Watch the video version of this Q&A episode on YouTube - https://youtu.be/s1CygehzJgM 

A patient receives physical therapy services at an outpatient neurological rehabilitation clinic. After examining the patient, the physical therapist determines they would benefit from constraint-induced movement therapy using a mitt. Which of the following diagnoses would MOST likely benefit from this intervention?

1. Posterior cord syndrome
2. Complete C4 spinal cord injury
3. Right hemisphere stroke
4. Amyotrophic lateral sclerosis

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 receives physical therapy services at an outpatient neurological rehabilitation clinic. After examining the patient, the physical therapist determines they would benefit from constraint-induced movement therapy using a mitt. Which of the following diagnoses would MOST likely benefit from this intervention?

1. Posterior cord syndrome
2. Complete C4 spinal cord injury
3. Right hemisphere stroke
4. Amyotrophic lateral sclerosis

Assuming you are a regular podcast listener, the first thought that likely entered your mind after reading this question was…another question on constraint-induced movement therapy.

The good news is that if you reviewed the explanation associated with last week’s question, there should be close to 100% probability that you answered the question correctly. 

It’s impossible to predict the frequency of any specific topic on the NPTE since the examination blueprint published by the Federation of State Boards of Physical Therapy provides only a broad overview of the system and content outline weighting. 

What is important is that over the course of your study plan you develop talking knowledge of as many different topics as possible.

Let’s take a deeper dive into constraint-induced movement therapy.

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. 

Constraint-induced movement therapy involves immobilization of the unaffected extremity using a sling or mitt to force use of the paretic limb.

Armed with this knowledge, let’s explore each of the options:

Option 1 - Posterior cord syndrome
Posterior cord syndrome is a relatively rare syndrome that is caused by compression of the posterior spinal artery and is characterized by loss of proprioception, two-point discrimination, and stereognosis. Motor function is preserved and therefore a patient with this condition would not benefit from the use of constraint-induced movement therapy ……Survey Says…No!

Option 2 - Complete C4 spinal cord injury 
A patient with a complete C4 spinal cord injury will have innervation of the face and neck, diaphragm, and trapezius muscles. They would not have innervation to the majority of upper extremity muscles and therefore would have no functional use of their arms. This patient would not benefit from the use of constraint-induced movement therapy …… Survey Says…Impossible!

Option 3 - Right hemisphere stroke 
A right hemisphere stroke occurs when the blood supply to the right side of the brain is stopped. The condition typically presents with unilateral weakness of the left side of the body. As a result, the patient may benefit from the use of constraint-induced movement therapy since the rehabilitation technique is designed to promote increased functional use of the affected upper extremity.…… Survey Says…Boom Time!

Option 4 - Amyotrophic lateral sclerosis 
Amyotrophic lateral sclerosis (ALS) is a chronic degenerative disease that produces both upper and lower motor neuron impairments. Muscle weakness due to denervation eventually causes significant fasciculations, atrophy, and wasting of the muscles. ALS is a rapidly progressing disease and improvement in a patient’s strength or functional abilities is unlikely to occur. Therefore, this patient would be unlikely to benefit from constraint-induced movement therapy …..Survey Says…Not Happening!

The correct answer is Option 3

Let’s explore the all student data:
8% of students selected Option 1, Posterior cord syndrome
3% of students selected Option 2, Complete C4 spinal cord injury
85% of students selected Option 3, Right hemisphere stroke, the correct response
4% of students selected Option 4, Amyotrophic lateral sclerosis

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!