NPTE-PT Neuromuscular System Interventions 4 — Questions and Answers
Question 1: Constraint-induced movement therapy (CIMT) is MOST appropriate for which patient?
- Acute stroke with complete flaccid hemiplegia and no wrist movement
- Chronic stroke with at least 10° of active wrist extension in the paretic limb (Correct answer)
- Bilateral upper extremity paresis of equal severity
- Patient within 48 hours of stroke onset with severe edema
Correct answer: Chronic stroke with at least 10° of active wrist extension in the paretic limb
CIMT eligibility requires sufficient residual motor function (typically ≥10° wrist extension and ≥10° finger extension) to perform mass practice; complete hemiplegia does not meet this threshold.
Question 2: The Bobath (NDT) approach primarily aims to achieve which therapeutic outcome?
- Maximal resistance training to hypertrophied weak muscles
- Inhibition of abnormal tone and facilitation of normal movement patterns through handling (Correct answer)
- Repetitive task practice regardless of movement quality
- Strengthening through progressive resistive exercise protocols
Correct answer: Inhibition of abnormal tone and facilitation of normal movement patterns through handling
NDT focuses on normalizing postural tone and facilitating typical movement patterns through therapist handling, key points of control, and preparation of the neuromuscular system.
Question 3: Current evidence MOST strongly supports which intervention for improving upper extremity function in chronic stroke?
- Passive range of motion performed by the therapist
- High-intensity, task-specific repetitive practice (Correct answer)
- Neurodevelopmental treatment as the sole intervention
- Relaxation and mindfulness to reduce tone
Correct answer: High-intensity, task-specific repetitive practice
Systematic reviews consistently show that high-dose, task-specific, repetitive practice drives cortical reorganization and produces the greatest functional gains in chronic stroke rehabilitation.
Question 4: A patient with cerebellar ataxia and coordination deficits is treated with Frenkel's exercises. What is the PRIMARY mechanism of this approach?
- Proprioceptive facilitation through joint compression
- Visual compensation and cognitive attention to substitute for impaired cerebellar error correction (Correct answer)
- Stretching tight antagonist muscles to allow smoother movement
- Building aerobic capacity to reduce fatigue-related ataxia
Correct answer: Visual compensation and cognitive attention to substitute for impaired cerebellar error correction
Frenkel's exercises use careful visual attention and slow, graded movement to teach patients to substitute visual and cognitive feedback for lost cerebellar coordination.
Question 5: Mirror therapy for upper extremity rehabilitation after stroke is thought to work through which PRIMARY mechanism?
- Directly strengthening the paretic limb through visual feedback
- Activating mirror neurons and creating an illusion of paretic limb movement to drive neuroplasticity (Correct answer)
- Providing proprioceptive input through tactile sensation to the paretic hand
- Reducing central sensitization and neuropathic pain via gate control
Correct answer: Activating mirror neurons and creating an illusion of paretic limb movement to drive neuroplasticity
Mirror therapy creates a visual illusion of bilateral movement; this activates mirror neuron systems and premotor cortex of the affected hemisphere, promoting cortical reorganization.
Question 6: Which outcome measure is MOST appropriate for assessing balance and fall risk across a broad range of neurological diagnoses?
- Manual muscle test (MMT)
- Berg Balance Scale (BBS) (Correct answer)
- Fugl-Meyer Assessment (FMA)
- Modified Ashworth Scale (MAS)
Correct answer: Berg Balance Scale (BBS)
The Berg Balance Scale assesses static and dynamic balance through 14 functional tasks and has strong validity and reliability as a fall-risk predictor in neurological populations.
Question 7: A patient with multiple sclerosis reports worsening of neurological symptoms during a physical therapy session on a warm day. Which intervention modification is MOST appropriate?
- Discontinue all exercise and refer back to neurology
- Apply cooling strategies, schedule sessions in cooler environments, and use energy conservation techniques (Correct answer)
- Increase exercise intensity to build heat tolerance over time
- Schedule all sessions in the afternoon to match the patient's peak energy
Correct answer: Apply cooling strategies, schedule sessions in cooler environments, and use energy conservation techniques
Uhthoff's phenomenon describes transient worsening of MS symptoms with increased body temperature; cooling vests, cool environments, and energy conservation prevent this during rehabilitation.
NPTE-PT Neuromuscular System Interventions 4
Constraint-induced movement therapy (CIMT) is MOST appropriate for which patient?