Watch the video version of this episode on YouTube - https://youtu.be/xrtJ070YVZw 

A patient attends an outpatient physical therapy clinic six weeks following a left hemisphere stroke and presents with poor functional use of their affected upper extremity. The therapist determines the patient would benefit from the use of a sling to force the patient to use their affected extremity more frequently. Which of the following recommendations would be MOST appropriate for sling use?

1. Wear the sling on the right arm for 10% of waking hours
2. Wear the sling on the right arm for 90% of waking hours
3. Wear the sling on the left arm for 10% of waking hours
4. Wear the sling on the left arm for 90% of waking hours

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A patient attends an outpatient physical therapy clinic six weeks following a left hemisphere stroke and presents with poor functional use of their affected upper extremity. The therapist determines the patient would benefit from the use of a sling to force the patient to use their affected extremity more frequently. Which of the following recommendations would be MOST appropriate for sling use?

1. Wear the sling on the right arm for 10% of waking hours
2. Wear the sling on the right arm for 90% of waking hours
3. Wear the sling on the left arm for 10% of waking hours
4. Wear the sling on the left arm for 90% of waking hours

The question describes the use of constraint-induced movement therapy. 

Let’s explore this rehabilitation technique.

Constraint-induced Movement Therapy
Constraint-induced movement therapy is a task-oriented intervention that has been shown to be effective in improving upper extremity function following a neurological injury, such as stroke. Constraint-induced movement therapy involves immobilization of the unaffected extremity using a sling or mitt to force the use of the paretic limb. For constraint-induced movement therapy to be effective, task-oriented training must occur with the involved limb for several hours each day.

The question requires the therapist to make two decisions.

Decision Time!

1. Will the sling be used on the affected or unaffected extremity?
2. Will the sling be used frequently or infrequently?

If you were familiar with constraint-induced movement therapy from your academic or clinical training, it was likely a very easy question to identify the correct response. 

Lack of familiarity makes it far less probable that the question was answered correctly. 

Let’s explore each of the options:

Option 1 - Wear the sling on the right arm for 10% of waking hours
The patient had a left hemisphere stroke and therefore would have right-sided weakness. After a stroke, it’s distinctly possible that a sling would be worn on the affected side to help protect the arm (e.g., for a flaccid arm). However, the question states that the therapist wants to force the patient to use their affected extremity. Therefore, the sling should be worn on the patient’s unaffected (left) arm. Additionally, wearing the sling for only 10% of waking hours would be less than the recommended timeframe.

Option 2 - Wear the sling on the right arm for 90% of waking hours
Wearing the sling for 90% of waking hours is consistent with the recommendation for constraint-induced movement therapy. 

For this rehabilitation technique to be effective, a high intensity of task-oriented practice of the affected extremity and of general sling use is necessary. However, the sling should be worn on the unaffected extremity to force the use of the affected extremity.

Option 3 - Wear the sling on the left arm for 10% of waking hours
The patient had a left hemisphere stroke and therefore would have right-sided weakness. Since the patient’s right extremity is affected, the left upper extremity should be constrained using a sling. However, wearing the sling for only 10% of waking hours would be less than the recommended timeframe.

Option 4 - Wear the sling on the left arm for 90% of waking hours
The patient should wear the sling on their left upper extremity for 90% of waking hours. For constraint-induced movement therapy to be effective, a high intensity of task-oriented practice and of general sling use is necessary.

The correct answer is Option 4

If you selected option 2 - Wear the sling on the right arm for 90% of waking hours, my guess is that you made a test taking mistake. Instead of focusing on facilitating use of the affected extremity, your focus was likely on protecting the affected extremity. In this scenario, you answered a different question than the question that was asked,  – a classic test taking mistake.

Let’s explore the all student data:
5% of students selected Option 1, Wear the sling on the right arm for 10% of waking hours
15% of students selected Option 2, Wear the sling on the right arm for 90% of waking hours
10% of students selected Option 3, Wear the sling on the left arm for 10% of waking hours
70% of students selected Option 4, Wear the sling on the left arm for 90% of waking hours, the correct response

System Classification
This question is a Neuromuscular and Nervous Systems question which represents approximately 24% of all exam items.

Content Outline Classification
This question is an Interventions question which represents approximately 29% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Check out page 299 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!