Adult and Older Adult Neuromuscular Answers to Sample Cases

Case A

 

Question 1. 1 False, 2 True, 3 True, 4 True, 5 False

1 – This is false because one criterion for use of a sit – stand mechanical lift is unsupported sitting balance.
2+3+4 – These are true because unsupported sitting, ability to hold lift handle and ability to weight bear on legs are criteria for use of the sit – stand mechanical lift.
5 – This is false because the ability to stand unsupported would mean the sit stand mechanical lift would not need to be used.

Question 2. CORRECT: 2

1+3 – These are incorrect because patient requires 2-person assist lying to sitting and has poor sitting balance so does not have necessary skill/foundation ability to perform a standing pivot transfer or use a mechanical sit to stand lift.
2 – Ceiling lift is correct; it is a safe method of transfer as a non weight bearing dependent lift because of patient’s 2-person assist requirements and poor sitting balance.
4 – This is incorrect because it is a manual, total lift, which is unsafe. When a patient requires a non weight bearing lift, WSBC regulations recommend using a mechanical lift as the appropriate transfer technique.

Question 3. CORRECT: 1

1 – Is correct because the patient can be supported in a seated or lying position to use this active-passive cycle safely, to treat rigidity and for use of exercise to improve and maintain a patient’s functional ability.
2+4 – Are incorrect as patient is using a wheelchair because of impaired sitting and standing balance so does not have the skills required to use a regular treadmill or perform single leg standing on a wobble board.
3 – Is incorrect as intramuscular stimulation is not a treatment used for Parkinson’s rigidity.

Question 4. CORRECT: 2, 3, 5

1 – This is incorrect because seated ankle circling movements do not represent a progression for a patient who is taking a few steps with the rollator walker.
2+3+5 – These are correct because they are appropriately graded clinical progressions of standing balance and gait in this case.
4 – This is incorrect as TENS over both calves is not indicated and does not promote progression of gait in this case.

Question 5. CORRECT: 3

1+2+4 – These are incorrect as a PTA cannot perform acupuncture and a PT must have credentialing in acupuncture in order to use as a treatment.
3 – This is correct as the PT would reassess the situation and advise PTA to carry out assignment of task as established by the PT. One can imagine multiple other correct approaches to this situation, but of the four options here, this is the only correct one.

 

 

 

Case B

 

Question 1. 1 True, 2 False, 3 True, 4 True, 5 False, 6 False, 7 False, 8 False

1+3+4 – True because they are all valid parts of an initial assessment of a patient who has had a SCI in order to determine the extent of the injury.
5+6+7+8 – False because they are contraindicated at this stage of the injury.
2 – False because cranial nerve testing is not indicated in this situation.

Question 2. CORRECT: 1, 5

1+5 – These are correct because education, contraindications, stages of healing and posture are important interventions to discuss with patient early on in their treatment.
3+4+6 – These are incorrect because they are contraindicated for this patient who has had a fusion and has a stable, braced C2 fracture.
2 – Is incorrect because the question asks for 2 selections of interventions for the first treatment; resisted arm exercises are indicated but not in the first treatment when A1 and A5 take priority.

Question 3. CORRECT: 1, 4

1+4 – These are correct because grade 2+ ankle dorsiflexion strength means the patient is at risk of losing dorsiflexion range of motion; both passive exercises and an ankle foot orthosis (AFO) would help to maintain ankle dorsiflexion.
5 – This is incorrect as active plantarflex exercises to increase push off will not address the active dorsiflexion weakness.
6 – This is incorrect as expecting motor control to return spontaneously in the absence of another intervention is not certain.
2+3 – These are incorrect as the neurologist and family physician would expect the physical therapist to intervene to strengthen the ankle dorsiflexors so referring the patient back is not appropriate.

Question 4. CORRECT: 2

1+3+4 – These are incorrect as the private physical therapist is responsible for the pool program and supervision of the rehabilitation assistant (physical therapy support worker). Discontinuation of the outpatient rehabilitation is not required as the concurrent treatment is compatible with the treatment approach and clinically indicated. Concurrent treatment with these two different treatments can occur.
2 – This is correct because the concurrent treatment is compatible with the treatment approach and clinically indicated. The private physical therapist is responsible for supervision of the rehabilitation assistant involved in the pool program.

 

 

 

Case C

 

Question 1. CORRECT: 2, 5

2+5 – These are correct because infection control procedures indicate to wash hands, wear gloves and apply new dressing to wound during direct patient contact with the area involved.
3 – This is incorrect as leaving a wound that is weeping open to air while ambulating a patient means there is a higher likelihood of contamination of equipment, environment and staff.
1 – This is incorrect as avoiding contact with the patient’s knee may not be possible during an ambulation intervention.
4 – This is incorrect as gloves/gown and mask are only required per infection control procedures during procedures that are likely to contact blood or other body fluids. In this case gown and gloves are required due to the knee area exposed but not mask.
6 – This is incorrect as deferring intervention because of a weeping knee wound would potentially delay patient recovery unnecessarily when infection control procedures can address the concern.

Question 2. CORRECT: 1- DVT, 2- Stroke and DVT, 3- DVT, 4- Stroke and DVT

2+4 – Shoulder pain and edema of upper limb are associated with both Stroke and DVT.
1+3 – Supraclavicular fullness and cyanosis of upper limb are associated with DVT and not Stroke because they indicate circulatory compromise of the limb.

Question 3. CORRECT: 1- False, 2- True, 3- False, 4- False

2 – This is true as patient is safe to mobilize when sufficiently anti coagulated.
1+3 – These are false as patient may have diagnostics done, but safe mobility should be done after anti coagulation is in place.
4 – This is false as having a DVT is not an absolute contraindication to mobilizing.

Question 4. CORRECT: 1- False, 2- False, 3- True

1 – False because an active DVT is a contraindication to the use of electrical stimulation.
2 – False because impaired sensation in the area to be treated is a contraindication to the use of TENS.
3 – True because a subluxed shoulder on its own not a contraindication or precaution to the use of TENS.

Question 5. CORRECT: 2, 3, 6

1 – This is incorrect as the patient can lie on right side if shoulder is protected by correct positioning.
2+3+6 – These are correct interventions for a subluxed shoulder.
4 – This is incorrect as there are effective treatments to address shoulder pain after stroke.(ie. sling, TENS, EMS, taping).
5 – This is incorrect as checking the shoulder will not reduce the subluxation.