Deck 22: Interventions for Weakness in Neuromotor Disorders

Question 1

Which of the following statements regarding the effects of strength training post-stroke is accurate based on current research evidence?

A)High-intensity strength training is well tolerated and produces significant strength gains.
B)High-intensity strength training is associated with increased spasticity in the trained limbs.
C)Intensive task specific strength training has little transfer effect to improve functional skills.
D)High-intensity progressive resistive exercise can adversely affect recovery of selective motor function.

Answer 1

A

Question 2

A physical therapist is working on improving active wrist extension and stabilization needed for reach and grasp in a 62 year-old women who is 2 weeks post-stroke.The therapist has decided to apply neuromuscular electrical stimulation (NMES) to the wrist extensors.Which of the following exercise design and electric stimulation parameters would be most effective to address this patient's therapeutic goal?

A)Electrical stimulation at 30-50 Hz,amplitude at motor threshold,while the patient is engaged in a reaching task requiring wrist extension.
B)Electrical stimulation at 50-70 Hz,amplitude at motor threshold,while the patient has supported limb in gravity eliminated position in relaxed position on table.
C)Electrical stimulation at 30-50 Hz,amplitude at sensory threshold,while the patient has arm supported on table top and is practice active ROM of wrist extension.
D)Electrical stimulation at 20-30 Hz,amplitude at sensory threshold,while the patient is lifting a mug off the table requiring wrist stabilization.

Answer 2

A

Question 3

Which of the following exercises reflects functional strength training exercise design to target weak hip abductors?

A)Forward step ups to 6 in.stair with light upper extremity support,repetitions to fatigue.
B)Seated bilateral hip abduction weight machine,70% 1RM,12 repetitions ×2 sets.
C)Lateral step down from 6 in.stair with light upper extremity support,repetitions to fatigue.
D)Sidelying lateral leg lifts with cuff weights,60-75% 1RM,10 repetitions ×2 sets.

Answer 3

C

Question 4

A physical therapist is designing a strength training program for an 8 year-old child with spastic diplegic cerebral palsy.Which of the following exercise prescriptions follow the recommended exercise guidelines for children with CP?

A)Exercise frequency= 3× week;duration 6-10 weeks;intensity 50-60% 1RM;volume 4-10 reps,1-2 sets;progression 2-5% increase in load.
B)Exercise frequency= 2× week;duration 10-16 weeks;intensity 40-50% 1RM;volume 12-15 reps,2 sets;progression 5% increase in load.
C)Exercise frequency= 3× week;duration 4-6 weeks;intensity 60-80% 1RM;volume 8-12 reps,1 set;progression 2-5% increase in load.
D)Exercise frequency= 2× week;duration 4-6 weeks;intensity 30-50% 1RM;volume 10-15 reps,2-3 sets;progression 5-8% increase in load.

Question 5

A physical therapist is working with a 44 year-old woman who has significant hemiparesis following a brain injury.The patient is unable to activate the hamstring muscle to move the limb through active range of motion and demonstrates 1+/2− manual muscle test (MMT) grade.Which type of muscle contraction and limb position would be most effective for exercise design initially to facilitate enhanced muscle activation in hamstrings when working with this patient in sidelying with limb on a power board?

A)Concentric contraction,start with the muscle in a lengthened position
B)Eccentric contraction,start with the muscle in a shortened position
C)Isometric contraction,start with the muscle in a mid-position
D)Isotonic contraction,start with the muscle in a shortened position

Question 6

A 49 year-old woman who has relapsing remitting multiple sclerosis (MS) is being evaluated by a physical therapist in an outpatient setting.The therapist suspects significant disuse atrophy in the trunk and lower extremities that is adversely affecting functional skills,with patient report of a recent decline in transfer and walking skills.The therapist is designing a home exercise program with therapeutic goals of improving strength,endurance and function,but is concerned about not over fatiguing this patient.Which of the following home exercise program (HEP) options would be most appropriate to address these goals for this patient?

A)Treadmill training at moderate intensity for 45 minutes,4× week.
B)Aquatic exercise program with functional strengthening activities,for 30 minutes,3× week in a cool pool.
C)Lower extremity PRE program using cuff weights performed on floor or bed level,repetitions to fatigue,1 set,4× week.
D)Lower extremity bicycle ergometer training program for 30 minutes with 1 minute high-intensity (speed) intervals every 5 minutes,3× week.

Question 7

A physical therapist is designing a lower extremity strengthening exercise for a 72 year-old patient with idiopathic Parkinson disease (PD).Which of the following exercise prescriptions would be optimal to improve muscle power needed for functional mobility tasks? Note: 1 RM = 1 repetition max

A)Straight leg raises performed in supine with 70% 1 RM load,hold leg lift for 4 seconds than lower;perform 10 repetitions × 2 sets.
B)Short arc quadriceps exercise performed in sitting with 50% 1 RM load;perform 20 repetitions × 3 sets.
C)Small range partial squats performed in standing with back of chair for support,slowly lower to count of 5 then return to standing,repetitions to fatigue × 1 set.
D)Sit-to-stand exercise from seated in standard chair without armrests,generate stand as quickly as possible followed by slow lower to chair;12 repetitions × 2 sets.

Question 8

Hemiparesis following a stroke is a significant contributor to functional limitations.Which of the following is an accurate description of the neural and/or structural muscle factors that underlie impaired force production in a patient with subacute stroke?

A)Reduced number of functioning motor units and selective loss of type II muscle fibers
B)Reduced motor unit innervation ratios and transsynaptic degeneration at the spinal motor neurons
C)Reduced motor unit activation and reduced percentage of type I muscle fibers
D)Reduced regulation of motor unit firing rate and selective loss of type I muscle fibers

Question 9

A physical therapist is working with a 38 year-old man in an inpatient rehabilitation setting who was diagnosed with Guillain-Barré syndrome (GBS) 4 weeks ago.He presents with moderate weakness in bilateral lower extremities.Which of the following progressive resistive exercise (PRE) prescriptions for the proximal hip muscles is most appropriate for this patient with special consideration to avoid overwork weakness? Note: 1 RM = 1 repetition max

A)Two sets of 4 to 5 repetitions at 30% of 1 RM with 5 minute rest between sets
B)One set 5 to 8 repetitions at 50% 1 RM with 4 second rest between repetitions
C)Two sets of 10 to 12 repetitions at 80% 1 RM,with 2 minute rest between sets
D)One set of 13 to 15 repetitions at 70% of 1 RM,with 30 second rest between repetitions

Question 10

For which of the following neurological diagnoses are you expecting that a strength training program targeted to weakened muscles will result in some remediation of weakness deficits with improved strength outcomes?
(1) Amyotrophic lateral sclerosis (ALS)
(2) Multiple sclerosis (MS)
(3) Parkinson disease (PD)
(4) Muscular dystrophy (MD)

A)1 and 4
B)2 and 3
C)1,2,and 3
D)1,2,3,and 4

Question 11

Which of the following statements regarding the use of home exercise programs (HEP) for patients with neurological diagnoses is inaccurate?

A)HEP are important to prevent detraining and deconditioning effects that may adversely affect function in patient with neurological conditions.
B)Only 50% of elderly individuals consistently perform their HEP upon discharge from physical therapy services.
C)The primary factor affecting HEP adherence is lack of motivation;therefore the therapist needs to address this barrier when educating patients.
D)The therapist should prioritize HEP activities based on patient's needs and integrate them into a patient's daily routine.

Question 12

A 20 year-old male patient with C-7 incomplete spinal cord injury has residual weakness in his triceps muscles bilaterally that is affecting his ability to stabilize and support body load while ambulating with Loftstrand crutches on level surfaces.The therapist is designing a strengthening exercise to address this problem.Which of the following exercises best represents the application of the principle of specificity of training for this patient's needs?

A)Performing concentric full range of motion (ROM) elbow extension with use of Theraband resistance in sitting position.
B)Perform moderate resisted bilateral upper extremity (UE) motions on incline press machine in supported sitting position.
C)Performing small range full body push-ups in sitting with hands positioned on push-up blocks.
D)Perform proprioceptive neuromuscular facilitation (PNF) D-1 flexion/extension exercise;slow reversals against the therapist's manual resistance in supported sitting.