Watch the video version of this episode on YouTube - https://youtu.be/M4lVSR6bwC8

A physical therapist orders a wheelchair with anti-tip tubes for a patient in preparation for discharge from a rehabilitation hospital. A patient with which of the following conditions would benefit the MOST from this option?

1. Guillain-Barre syndrome
2. C5 tetraplegia 
3. Stroke with hemiparesis
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 physical therapist orders a wheelchair with anti-tip tubes for a patient in preparation for discharge from a rehabilitation hospital. A patient with which of the following conditions would benefit the MOST from this option?

1. Guillain-Barre syndrome
2. C5 tetraplegia 
3. Stroke with hemiparesis
4. Amyotrophic lateral sclerosis

Wheelchairs
Wheelchairs can be manually propelled or externally powered. Considerations when selecting an appropriate wheelchair and its component options include the patient’s physical needs, physical abilities, cognition, coordination, and endurance.

Anti-tip Tubes
Anti-tip tubes are an easy to install option that fit most standard wheelchair models and are designed to instantly improve patient safety by preventing the wheelchair from tipping backwards. 

The question requires students to reflect on the clinical presentation of each of the presented diagnoses and then determine which individual would benefit from a wheelchair equipped with anti-tip tubes.

Let’s explore each of the options:

Option 1 - Guillain-Barre syndrome
Guillain-Barre syndrome is a temporary inflammation and demyelination of the peripheral nerves’ myelin sheaths. Guillain-Barre syndrome results in motor weakness in a distal to proximal progression, sensory impairment, and possible respiratory paralysis.

Since the extent of impairment for each patient depends on the clinical course of their condition, wheelchair needs will be highly variable. The majority of patients with Guillain-Barre syndrome experience significant improvement in their condition with many making a full recovery.

Option 2 - C5 tetraplegia
C5 tetraplegia, also known as C5 quadriplegia, refers to a type of tetraplegia (paralysis affecting all four limbs) resulting from a spinal cord injury at the C5 level. This type of pathology causes varying degrees of paralysis in the arms, hands, trunk, and legs, but typically allows for some shoulder and elbow function.

Anti-tip tubes are commonly used with patients who have spinal cord injuries. In this particular case, a patient with C5 tetraplegia would have significant physical limitations and would be dependent on a wheelchair indefinitely for mobility needs. Anti-tip tunes provide the patient with a measure of safety in the event of backward tipping. 

Option 3 - Stroke with hemiparesis
Stroke is a medical condition in which inadequate blood flow to a portion of the brain causes cell death. A stroke with hemiparesis, also known as a stroke causing weakness on one side of the body, occurs when a stroke damages the brain, leading to impaired motor function and weakness on the opposite side of the body.

The clinical presentation of a stroke is determined by the location and extent of the infarct. Since typical characteristics of a stroke include hemiplegia or hemiparesis, a hemi frame wheelchair or a one-hand drive frame would be the most likely needed components.

Option 4 - Amyotrophic lateral sclerosis
Amyotrophic lateral sclerosis (ALS) is a chronic degenerative disease that produces both upper and lower motor neuron impairments. ALS is usually a rapidly progressing neurological disease with an average course of two to five years with 20-30% of patients surviving longer than five years.

Patients with ALS will likely need frequent modifications to their wheelchair as the disease progresses and eventually will become dependent for all mobility. Due to the rapid progression of ALS and subsequent physical limitations, anti-tip tubes become a less critical wheelchair adaptation for this population. 

The correct answer is Option 2

Let’s explore the all student data:
9% of students selected Option 1, Guillain-Barre syndrome
50% of students selected Option 2, C5 tetraplegia, the correct response
27% of students selected Option 3, Stroke with hemiparesis
14% of students selected Option 4, Amyotrophic lateral sclerosis

System Classification
This question is a Non-Systems question which represents approximately 14% of all exam items.

Content Outline Classification
This question is an Equipment, Devices, and Technologies; Therapeutic Modalities question which represents approximately 6% 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 pages 695-699 in PTEXAM: The Complete Study Guide.

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