Chrissy Durrough
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Hi Valerie,
Thanks for this questions! I wouldn’t worry about memorizing the differences between the EDGE recommendations, especially since the Core Outcome Measures are now available. It is good to be somewhat familiar with the StrokeEDGE outcome measures because they could appear on the NCS exam – so I would just use the EDGE documents as a list of measures to review at this point.I am working on updating the NCS Advantage content over the next year as I am personally preparing for and taking the MOSC recertification exam!
ChrissyHi Karen,
I am not familiar with an MS CPG. This website is my CPG resource that contains CPGs sponsored by the Academy of Neurologic Physical Therapy: https://neuropt.org/practice-resources/anpt-clinical-practice-guidelinesIf there is a good MS CPG available, please let me know and I’ll take a look!
Chrissy
Hi Erin,
I am not aware of any specific cut-offs for dual task training – but I would be interested if you can find the article! I did a quick literature search and couldn’t find anything other than the general recommendations to train dual tasking in the early stages of the disease (H&Y III and earlier) and implement more compensations later on.Here is one article that discusses dual tasking in PD: https://www.bu.edu/neurorehab/files/2017/10/Effectiveness-of-Dual-Tasking.pdf
Again, please let me know if you find the article you’re thinking of!
Chrissy
Hi Janine,
Let me know if you did not receive your certificate. It was sent to your gmail account.
ChrissyHi Yinghua,
Your certificate was emailed to your gmail account on March 14. Let me know if you cannot find it in your inbox or spam folder.
ChrissyThese certificates have been sent out. During the exam window, I batch certificates and generate them all a couple times a week in order to prioritize more urgent exam questions. If you don’t receive your certificate within a few days, the most common issue is not completing the complete case-based exam (you can submit the exam without answering any questions to meet this requirement). Please make sure you are completing all the requirements for your certificate, which will automatically notify me to generate your certificate.
Hi Jean,
Seat depth should not need to be adjusted to accommodate the fixed posterior pelvic tilt. The other exam questions related to seat depth are reinforcing the idea that too deep of a seat can cause posterior pelvic tilt.
Here is a link that provides a little more information about PPT in seating: https://hub.permobil.com/blog/posterior-pelvic-tilt-the-correction-of-sacral-sitting
Hope this helps!
Chrissy
Hi Diana,
Thanks for pointing this out! You are absolutely correct. The question was changed in the master key to be one day post-concussion instead of two weeks, but this update never made it onto the actual exam. The question and explanation have been updated on the site.The patient should continue engaging in physical and cognitive rest until he is two days post-concussion, then we can initiate light aerobic exercise.
Chrissy
Hi Lauren,
Thanks for this question! The pathway to lead to the correct answer is:
1. Patient has decreased ankle strength OR impaired/absent proprioception at the knee/ankle OR ankle PF spasticity –> YES
2. Spasticity, PF contracture, or absent proprioception affects foot placement during standing or gait –> NO
3. Determine if DF stop is indicated –> YES (PF strength <=4, excessive DF in stance), DF stop indicated 4. Determine if DF assist is required --> YES (DF strength <=4) The patient's spasticity is mild (MAS grade of 1) and there is no indication that it is affecting foot placement in stance or gait. Standing posture is marked by excess ankle DF. Decreased foot clearance could be due to spasticity, but it is more likely explained by weakness given the mild nature of his spasticity - especially given his knee flexes during stance phase of gait. Hope this helps! ChrissyHi Kennedi,
From what I am seeing in my literature review, it is safe to engage in early mobilization within 24 hours after ischemic stroke if no tPA is administered. If IV tPA is administered for an ischemic stroke, it is best to wait 24 hours to monitor for hemorrhage. [1]After subarachnoid hemorrhage, mobility can be initiated 24-48 hours after aneurysm treatment. After intracerebral hemorrhage, mobility can be initiated 24 hours after stable ICH volume. [2]
There is evidence that early out-of-bed mobilization within 24 to 72 hours of ICH may improve early functional independence. [3]
Admittedly, acute care is not my area of expertise. I do not have direct acute care experience since my residency program and am open to any resources you have found to be helpful in your studies!
References:
1. Physical Therapy Case Files Acute Care by Erin E. Jobst
2. Olkowski BF, Shah SO. Early mobilization in the neuro-ICU: how far can we go? Neurocrit Care. 2017;27:141-150.
3. Yen HC, Jeng JS, Chen WS, et al. Early mobilization of mild-moderate intracerebral hemorrhage patients in a stroke center: a randomized controlled trial. Neurorehabilitation and Neural Repair. 2020;34(1):72-81.Hi Lauren,
I believe any degree of ankle plantarflexor spasticity, they enter the “Yes” branch of the AFO decision tree. The subsequent selections allow for discretion regarding the severity of spasticity and how it is affecting gait. It is possible for someone to enter the “Yes” branch of the decision tree initially and have no AFO recommended.
ChrissyHi Jennifer,
Thanks for this question! For determining motor function for AIS grades, we ignore levels where there is no muscle test – so the only levels that count toward that “half of key muscle functions” are C5-T1 and L2-S1.For Practice ASIA 3, the neurologic level of injury is T10 and sensory and motor function are preserved in S4-5. Therefore, we look at the motor function in L2-S1 to determine the AIS grade. 7/10 of these levels (4/5 on the right and 3/5 on the left) are graded 3 or better. Because at least half of key muscle functions below the NLI have a muscle grade of >=3/5, this person’s injury is graded as AIS D.
Chrissy
Hi Rachel,
A score of 500/800 (62.5%) is passing for the NCS exam. However, some questions are thrown out upon review after the exam. You can find more details on this website, and below is the excerpt about scoring: https://specialization.apta.org/about-specialist-certification/exam-development“Examination Scoring
After key validation, a procedure designed to identify items that may be miskeyed or not functioning as expected, candidates’ responses are scored and converted to standard scores. The standard scores are scaled so that the minimum passing score on each examination is 500.The certification examinations assess a clearly defined domain of knowledge and skills. Candidates are certified upon achievement of a passing score on the examination.”
You can also view our NCS Advantage Test Day Guidelines page here: https://rehabknowledge.com/ncs-advantage/test-day-guidelines/
Chrissy
Hi Yinghua,
Absolutely, increased ICP could absolutely cause the symptoms mentioned in this case. However, a hemorrhagic stroke causing increased ICP would still be classified as a stroke. Most strokes are ischemic in nature, so the better answer is the umbrella “stroke” answer rather than getting so specific to postulate about the type of stroke.
Hope this helps!
Chrissy
