lab cases (liv)

Question 1

you’re working with a patient with a 2/5 MMT for trunk extension. You want to work on trunk extension stabilization. What PNF strategy would you do with a patient like this? Which side would emphasize stabilization of trunk extensors?

Answer 1

Reversal of isometrics/rhythmic stabilization would work on stabilization.
Pulling anteriorly at the shoulders (finger tips behind shoulder) will facilitate trunk extensors “hold, dont let me move you”

Question 2

How could a therapist progress rhythmic stabilization/alternating isometrics to be a controlled mobility exercise?

Answer 2

progress to slow reversals with quick stretches to now work on mobility

Question 3

you’re working with a patient and want to use a PNF technique for stabilization. which technique is more dynamic?

Answer 3

trick question! rhythmic stabilization is more complex
but it is not more dynamic that alternating isometrics

Question 4

the pusher weight shift with a ball is fairly passive for a patient. how might you transition this into something more active, dynamic, or functional?

Answer 4

once the patient is ready to progress, some ideas could be using a walking stick and having them lean and reach away from their affected side (the side they push to)
many different way to make this functional for the patient!

Question 5

you are evaluating a patient with pusher’s syndrome. when you walk into the room, they are pushing towards their left side.
which side is their weak side?
which side is their lesion on?

Answer 5

weak side is left
lesion is on the right
pusher patient’s push away from the side of their lesion.

Question 6

you just finished laterally shifting your pusher patient on the swiss ball. what should be your next step in your treatment session?

Answer 6

follow this stretching/movement with a functional skill

ex: transfer towards their strong side (the side they don’t push towards)

Question 7

you are working with a patient 2 weeks post stroke. you tend to stabilize just their feet during bridging but notice they are struggling and seem to be compensating with their less affected side. how might you change your hand placements if they continue to decline in therapy?

Answer 7

bring your hands more proximal. the more proximal your hand placements are, the more assistive you are for the patient.
stabilize at the knee. may need pelvis stabilization.

Question 8

when facilitating a dynamic trunk, how might you as a therapist get a feel for the patient’s trunk mobility?

Answer 8

go to the end ranges of both anterior and posterior pelvic tilt

(neither of these end ranges are functional positions. patient should be somewhere in the middle to help the patient have a dynamic trunk)

Question 9

in order to achieve dynamic stability the ventral and dorsal trunk activity is ____________
for movement the activity is ______________

Answer 9

dynamic stability = co contraction of ventral and dorsal trunk
movement= co activation of ventral and dorsal trunk

Question 10

you are trying to facilitate a patient’s dynamic trunk anteriorly but it remains unsuccessful due to patient stiffness. What should be your next step in treatment?

Answer 10

NDT anterior mobilization of the lumbar spine

Question 11

you have a patient on with a grade 3 Ashworth level of spasticity. they are weak and tight on the right side. you believe a mobilization would help them. what should you steer clear of? what might be a good treatment choice?

Answer 11

steer clear of bouncing, manipulations/mobilization at a high velocity due to kicking in the spasticity.
a lateral trunk mobilization- to the right in order to lengthen the right side first.

Question 12

as a therapist on the pt more involved side:
for anterior facilitation our hands are ________
for anterior mobilization our hands are ______

Answer 12

facilitation uses fingers at the lumbar spine
mobilization uses the heel of the hand at the lumbar curve (so it is a bit lower- be careful!!!)

Question 13

you are working with a patient and they need mobilization on both sides for a lateral shift. what is your order of treatment to address both sides?

Answer 13

as a therapist you should:
-mobilize one side
-facilitate movement on the same side (use it or lose it principle)
-mobilization of the other side
-facilitate movement of the other side now

usually a patient just has one side that is tight

Question 14

you are mobilizing a patient from a lateral position. where should your hands be?

Answer 14

one hand will be on the lower corner of the ribs
one hand in front- thumb and middle finger on clavicle

Question 15

you are ready to facilitate movement on your patient’s trunk, sitting for a bit. how would you position the patient for optimal results?

Answer 15

• hips higher than knees
• knees flexed around 90
• feet underneath her
• thighs parallel and hip distance apart
• feet a bit forward for more stability

Question 16

your patient with a R sided stroke is not bearing weight on one side. you want to work on weight shifts. what side would you mostly likely be shifting to?

Answer 16

R sided stroke so L side impairments. probably not bearing weight to the left side.
want to shift towards the L.
make sure the patient maintains:
* a dynamic trunk
* relaxed shoulders
* movement is occuring at the lower trunk
* always return to midline before starting again

Question 17

you’re working with a patient trying to do a functional task for rolling. you decide to work on half bridges. how might you specify the patient’s movement to be more functional for rolling?

Answer 17

in half bridging you would also guide the hip into adduction

hip abduction in half bridging helps with gait/standing

Question 18

your patient is stiff and shortened on their right side. what bed position might be helpful for the patient?

Answer 18

sidelying on the affected side (R) would be helpful because they would be stretching and lengthening their R in this position.

Question 19

you’re working with a patient with a strong extension synergy. you want to transfer supine to sitting, with forced use (towards strong side). what is important to have success in this transfer?

Answer 19

position the patient in hooklying with knees and hips flexed in order to avoid synergies.

Question 20

you are working with a Mod A patient and want to work on posterior scoots. what position should you perform this exercise in?

Answer 20

scooting backwards from the front. (from the side is only appropriate for min A patients)

Question 21

you want to do a pre gait activity using scooting on a mat. which activity would you pick for this goal?

Answer 21

unilateral scooting is great for pre gait due to the lateral weight shifts.
“lift off” in both anterior and posterior scoots is functional for sit <-> stand.

Question 22

you are working on a patient who is fearful of falling in a stand pivot transfer. how do you address the concern while still working on transfers?

Answer 22

squat pivot transfer- center of gravity is lower, less chance of falling.

Question 23

T or F: stand pivot transfers represent a higher level of function than a squat/scoot transfer

Answer 23

FALSE
it depends on what each of the limbs/trunk is doing to participate. the patient could be doing more in a squat pivot than a stand pivot.

Question 24

your patient needs to go to the bathroom very soon. what is your best option for a efficient transfer?

Answer 24

modified stand pivot transfer

Question 25

you transitioned your patient from prone on elbows to quadruped. you want to work on stability. what are your options?

Answer 25

alternating isometrics
and
rhythmic stabilization

Question 26

in pre gait and standing activities, what is the difference between a Min a and Mod A patient?

Answer 26

entire forearm/elbow is around a Mod A patient’s pelvis
hand hold for Min A on pelvis

Question 27

we have a patient with L sided weakness that we want to work on stance phase of gait on her weak side in half kneeling. we also want to work on mobility. how should the patient be positioned and which exercises might we use?

Answer 27

right leg would be up and flexed, left knee down and extended.
in half kneeling we could do rhythmic initiation or slow reversals.

Question 28

describe the sequence of slow reversal holds of standing weight transfers. what neurophysiological principle is at play ?

Answer 28

• more involved side is positioned in front
• leg block/receiving position on weaker side
• rhythmic initiation first of weight shifts forward and back
• resisted motions
• hold, hold, hold at the end of the anterior/posterior motions
• reverse to the other direction, hold at the end

this uses successive induction as the effort one direction overflows to the next direction

Question 29

in standing weight transfers using slow reversal holds, how could you progress the activity for a patient with more proximal control?

Answer 29

do hand holds at the shoulders

more distal= less stability given

Question 30

sit to stand: what is harder? concentric or eccentric?

Answer 30

concentric (standing up against gravity) is more difficult than eccentric (sitting back down)

Question 31

in sit to stands from the side, where is the front hand of the therapist on the patient? what is the importance of this?

Answer 31

this is important to provide a forward pressure to the patients distal thigh- not patella. this placement on the distal thigh is also important for feeling for quad activation!

Question 32

cues for standing to sitting

Answer 32

1. bend the knees
2. lean forward
3. look forward
4. sit down

Question 33

table instructions for stand to sit

Answer 33

table forward
table down
once the patient is sitting, table back towards the patient

Question 34

what is a way to progress a sit to stand transition to involved the patient more?

Answer 34

patient can apply the pressure to the distal thigh themselves
patient can reach anteriorly to initiate a forward weight shift

Question 35

you’re working with a patient with R hemiplegia. when sitting to stand, they continually bear weight mainly on their L side. What motor learning concept does this display?

Answer 35

learned non use

Question 36

you are taking a patient through the pre gait sequence. what are the progressions of this for stance phase?

Answer 36

STANCE
1. bilateral knee flexion
2. reciprocal bending of knees with lateral weight shift (don’t forget to hold at midline)
3. weight shift to involved side, then heel/toe slides on less involved.
4. weight shift to involved, step with less involved
5. weight shifts in above position
6. less involved steps back now
7. weight shifts in above
8. full steps forward and backward with less involved

do not let go on pelvis

Question 37

you are taking a patient through the pre gait sequence. what are the progressions of this for swing phase?

Answer 37

SWING
1. less involved forward, work on pelvic drop, knee flexion, and heel rise with eversion on more involved
2. work on graded extension/flexion of involved knee in stride
3. assist patient in sliding involved foot forward
4. step with involved.
5. work on stepping without sliding the foot

dont let go on pelvis

Question 38

you are working on a patient in a busy therapy room. you are gait training a patient using various speeds, in a random order. their hands are holding onto a rolling table, which is controlled by a tech. what type of activity is this based on environment, body, and manipulation?

Answer 38

open task (intertrial variability with body transport)
body transport (pt is moving!)
no manipulation (holding onto something is not manipulation)

Question 39

what are the active ingredients for neuroplasticity/motor learning?

Answer 39

task specific
repetitive practice
intensity of training
salience

Question 40

what is salience?

Answer 40

how relevant and important the brain finds something to be

Question 41

CPG for moderate to high intensity gait training

Answer 41

70-85% HR max
60-80 HR reserve
RPE >/= 14