Adult and Older Adult Neuromuscular Sample Cases

Click here for Adult and Older Adult Neuromuscular Answers to Sample Cases.

Case A

The physical therapist was asked to treat a 70-year-old man who lives at a residential care facility. He has Parkinsons disease and has mild cognitive impairment (Cognitive Performance Scale of 2) due to dementia. In the past week, there was a sudden deterioration in his abilities to transfer and walk and he also fell a few times when transferring. He is refusing to sleep in his own bed and to eat.

1.  The care aides at the facility asked the physical therapist if the patient could use a sit-stand mechanical lift for transfers. What are the essential criteria about the patient’s abilities that would permit the safe use of a sit-stand mechanical lift? Indicate True or False.

1 – Sit with moderate assistance.

2 – Sit unsupported.

3 – Hold onto the lift handles.

4 – Able to weight bear on his legs.

5 – Stand unsupported.

2.  The patient has significant rigidity and requires moderate assistance from the physical therapist and the physical therapy assistant to move from a lying position to sitting at the edge of the bed. The patient also has poor sitting balance and tends to lean backwards. What transfer method should the physical therapist recommend to the care aides for transferring the patient from his bed to a wheelchair? (Select 1)

1 – Standing pivot transfer.

2 – Mechanical ceiling lift.

3 – Mechanical sit-stand lift.

4 – Chicken / drag lift technique.

3. Due to the increase in rigidity and impaired sitting and standing balance, the patient is using a temporary wheelchair. However, the patient is eager to ‘keep moving’ and worries sitting too much will worsen his condition. What treatment should the physical therapist provide for the patient? (Select 1)

1 – Use of an active-passive motorized cycle.

2 – Walking on a regular treadmill.

3 – Intramuscular stimulation.

4 – Single leg standing with a wobble board.

4.  The patient continues to improve and is now able to walk a few steps with a rollator walker. What treatment progressions should the physical therapist provide for the patient? (Select 3)

1 – Seated ankle circling movements.

2 – Static standing balance exercises.

3 – Walking with a rollator walker.

4 – Transcutaneous electrical stimulation over both calves.

5 – Stepping sideways.

6 – Single leg hops.

5.  The physical therapist assistant was trained in acupuncture overseas and proposed acupuncture as a useful adjunct treatment for the patient. The physical therapist has not had training in acupuncture. What action should the physical therapist take? (Select 1)

1 – Perform an online literature search about acupuncture and assign the physical therapy assistant to perform acupuncture on the patient.

2 – Perform an online literature search about acupuncture and carry out the treatment on the patient.

3 – Perform a reassessment and advise the physical therapist assistant to continue with the previously established and assigned treatment plan.

4 – Perform acupuncture on the patient with the guidance of the physical therapist assistant about needle placement.

Case B

The physical therapist in a hospital outpatient neurology department is treating a 40-year-old man who had a thoracic spinal cord injury. The patient’s injury resulted in ipsilateral motor deficits and contralateral temperature and pain deficits (Brown Sequard Syndrome). He has a T4 transverse process fracture with a 5 level fusion and a stable C2 fracture. He had the fusion six weeks ago and is wearing a neck brace.

1.  What should the physical therapist include in the patient’s initial assessment? Indicate True or False.

1 – Dermatomes of the upper and lower extremity.

2 – Cranial nerve testing.

3 – Upper and lower extremity reflexes.

4 – Myotomes of the upper and lower extremity.

5 – Posterior anterior accessory glide of all thoracic spine segments.

6 – Cervical spine range of motion.

7 – Thoracic spine range of motion.

8 – Passive intervertebral range of motion of the cervical spine.

2.  What should the physical therapist include in the interventions for the patient’s first treatment? (Select 2)

1 – Education about injury, contraindications, and stages of healing.

2 – Resisted arm exercises.

3 – Cervical spine range of motion exercises.

4 – Thoracic spine range of motion exercises.

5 – Postural education.

6 – Cervical spine intervertebral passive accessory mobilizations.

3.  The patient has right dorsiflexion strength of 2+. How should the physical therapist proceed regarding the patient’s muscle weakness? (Select 2)

1 – Give the patient passive range of motion exercises to maintain dorsiflexion.

2 – Refer the patient back to his family physician.

3 – Refer the patient back to the neurologist.

4 – Refer the patient for assessment for an ankle foot orthosis.

5 – Give the patient active plantar flexion exercises to increase push-off.

6 – Tell the patient not to worry because the motor control will come back.

4.  The patient is 12 weeks post-op. He still requires joint mobilizations on his hypomobile cervical spine and is beginning to participate more actively in his rehab program. He has been contacted by a private clinic that specializes in active rehabilitation for ICBC cases. The clinic will be starting treatment with the patient. With consent, the private physical therapist calls the outpatient physical therapist to inform her that they will be beginning a pool program with the patient. This will be carried out by a rehabilitation assistant (RA). The patient is aware of this plan and consents. What action should the outpatient physical therapist take regarding the concurrent treatments? (Select 1)

1 – Continue with the outpatient rehabilitation; supervise the RA’s pool program.

2 – Continue with the outpatient rehabilitation; the private physical therapist will supervise the RA’s pool program.

3 – Continue with the outpatient rehabilitation; avoid co-treating with the private physical therapy clinic.

4 – Discontinue the outpatient rehabilitation; supervise the RA’s pool program.

Case C

A 65-year-old woman has been admitted to hospital and diagnosed with a left middle cerebral artery (MCA) stroke. She presents with right-sided weakness and sensory impairment.

1. The patient suffered a fall at home at the time of her stroke, and as a result has a laceration on her right knee. The wound appears to be weeping through the dressing and the dressing is peeling off around the edges. The physical therapist will need to support the right leg when the patient moves from lying to sitting. How should the physical therapist proceed with mobilizing the patient? (Select 2)

1 – Avoid contact with the patient’s knee at all times.

2 – Wash hands then wear gloves while mobilizing the patient.

3 – Remove the dressing and allow the wound to air-out.

4 – Wear gloves, mask and gown while mobilizing the patient.

5 – Ask the nurse to apply a new dressing to the wound.

6 – Defer mobilization until the wound has stopped weeping.

2. Two days following admission, the physical therapist arrives to see the patient and finds her right arm to be extremely painful and edematous. The physical therapist suspects a possible upper extremity deep vein thrombosis (DVT). Match the signs or symptoms as being associated with either “DVT” or “Stroke and DVT”.

1 – Supraclavicular fullness.

2 – Edema of the upper extremity.

3 – Cyanosis of the upper extremity.

4 – Shoulder pain.

3. The physician is investigating for deep vein thrombosis. At what point during the investigation and treatment process for deep vein thrombosis (DVT) should the physical therapist recognize that it is safe to mobilize the patient? Indicate True or False.

1 – After a doppler ultrasound has been completed.

2 – After the patient is started on an anticoagulant.

3 – Immediately after suspecting a DVT.

4 – At no point while the patient has a DVT.

4. The physical therapist has had good success in treating post-stroke shoulder pain using transcutaneous electrical neuromuscular stimulation (TENS) in other patients. What should the physical therapist recognize with regards to safe use of TENS? Indicate True or False.

1 – It is safe to apply TENS to the shoulder of a patient with an active DVT.

2 – It is safe to apply TENS to an area with impaired sensory awareness.

3 – It is safe to apply TENS to a subluxed shoulder.

5. The patient is reporting right shoulder pain, particularly at night. The physical therapist notices that the patient’s shoulder is subluxed. How should the physical therapist address this? (Select 3)

1 – Instruct the patient not to lie on her right side.

2 – Instruct staff on how to position the patient in bed.

3 – Post photos of proper positioning in the patient’s room.

4 – Inform the patient that there is no effective treatment for shoulder pain after stroke.

5 – Ask the rehabilitation assistant to check the patient’s shoulder every hour.

6 – Provide the patient and family with education about shoulder pain and subluxation post-stroke.