Content for Exam 2

Question 1

Scapular Patterns

Answer 1

In sidelying,
-Anterior elevation: 1 o clock
-Posterior elevation: 7 o clock
-Anterior depression: 5 o clock
-Posterior depression: 11 o clock

Anterior elevation – goes with D1 flexion – goes with protraction

Posterior depression – goes with D1 extension - goes with retraction

Question 2

Pelvic Patterns

Answer 2

In sidelying,
-Anterior elevation: 1 o clock
-Posterior elevation: 11 o clock
-Anterior depression: 5 o clock
-Posterior depression: 7 o clock

Question 3

Anterior elevation

Answer 3

“pull your pelvis up and fwd” – promotes pelvis protraction during preswing

Question 4

Posterior depression

Answer 4

“sit back into my hands” – promotes trailing limb posture

Question 5

PREP algorithm complete

Answer 5

potential to return to normal
or near-normal hand and arm function within 12 weeks

Question 6

PREP algorithm notable

Answer 6

Potential to be using affected hand and arm in most activities of daily living within 12 weeks, though normal function is unlikely

Question 7

PREP algorithm limited

Answer 7

Potential to have some movement in affected hand and arm within 12 weeks, but it is unlikely to be used functionally for activities of daily living

Question 8

PREP algorithm none

Answer 8

minimal movement in affected hand and arm, with little improvement at 12 weeks

Question 9

E-stim for inferior subluxation

Answer 9

suprapinatus and posterior deltoid

Question 10

E-stim for anterior subluxation

Answer 10

supraspinatus and anterior deltoid

Question 11

Berg Balance Scale cut off scores

Answer 11

A cut-off score of 12/56 is predictive of regaining unassisted ambulation (no physical assistance) by discharge.

A cut-off score of 29/56 is predictive of regaining community ambulation speed (>0.8 m/sec) by discharge*

Question 12

What are the determinants of long-distance walking function

Answer 12

Balance is the main determinant in individuals with more severe gait deficits

Cardiovascular fitness is the main determinant in individuals with more mild deficits

Spasticity does NOT appear to be a major determinant of gait speed

Question 13

What NIHSS scores predict good and bad outcomes

Answer 13

≥ 16 forecasts a high probability of death or severe debility, ≤ 6 forecasts good recovery

Question 14

MCA syndrome

Answer 14

Contralateral weakness (UE and face)
Contralateral sensory impairment (UE and face)
Aphasia (L/dominant hemisphere) – expressive, receptive, global
Neglect (R/nondominant hemisphere)

Question 15

ACA Syndrome

Answer 15

Sensory impairment in contralateral LE

Weakness in contralateral LE

Altered mental status - frontal lobe behavioral abnormalities (poor judgment, decreased attention, decreased motivation, difficulty registering emotions
Speech perseveration (aphasia)

Abulia (a lack of drive/will power)

Question 16

Posterior Cerebral Artery

Answer 16

Contralateral homonymous hemianopsia
Contralateral limb weakness
Thalamic pain syndrome (abnormal sensations of temperature/proprioception/touch, tingling, paresthesia, intractable pain, allodynia)

Question 17

Disruption of PCA anterior supply results in what?

Answer 17

apathy, amnesia

Question 18

Disruption of PCA posterior supply results in what?

Answer 18

neglect (R hemisphere), aphasia
Visual agnosia, anomia

Question 19

Lacunar Syndrome

Answer 19

Small infarcts at the end of deep penetrating arteries, often affecting white matter

Pure contralateral weakness, Pure contralateral sensory loss, Parkinsonism (basal ganglia), Large majority are asymptomatic

Question 20

VertebroBasilar Artery Syndrome

Answer 20

Headache, D/N/V, diplopia, nystagmus, dysarthria, dysphagia
Ipsilateral ataxia (possibly due to double-crossing over of pathways), dysmetria, hemiparesis
Bilateral effects if trunk of basilar artery occluded
Locked-in syndrome

Question 21

Superior Cerebellar Artery Syndrome

Answer 21

Headache, D/N/V, Nystagmus, diplopia, dysarthria
Dysmetria
Ipsilateral limb/gait ataxia
Ipsilateral Horner’s syndrome
Contralateral loss of touch/pain/temp in extremities, torso, and face, if any
Contralateral mild hemiparesis, if any

Question 22

Anterior Inferior Cerebellar Artery

Answer 22

D/N/V, nystagmus, diplopia, dysarthria, dysmetria
Ipsilateral deafness
Ipsilateral ataxia, ipsilateral loss of balance
Ipsilateral Horner’s syndrome (decreased sweating on face, ptosis, constricted pupil)
Ipsilateral loss of touch/pain/temp and weakness in face
Contralateral loss of pain/temp and weakness in limbs, if any

Question 23

Posterior Inferior Cerebellar Artery (PICA)

Answer 23

D/N/V, nystagmus, dysarthria, dysmetria
Ipsilateral ataxia, ipsilateral loss of balance
Ipsilateral Horner’s Syndrome
Dysphagia (CN nuclei IX, X)
Hoarseness of voice (CN nuclei IX, X)
Ipsilateral loss of touch/pain/temp on face (CN V nucleus)
Contralateral loss of pain/temp on body, if any

Question 24

Spinal artery and vertebral arteries

Answer 24

Medial medullary syndrome,

paresis of contralateral U&LE
Contralateral loss of touch and proprioception
Ipsilateral tongue deviation (hypoglossal nucleus)

Question 25

Suspect stroke If, ANY of the following with HINTS

Answer 25

HIT - Normal Nystagmus - Direction-changing, vertical or purely torsional Test of skew – positive with cover/uncover test

Question 26

Suspect peripheral vestibular problem If, ALL of the following

Answer 26

HIT – Abnormal (showing corrective saccade) Nystagmus - Direction-fixed and horizontal Test of skew – negative with cover/uncover test

Question 27

Pusher Syndrome

Answer 27

Stroke in R or L posterolateral thalamus, insular cortex, superior temporal gyrus, operculum, internal capsule Pt posture tilted towards the affected hemi-side, actively pushes/leans towards the Hemi side, loses perception/sense of upright posture.

Question 28

_____is the main determinant in individuals with more severe gait deficits

Answer 28

Balance

Question 29

______is the main determinant in individuals with more mild deficits

Answer 29

Cardiovascular fitness

Question 30

Slow-flexed walker characteristics

Answer 30

Excessive hip and knee flexion in midstance Inadequate dorsiflexion in swing Forward trunk lean

Question 31

Slow-Extended Walker (Circumduction) characteristics

Answer 31

Quads too weak to support the knee during stance phase Glut Max retracts femur into knee hyperextension to for stance limb support Ankle PF spasticity Hip hike and circumduction occur for foot clearance Usually require an assistive device

Question 32

Fast Walker characteristics

Answer 32

Lack of heel rise in terminal stance due to inadequate PF strength Knee hyperextension in stance to compensate for lack of heel rise to allow the body to progress forward on the forefoot Step length is compromised due to lack of transition of momentum from unaffected side

Question 33

Moderate Walker characteristics

Answer 33

Increased weakness of plantarflexors Weakness in hip extensors (glut max) and knee extensors (quads) Greater knee flexion in mid stance

Question 34

Independence in ADLs post-stroke is predicted by...

Answer 34

Age Stroke severity (NIH stroke scale) UE paresis

Question 35

NIHStrokeScale

Answer 35

0 No stroke symptoms 1-4 Minor stroke 5-15 Moderate stroke 16-20 Moderate to severe stroke 21-42 Severe stroke

Question 36

Orpington Prognostic Scale

Answer 36

Total score ranges from 1.6 – 6.8 Higher scores indicate a more severe stroke and a worse prognosis

Question 37

Proportional Recovery model

Answer 37

Uses the Fugl-Meyer outcome measure for UE to predict UE recovery, In 3 to 6 months, the majority of patients (recoverers) are estimated to recover a fixed proportion, between 0.55 and 0.85 (average ~ 70%), of their potential recovery. A minority of patients (non-recoverers) show only very moderate improvement, which cannot be linked to potential recovery

Question 38

PREP model

Answer 38

Algorithm that predicts functional recovery of UE at 3 months. The algorithm is based on the evidence that sparing of descending white matter pathways is related to better recovery of upper limb function after stroke. It has good predictive value but requires the use of neurophysiological and neuroimaging assessment

Question 39

PREP-2 algorithm

Answer 39

does not need MRI, instead uses NIHSS to predict UE recovery at 3 months post-stroke. If you do not have TMS score, you still can make some predictions.

Question 40

If patient’s SAFE score is >5 when using PREP-2 algorithm...

Answer 40

you don’t need TMS to predict recovery

Question 41

If patient’s SAFE score is < 5 when using PREP-2 algorithm...

Answer 41

if NIHSS is <7, then recovery could be good<>limited If NIHSS is >7, then can be Good or poor, but you can lean more towards poor

Question 42

IV tPA

Answer 42

IV tPA should be administered to all eligible acute stroke patients within 3 hours of last known normal . BP should be maintained <180/105 mm Hg for at least the first 24 hours after IV alteplase treatment.

Question 43

Patients ≥18 years should undergo mechanical thrombectomy with a stent retriever if they:

Answer 43

Have minimal prestroke disability Have a causative occlusion of the internal carotid artery or proximal middle cerebral artery Have a National Institutes of Health stroke scale score of ≥6 Have a reassuring noncontrast head CT (ASPECT score of ≥6) If they can be treated within 6 hours of last known normal. No perfusion imaging (CT-P or MR-P) is required in these patients.

Question 44

Unilateral spatial neglect can occur with a lesion in any of the following areas:

Answer 44

Posterior parietal cortex Frontal lobe Cingulate gyrus Striatum Thalamus

Question 45

Action-Intentional Disorders

Answer 45

Motor neglect, Not a deficit of the motor pathway, but rather a failure or decreased ability to move in the contralesional space (space contralateral to the damaged hemisphere) despite being aware of a stimulus in that space.

Question 46

Inattention unilateral spatial neglect

Answer 46

Sensory neglect, Lack of awareness, or decreased awareness, of sensory stimulation in the contralesional hemispace. This decreased sensory awareness occurs even though the sensory pathways and the primary sensory cortical areas are intact

Question 47

Restitutive Approach for USN

Answer 47

aim to alter the underlying cognitive impairment. More often used in the early stage of the stroke pathway when plasticity is thought to be greatest

Question 48

Compensatory Approach for USN

Answer 48

emphasis on coping with and finding ways of adapting to existing impairments. More often used in later stages of the stroke pathway

Question 49

Top-Down Approach for USN

Answer 49

Requires awareness of the disorder. Aim to train the person to voluntarily compensate for their neglect Methods include training in scanning and usually provide feedback Focus on the level of disability rather than impairment.

Question 50

Bottom-Up Approach for USN

Answer 50

Do not require awareness of the disorder. Aim to modify underlying factors, i.e. to alter the impaired representation of space. Prism-wearing and prism adaptation training are popular recent examples of a bottom-up approach

Question 51

Pusher Syndrome prognosis

Answer 51

Only 6 months after a stroke, pathological pushing behavior is rarely still evident. Pusher syndrome thus has a good prognosis and does not seem to negatively influence the outcome of rehabilitation.

Question 52

Pusher syndrome treatment ideas

Answer 52

perform treatments in upright position, do no correct passively instead use verbal and visual cues for patient to actively correct themselves. Focus on midline and verticality is key, patients need to see their deficits

Question 53

King-Devick test

Answer 53

Developed to assess eye movement in children with reading difficulty, quantifies saccadic movements and has been proposed for both oculomotor assessment and acute diagnosis in patients with concussion. Due to variability in performance, patients require a baseline measurement for valid post-injury comparison

Question 54

Rancho Level I

Answer 54

No response, Dependent/Total Assist

Question 55

Rancho level II

Answer 55

Generalized Response, Dependent/Total Assist

Question 56

Rancho level III

Answer 56

Localized response, Dependent/Total Assist

Question 57

Rancho level IV

Answer 57

Confused/Agitated, MAX A (mostly due to risky behavior)

Question 58

Rancho level V

Answer 58

Confused, Inappropriate, Non-Agitated, MAX A

Question 59

MST strategies for problem recognition

Answer 59

watching videos of someone else doing the task at hand, and demonstrating how they overcame their failures

Question 60

MST strategies for problem solving

Answer 60

Self-reflection activities - self-prediction of performance prior to performance and self-evaluation following performance

Question 61

MST strategies for decision making

Answer 61

allow for errors safely -> self-recognition of errors (if not happening, provide timely feedback) -> encourage to develop self correction strategies for future use -> practice with multiple reps -> generalize strategies for similar tasks

Question 62

Rancho VI

Answer 62

Confused, Appropriate, MOD A

Question 63

Rancho level VII

Answer 63

Automatic, Appropriate, MIN A

Question 64

Rancho level VIII

Answer 64

Purposeful, Appropriate, SBA