lab cases pt 2 (liv)

Question 1

when performing upper extremity WB progressions with patients, what position of the shoulder comes first?

Answer 1

flexed shoulder position first. if stable, can progress to shoulder extension

shoulder extension is a very demanding for GH stability in our patients.

Question 2

you are working with a patient post stroke that has an apraxic gait. you want to help them become more independent. What would be an intervention that PTs should be cautious about that could make their gait worse?

Answer 2

the use of an assistive device

difficult to wean, easy to over support the patient

Question 3

you are working with a patient with R hemiparesis, working on turning from a forced use standpoint. which side should the patient pivot towards?

Answer 3

a pivot towards the weak side = more weight bearing on weakside

progress to more “normal” pivots towards stronger side

Question 4

cueing progression for backwards walking

Answer 4

• look forward
• shift towards therapist, shift weight back
• bend knee
• guide foot backwards
• toe first initial contact

Question 5

you are working on gait with your patient and they are struggling to take a step in swing phase. what are three ways you can facilitate a better swing?

Answer 5

decrease the friction of the stepping foot
increase the step length of the less involved foot
manually assist their foot

Question 6

you are working with a patient to do a step progression you feel unsafe and a bit intimidated with your hand holds. what is another option of hand holds with this patient? which steps would be appropriate?

Answer 6

you could change to shoulder on ischial tuberosity and both hands wrapped around knee

isometric, eccentric (down and back), and concentric would be appropriate.
eccentric (down and forward) would not be appropriate.

Question 7

you are trying to gain adduction of the scapula of your brunnstrom 3 patient. how would your body be positioned for this skill, and how would you help your patient to move their thorax on a fixed scapula

Answer 7

PT positioned with leg wrapped around, adducted and IR to facilitate anterior pelvic tilt

you would need to stabilize patient and then add a weight shift. (DF)

Question 8

you are inhibiting the hand of a patient who is spastic but having trouble. what would be a good treatment to precede this one?

Answer 8

hand mobilizations and then inhibition afterwards

Question 9

for a carpal bone mobilizations, where should the therapist place their hands?

Answer 9

hamate and trapezium

Question 10

you are working on a patient in UE weight bearing. you have them symmetrical, but near midline. what could be your next 2 progressions

Answer 10

• asymmetrical
• 1/2 standing
• less involved on a moving surface

Question 11

as a therapist, should you go to reaching in a patient that has trouble with midline activites?

Answer 11

i would argue no. as “activities with body in midline precede those requiring weight shifts”

Question 12

you are performing D1 flexion pattern for a patient with tight triceps. what is the antagonist? what is the agonist?

Answer 12

antagonist- triceps
agonist- pec major, anterior delt, biceps

Question 13

if trying to gain shoulder flexion, trying to use autogenic inhibition- which PNF technique should you perform? what structures are you targeting?

Answer 13

hold relax
targeting golgi tendon organs

Question 14

your CI asks you the difference between hold relax and contract relax- what you saying???

Answer 14

hold relax is an isometric
contract relax is an isotonic concentric

Question 15

you are working with a patient with a Brunnstrom stage 4 arm. should you do PNF with them?

Answer 15

no, you should not do PNF with those dominated by a synergy

Question 16

you are performing hold relax active contraction with a patient, instructing them to “hold, hold, hold” and then moving into move ROM. what is the problem with this?

Answer 16

you need to hold for 5-8 seconds atleast- if not 10 seconds

Question 17

in a patient with continuing, but decreasing spasticity, which PNF diagonal would be beneficial for them?

Answer 17

D1 diagonals

D2 feeds the flexion synergy (scapular elevation and retraction)