OVER 96% PASS RATE FOR THE NCS, OCS, AND PCS EXAMS › forums › PCS Advantage › #64 case based exam
I overlooked this when taking the test the first time. Besides your explanation, I want to make sure I am naming correctly, is the reason #64 can be considered l4-L5 because the Hamstring is grade 3 or better?
Going from the Campbell’s text, for naming myelomeningocele; table 23.1 pg 552
L1-L2 Exceeds criteria for L1 but does not meet L2 criteria.a
L2 Iliopsoas, sartorius, and the hip adductors all must be grade 3 or better.
L3 Meets or exceeds the criteria for L2 plus the quadriceps are grade 3 or better.
L3-L4 Exceeds criteria for L3 but does not meet L4 criteria.
L4 Meets or exceeds the criteria for L3 and the medial hamstrings or the tibialis anterior is grade 3 or better.
A weak peroneus tertius may also be seen.
– Exceeds criteria for L4 but does not meet L5 criteria.
L5 Meets or exceeds the criteria for L4 and has lateral hamstring strength of grade 3 or better plus one of the following: gluteus medius grade 2 or better, peroneus tertius grade 4 or better, or tibialis posterior grade 3 or better.
64. After a review of the child’s medical records and completion of a comprehensive examination, you determine that the child has strength of at least 3/5 muscle grade in the following muscle groups: hip flexion, hip adduction, knee extension and flexion; and 2/5 muscle grade in the following muscle groups: hip abduction, ankle dorsiflexion, foot inversion, and toe extension. Which spinal lesion level best describes this child’s neural impairment?
In myelomeningocele, therapists must be mindful of the fact that the spinal lesion level does not always correlate with an exact muscle function level. Therefore, detailed manual muscle testing is critical for determining a child’s muscle function and potential motor abilities. In many cases, children with a L4-5 lesion level have active movement in hip flexion, hip adduction, knee extension, hip abduction, knee flexion, ankle DF and inversion, and toe extension. For a L1-3 lesion level, you might see active movement at hip flexion and adduction. For a L3-4 lesion level, you might see active movement at hip flexion and adduction plus knee extension. For a S1-3 lesion level, you might see active movement in all lower extremity muscles, although significant weakness may be present in more distal muscle groups.
For an L4, possible muscle function includes: medial knee flexors (3/5) and ankle dorsiflexors (3/5) as well as all levels from L3 (knee extensors 3/5) and L2 (hip adductors 3/5, hip flexors 3/5), L1 (lower trunk, hip flexors 2/5), and above. For an L5 lesion, possible muscle function includes: hip abductors (2/5), lateral knee flexors (3/5), ankle invertors (3/5), toe extensors (palpable at ankle). L5 clues in this patient are the hip abductors, foot inversion, and toe extension. We would expect stronger muscle groups if the child was S1-3 as well as hip extension and ankle plantarflexion present to some extent.
Here is a resource I find helpful: https://depts.washington.edu/dbpeds/HOW%20SB%20LESIONS%20IMPACT%20DAILY%20FUNCTION.pdf
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