Adult Neurology: Past Paper Questions

Question 1

Explain the difference in approach to treating a patient with right hemiplegia versus a patient with left hemiplegia. (6)

Answer 1

L CVA: (L=Loser)
1.Speech and Language deficits.
2.Slow and Cautious.
3.Memory deficits.
4.Do not underestimate their ability (they will. [loser]) and their ability to communicate.
5.Try other forms of communication.
6.Keep the message simple and brief.

R CVA: (R= Runs)
1.Spatial - perceptual deficits.
2.Quick and Impulsive.
3.Do not overestimate their abilities. (they will [run before they can walk.])
4.Use verbal uses of they have difficulty with demonstration.
5.Watch what they can do safely (DO NOT TAKE THEIR WORD FOR IT)

Question 2

Why is it important to obtain information from Mr Mothusi regarding his home and work circumstances? (6)

Answer 2

1.Provide functional goals for Rx. outcome.
2.Provides details that must be considered in planning of Rx. as the patient must adapt to their environment.
3.To identify precautions and contraindicators.
4.To practise task/vocational oriented tasks during Rx as they will be more functional.
5.To aid in what motions or excercise patterns should be prioritized.
6.To identify possiblources of aid or consider providing mobility aids.

Question 3

Discuss the physiotherapy management to improve his stance phase duration during gait? (8)

Answer 3

1.(Initial contact) Ensure adequate hip flexor by,
2.(Initial contact) Aid heel strike by increasing tibialis anterior strength
3.(Loading response) Decreased knee flexion or hyper extension
4.(Loading response) Ankle foot slap/ poor eccentric control
5.(Loading response) Ankle may be in equina varus(inversion)
6.(Midstance) Trendellen burg sign: pelvic drop on the unaffected side due to weak abductors
7.(Midstance) Decreased hip extension: to compensate and bring trunk forwward Trunk may be flexed to the affected side (to balance
CoG due to pelvic drop to unaffected side)
8. Poor plantar flexion strength for push off

Question 4

Discuss your role as a physiotherapist in the acute stage management of a patient with a traumatic head injury. (20)

Question 5

Mr Mothusi had a left cerebrovascular accident (CVA) two weeks ago. He now presents with right hemiplegia with increased tone in the right lower and upper limbs. He has been referred to you for physiotherapy and you will manage him until discharge from the hospital.
Explain how your approach to treating Mr Mothusi would differ to that of treating a patient with a right CVA. (6)

Question 6

Discuss the physiotherapy management to improve his stance phase duration. (8)

Question 7

Write short notes on oedema in the upper limb after stroke. (6)

Question 8

Describe one outcome measure used specifically in rehabilitation of the hemiplegic upper limb. (4)

Question 9

Discuss the benefits of early sitting in the management of a patient who has sustained a head injury. (10)

Question 10

Discuss three possible causes of knee hyperextension when walking. (7)

Question 11

List six tests you would do to confirm cerebellar dysfunction. (3)

Question 12

Mrs Botha fell off a ladder four days ago and sustained a traumatic brain injury (TBI)
resulting in a flaccid upper and lower limb. She currently scores 13/15 on the Glasgow coma scale. Today is the first day that she is receiving physiotherapy.
Which three areas are assessed in the Glasgow Coma Scale and what is the maximum score given to each area?

Question 13

Mrs Botha fell off a ladder four days ago and sustained a traumatic brain injury (TBI)
resulting in a flaccid upper and lower limb. She currently scores 13/15 on the Glasgow coma scale. Today is the first day that she is receiving physiotherapy.
Name four possible physical complications of TBI that you would need to be
aware of when starting physiotherapy. (4)

Question 14

Mrs Botha fell off a ladder four days ago and sustained a traumatic brain injury (TBI)
resulting in a flaccid upper and lower limb. She currently scores 13/15 on the Glasgow coma scale. Today is the first day that she is receiving physiotherapy.
Discuss your role as a physiotherapist in the management of one of the complications of a TBI (4x4=16)

Question 15

Why is it necessary to ensure adequate mobility of the scapula in the
management of a patient with hemiplegia? (4)

Question 16

Discuss how the following three factors would affect recovery of upper limb
function:
Adaptive muscle length.

Question 17

Discuss how the following three factors would affect recovery of upper limb
function:
Visiospatial impairments.

Question 18

Discuss how the following three factors would affect recovery of upper limb
function:
Shoulder pain.

Question 19

Why is it important to ask about occupational activities and use of transport
during your subjective evaluation? (5)

Question 20

Mr Musa had a stroke affecting the right middle cerebral artery. He now presents
with spastic hemiplegia and pusher syndrome.
List six common secondary gait problems with which Mr Musa might present. (6)

Question 21

Mr Smith, 55 years of age, sustained TBI during a road traffic accident two months ago. He sustained damage to the fronto-parietal lobe region. He now presents with behavioural and personality changes, a painful shoulder and difficulty doing fine motor activities with his dominant hand.
Describe two behavioural and personality changes that Mr Smith may exhibit. (4)

Question 22

Mr Smith, 55 years of age, sustained TBI during a road traffic accident two months ago. He sustained damage to the fronto-parietal lobe region. He now presents with
behavioural and personality changes, a painful shoulder and difficulty doing fine motor activities with his dominant hand.
Name two signs and or symptoms of parietal lobe damage that you would
need to be aware of during therapy. (2)

Question 23

Mr Smith, 55 years of age, sustained TBI during a road traffic accident two months ago. He sustained damage to the fronto-parietal lobe region. He now presents with
behavioural and personality changes, a painful shoulder and difficulty doing fine motor activities with his dominant hand.
Describe four factors that could have influenced the onset of Mr Smith’s
shoulder pain. (8)

Question 24

Mr Smith, 55 years of age, sustained TBI during a road traffic accident two months ago. He sustained damage to the fronto-parietal lobe region. He now presents with
behavioural and personality changes, a painful shoulder and difficulty doing fine motor activities with his dominant hand.
Prescribe three exercises to assist with the recovery of Mr Smith’s hand. (6)

Question 25

Mr Vika is 18 years old and sustained a traumatic brain injury in a quad bike accident
five months ago. Although he is making good physical recovery, he still has flaccid paralysis of the left upper limb. Additionally, he now quickly loses his temper and becomes aggressive.
In addition to Mr Vika’s behavioral problems, describe two associated cognitive
problems with which he may present. (4)

Question 26

Mr Vika is 18 years old and sustained a traumatic brain injury in a quad bike accident
five months ago. Although he is making good physical recovery, he still has flaccid paralysis of the left upper limb. Additionally, he now quickly loses his temper and becomes aggressive.
Explain how you would manage the cognitive problems you identified above in
order to minimise their effects on your physiotherapy intervention. (6)

Question 27

Mr Vika is 18 years old and sustained a traumatic brain injury in a quad bike accident
five months ago. Although he is making good physical recovery, he still has flaccid paralysis of the left upper limb. Additionally, he now quickly loses his temper and becomes aggressive.
Mr Vika feels that using an arm sling makes it easier for him to move around
without being concerned about his left upper limb.
Advise him of the advantages and disadvantages regarding the use of an arm sling (10)

Question 28

Mr Zakes, a 40-year-old teacher, had a right cerebrovascular accident two days ago.
He presents with increased tone on the affected side and has pusher syndrome. He used to commute to work by taxi.
What gait retraining guidelines would you follow when treating him? (8)

Question 29

Mr Zakes, a 40-year-old teacher, had a right cerebrovascular accident two days ago.
He presents with increased tone on the affected side and has pusher syndrome. He used to commute to work by taxi.
Why would it be important to include social history and home circumstances during subjective assessment? (6)

Question 30

Justify the use of the following assistive devices when treating him:
Walking tripod (2)
Standing frame (2)
Lower limb back slab (2)

Question 31

Mr Jonathan, a 45 year old man, had a right cerebrovascular accident a month ago and
presents with spastic left hemiplegia. On being brought into standing, he leans to the left side and resists correction. You suspect that he has pusher syndrome. He also has knee hyperextension when attempting to walk.
Describe the physiotherapy management of Mr Jonathan’s pusher syndrome. (6)

Question 32

Mr Jonathan, a 45 year old man, had a right cerebrovascular accident a month ago and
presents with spastic left hemiplegia. On being brought into standing, he leans to the left side and resists correction. You suspect that he has pusher syndrome. He also has knee hyperextension when attempting to walk.
Discuss the possible causes of Mr Jonathan’s knee hyperextension. (6)

Question 33

Mr Jonathan, a 45 year old man, had a right cerebrovascular accident a month ago and
presents with spastic left hemiplegia. On being brought into standing, he leans to the left side and resists correction. You suspect that he has pusher syndrome. He also has knee hyperextension when attempting to walk.
Explain three factors that may affect functional outcomes after stroke. (6)

Question 34

Mrs Manzini, a 70 year old woman, sustained serious head injuries. She is now out of ICU and presents with right hemiplegia and typical frontal lobe behaviour following damage to her frontal lobe. She also sustained damage to her parietal lobe and has a subluxed right shoulder.
Describe three signs and symptoms of parietal iobe damage that you would need to be aware of during therapy. (6)

Question 35

Mrs Manzini, a 70 year old woman, sustained serious head injuries. She is now out of ICU and presents with right hemiplegia and typical frontal lobe behaviour following damage to her frontal lobe. She also sustained damage to her parietal lobe and has a subluxed right shoulder.
Discuss how the cognitive and behavioural problems with which Mrs Manzini may
present could impact on her rehabilitation and how you would manage them.
(10)

Question 36

Mrs Manzini, a 70 year old woman, sustained serious head injuries. She is now out of ICU and presents with right hemiplegia and typical frontal lobe behaviour following damage to her frontal lobe. She also sustained damage to her parietal lobe and has a subluxed right shoulder.
Describe two factors that might have contributed to Mrs Manzini’s shoulder subluxation. (4)

Question 37

Describe five factors that make hemiplegic upper limb rehabilitation challenging. (10)

Question 38

Write short notes on oedema in a hemiplegic upper limb. (6)

Question 39

Mrs. Troy is a 45 year old woman who sustained a traumatic brain injury in a road traffic accident. She was the bread winner and lives with her unemployed husband and one child (ten years old) in Soweto. She now presents with cognitive problems and dense right hemiplegia.
Discuss the possible impact of Mrs Troy’s cognitive problems on her family. (6)

Question 40

Mr Thupi had a left cerebro vascular accident (CVA) a week ago and has just started
physical rehabilitation. He has increased muscle tone (tonic and phasic) and decreased stance phase duration on the affected side.
What is the significance of doing muscle tone testing? (6)

Question 41

Mr Thupi had a left cerebro vascular accident (CVA) a week ago and has just started
physical rehabilitation. He has increased muscle tone (tonic and phasic) and decreased stance phase duration on the affected side.
Explain possible gait problems he may have during the midstance stage of the gait
cycle. (8)

Question 42

Mrs Pillay fell off a ladder four days ago and sustained a traumatic brain injury resulting in a flaccid upper and lower limb. She currently scores 13/15 on the Glasgow Coma Scale and her affected upper limb is beginning to present with a shoulder subluxation.
Briefly discuss how you would manage Mrs Pillay’s shoulder subluxation. (9)

Question 43

Explain four factors that may affect functional outcome after stroke. (8)

Question 44

Mr Tullip had a left cerebro vascular accident (CVA) a week ago and has just started
physiotherapy sessions. He has increased muscle tone (tonic and phasic) and
decreased stance phase duration on the affected side.
Explain possible gait problems he may have during the midstance stage of the gait
cycle. (8)

Question 45

Describe five factors that make rehabilitating a hemiplegic upper limb challenging.
(10)

Question 46

Discuss the benefits of early sitting in the management of a patient who has sustained a traumatic head injury. (10)

Question 47

Discuss four factors that are likely to enhance practice when rehabilitating a patient with a hemiplegic upper limb. (8)

Question 48

Discuss your role as a physiotherapist in the acute stage management of a patient with a head injury. (12)

Question 49

Describe the physiotherapy management of pusher syndrome. (6)

Question 50

Explain three factors that may affect functional outcome after stroke. (6)

Question 51

Discuss the possible causes of Mr Jonathan’s knee hyperextension. (6)