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Your patient sustained a traumatic brain injury (TBI) 9 months ago. They are ambulatory with a FWW and supervision, but fatigue after about 10 minutes of walking due to an inefficient, hemiparetic gait pattern. They would like to eventually walk without the walker. According to the 2020 Locomotor Clinical Practice Guideline, which of the following approaches would be most highly recommended?  

Considering Betsaida and Rick’s clinical presentations, compare and contrast how you would approach their treatment sessions in terms of environment, maximizing their learning, etc. What would be the same? What would be different? (1 point each, 2 points)

Dr. Curious is interested in the relative impact of heredity (“nature”) versus environment (“nurture”) on running speed.  Which of the following research designs would be most effective in addressing this question?  

Therapeutic hypothermia is an area of spinal cord injury research that falls into which category?

Which of the following statements about cognitive multisensory rehabilitation (CMR) is false?

Additional information from Betsaida’s evaluation: Patient Goals: “I want to return to living in my own home.  I want to be able to get up, use the bathroom, take a shower, and walk by myself.”   Movement Analysis:  Bed mobility: Betsaida rolls onto her weaker side by pulling on a bedrail with her RUE, but is unable to do so without the rail.  Once she is on her left side, she requires assistance to place her LUE in a stable position for the initial push-up to sitting midline. Transfers: Betsaida sits with her weight shifted onto her right hip and RUE.  Her left UE rests across her lap, but when verbally cued, she can move it to rest her left hand on the mat next to her.  Her grip is weak and she cannot keep hold of the edge of the mat with her left hand.  She uses multiple forward/backward rocks to get momentum to stand, then requires Mod A for lift-off, balance, and knee stabilization when she is pivoting to sit in her wheelchair.  Gait/Stairs:  Betsaida walks short distances (10-20 feet) with her LBQC and the AFO she was given at the hospital.  Her daughter provides Min-Mod A because her gait is unsteady, and Betsaida fatigues quickly. Her L ankle is well supported by the AFO, but she has excess knee and hip flexion in stance phase and inadequate limb clearance in swing phase, resulting in a toe drag. She leans heavily on her cane. For stairs, she defaults to a step-to pattern, ascending with her stronger RLE and descending with the weaker LLE. Her daughter and son hold her up around her waist but her LLE continues to buckle and her L toe catches on the step. You are worried about their collective safety. Given Betsaida’s current status, identify one of the objective measures recommended by the CPG: Core Set of Outcome Measures for Adults with Neurological Conditions that you would complete with Betsaida during your evaluation. Provide specific justification as to why you chose this measure for Betsaida.

You refer Pat to a movement disorder neurologist, who does diagnose Pat with FND. When you see Pat for the first time after diagnosis, they have a lot of questions. Which of the following statements is supported by research?

Caleb is a 25 y/o male (he/him) who has been diagnosed with a C6 ASIA A SCI that was sustained in a motor vehicle accident 1 week ago after he fell asleep at the wheel and his car rolled over.  He sustained a C5 spinal fracture dislocation, as well as chest, facial, and upper extremity injuries. During your morning PT session, you arrive to find Caleb in bed, complaining of a pounding headache.  You check his BP and discover it is 180/80 at rest. His BP is normally 108/70. You also note that Caleb’s face is sweating profusely and he is very flushed. What do you think is the cause of these symptoms (name it)?   What would you do about it?  Name at least 3 things you would do to respond.  (2 points)

Your new patient, Mrs. T, is 80 years old and coming to you for evaluation after a recent fall. She is ambulatory with a single point cane, so you complete the 10MWT and discover that her gait speed is 0.75 m/s. What does this tell you about her function?

Objective Testing Results: Light touch and sharp/dull sensation: impaired LUE/LE.  Proprioception: impaired LUE, intact LLE. Abnormal Synergy: Selective movement noted BUE/LE.  Spasticity: MAS 1+ in L calf, 2 in L biceps. MMT: RLE/RUE 4/5 throughout.  LLE: hip flexion 3+/5, hip abduction 3-/5, hip extension 3-/5, knee extension 4/5, ankle DF and PF 3-/5.  LUE: 3+/5 throughout.  Design a treatment intervention to address Betsaida’s strength deficit. Your intervention should be functional (not just a classic therapeutic exercise) and be an appropriate level of challenge for her current status. Describe this in enough detail that it could be replicated by another therapist who is treating Betsaida for the first time. Include the following (4 points total): a) set-up of the functional activity, including equipment/environment, patient position, what you are doing as the therapist (cues, physical assist, etc) (1 point) b) what muscle groups you are targeting with this functional activity (1 point) c) what your thoughts are about dosing and how you will determine if that dosing is appropriate for Betsaida (1 point) d) choose one of the three OPTIMAL Theory concepts and describe how you would apply it to this intervention (1 point)