NPTE-PT Neuromuscular System Interventions 2 — Questions and Answers
Question 1: A patient with stroke has difficulty initiating voluntary movement. Which PNF technique is MOST appropriate to address this impairment?
- Contract-relax
- Rhythmic initiation (Correct answer)
- Repeated contractions
- Slow reversal hold
Correct answer: Rhythmic initiation
Rhythmic initiation progresses from passive to active assistive to active movement, teaching the motor pattern to patients who cannot initiate movement voluntarily.
Question 2: Which motor learning feedback schedule produces the BEST long-term retention of a motor skill in neurological rehabilitation?
- Continuous feedback after every trial
- Faded feedback with reduced frequency over time (Correct answer)
- Blocked feedback after every 10 trials
- No augmented feedback provided
Correct answer: Faded feedback with reduced frequency over time
Faded feedback (reducing frequency over time) promotes retention because it prevents dependency and forces the patient to self-evaluate, consistent with the guidance hypothesis.
Question 3: Neuromuscular electrical stimulation (NMES) produces its strongest therapeutic effect in which patient population?
- Complete spinal cord injury with no voluntary movement
- Upper motor neuron lesion with intact peripheral nerve and some volitional control (Correct answer)
- Peripheral neuropathy with axonal degeneration
- Myasthenia gravis with neuromuscular junction dysfunction
Correct answer: Upper motor neuron lesion with intact peripheral nerve and some volitional control
NMES requires an intact lower motor neuron (peripheral nerve) and is most effective when combined with voluntary effort, making it ideal for upper motor neuron lesions.
Question 4: During motor skill acquisition, random practice of multiple tasks is preferred over blocked practice because of which effect?
- Random practice reduces overall training time
- Contextual interference from random practice enhances long-term retention and transfer (Correct answer)
- Blocked practice causes excessive muscle fatigue
- Random practice increases motivation through novelty
Correct answer: Contextual interference from random practice enhances long-term retention and transfer
The contextual interference effect demonstrates that the cognitive effort required during random practice leads to superior retention and transfer compared to blocked practice.
Question 5: Surface EMG biofeedback is used with a post-stroke patient. What is the PRIMARY therapeutic goal?
- Accurately measure absolute muscle force
- Provide real-time sensory information to facilitate volitional muscle activation (Correct answer)
- Replace the need for manual muscle testing
- Assess peripheral nerve conduction velocity
Correct answer: Provide real-time sensory information to facilitate volitional muscle activation
EMG biofeedback gives patients visual or auditory representation of muscle activity, helping them learn to volitionally activate muscles that they may not be able to sense or control.
Question 6: Which duty cycle parameter in NMES is MOST directly adjusted to manage muscle fatigue during functional electrical stimulation training?
- Pulse frequency (Hz)
- Pulse width (microseconds)
- Peak current amplitude (mA)
- On-to-off time ratio (Correct answer)
Correct answer: On-to-off time ratio
The duty cycle (on:off ratio) determines how long the muscle is actively contracting versus resting; longer off times reduce fatigue during repetitive NMES-assisted movement.
Question 7: A therapist uses PNF rhythmic stabilization at the shoulder for a patient with rotator cuff weakness post-neurological injury. What is the PRIMARY physiological mechanism?
- Stretching the glenohumeral capsule through alternating rotation
- Facilitating co-contraction of agonist and antagonist muscles via alternating isometric resistance (Correct answer)
- Inhibiting overactive muscles through reciprocal inhibition
- Strengthening only the external rotators through concentric contractions
Correct answer: Facilitating co-contraction of agonist and antagonist muscles via alternating isometric resistance
Rhythmic stabilization uses alternating isometric resistance to both agonist and antagonist, promoting dynamic joint stability through simultaneous co-contraction.
NPTE-PT Neuromuscular System Interventions 2
A patient with stroke has difficulty initiating voluntary movement.
Which PNF technique is MOST appropriate to address this impairment?