Check Point 1 by

ALS

2023-11-06 13:52:09 UTC

Ralph, a 45 yo male diagnosed w ALS 6 months ago is starting to notice more trouble clearing his L foot on the rugs at home. Currently, he is ambulating with close supervision by his wife, who has a full-time job. He is coming to OPPT to work on his gait. What is the most appropriate intervention we would want to do to address his gait deviations?

a. Strengthen L DF with resistance bands (ex. 4 way ankle)

b. Trial a carbon fiber AFO with gait training

c. HIGT to work on his endurance and gait mechanics

d. Stretching of PF to help decrease tone and ROM restrictions

e. Remove the rugs at home

Pain

2023-11-06 13:52:55 UTC

Your patient is a 42 yo female that is coming in for her first visit s/p chronic R MCA CVA 7 months ago. She presents with continuous impairments in muscle strength and L arm pain with daily activities. She rates her pain at an 8/10 with activity and 3/10 at rest. Which of the following is the most appropriate home exercise to send her home with Day 1?

a. L-R discrimination for 10 minutes 2x/day for 5 consecutive days/wk

b. Explicit motor imagery for 10 minutes 2x/day for 5 consecutive days/wk

c. L-R discrimination for for 30 minutes 2x/day for 5 consecutive days/wk

d. Explicit motor imagery for 10 minutes 1x/day for 5 consecutive days/wk

OPTIMAL

2023-11-06 13:55:04 UTC

Your patient is a 38 year old male s/p L transtibial amputation. He is coming to out patient rehab to work on gait training. He has 2 daughters and wants to return to coaching their lacrosse team. He has been safe ambulating around his house but he is feeling discouraged because he is worried to walk on the lacrosse field so he hasn’t seen his daughters play. Which of the following would be the appropriate use of OPTIMAL theory and which component is it targeting?

a. we walked over flat ground last time, let’s try an obstacle course today; autonomy

b. imagine you are stepping over the teams lacrosse sticks after stick check; external focus

c. think about really lifting your foot high up off the ground; external focus

d. do you want to try walking outside today?; enhanced expectancies

HD

2023-11-06 13:55:21 UTC

Patient is a 36-year-old female diagnosed with Huntington’s disease 4 years ago. Patient was referred to PT after two previous falls within the last 5 weeks. The patient complains of feeling like she cannot control her movement as well as her hands being “shaky.” She drops things frequently after she picks things up. Her family has been noticing that she has been having difficulty following recipes, which has affected her job as a baker. Upon walking into the initial evaluation, you observe the patient ambulating with a stiff gait. What is the most appropriate prioritized exam?

UHDRS, Coordination, tone testing, TUG
ROM, MMTs, Coordination, DGI
ROM, Coordination, 5x STS, FGA, UHDRS
Tinetti, isometric strength testing, 6MWT, Coordination

Locomotor

2023-11-06 13:57:05 UTC

Pt is 60yo female s/p L ACA CVA who presents to outpatient PT with decreased endurance, impaired transfers, and decreased R limb swing. Pt reports taking metoprolol and baby aspirin to manage HTN. Pt goals is to play with grandchildren and step over toys. You spoke to MD and they cleared you for high intensity gait training. Which of the following treatment / parameters would be best for this patient?

A. Stepping over bean bags on treadmill at HR zone 50% of heart rate max for 20 minutes of 30 minute session

B. Marching at parallel bars at RPE 14 for 20 minutes of 30 minute session

C. Stepping over bean bags on treadmill at RPE 16 for 20 mins of 30 minute session.

D. Side stepping on treadmill at HR zone 65% of heart rate max for 20 minutes of 30 minute session.

OPTIMAL/Motor Learning

2023-11-06 13:58:02 UTC

Patient is a 54 year old male s/p R MCA CVA x 4 weeks ago. Pt presents with hemi-neglect, PMH of HTN, depression, anxiety, and OCD. What intervention is best for treatment of this patient’s impairments?

A. While gait training, provide frequent verbal cues for the patient to focus on taking big steps with their L side and allow them to pick where they want to walk to (the cafeteria or the nurses station) telling them you bet they can walk even further than they did yesterday.

B. Starting the session by asking the patient if they would like to start with stairs or gait training. While doing stairs they complain of extreme fatigue and an RPE of 19/20 so you call it a day and bring them back to their room.

C. High-intensity gait training using the litegait with cues to pretend to step over a puddle when navigating through an obstacle course and responding with “you walked for 5 minutes yesterday, how long can you do today?” when the patient expresses that they do not want to continue with treatment.

D. Perform high-intensity gait training on a treadmill in a weighted vest to increase intensity to 90% of HR max. Tell the patient they have been doing so well, and that you’ve worked with a lot of people who’ve had strokes like them and they’ve been able to walk at 3.0 speed at this time; you bet they can today!

Prosthetic Rehab

2023-11-06 13:58:09 UTC

Claudia is a transfemoral amputee reporting to outpatient therapy 6 months after surgery with a goal to improve gait and mobility. Upon assessment Brian notices Claudia has an excessive varus knee moment. What would be your first step to address this problem?

A) Call the prosthetist

B) Tighten the prosthetic

C) Do nothing as this is normal for time period as the residual limb is still shaping

D) Have the patient doff and donn the prosthetic and check the sock ply (Correct Answer)

Pain

2023-11-06 13:58:48 UTC

Pt comes into outpatient PT s/p R MCA CVA x 7 months ago and complains of burning and shooting pain. As part of their initial treatment the pt was able to identify L and R images of flat hands with an accuracy of 95% and speed of 2.3 sec. Based on this information, what would be the next best plan of care for this pt?

A. progress to mirror therapy as the pt demonstrates normal results with limb laterality

B. progress to motor imagery imagining you are moving your own limb without pain

C. continue with L/R discrimination progressing to images of more complex positions and orientations

D. utilize tactile discrimination as this is the best option to decrease neuropathic pain

Locomotion Training

2023-11-06 13:59:13 UTC

JimBob is a 66-year-old male who suffered an MCA stroke 3 weeks ago and is currently in inpatient rehab. PLOF was ambulating independently throughout the community with his wife Michele. JimBob’s long-term goal for PT is to improve ambulation so he can get back to walking outdoors with his wife. JimBob’s current level of assistance is bed mobility supervision, transfers minA with LBQC, and gait modA x2 with LBQC due to poor stance control. As the PT, what would be the BEST treatment plan to help JimBob reach his long-term goal of improving ambulation?

Working on ambulation on variable surfaces, hardwood floor, and carpet, with a LBQC and mod A.
Spend sessions utilizing Body Weight Support Treadmill Training (BWSTT) with 75% of body weight supported to aid in preventing knee buckle
Body Weight Support (BWS) training throughout the gym over variable surfaces including ramps, cones and steps.
Have JimBob walk on a treadmill with varying speed and incline to increase the intensity of the session while having to step over obstacles on the treadmill.

Prosthetics

2023-11-06 14:01:09 UTC

Janice comes into your clinic with a new prosthesis looking to improve her balance and walking ability. Prior to her traumatic transfemoral amputation, Janice was a plumber who traveled house to house. Other job demands include climbing stairs to access pipes, kneeling, and squatting. Her goals are to return to her job demands and to start exercising for her health.

What is Janice’s assigned K-Level?

What outcome measure did we discuss that would help one assign Janice her appropriate K-Level?

CHAMP
BAMS
AMP
DGI

What prosthetic would be most appropriate for Janice?

Microprocessor, Single Axis Foot
Polycentric knee, SACH
Fluid Control Knee, Dynamic Response Foot
Weight activated locking knee, SACH