Practice test 2 questions.

[Alex Turcios]

Hi, I have a few questions regarding practice test 2

1) Question regarding which outcome measure score is a fall risk. two choices are berg balance score of 49, and another choice of Functional Gait assessment score of 21. Isent 49 at the berg a fall risk? its below 50, but i understand that its not until you score less then 40 where one becomes an absolute certainty that they will fall. How do i go about this question?

2) Question asks about a Posterior spinal artery infarct and what deficits would be seen during gait. The correct answer is decreased foot clearance during swing. I selected foot slap during loading response as I figured the slap would help provide increased sensory input for the impaired sensory tracts of the spinal cord.

3) Ask about discharge destination for a patiet who walks .5m/s. I looked into the source fritz and Lsardi and could not fins any correlation of walking speed and d/c destination. I know that as per the 10m walk test states that >.8 is outdoor, .4-.8m/s is limited outdoors, and <.4m/s is indoors. Does this mean that since they can ambulate outdoors (though limited) they would be discharged home?

4) This is the question about worstening back pain that ended up having a a referral to ED for spinal neoplasm. I could see that it is not Guillain barre, my thought was because GBS does not have incontinence as a hallmark sign. Is this true? Also, as for the other choices, deffering a patient until pain improves, could that ever be a correct answer? I woul imagine that the questions they ask would not have this as a possible correct answer. Another option was to proceed with the evaluation and sent reports to PCP for review and attestation, could this ever a valid answer in the NCS exam? I guess what I am asking here is more of a test taking strategy as opposed to assist with the information itself. Could I safly omit those types of answers?

[Chrissy Durrough Lugge]

1) This question was written when the falls risk cut-off for the BBS was 45/56. It has been updated to have one correct answer.

2) You’re correct that both decreased foot clearance and increased force at initial contact can result from impaired sensation. This patient has an acute/sub-acute CVA as he has just been admitted to inpatient rehab. At this point, it is more likely that we will see decreased foot clearance during swing phase due to the inability to feel where his feet are in space and to increase sensory input through the floor. As the patient progresses and can consistently clear his feet and achieve heel strike at initial contact, we might see foot slap during loading response.

3) Figure 1 in the Fritz and Lusardi paper shows how walking speed is linked to discharge location. Walking speeds <0.1 m/s indicate increased likelihood of being discharged to a SNF while walking speeds >0.1 m/s indicate a discharge to home is more likely.

4) This patient was referred for back pain but presents with concerning signs of neurologic dysfunction. Given that a source of these signs has not been identified, the therapist’s best recommendation is for the patient to receive immediate medical attention. Because the patient’s symptoms have been gradually worsening, spinal neoplasm is more likely than Guillain-Barre syndrome. This patient has a number of red flags warranting immediate medical attention (age >50, symptoms radiating below the knee, atypical pain that is not affected by position changes, incontinence).

Here is the abstract from an article about red flags in acute low back pain (https://www.consultant360.com/peer-reviewed/acute-low-back-pain-recognizing-red-flags-workup#:~:text=%E2%80%9CRed%20flags%E2%80%9D%20include%20pain%20that,of%20a%20severe%20or%20rapidly):
A focused history and physical examination directed towards uncovering signs that suggest a serious underlying cause of low back pain are crucial. “Red flags” include pain that lasts more than 6 weeks; pain in persons younger than 18 years or older than 50 years; pain that radiates below the knee; a history of major trauma; constitutional symptoms; atypical pain (eg, that which occurs at night or that is unrelenting); the presence of a severe or rapidly progressive neurologic deficit; urinary and/or fecal incontinence; poor rectal tone; and a history of malignancy. These markers provide a cost-effective means of guiding your selection of laboratory and diagnostic imaging studies.

[Alex Turcios]

Thank you!
Wow, cant believe I overlooked that graph from fritz and lusardi!

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