S2_L2: CVA

Question 1

This results in a sudden, specific neurological deficit and occurs when a brain blood vessel is either occluded by a clot or bursts

Answer 1

Stroke / Cerebrovascular Accident

Question 2

During the acute phase of stroke rehabilitation, what is the primary goal?

A) Maximize functional independence
B) Prepare for discharge home
C) Begin long-term rehabilitation planning
D) Evaluate the need for surgical intervention

Answer 2

B) Prepare for discharge home

Question 3

Which of the following is NOT a common goal of stroke rehabilitation?

A) To improve mobility and range of motion
B) To reduce the risk of future strokes
C) To promote cognitive and emotional well-being
D) To treat the underlying cause of the stroke

Answer 3

D) To treat the underlying cause of the stroke

Question 4

What is the primary objective of constraint-induced movement therapy (CIMT) in stroke rehabilitation?

A) To limit the use of the affected limb
B) To promote the use of the affected limb
C) To immobilize both limbs
D) To prevent muscle atrophy in the affected limb

Answer 4

B) To promote the use of the affected limb

Question 5

What is the term for a communication disorder that can occur after a stroke, making it difficult for individuals to produce or understand speech?

A) Dysphagia
B) Aphasia
C) Apraxia
D) Hemiparesis

Answer 5

B) Aphasia

Question 6

What is the main purpose of rehabilitation in the chronic phase of stroke recovery?

A) To achieve maximal recovery within the first few days
B) To address long-term disability and improve quality of life
C) To provide surgical interventions
D) To focus on prevention of future strokes

Answer 6

B) To address long-term disability and improve quality of life

Question 7

During the acute phase of stroke rehabilitation, which type of therapy is most commonly emphasized?

A) Constraint-induced movement therapy (CIMT)
B) Hydrotherapy
C) Passive range of motion exercises
D) Bed rest

Answer 7

A) Constraint-induced movement therapy (CIMT)

Question 8

Which therapy modality involves using electrical currents to stimulate muscles and facilitate muscle strengthening in stroke patients?

Answer 8

Neuromuscular electrical stimulation (NMES)

Question 9

Which phase of stroke rehabilitation primarily focuses on optimizing long-term function and quality of life?

A) Acute phase
B) Subacute phase
C) Chronic phase
D) Maintenance phase

Answer 9

C) Chronic phase

Question 10

Enumerate the 3 stages of the evolution of the recovery process from onset to the return to community life

Answer 10

1. Acute
2. Active Rehabilitation
3. Adaptation to Personal Environment

Question 11

Determine the stage in the evolution of the recovery process.

1. improves compensatory strategies
2. reduces disability

A. Acute
B. Active Rehabilitation
C. Adaptation to Personal Environment

Answer 11

1. B
2. B

Question 12

The inpatient length of stay for acute stroke is currently _____ days

Answer 12

2 to 4

Question 13

TRUE OR FALSE: The greatest deficit in persons with hemiplegia who have recovered basic motor skills and who have returned home is in the psychosocial and environmental areas

Answer 13

True

Question 14

Which of the following impairments is typically associated with apraxia in stroke survivors?

A) Muscle weakness
B) Sensory deficits
C) Coordination problems
D) Loss of consciousness

Answer 14

C) Coordination problems

Question 15

In stroke rehabilitation, what does the term “spasticity” refer to?

A) Inability to initiate movement
B) Rapid, involuntary muscle contractions
C) Difficulty with speech articulation
D) Impaired coordination of fine motor tasks

Answer 15

B) Rapid, involuntary muscle contractions

Question 16

When conducting a motor assessment in stroke rehabilitation, which scale is commonly used to assess upper extremity motor function?

A) Functional Independence Measure (FIM)
B) Berg Balance Scale
C) Modified Ashworth Scale
D) Chedoke-McMaster Stroke Assessment

Answer 16

D) Chedoke-McMaster Stroke Assessment

Question 17

Which approach to gait training in stroke rehabilitation focuses on repetitive practice of functional walking tasks, incorporating real-life scenarios?

A) Body-weight-supported treadmill training
B) Overground walking training
C) Robotic-assisted gait training
D) Neurodevelopmental treatment (NDT)

Answer 17

B) Overground walking training

Question 18

Which specialized assessment tool is used to evaluate the quality of upper limb movements and motor recovery following stroke?

A) Fugl-Meyer Assessment (FMA)
B) National Institutes of Health Stroke Scale (NIHSS)
C) Barthel Index
D) Chedoke-McMaster Stroke Assessment

Answer 18

A) Fugl-Meyer Assessment (FMA)

Question 19

Enumerate the 4 pathways a client does after the acute stage of recovery process.

Answer 19

1. Returns home with or without home care services
2. Goes to a rehabilitation hospital for a 2 to 4 week stay
3. Goes to a subacute facility to become strong enough for the rehabilitation regimen
4. Goes to a long-term care facility for rehabilitation or maintenance care

Question 20

Historically, the recovery of motor function is to be completed _____ months after onset

Answer 20

3 to 6

Question 21

CNS response to injury: initial loss of (1)_____ function, increase in (2)_____ after 48 hours and the emergence of (3)_____ of movement

Answer 21

1. voluntary
2. deep tendon reflexes
3. synergistic patterns

Question 22

TRUE OR FALSE: The dependence of synergistic movement decreases as voluntary function increases

Answer 22

True

Question 23

Therapy interventions should emphasize (1)_____ on the affected side to maximize return and help the client achieve the (2)______

Answer 23

1. movement patterns
2. highest level of function

Question 24

Enumerate the Predictors of Recovery.

Answer 24

1. Motor Recovery
2. Arm Recovery

Question 25

TRUE OR FALSE: Initial return of arm movement in the first 4 days is one indicator of the possibility of full arm recovery.

Answer 25

False first 2 weeks*

Question 26

TRUE OR FALSE: Failure to recover grip strength before 24 days will result in no recovery of arm function at 3 months

Answer 26

True

Question 27

The following are common impairments in stroke, EXCEPT: A. Pain B. Edema C. Hypotonicity D. Shoulder subluxation E. None

Answer 27

E. None

Question 28

TRUE OR FALSE: Stroke may result to depression

Answer 28

True

Question 29

How does weakness from stroke differ from generalized weakness or orthopedic weakness?

Answer 29

it involves one entire side of the body and includes the trunk and extremities

Question 30

Trunk control allows the body to? (1-4)

Answer 30

1. Reman upright 2. Adjust to weight shift 3. Control movements against the constant pull of gravity 4. Change and control body position for balance and function

Question 31

This refers to the overall state of tension in the body musculature

Answer 31

Postural tone

Question 32

Postural tone is influenced by the input from the? (1-4)

Answer 32

1. Corticospinal tracts 2. Vestibular system 3. Alpha and gamma systems 4. Peripheral-tactile and proprioceptive receptors

Question 33

Enumerate the steps in MRP.

Answer 33

1. Analysis of Task 2. Practice of Missing Components 3. Practice of Task 4. Transference of Learning

Question 34

1. Explanation-identification of goal 2. Re-evaluation A. Analysis of Task B. Practice of Missing Components C. Practice of Task D. Transference of Learning

Answer 34

1. B/ C 2. C

Question 35

1. Observation 2. Involvement of relative and staff A. Analysis of Task B. Practice of Missing Components C. Practice of Task D. Transference of Learning

Answer 35

1. A 2. D

Question 36

1. Instruction 2. Opportunity to practice in context A. Analysis of Task B. Practice of Missing Components C. Practice of Task D. Transference of Learning

Answer 36

1. B/ C 2. D

Question 37

1. Practice + verbal and visual feedback + manual guidance 2. Consistency of practice A. Analysis of Task B. Practice of Missing Components C. Practice of Task D. Transference of Learning

Answer 37

1. B/ C 2. D

Question 38

1. Analysis 2. Organization of self-monitored practice A. Analysis of Task B. Practice of Missing Components C. Practice of Task D. Transference of Learning

Answer 38

1. A 2. D

Question 39

1. Comparison 2.Structured learning environment A. Analysis of Task B. Practice of Missing Components C. Practice of Task D. Transference of Learning

Answer 39

1. A 2. D

Question 40

Describe the 1st level of trunk control

Answer 40

Ability to perform basic movement components

Question 41

Describe the 2nd level of trunk control

Answer 41

manifests with trunk and extremity patterns coordination, may be best explained through anticipatory postural control

Question 42

Describe the 3rd level of trunk control

Answer 42

allows strength and stability for power production from arm and leg

Question 43

Enumerate motor control deficits seen in stroke patients.

Answer 43

1. Improper Initiation 2. Inappropriate Muscle Selection 3. Inappropriate Sequencing 4. Excessive Force Production

Question 44

Determine which motor control deficit is being described. When force is excessive, the movement pattern is slow and the extremity feels stiff. A. Improper Initiation B. Inappropriate Muscle Selection C. Inappropriate Sequencing D. Excessive Force Production

Answer 44

D. Excessive Force Production

Question 45

Determine which motor control deficit is being described. Occurs when the client attempts to move the arm or leg in space and substitutes the stronger proximal muscles for weaker distal muscles A. Improper Initiation B. Inappropriate Muscle Selection C. Inappropriate Sequencing D. Excessive Force Production

Answer 45

A. Improper Initiation

Question 46

Determine which motor control deficit is being described. Will include improper initiation and excessive co-contraction. A. Improper Initiation B. Inappropriate Muscle Selection C. Inappropriate Sequencing D. Excessive Force Production

Answer 46

C. Inappropriate Sequencing

Question 47

Determine which motor control deficit is being described. Muscles easily fatigue and the extremity slowly falls back to the starting position. A. Improper Initiation B. Inappropriate Muscle Selection C. Inappropriate Sequencing D. Excessive Force Production

Answer 47

D. Excessive Force Production

Question 48

Determine which motor control deficit is being described. Occurs when the client substitutes a strong muscle group for a paralyzed muscle although it is inappropriate for the function A. Improper Initiation B. Inappropriate Muscle Selection C. Inappropriate Sequencing D. Excessive Force Production

Answer 48

B. Inappropriate Muscle Selection

Question 49

Determine which motor control deficit is being described. Therapists often label this movement a “spastic” pattern and intervene with inhibition techniques. A. Improper Initiation B. Inappropriate Muscle Selection C. Inappropriate Sequencing D. Excessive Force Production

Answer 49

D. Excessive Force Production

Question 50

Determine which motor control deficit is being described. Happens when the patient activates muscles with inappropriate effort during voluntary movement. A. Improper Initiation B. Inappropriate Muscle Selection C. Inappropriate Sequencing D. Excessive Force Production

Answer 50

D. Excessive Force Production

Question 51

TRUE OR FALSE: Excessive co-contraction occurs when the client activates too many muscles either at the same time or out of sequence for the task

Answer 51

True

Question 52

A clinically associated with paralysis and weakness A. Hypotonicity B. Spasticity

Answer 52

A. Hypotonicity

Question 53

A clasp-knife phenomenon A. Hypotonicity B. Spasticity

Answer 53

B. Spasticity

Question 54

Hyperactive tendon responses A. Hypotonicity B. Spasticity

Answer 54

B. Spasticity

Question 55

extremities display no resistance to passive movement and feel heavy A. Hypotonicity B. Spasticity

Answer 55

A. Hypotonicity

Question 56

Resistance to stretch A. Hypotonicity B. Spasticity

Answer 56

B. Spasticity

Question 57

Increased velocity-dependent A. Hypotonicity B. Spasticity

Answer 57

B. Spasticity

Question 58

Clinical Hypertonicity can be separated from spasticity partly because clinical hypertonicity responds to ______

Answer 58

movement interventions

Question 59

Situations in which hypertonicity occurs: 1. Increase tone as a result of ______ 2. Increased tension on a two-joint muscle caused by _____ and the resultant _____ of muscles 3. Increased tone that is voluntarily produced during attempts at _____ movement

Answer 59

1. proximal instability 2. poor joint alignment & shortening 3. active

Question 60

Why does arm pain present in CVA patients?

Answer 60

arm pain may be d/t imbalance of muscles, improper movement patterns, joint dysfunction, improper weight-bearing patterns, muscle shortening, or diminished sensation and sensory interpretation

Question 61

Enumerate the sources of pain.

Answer 61

1. Joint Pain 2. Muscle and Tendon Pain 3. Shoulder-Hand Syndrome/ Complex Regional Pain syndrome

Question 62

What is the reason for joint pain in CVA pts?

Answer 62

loss of scapular and humeral rhythm and insufficient humeral external rotation

Question 63

What is the reason for muscle or tendon pain in CVA pts?

Answer 63

When a shortened or posturing muscle is stretched too quickly or beyond available length

Question 64

What is the s/sx for Shoulder-Hand Syndrome in CVA pts?

Answer 64

1. tenderness and swelling of the hand 2. altered sensitivity in the shoulder and entire arm 3. loss of shoulder and hand range of motion, severe edema, and loss of skin elasticity 4. demineralizaiton of bone, severe soft tissue deformity, and joint contracture

Question 65

Mx for SHS: Five Steps for intervention for severe and chronic arm pain 1. Eliminate ____ 2. ______ the arm and hand to touch 3. Eliminate _____ 4. Introduce pain-free arm movements by reestablishing _____ 5. Beginning with ______ gradually increase the variety and complexity of arm movements

Answer 65

1. pain 2. desensitize 3. hand edema 4. scapular mobility 5. guided arm movements below 60°

Question 66

Hand and foot edema is another common secondary impairment that develops as a consequence of (1)_____ and (2)_____ factors

Answer 66

1. loss of movement control 2. hospitalization

Question 67

TRUE OR FALSE: Foot edema is more common than hand edema

Answer 67

False It is as common as hand edema

Question 68

Foot edema limits ankle joint ______ range

Answer 68

dorsiflexion

Question 69

Edema begins on the (1)_____ surface of the hand and foot, progresses (2)____, and then continues (3)_____ across the wrist or ankle

Answer 69

1. volar 2. dorsally 3. proximally

Question 70

TRUE OR FALSE: Edema must be eliminated before active reeducation begins

Answer 70

True

Question 71

Describe edema in stage I.

Answer 71

tissue feels soft and fluid

Question 72

Describe edema in stage II.

Answer 72

tissue is gelatinous and pitting, the edematous fluid cannot be physically expressed

Question 73

Describe edema in stage III.

Answer 73

characterized by hard, lumpy tissue that does not “pit” in response to manual pressure

Question 74

Match the description to its edematous stage Requires gentle bilateral compression to break up the hard, solid areas into regions of softness A. Stage I B. Stage II C. Stage III

Answer 74

C. Stage III

Question 75

Match the description to its edematous stage must be softened and liquified through trans-tissue massage A. Stage I B. Stage II C. Stage III

Answer 75

B. Stage II

Question 76

Match the description to its edematous stage elevation, elastic gloves, bandaging, and retrograde massage are ineffective A. Stage I B. Stage II C. Stage III D. A and B E. B and C

Answer 76

E. B and C

Question 77

Match the description to its edematous stage responds to retrograde massage and elevation A. Stage I B. Stage II C. Stage III

Answer 77

A. Stage I

Question 78

TRUE OR FALSE: When edematous tissue is soft and fluid, active and active assistive extremity movement patterns produce muscular contractions that assist venous and lymphatic return of the fluid.

Answer 78

True

Question 79

______ occurs when any of the biomechanical factors contributing to the glenohumeral joint stability are interrupted

Answer 79

Shoulder Subluxation

Question 80

In persons with hemiplegia, subluxation is related to a change in what?

Answer 80

angle of the glenoid fossa d/t muscle weakness

Question 81

In the frontal plane, the scapula is normally held at an angle of ____

Answer 81

40°

Question 82

Determine the kind of SH subluxation 1. elbow flexes and the forearm supinates as tension increases in biceps 2. present in the acute stage 3. humerus subluxate inferiorly with internal rotation A. Inferior B. Anterior C. Superior

Answer 82

1. B 2. A 3. A

Question 83

Determine the kind of SH subluxation 1. d/t coracohumeral ligament rupture 2. unlocking mechanism of the capsule is lost 3. occurs when the humeral head lodges under the coracoid process in a position of internal rotation and slight abduction A. Inferior B. Anterior C. Superior

Answer 83

1. A 2. A 3. C

Question 84

Coracohumeral ligament rupture occurs from a

Answer 84

forced abnormal passive motion

Question 85

Determine the kind of SH subluxation 1. found in clients with atypical patterns of return and trunk rotational asymmetries 2. occurs with inappropriate muscle firing and co-contraction 3. humeral head is "locked" in this position so that every movement of the humerus is accompanied by scapular movement A. Inferior B. Anterior C. Superior

Answer 85

1. B 2. C 3. C

Question 86

Determine the kind of SH subluxation 1. scapula elevates and tilts forward on the rib cage and the humerus hyperextends with internal rotation 2. not painful 3. result in downward rotation of the scapula A. Inferior B. Anterior C. Superior

Answer 86

1. B 2. C 3. A

Question 87

Mobility skills are selected in three functional positions. What are they?

Answer 87

1. supine 2. sitting 3. standing

Question 88

Determine the following problems seen in which gait deviations. 1. Lack of proper initiation pattern and direction 2. Atypical leg muscle firing patterns 3. Loss of ability to transfer weight through foot 4. Inability to continue to move forward as a leg 5. Poor trunk control A. Forward Progression B. Single & Double Limp Support C. Swing (early and late)

Answer 88

1. A 2. C 3. B 4. C 5. A

Question 89

Determine the following problems seen in which gait deviations. 1. Insufficient ankle joint dorsiflexion range 2. Insufficient trunk control to maintain position over one leg 3. Foot posturing 4. Inappropriate foot contact 5. Poor lower extremity control A. Forward Progression B. Single & Double Limp Support C. Swing (early and late)

Answer 89

1. A 2. B 3. C 4. A 5. B

Question 90

Determine the causes seen in forward progression. You may choose 2 answers 1. Muscle tightness 2. Loss of control edema 3. Excessive lateral shift 4. Foot posturing A. Poor trunk control B. Lack of proper initiation pattern and direction C. Insufficient ankle joint dorsiflexion range D. Inappropriate foot contact

Answer 90

1. C & D 2. C 3. B 4. D

Question 91

Determine the causes seen in forward progression. 1. Loss of alignment of upper trunk over lower trunk 2. Loss of control of upper trunk as leg initiates weight shift forward 3. Excessive forward trunk flexion 4. Weakness of foot and ankle muscles A. Poor trunk control B. Lack of proper initiation pattern and direction C. Insufficient ankle joint dorsiflexion range D. Inappropriate foot contact

Answer 91

1. A 2. A 3. B 4.D

Question 92

Determine the causes seen in single and double limb support. 1. Muscle tightness 2. Loss of ankle joint dorsiflexion range 3. Asymmetries during unilateral stance 4. Loss of knee control in unilateral stance 5. Hip instability A. Insufficient trunk control to maintain position over one leg B. Poor lower extremity control C. Loss of ability to transfer weight through foot

Answer 92

1. C 2. B 3. A 4. B 5. B

Question 93

Determine the causes seen in single and double limb support. 1. Weakness or inappropriate activation of leg muscles 2. Loss of control of upper trunk over lower trunk 3. Toe clawing or curling 4. Inability to maintain leg on floor or behind body A. Insufficient trunk control to maintain position over one leg B. Poor lower extremity control C. Loss of ability to transfer weight through foot

Answer 93

1. C 2. A 3. B 4. C

Question 94

Enumerate the problems in early and late swing

Answer 94

1. Atypical leg muscle firing patterns 2. Inability to continue to move forward as a leg 3. Foot posturing

Question 95

TRUE OR FALSE: Atypical leg muscle firing patterns are due to a loss of ankle and foot PF. It also presents a problem with initiation patterns A. Both statements are true B. Both statements are false C. Only the 1st statement is true D. Only the 2nd statement is true

Answer 95

D. Only the 2nd statement is true

Question 96

TRUE OR FALSE: Atypical leg muscle firing patterns is d/t a lack of proper initiation. It is also caused by the inability to control trunk and lower extremity A. Both statements are true B. Both statements are false C. Only the 1st statement is true D. Only the 2nd statement is true

Answer 96

A. Both statements are true

Question 97

What is the spinal pattern and muscle activity in posterior weight shift of the lower body in sitting?

Answer 97

Spinal Pattern: Flexion Muscle Activity: Concentric Flexor Acivity

Question 98

What is the spinal pattern and muscle activity in anterior weight shift of the lower body in sitting?

Answer 98

Spinal Pattern: Extension Muscle Activity: Concentric extension activity

Question 99

What is the spinal pattern and muscle activity in lateral weight shift to the right of the lower body in sitting?

Answer 99

Spinal Pattern: lateral flexion (convexity to right) Muscle Activity: Eccentric lateral activity on (R), Concentric lateral activity on (L)

Question 100

What is the spinal pattern and muscle activity in posterior weight shift of the upper body in sitting? NOTE: pt is sitting back up

Answer 100

Spinal Pattern: Extension Muscle Activity: Concentric extension activity

Question 101

What is the spinal pattern and muscle activity in anterior weight shift of the upper body in sitting? Note: pt is reaching down the floor

Answer 101

Spinal Pattern: Flexion Muscle Activity: Eccentric extension activity

Question 102

What is the spinal pattern and muscle activity in lateral weight shift of the upper body in sitting? Note: pt reaches sideways and down to right

Answer 102

Spinal Pattern: lateral flexion (convexity to right) Muscle Activity: Eccentric lateral activity on (L)

Question 103

What is the spinal pattern and muscle activity in lateral weight shift of the upper body in sitting? Note: pt comes back up to middle

Answer 103

Spinal Pattern: Spine moves back to neutral Muscle Activity: Concentric lateral activity on (L)

Question 104

The following are common impairments in stroke, EXCEPT: A. Loss of control B. Spasticity C. Hypertonicity D. Psychosocial issues E. None

Answer 104

C. Hypertonicity