NPTE-PT Neuromuscular System Interventions 3 — Questions and Answers
Question 1: A patient with unilateral vestibular hypofunction is prescribed gaze stabilization exercises. What is the PRIMARY mechanism of these exercises?
- Strengthening the extra-ocular muscles for better tracking
- Promoting adaptation of the vestibulo-ocular reflex (VOR) (Correct answer)
- Habituating the patient to motion-induced nausea
- Improving central visual acuity
Correct answer: Promoting adaptation of the vestibulo-ocular reflex (VOR)
Gaze stabilization exercises (head moving while eyes stay fixed on a target) drive VOR adaptation so the brain recalibrates the reflex to compensate for vestibular hypofunction.
Question 2: The Epley canalith repositioning maneuver is the first-line treatment for which condition?
- Vestibular neuritis causing continuous vertigo
- Posterior canal BPPV causing brief positional vertigo (Correct answer)
- Meniere's disease with endolymphatic hydrops
- Central vertigo from cerebellar stroke
Correct answer: Posterior canal BPPV causing brief positional vertigo
The Epley maneuver uses gravity and head positioning to move displaced otoconia from the posterior semicircular canal back into the utricle, resolving posterior canal BPPV.
Question 3: During treadmill training with body weight support (BWS) for a patient with incomplete SCI, which variable should be PROGRESSIVELY reduced as the patient improves?
- Treadmill belt speed
- Percentage of body weight supported (Correct answer)
- Duration of each treadmill session
- Therapist verbal cueing frequency
Correct answer: Percentage of body weight supported
BWS is systematically decreased (often starting at 30–40% support) as the patient gains strength and motor control, progressively loading the lower extremities toward full weight-bearing.
Question 4: A patient with Parkinson's disease benefits from rhythmic auditory stimulation (RAS) during gait training. What is the PRIMARY mechanism?
- External auditory rhythm substitutes for impaired internal timing from basal ganglia dysfunction (Correct answer)
- RAS increases dopamine synthesis in the substantia nigra
- RAS activates the cerebellum to compensate for tremor
- Auditory input reduces rigidity through reciprocal inhibition
Correct answer: External auditory rhythm substitutes for impaired internal timing from basal ganglia dysfunction
Parkinson's disease impairs internal rhythm generation in the basal ganglia; an external metronome or musical beat provides a substitute timing signal that the motor system can lock onto.
Question 5: Which intervention has the STRONGEST evidence for producing long-term functional improvement in patients with upper motor neuron spasticity?
- Prolonged low-load passive stretch
- Task-specific training emphasizing active movement (Correct answer)
- Cryotherapy applied to spastic muscles before exercise
- Electrical stimulation to antagonist muscles in isolation
Correct answer: Task-specific training emphasizing active movement
Task-specific training drives neuroplasticity and functional carry-over; while stretching and modalities can temporarily reduce tone, active task practice produces the most durable functional gains.
Question 6: What is the OPTIMAL period to initiate neuromuscular re-education following peripheral nerve repair surgery?
- Immediately post-operatively with maximal resistance exercise
- When early clinical or EMG signs of reinnervation appear, typically 3 or more months post-repair (Correct answer)
- Only after full motor strength is documented at the target muscle
- Exclusively as prehabilitation before surgery
Correct answer: When early clinical or EMG signs of reinnervation appear, typically 3 or more months post-repair
Re-education begins when reinnervation is detected (early voluntary signals or EMG activity) so the patient can practice facilitating the newly reconnected motor units before full recovery.
Question 7: When positioning a patient with SCI who has lower extremity flexor spasticity at night, which position BEST counteracts the spastic pattern?
- Hip and knee flexion with ankle plantar flexion
- Hip extension, knee extension, and ankle in neutral with a splint (Correct answer)
- Side-lying with hips and knees flexed to 90°
- Supine with pillows placed under the knees
Correct answer: Hip extension, knee extension, and ankle in neutral with a splint
Anti-spasticity positioning places joints in the opposite direction of the dominant spastic pattern; prolonged positioning in extension counteracts lower extremity flexor spasms.
NPTE-PT Neuromuscular System Interventions 3
A patient with unilateral vestibular hypofunction is prescribed gaze stabilization exercises.
What is the PRIMARY mechanism of these exercises?