Question 1

During observational gait analysis,you note the patient's left knee snaps back into locked extension during left mid-stance weight-bearing (right swing) of gait.Which of the following is the best electrical stimulation (ES) setup to trial first for the left lower extremity?

Accepted Answer

ES to the gastroc-soleus during stance activated by a heel switch on the right foot is the best electrical stimulation (ES) setup to trial first for the left lower extremity because it will help to prevent the left knee from snapping back into locked extension during left mid-stance weight-bearing (right swing) of gait.

Question 2

During the outpatient physical therapy examination,a 56 year-old patient with stroke states,"My elbow won't hold when I lean on my arm." Upon further examination,you observe that the scapular stabilizer muscles are not activating sufficiently to provide proximal stability.What treatment adjunct is MOST appropriate to accompany the patient's home exercise program?

Accepted Answer

Elastic tape can be applied in a manner that facilitates muscle activation and provides sensory feedback to enhance scapular stabilizer function, which is essential for proximal stability during weight-bearing activities. This approach is more functional and specific to the patient's needs compared to the other options.

Question 3

A 67 year-old male presents to an outpatient physical therapy clinic 7 weeks after a cerebrovascular accident with left hemiplegia.He has pain in the left shoulder with upper extremity movement and with functional mobility tasks such as bed mobility.During the physical therapy examination,you notice a subluxation of the left humeral head.Which of the following interventions is the MOST appropriate for this condition?

Accepted Answer

A

Question 4

A 34 year-old female presents to the outpatient clinic for a physical therapy examination following a traumatic brain injury 15 months ago.She demonstrates a toe drag during the swing phase of gait.The MOST appropriate course of action is to trial:

Accepted Answer

Functional electrical stimulation (FES) is appropriate to increase dorsiflexion during the swing phase, addressing the toe drag by stimulating the muscles responsible for lifting the foot.

Question 5

Your patient recently experienced an ischemic stroke involving the middle cerebral artery (3 weeks ago).You evaluate the patient in the inpatient rehabilitation setting and the patient is able to walk 10 ft with moderate to maximal assistance of two people.The patient demonstrates a medial/lateral wobble of the right ankle in mid-stance during gait.Based on the diagnosis,prognosis,and stage of rehabilitation,you opt for which of the following approaches to address the ankle instability for gait training:

Accepted Answer

DGiven the patient's recent ischemic stroke and current stage of rehabilitation, both a compensatory approach with an ankle foot orthosis (C) and a compensatory approach with functional electrical stimulation (D) are appropriate choices. The compensatory approach aims to adapt to the patient's current level of function and provide immediate support for the ankle instability, which is crucial in the early stages of stroke rehabilitation. An ankle foot orthosis can provide the necessary support to stabilize the ankle, while functional electrical stimulation can help in activating the muscles around the ankle to improve stability and gait pattern.

Question 6

When evaluating a patient in an inpatient rehabilitation setting with segment instability at the knee,which of the following is the MOST appropriate course of action in the evaluation?

Accepted Answer

Administering a functional outcome measure is the most appropriate course of action because it directly assesses how the segment instability at the knee affects the patient's function, which is crucial for planning appropriate rehabilitation interventions.

Question 7

What is the MOST appropriate electrode placement for electrical stimulation to address shoulder subluxation?

Accepted Answer

The most appropriate electrode placement for addressing shoulder subluxation with electrical stimulation is on the supraspinatus and posterior deltoid. This combination targets muscles that are key in stabilizing the shoulder joint and can help in reducing subluxation by promoting muscle activation and synergy that support the shoulder's proper alignment.

Question 8

A lesion in which of the following structures could result in ataxia,dysmetria,intention tremors,adiadochokinesia,and dysergia?

Accepted Answer

The posterior lobe of the cerebellum is responsible for coordinating voluntary movements. Lesions in this area can lead to ataxia (lack of voluntary coordination of muscle movements), dysmetria (inability to judge distance or scale), intention tremors (trembling when performing movements), adiadochokinesia (inability to perform rapid alternating movements), and dysergia (incoordination of movements). These symptoms are characteristic of cerebellar dysfunction, specifically related to the posterior lobe.

Question 9

A patient diagnosed with a left anterior cerebral artery stroke is 8 months post-onset and presents with decreased right ankle stability in the sagittal plane that is adversely affecting his gait and balance.After a thorough physical therapy examination,you think an AFO is the optimal approach to provide stability at this point.After sharing this with the patient,he is against bracing for cosmetic reasons and due to a belief that an AFO equates to "giving up".What is the best initial course of action?

Accepted Answer

B) Providing patient education regarding the prognosis and rationale for the AFO, while also offering alternative interventions to trial initially, respects the patient's autonomy and concerns. It allows for a collaborative approach to care, which can improve patient adherence and satisfaction.

Question 10

During observational gait analysis,you observe genu recurvatum of the left knee in mid-stance.Which of the following interventions will best enable the patient to regain motor control-stability of the left hip,knee,and ankle?

Accepted Answer

Body weight support ambulation training (BWSAT) with 30-40% body weight-support can help the patient regain motor control and stability by allowing them to practice proper gait patterns with reduced weight-bearing, thus improving muscle activation and coordination.

Quiz 24: Therapeutic Intervention for Impaired Motor Controlstability