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You are treating Juan (he/him) in outpatient PT about 3 months after he experienced a left hemisphere stroke impacting his right arm motor control. You do the quick Fugl-Meyer screen and find that he is able to flex his right shoulder forward with his elbow straight. When you ask him to abduct his shoulder out to the side, his elbow flexes and his forearm supinates. You ask him to repeat the shoulder abduction movement two more times with cues to keep his arm straight, but you continue to note elbow flexion and forearm supination. What do these screening results tell you? 

Assume that the body structure/functions you assessed in the previous question showed impairment in those areas.  Given what you know to this point, choose a type of ankle-foot orthosis that you think might benefit Betsaida and provide rationale/justification. 

While in the line of duty, Private Roads (she/her) experienced a blast injury with injuries affecting her head and neck. She is reporting some blurry vision. Her peripheral vision is reduced on the right side in both the upper and lower quadrants. Her resting gaze is stable and her H-test is smooth and accurate. During the pupillary light reflex test, neither eye constricts when you shine the light in the right eye, and both eyes constrict when you shine the light in the left eye. Which cranial nerve is involved?

Home setup: Betsaida lives alone in a single level apartment with one step to enter, no handrails. There is thick carpet in all rooms, except for tile and throw rugs in the bathroom and kitchen.  The bathroom has a shower stall only (no tub), standard toilet seat.  Betsaida will be discharging home. With this in mind, identify two anticipated environmental factors related to this case and make a recommendation for each in order to maximize her safety at home. (2 pts)

Cognition/Communication: Betsaida greets you pleasantly and is able to tell you her name. She does not recall the date or that she is in the hospital.  She tells you that she cannot remember having a stroke but “that’s what they told me I have, so I guess it must be true.”  She asks you to repeat your name several times throughout the session. Vision/Perception: Betsaida wears glasses, and has them in the hospital with her. She reports that her vision is “blurrier” since the stroke. While she is walking with you, she bumps into the door frame of her room on her left, does not notice people on her left, gets distracted by the activity in the hallway and needs to be redirected to attend to her walking.        Hearing: Betsaida has presbycusis. Her daughter forgot to bring her hearing aids to the hospital. Based on Betsaida’s presentation, briefly describe 2 strategies that you will use to maximize your communication with her during today’s PT session. (1 pt each, 2 pts total)

You are reviewing the medical chart of Ronnie, a patient who was referred for neuro PT after an acute infection in the midbrain. The chart indicates that Ronnie has Cranial Nerve IV palsy. Which of the following would you observe and/or expect Ronnie to report experiencing?

Herfindahl-Hirschman Index (HHI)

Describe Physician-Induced Demand hypothesis – what is its basic premise, what are some of its implications?

ESSAY: Write a short essay on the question listed below (25 points)

Which of the following factors in the U.S. is the primary driver for why U.S. spends more on healthcare than other nations?