Neuro midterm

Which of the following BEST describes the optimal timing for conducting an examination of a patient's sensory abilities? a. Before a cognitive or perceptual examination b. During a cognitive or perceptual examination c. After a cognitive or perceptual examination d. Between a cognitive and a perceptual examination

a. Before a cognitive or perceptual examination

Which of the following is a sympathetic nervous system response that is MORE likely to be present after traumatic brain injury? a. Increased heart rate b. Decreased blood pressure c. Slowed respiration rate d. Hypothermic state

a. Increased heart rate

Having a patient use a wall calendar to assist in staying to a routine is an example of a strategy to address which of the following cognitive and perceptual deficits? a. Memory impairment b. Attention impairment c. Agnosias d. Impairments of executive functions

a. Memory impairment

A patient with traumatic brain injury appears to have relatively intact visual fixation and visual pursuit and does not withdraw from noxious stimulus, but rather localizes to it. What is the MOST appropriate classification of the state of alteration of consciousness for this patient? a. Minimally conscious state b. Comatose state c. Vegetative state d. Ozymandias state

a. Minimally conscious state

You note in your patient's chart that the physician suspects heterotrophic ossificans of the shoulders. This should alert you to avoid implementing which of the following planned interventions? a. Passive range of motion of the upper extremities b. Weightbearing activity of the upper extremities while patient is seated c. Transfer training d. Exercise to facilitate improved voluntary motion of the upper extremities

a. Passive range of motion of the upper extremities

You note in the PT evaluation that your next patient has pusher syndrome. Which of the following would NOT be an effective technique to include while working on sitting balance? a. Passively correct the patient's posture and give verbal cues. b. Sit on the patient's good side and ask him to "lean toward me." c. Ask the patient to tell you which direction he is tilted. d. Prop patient with his good side against a wall and ask him to lean into the wall.

a. Passively correct the patient's posture and give verbal cues.

What is the MOST appropriate term to describe the process that requires integration of multiple sensory inputs and results in the awareness of objects and experiences within an environment? a. Perception b. Sensation c. Cognition d. Stimulation

a. Perception

Which proprioceptive neuromuscular facilitation technique is most effective in overcoming the effects of rigidity? a. Rhythmic initiation b. Alternating isometrics c. Hold-relax technique d. Rhythmic stabilization

a. Rhythmic initiation

A patient who is 5 weeks post-left cerebrovascular accident presents in stage 3 of motor recovery for the upper extremity with spasticity of elbow flexors. Which of the following combinations of treatment is MOST effective for achieving active elbow extension (single joint isolation) of the right upper extremity? a. Rhythmic rotation of right upper extremity with tapping of elbow extensors b. Rhythmic rotation of right upper extremity with sustained stretching of right biceps c. Alternating chopping patterns to the left and right in sitting d. Alternating lifting patterns to the left and right in sitting

a. Rhythmic rotation of right upper extremity with tapping of elbow extensors

What is the MOST appropriate term to describe brain tissue damage from a cascade of biochemical, cellular, and molecular events; hypoxia; edema; and increased intracranial pressure? a. Secondary brain injury b. Primary brain injury c. Concomitant brain injury d. Exposure brain injury

a. Secondary brain injury

Interventions to improve motor control should focus on all of the following EXCEPT: a. Strength training of individual muscle such as hip flexor b. Practice of functional tasks c. Progression of movements such as rolling, supine to sit, sitting balance, sit to stand d. Many repetitions of activity

a. Strength training of individual muscle such as hip flexor

A patient who is 7 weeks post-right anterior cerebral artery infarct presents with movement of the left upper extremity into an obligatory extension synergy. When examining the left lower extremity, the patient can extend the knee with the hip positioned at 90 degrees of flexion in sitting, but is unable to perform ankle dorsiflexion. What is this patient's stage of motor recovery? a. The upper extremity is in stage 3 and the lower extremity is in stage 4. b. The upper extremity is in stage 3 and the lower extremity is in stage 3. c. The upper extremity is in stage 4 and the lower extremity is in stage 3. d. The upper extremity is in stage 4 and the lower extremity is in stage 4.

a. The upper extremity is in stage 3 and the lower extremity is in stage 4.

Generally speaking in regards to strengthening exercises, there is not likely a benefit to attempt to strengthen any muscles with a reported strength less than: a. 1/5 b. 2/5 c. 3/5 d. 4/5

b. 2/5

Utilizing a sensory integration approach to perceptual retraining for remediating underlying deficits is MOST commonly associated with which of the following patient types? a. An adolescent with a brain injury resulting in aphasia and dysphagia b. A child with developmental sensorimotor or learning problems c. A child with a traumatic limb amputation d. An adult with difficulty planning and organizing daily home and work activities

b. A child with developmental sensorimotor or learning problems

The relative inability of a patient to stay focused on a conversation during the initial evaluation of tasks such as donning or doffing clothing, preparing a basic meal on the stovetop, or doing mat exercises in a loud therapy gym is MOST likely indicative of a breakdown in which of the following cognitive systems? a. Short-term memory b. Attention c. Long-term memory d. Executive function

b. Attention

Which of the following neuromuscular patient presentations are LEAST likely to be seen as a direct result of a traumatic brain injury? a. Upper and lower extremity paresis b. Chorea form movements c. Abnormal tone d. Abnormal gait patterns

b. Chorea form movements

A patient who is 2 months post-left cerebrovascular accident tends to lean toward the involved side while in sitting or standing, but is in good alignment when looking at a mirror. Given this presentation, which of the following scales should be used? a. Berg Balance Scale b. Clinical Assessment Scale for Contraversive Pushing c. Timed Get-Up-and-Go Test d. Motor Assessment Scale

b. Clinical Assessment Scale for Contraversive Pushing

Your next patient has had right hemispheric damage and left hemiplegia. Which of the following behaviors might you expect to see exhibited by your patient? a. Hesitancy in trying a new task b. Impulsivity c. Difficulty with communication d. Unrealistic about existing problems

b. Impulsivity

If your patient is characterized as having cognitive and perceptual difficulties, you could expect to observe any of the following EXCEPT: a. Inability to do tasks independently or safely b. Inability to localize to light-touch testing c. Difficulty switching from one task to the next d. Diminished capacity to identify objects necessary for task completion

b. Inability to localize to light-touch testing

Your patient has left side unilateral neglect. All of the following treatment suggestions are appropriate to facilitate right brain activity EXCEPT: a. Use of shapes and blocks with activities b. Lots of verbal cues c. Clenching and unclenching the left hand during or prior to a functional activity d. Presenting items to the patient's left side

b. Lots of verbal cues

A patient presents with difficulty transitioning from sit-to-stand secondary to left anterior cerebral artery infarct. Upon creating a treatment plan, which of the following should be focused on FIRST? a. Have the patient practice initiating hip and knee extension from a high-seating surface. b. Patient is instructed to clasp upper extremities together and reach forward toward an object located in front of and slightly lower than the knees. c. Position the right foot slightly behind the left foot and have the patient practice pushing into standing. d. Position the left foot slightly behind the right foot and have the patient practice pushing into standing.

b. Patient is instructed to clasp upper extremities together and reach forward toward an object located in front of and slightly lower than the knees.

You are reviewing the chart of your patient with a traumatic brain injury and the nurse notes that your patient is at Rancho Level 4. You expect to encounter any of the following cognitive impairments EXCEPT: a. Behavior that is bizarre and nonpurposeful b. Response to stimuli in a generalized manner c. Brief attention span d. Lack of short-term recall

b. Response to stimuli in a generalized manner

You observe that your patient in the ICU exhibits eye opening but does not localize to noxious stimuli. He would be classified as being in which state? a. Coma b. Vegetative state c. Minimally conscious state d. Amnesic state

b. Vegetative state

Interventions directed toward modification of activities or the environment to minimize functional limitations are called: a. Preventive interventions b. Facilitative interventions c. Compensatory interventions d. Restorative interventions

c. Compensatory interventions

You observe that your patient appears apathetic in therapy sessions, sometimes displays inappropriate behavior, and lacks insight into the feelings of others. You report that he displays which of the following deficits? a. Apraxia b. Agnosias c. Impairment of executive functions d. Attention impairments

c. Impairment of executive functions

You read in the PT evaluation that your patient has had a stroke involving the middle cerebral artery. You would expect to see any of the following deficits in your patient EXCEPT: a. Motor speech disorder b. Unilateral neglect c. Intention tremor d. Less motor deficit in leg as compared to arm and face

c. Intention tremor

The Glasgow Coma Scale is the most widely used clinical scale that measures levels of consciousness and helps define and classify the level of brain injury sustained. Which of the following is NOT a traditional scoring component of this scale? a. Eye opening response b. Motor response c. Length of post-traumatic amnesia d. Verbal response

c. Length of post-traumatic amnesia

Upon examination, a patient presents with left upper extremity hemiplegia and left lower extremity hemiparesis and apraxia. Upon skin inspection, bruising on the left arm is noted. Which of the following is the MOST likely cause of this clinical presentation? a. Right internal carotid artery syndrome b. Right anterior cerebral artery syndrome c. Right middle cerebral artery syndrome d. Right posterior cerebral artery syndrome

c. Right middle cerebral artery syndrome

You are working with a patient who experienced cerebrovascular accident and note that she is now able to make some voluntary movement out of synergy pattern. You will document that she is currently in which motor recovery stage? a. Stage 2 b. Stage 3 c. Stage 4 d. Stage 5

c. Stage 4

A patient who is 5 weeks post-right middle cerebral artery infarct presents for rehabilitation with the primary goal of regaining use of the left upper extremity that is in stage 2 of motor recovery. Given this presentation, which of the following activities should be done FIRST on the involved upper extremity? a. Starting from a weightbearing position of elbow flexion and wrist extension, the patient is asked to push into elbow extension and back to flexion. b. Starting from a weightbearing position of elbow and wrist extension, the patient is asked to reach for objects with the right upper extremity. c. Starting from a weightbearing position of elbow and wrist extension, approximation is applied through the left upper extremity. d. Starting from a weightbearing position of elbow flexion and wrist extension, the patient is asked to reach for objects with the right upper extremity.

c. Starting from a weightbearing position of elbow and wrist extension, approximation is applied through the left upper extremity.

A patient is involved in a cotreatment session with a physical therapist and an occupational therapist. The patient is standing at the sink and practicing the steps involved in teeth brushing. Which of the following examples of therapeutic goals MOST closely resembles a remedial approach to rehabilitation? a. The patient will understand the importance of good oral hygiene. b. Mastery of the teeth-brushing skill while standing at the sink will translate to other daily routines. c. Teeth brushing will be performed independently while standing at the sink. d. The patient will tolerate standing for 5 minutes while at the sink with minimal assistance.

c. Teeth brushing will be performed independently while standing at the sink.

A patient who is 5 weeks post-left cerebrovascular accident presents with no volitional movement of the right upper extremity but movement is noted as a result of a reflex response or as an associated reaction. When examining the right lower extremity, the patient can move the hip and knee but only in a flexion synergy. What is this patient's stage of motor recovery? a. The upper extremity is in stage 3 and the lower extremity is in stage 3. b. The upper extremity is in stage 2 and the lower extremity is in stage 4. c. The upper extremity is in stage 2 and the lower extremity is in stage 3. d. The upper extremity is in stage 3 and the lower extremity is in stage 4.

c. The upper extremity is in stage 2 and the lower extremity is in stage 3.

You want to get your patient with traumatic brain injury who is in Rancho Level 3 up to a bedside chair. Which of the following is the BEST chair to have at bedside? a. Recliner chair b. Regular upright wheelchair c. Tilt-in-space wheelchair d. Shower chair

c. Tilt-in-space wheelchair

Chart review of a patient who is using a manual wheelchair reveals intact right and left visual fields; however, the patient has multiple abrasions on his left arm, demonstrates difficulty reading by not scanning all the way to the left side of the page, and routinely leaves the left side of meal trays untouched when they are served in the patient's room. Which is the MOST likely condition responsible for these findings? a. Left hemisphere stroke b. Left homonymous hemianopsia c. Unilateral neglect d. Executive function deficit

c. Unilateral neglect

A patient with a recent severe traumatic brain injury has no purposive cognitive or communicative engagement but occasionally smiles or cries. What is the MOST appropriate classification of altered state of consciousness if the patient manages basic cardiorespiratory and homeostatic functions, tracking some of the physical therapist's movements in the room, but is not able to reliably execute purposive movement of muscle groups? a. Minimally conscious state b. Comatose state c. Vegetative state d. Cortical reactivation state

c. Vegetative state

Which of the following elements enhances the return of sensory function? a. Inflatable pressure splints during functional training b. Initial attempts at an activity with eyes closed c. Joint approximation during weightbearing activities of the extremities d. All of the above

d. All of the above

During functional locomotor training in the parallel bars, the therapist places a piece of brightly colored tape on the left shoe of a patient who has experienced a stroke and then cues the patient to "find the tape and move the foot the tape is on." This intervention is BEST described as which of the following? a. An intervention that is not recommended due to safety concerns b. A sensory integration approach to the therapy goal c. A top-down cognitive intervention strategy d. An environmental adaptation to help accomplish a therapy goal

d. An environmental adaptation to help accomplish a therapy goal

A patient does not appear able to follow your verbal instructions, even when provided with additional visual cues. You conclude that she may have problems with which of the following? a. Hearing loss b. Receptive aphasia c. Hemianopsia d. Any of the above

d. Any of the above

Upon examination, it is noted that a patient appears to understand the physical therapist's questions, but hesitates and is slow when answering. Based on this presentation, what is the MOST likely location of the lesion and what is the impairment noted? a. Wernicke's area, expressive aphasia b. Wernicke's area, receptive aphasia c. Broca's area with fluent aphasia d. Broca's area with nonfluent aphasia

d. Broca's area with nonfluent aphasia

What is the MOST likely classification of the altered state of consciousness for a patient with traumatic brain injury who presents with a completely nonfunctional arousal system; no auditory, visual, cognitive, or communicative function; and is ventilator dependent? a. Neurogenic reserve state b. Vegetative state c. Minimally conscious state d. Comatose state

d. Comatose state

In a confused and agitated patient, the PTA should do all of the following EXCEPT: a. Expect consistency b. Expect no carryover c. Model calm behavior d. Expect flexibility from the patient

d. Expect flexibility from the patient

Which of the following is the MOST important protocol for preventing common secondary impairments for patients in comatose or vegetative states after brain injury? a. Eliminate the use of tilt-in-space wheelchairs to enable proper positioning in rigid- frame chairs. b. Position lower extremities in full extension whenever possible while in bed. c. Encourage plantarflexion of the foot by serial casting. d. Reposition patients every 2 hours to decrease likelihood of skin breakdown.

d. Reposition patients every 2 hours to decrease likelihood of skin breakdown.

Which of the following questions is most appropriate for a person in Rancho Level 4? a. What day is it today? b. Would you like to go to therapy today? c. What did we do in therapy yesterday? d. Would you like to walk on the treadmill or ride the bike?

d. Would you like to walk on the treadmill or ride the bike?