NPTE-PT Test Test Neuromuscular System Interventions 1 — Questions and Answers
Question 1: A patient with left hemiplegia following stroke presents with increased upper extremity tone that is limiting the initiation of active movement training. The physical therapist decides to use a PNF technique to reduce hypertonia before beginning active exercise. Which technique is MOST appropriate?
- Rhythmic initiation
- Rhythmic rotation (Correct answer)
- Contract-relax
- Repeated contractions
Correct answer: Rhythmic rotation
Rhythmic rotation involves passively rotating the limb in a rhythmic pattern, which is specifically used to reduce hypertonia and spasticity before active movement training. Rhythmic initiation teaches movement patterns, contract-relax improves ROM through autogenic inhibition, and repeated contractions are used to strengthen weak muscles.
Question 2: A physical therapist is treating a patient with cerebellar ataxia secondary to multiple sclerosis who demonstrates dysmetria and gait instability. Which intervention has the STRONGEST evidence for improving limb coordination in this patient?
- Frenkel exercises progressing from supine to sitting to standing (Correct answer)
- Plyometric training emphasizing rapid force production
- High-speed treadmill training with body weight support
- Progressive maximal resistance strengthening of the lower extremities
Correct answer: Frenkel exercises progressing from supine to sitting to standing
Frenkel exercises are specifically designed to address cerebellar ataxia. They use slow, precise movements with visual feedback to compensate for proprioceptive and coordination deficits, progressing systematically from supine to sitting to standing as control improves. Plyometrics and maximal resistance training are contraindicated because they demand rapid, high-load movements the ataxic patient cannot control.
Question 3: A physical therapist is screening a patient 5 months post-stroke with right hemiplegia for constraint-induced movement therapy (CIMT). Which criterion MUST the patient meet to qualify for the standard CIMT protocol?
- Full active range of motion in the affected upper extremity
- Ability to extend the wrist at least 10° and extend the digits at least 10° from a fully flexed position (Correct answer)
- Modified Ashworth Scale score of 0 throughout the affected upper extremity
- Bilateral upper extremity involvement with symmetrical weakness
Correct answer: Ability to extend the wrist at least 10° and extend the digits at least 10° from a fully flexed position
Standard CIMT requires a minimum motor criterion: volitional wrist extension of at least 10° and digit extension of at least 10° from a fully flexed position. This threshold ensures the patient has enough residual motor control to engage in the intensive repetitive task practice that drives cortical reorganization. Full ROM and complete absence of spasticity are not required.
Question 4: A 52-year-old patient reports episodic vertigo triggered by rolling to the right side in bed. The Dix-Hallpike test is positive on the right with upbeat-torsional nystagmus beating toward the ground. Which intervention is MOST appropriate?
- Gaze stabilization exercises in standing to promote vestibular adaptation
- Canalith repositioning using the Epley maneuver performed toward the right (Correct answer)
- Brandt-Daroff habituation exercises performed three times daily at home
- Foam surface balance training to reduce reliance on somatosensory input
Correct answer: Canalith repositioning using the Epley maneuver performed toward the right
A positive right-sided Dix-Hallpike with upbeat-torsional nystagmus indicates right posterior semicircular canal BPPV. The Epley maneuver is the first-line canalith repositioning procedure for posterior canal BPPV and is performed toward the affected side to move displaced otoconia out of the posterior canal into the utricle. Gaze stabilization and foam training address vestibular hypofunction, not canalith displacement.
Question 5: A physical therapist is treating a patient with Guillain-Barré syndrome in the early recovery phase with 3+/5 strength in the lower extremities. Which exercise guideline is MOST critical to follow to avoid a setback?
- Exercise to the point of maximum fatigue to drive neuromuscular adaptation
- Avoid all active exercise until the patient reaches 4/5 strength bilaterally
- Use submaximal exercise intensity and monitor for residual fatigue lasting more than 30 minutes post-session (Correct answer)
- Prioritize eccentric loading exercises to maximize muscle hypertrophy during recovery
Correct answer: Use submaximal exercise intensity and monitor for residual fatigue lasting more than 30 minutes post-session
Patients with Guillain-Barré syndrome are highly susceptible to overwork weakness, in which excessive exercise temporarily or permanently worsens strength in recovering muscles. Exercise should remain submaximal, and the therapist must monitor for prolonged post-exercise fatigue exceeding 30 minutes as the primary sign that intensity was too high. Exercising to fatigue is specifically contraindicated in this population.
Question 6: A physical therapist is applying EMG biofeedback to facilitate re-education in a patient with foot drop following a common peroneal nerve injury at the fibular head. Where should the active electrode be placed to provide the MOST relevant feedback for this impairment?
- Tibialis posterior muscle belly
- Gastrocnemius medial head
- Tibialis anterior muscle belly (Correct answer)
- Peroneus longus muscle belly
Correct answer: Tibialis anterior muscle belly
Foot drop results from weakness of the ankle dorsiflexors, primarily the tibialis anterior, which is innervated by the deep peroneal nerve — a branch of the common peroneal nerve. Placing the EMG electrode over the tibialis anterior provides direct visual or auditory feedback to facilitate voluntary activation of the muscle responsible for foot clearance during the swing phase. The other muscles listed are either plantarflexors or evertors and are not the primary cause of foot drop.
NPTE-PT Test Test Neuromuscular System Interventions 1
A patient with left hemiplegia following stroke presents with increased upper extremity tone that is limiting the initiation of active movement training.
The physical therapist decides to use a PNF technique to reduce hypertonia before beginning active exercise.
Which technique is MOST appropriate?