional status
ASIA C incomplete SCI carries potential for neurological recovery; equipment must support present function while allowing adjustments as the client's status changes.
Question 7: Heterotopic ossification (HO) following spinal cord injury MOST commonly develops at which anatomical location?
- Shoulder and elbow joints
- Wrist and hand joints
- Hips and knees (Correct answer)
- Ankles and feet
Correct answer: Hips and knees
HO after SCI preferentially forms at the hips and knees, where it can severely restrict range of motion and significantly compromise seated positioning.
SMS Neurological and Medical Conditions 2
A teenager with Duchenne muscular dystrophy (DMD) transitions to full-time wheelchair use.
Which postural complication is MOST commonly observed?