Full Test Bank Motor Control Therapeutic Care Chapter 24

Chapter 24: Therapeutic Intervention for Impaired Motor Control—Stability

Deborah Nervik Chamberlain, PT, DPT, MHS, DHS, PCS

Monica Diamond, PT, MS, NCS, C/NDT

Megan Danzl, PT, DPT, PhD, NCS

Dennis W. Fell, PT, MD

Multiple Choice

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?

A. ES to the gastroc-soleus during stance activated by a heel switch on the right foot

B. ES to the quadriceps during stance activated by a heel switch on the right foot

C. ES to the anterior tibialis during stance activated by a heel switch on the left foot

D. ES to the hamstrings during stance activated by a heel switch on the right foot

2. 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?

A. Body weight support ambulation training (BWSAT) with 30–40% body weight-support

B. Overground gait training with an ankle-foot orthosis on the left lower extremity

C. Left lower extremity long arc quad exercise in sitting

D. Non-elastic tape applied in a “Y” configuration over the gastroc-soleus muscles

3. 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:

A. Remediation approach with an ankle foot orthosis

B. Remediation approach with functional electrical stimulation

C. Compensatory approach with an ankle foot orthosis

D. Compensatory approach with functional electrical stimulation

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:

A. Functional electrical stimulation (FES) to increase dorsiflexion

B. A leaf spring ankle foot orthosis (AFO)

C. Non-elastic tape applied to the anterior tibialis muscle

D. Electromyographic feedback

5. 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?

A. An air splint to use when weight-bearing through the upper extremity

B. Application of an upper extremity sling to provide stability to the entire limb

C. Allowing the patient to borrow one of the clinic’s portable electrical stimulation devices

D. Application of elastic tape to facilitate the scapular stabilizers

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

A. Supraspinatus and posterior deltoid

B. Infraspinatus and middle deltoid

C. Triceps and posterior deltoid

D. Trapezius and supraspinatus

7. 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?

A. Functional electrical stimulation (FES)

B. Interferential current stimulation (IFC)

C. Neuromuscular electrical stimulation (NMES)

D. Transcutaneous electrical nerve stimulation (TENS)

8. 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?

A. Complete a manual muscle test for strength in all major muscle groups

B. Conduct a formal comprehensive range of motion (ROM) examination

C. Administer a functional outcome measure to determine the effect of instability on function

D. Fit the patient with a knee ankle orthotic in order to proceed with the evaluation

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?

A. Inform the patient that an AFO is the only course of action at this point in time and that you cannot treat him if he will not comply

B. Provide patient education regarding prognosis and the rationale for the AFO but offer alternative interventions to trial initially

C. Tell the patient that an AFO does not mean he is giving up and that he should not let vanity stand in his way

D. Suggest to the patient that he be examined by another physical therapist to seek out a second opinion

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

A. Posterior lobe of the cerebellum

B. Anterior lobe of the cerebellum

C. Putamen of the basal ganglia

D. Caudate of the basal ganglia