DPT Neurological Rehabilitation 3 — Questions and Answers
Question 1: A patient with multiple sclerosis reports extreme fatigue after a short physical therapy session. Which principle should PRIMARILY guide your session planning?
- Schedule sessions during cooler times and incorporate frequent rest breaks (Correct answer)
- Maximize session intensity to improve aerobic conditioning rapidly
- Avoid all exercise as it worsens MS fatigue permanently
- Use passive modalities only to prevent exacerbation
Correct answer: Schedule sessions during cooler times and incorporate frequent rest breaks
MS-related fatigue is worsened by heat (Uhthoff's phenomenon) and overexertion; scheduling during cool times and including rest breaks optimizes participation and prevents symptom exacerbation.
Question 2: Which intervention has the STRONGEST evidence for improving walking speed and endurance in patients with chronic stroke?
- Body-weight supported treadmill training with progressive overload (Correct answer)
- Passive range of motion exercises for the lower extremities
- Electrical stimulation to antagonist muscles only
- Stretching and positioning programs alone
Correct answer: Body-weight supported treadmill training with progressive overload
Body-weight supported treadmill training allows high-repetition, task-specific walking practice with adjustable loading, which has the strongest evidence base for improving locomotor outcomes after chronic stroke.
Question 3: A patient with Guillain-Barré syndrome is in the recovery phase with 3/5 strength in bilateral lower extremities. Which precaution is MOST important during exercise?
- Avoid overwork fatigue as it can worsen denervated muscle recovery (Correct answer)
- Perform maximum resistance exercise to accelerate nerve regeneration
- Focus exclusively on sensory re-education before motor training
- Restrict all active exercise until strength reaches 5/5
Correct answer: Avoid overwork fatigue as it can worsen denervated muscle recovery
Overwork fatigue in GBS can damage recovering axons and denervated muscles, so exercise intensity must be carefully dosed to avoid setting back recovery.
Question 4: When treating a patient with hemispatial neglect following right hemisphere stroke, which cueing strategy has the BEST evidence?
- Visual scanning training toward the neglected left side (Correct answer)
- Patching the right eye to force left visual field use
- Strengthening the left upper extremity to increase awareness
- Verbal reminders to look left given by the caregiver
Correct answer: Visual scanning training toward the neglected left side
Systematic visual scanning training toward the neglected hemispace is the most evidence-based intervention to improve awareness and functional use of the contralesional side.
Question 5: Which classification correctly describes an ASIA B spinal cord injury?
- Sensory incomplete — sensory but not motor function preserved below the lesion level (Correct answer)
- Motor incomplete — motor function preserved below level with more than half key muscles graded ≥3
- Complete — no motor or sensory function preserved in S4-S5
- Motor incomplete — more than half of key muscles below level grade ≥3
Correct answer: Sensory incomplete — sensory but not motor function preserved below the lesion level
ASIA B is sensory incomplete, meaning sensory function is preserved below the neurological level including S4-S5, but no motor function is preserved below the neurological level.
Question 6: A patient recovering from a brainstem stroke presents with ipsilateral facial weakness and contralateral limb weakness. This pattern is MOST consistent with which type of syndrome?
- Crossed (alternating) hemiplegia syndrome (Correct answer)
- Locked-in syndrome
- Lateral medullary (Wallenberg) syndrome
- Weber syndrome only
Correct answer: Crossed (alternating) hemiplegia syndrome
Crossed hemiplegia (alternating hemiplegia) occurs with brainstem lesions where ipsilateral cranial nerve signs cross with contralateral body hemiplegia due to the decussation of corticospinal fibers.
Question 7: Which assessment tool is MOST appropriate for measuring balance and fall risk in community-dwelling patients with Parkinson's disease?
- Mini-BESTest (Balance Evaluation Systems Test) (Correct answer)
- Pediatric Balance Scale
- Functional Gait Assessment for vestibular only
- Romberg test exclusively
Correct answer: Mini-BESTest (Balance Evaluation Systems Test)
The Mini-BESTest comprehensively assesses anticipatory postural adjustments, reactive control, sensory orientation, and dynamic gait — all domains affected in Parkinson's disease.
DPT Neurological Rehabilitation 3
A patient with multiple sclerosis reports extreme fatigue after a short physical therapy session.
Which principle should PRIMARILY guide your session planning?