NCS Advantage

[Chrissy Durrough Lugge]

The NCS Advantage is Rehab Knowledge Advantage’s NCS prep course that contains organized content and practice exams to guide your study process. This forum can be used to clarify any questions from the course and to elaborate on any topics introduced in our lectures.

[Suzanne Adkins]

Hello there!

Just wrapped up with the Stroke lecture – fantastic and thorough review! I had a quick practical question regarding ideal strengthening guidelines outlined in the Pak 2008 article. The article recommends a 60-80% 1RM level of resistance. In the clinical setting, do you typically test the 1 RM of your patients and use this as a guide? If so, how do you calculate it; if not, are there other ways you’ve found useful to help in implementing the appropriate level of resistance?

Thanks so much!

[Melissa Dygulski]

Great question, Suzanne! I do not test for 1 RM in the clinic because usually these patients have a multitude of impairments and may be unsafe. I feel that 1 RM is something used more in the healthy population or near discharge depending on the level of the patient and what they are trying to return to.
That being said, there is a way to use % of the 1 RM to get optimal results for resistance training. Below I’ve listed the training intensity vs. number of repetitions that can be used when determining amount of resistance for your patients. Note: The number of reps listed means that at the patient is only physically able to complete that number, no more, with good form in one set. Use clinical judgment to determine what percentage to start your patients at.

100% of 1 RM = 1 rep
95% of 1 RM = 2 reps
90% of 1 RM = 4 reps
85% of 1 RM = 6 reps
80% of 1 RM = 8 reps
75% of 1 RM = 10 reps
70% of 1 RM = 12 reps
65% of 1 RM = 14 reps
60% of 1 RM = 16 reps

Does that help?

[Suzanne Adkins]

That’s great! Thanks so much.

[Andrew Wagner]

Hello,

Just working my way through the neuroanatomy module and it says that the tectospinal tract turns the head toward sound but I believe the role of this tract is turning the head in response to visual stimuli. The super colliculus of the midbrain receives input from the optic nerves as part of the visual pathway and transmits the information to the contralateral cervical spinal cord via this tract.

Thanks! Great stuff so far.

Andrew Wagner, PT, DPT

[Andrew Wagner]

Hello,

In reference to the same presentation on neuroanatomy and neuroscience.

The autonomic nervous system section states that the sympathetic nervous system causes “pupillary constriction”. The sympathetic nervous system causes pupillary dilation, not constriction. Horner’s sign, which is seen with PICA strokes causes an ipsilateral constriction of the pupil due to loss of sympathetic input (therefore impairing the normal pupillary dilation).

Andrew Wagner, PT, DPT

[Andrew Wagner]

Hello,

In reference to the same presentation on neuroanatomy and neuroscience.

The Blood supply to the posterior limb of the nternal capsule is said to be the posterior cerebral artery.

The posterior limb of the internal capsule is supplied by the lenticulostriate branches of the MCA. Sometimes the ACA, but not often.

References:
http://www.umassmed.edu/strokestop/module_three/module_fr.html
http://stanfordmedicine25.stanford.edu/the25/ics.html

Andrew Wagner, PT, DPT

[Chrissy Durrough Lugge]

Hi Andrew,

Thanks for posting to the discussion forum! We’ll work through your comments one by one:
1. You are correct about the tectospinal tract. It serves to turn the head toward visual stimuli, in addition to sound. The handouts have been updated to reflect this.
2. You are 100% right about the autonomic nervous system. The sympathetic nervous system causes pupillary dilation and the parasympathetic nervous system causes pupillary constriction. We have corrected the handouts.
3. We double checked the blood supply for the posterior limb of the internal capsule and found some conflicting opinions – but, you are right, most sources cite the lenticulostriate branches of the MCA and the anterior choroidal artery (branch of the internal carotid artery) as the primary blood supply. The posterior cerebral artery supplies much of the diencephalon (including the thalamus), as well as portions of the temporal and occipital lobes.

We apologize for these errors and appreciate you pointing them out. We are constantly re-evaluating the material to make sure you have the best material possible. Thank you for your patience as we continue to develop the course!

[Meredith Greene]

Regarding the 1 RM discussion…The APTA course to become a “Certified Exercise Expert for Aging Adults” recommends the following guidelines
using the Borg RPE terms
1. Have your patient perform (2) reps of the desired exercise with a weight you think will be appropriate.
2. Have the patient stop and ask him “Is that exercise fairly easy, somewhat hard, or hard?”. For 60-80% of 1 RM, the answer should be “Somewhat Hard”. This subjective RPE has been correlated to 60-80% 1RM. If it’s fairly easy, it’s 30-60% 1 RM, which is what we want to use with our frail/medically more fragile patients. At this level of intensity, he should be able to perform 12-25 reps with good form and no more.
3. Again, checking form continuously. “Somewhat hard” would be 12-14 on the Borg 20 point scale.
I have used this method with all of my patients with whom I’m trying to establish 60-80% of 1 RM. Yes, some of them reach that with only 2#, some with manual resistance, some with 8#. I’ve seen really good results with this and it’s very easy to teach your patient how to self-progress the weight used for carryover to exercising after d/c.

As an aside, I HIGHLY recommend this course. It is taught by 3 of the APTA leaders in Geriatric PT and 100% Evidence Based. I took it back in 2010 and it changed the way I treat.
Good luck!

[Chrissy Durrough Lugge]

Awesome information! Thanks so much for sharing, Meredith!

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