Chrissy Durrough Lugge
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Hi Tawiona,
All the examples you provided are correct. For cupulolithiasis, the goal is to displace the otoconia from being stuck in the cupula and convert the BPPV from cupulolithiasis to canalithiasis. We use a very fast movement like the Semont/Liberatory to try to break the otoconia free. Once the otoconia are free-floating in the canal (canalithiasis), we treat with the Epley.The BBQ roll is only used for horizontal canalithiasis.
Chrissy
Hi Paul,
Our exams are designed to aid in your study process by helping to identify knowledge gaps, become familiar with what NCS exam questions may look like, and improve test-taking endurance. Similar to our practice questions, you will likely find that some of the questions on the NCS exam are relatively straightforward while others require more critical thinking (including reasoning through several straightforward aspects to get to the correct answer). Again, our goal is not for all questions to replicate the NCS exam exactly; our hope with some of the simpler questions is that they will help you flag topics that warrant further review.We are proud that over 98% of our participants pass their NCS exams and feel this indicates our program is appropriately preparing individuals to sit for the exam.
Chrissy
The push-pull mechanism is where the left and right canals *in the same plane* are excited/inhibited. As you will see on slide 2.13 in the vestibular lecture, the posterior and anterior canals are not in the same plane on the left and right.
The co-planar pairs are:
– Left and right horizontal canals
– Right posterior and left anterior canal
– Right anterior and left posterior canalWe want to ask the patients to perform certain tasks as part of our assessment, though we wouldn’t expect the patient to follow our commands if they are truly in a coma. Visual tasks are important because they can help us identify if a person has locked-in syndrome rather than coma.
I think reviewing the Coma Recovery Scale will help you because it details the follow-up assessments if someone cannot follow commands (i.e., manually open eyes and present visual threat to assess visual startle as the visual function exam).
I doubt they are too in depth. A general understanding of what the big medications treat should be sufficient. For example, I would try to have a decent grasp of dopamine replacement therapy for Parkinson’s disease and what it helps/doesn’t help. Spasticity is another topic that where PT interacts closely with pharmacology.
Compared to complex seizures, absence seizures have an abrupt ending and no post-ictal phase.
Here are a couple links with short explanations of different types of seizures:
– https://magazine.medlineplus.gov/article/understanding-different-kinds-of-seizures
-https://www.aafp.org/pubs/afp/issues/2015/0115/p114.html#:~:text=Absence%20seizures%20can%20be%20differentiated,to%20be%20the%20main%20cause.Hi Alex,
Correct – a coma is a state of unarousable unconsciousness with no periods of wakefulness or eye opening in response to stimulation. A vegetative state (or unresponsive wakefulness syndrome) is marked by periods of wakefulness but no signs of awareness of oneself or the surroundings.Coma is caused by disordered arousal (level of consciousness) whereas vegetative state is caused by absence of awareness (content of consciousness.
The Coma Recovery Scale-Revised (or CRS-R or JFK Coma Recovery Scale) is a standardized neurobehavioral assessment measure designed for use in individuals with disorders of consciousness. The scale is intended to be used to establish diagnosis, monitor behavioral recovery, predict outcomes, and assess treatment effectiveness. It consists of 6 subscales to assess brainstem, subcortical, and cortically mediated behaviors. The scale is intended to be administered repeatedly over time to monitor change.
The scale details how to assess each item (including auditory, visual, motor, oromotor, communication, and arousal functions). For instance, motor responses range from appropriate functional use of objects to no response to noxious stimuli. You can see the details for the assessment here: https://www.tbims.org/combi/crs/CRS%20Syllabus.pdf
Once a person with a disorder of consciousness demonstrates presence of sleep-wake cycles but lacks evidence of awareness of self and environment, they are considered to be in a vegetative state. When they have discernable and reproducible evidence of awareness of self or environment (simple command following, yes/no responses, intelligible verbalization, purposeful behavior), they are considered to be in a minimally conscious state.
I believe you can flag most questions to go back and review. The exception are the vignettes where questions build upon one another. Once you complete a section (50 questions), you cannot return to that section.
I’m not sure if there is any more recent information that is distributed to individuals taking the exam this year – this is the most recent information I have heard and found on the website (https://specialization.apta.org/become-a-specialist/exam-specialty-resources/exam-day).
Hi Alex,
Spinal shock always resolves over a period of days to months – even if someone has a complete spinal cord injury. There are a number of indicators that spinal shock has resolved. In the case of a complete SCI without lower motor neuron injury, the easiest signs to recognize are the emergence of spasticity and/or return of deep tendon reflexes.If you want to get into the weeds of spinal shock, this article has some good info and I included an excerpt below: Ko H. Revisit spinal shock: pattern of reflex evolution during spinal shock. Korean J Neurotrauma. 2018;14(2):47-54.
“Spinal shock usually lasts for days or weeks after spinal cord injury and the average duration is 4 to 12 weeks. Spinal shock is terminated earlier and the pyramidal tract signs and defense reactions occur sooner in incomplete lesions than with complete transverse lesions. The identification of clinical signs that determine the duration of spinal shock is controversial. There is no uniform consensus on defining the cessation of spinal shock. Most references define the end of spinal shock with a return of specific reflexes. However, not all reflexes are uniformly depressed in each patient. Reflexic changes are individualized. The resolution of spinal shock occurs over a period of days to months, and spinal shock slowly transitions to spasticity. Various authors have defined the termination of spinal shock as the appearance of the bulbocavernosus reflex, the recovery of deep tendon reflexes, or the return of reflexic detrusor activity. Nevertheless, there are many questions to answer, such as: When should we define spinal shock as the end? What types of reflexes appear first among polysynaptic cutaneous reflexes, monosynaptic deep tendon reflexes, and pathological reflexes? Should it include changes in autonomic reflexes such as a detrusor reflex?”
Hi Karen,
Tumor grade is not the same as cancer stage. Tumors are graded as 1-4 and can begin as any grade. Cancer begins as stage 1 and can spread – it is generally named for the stage at initial diagnosis.-This link explains a little more about tumor grading: https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/tumor-grade
-And cancer staging: https://www.cancer.gov/about-cancer/diagnosis-staging/stagingChrissy
Hi Valerie,
Great question! I would refer to the Core Outcomes CPG for this one because that is the most recent recommendation from the ANPT – and they recommend recording distances in meters. Clinically, I tend to use feet because that is easier for me to visualize having used the standard system my whole life.
ChrissyHi Karen,
There isn’t a minimum muscle grade for FES to be indicated. However, you should be able to elicit a muscle contraction with FES in order to justify its use.Ha! Sorry for the long explanation of the wrong video!
This is a grainy video. A big hint is that you know he is in right Dix-Hallpike. Left posterior canalithiasis wouldn’t produce this robust response in right Dix-Hallpike position. For me, the nystagmus is most clear when the patient has his eye open completely and the nystagmus starts to “settle” a bit – around 17 seconds and 28 seconds are little windows where I think it is easier to see.
Hi Alyson,
Are you working through the “Diagnosing BPPV: Interpreting Nystagmus” tutorial or the “Diagnosing BPPV: Bonus Videos”?Since you refer to looking at only one eye, I am assuming it is the “Diagnosing BPPV: Interpreting Nystagmus” tutorial (case 3 on the bonus videos is a binocular video) – and I think you might actually have it mostly figured out. We are looking at the patient’s LEFT eye in this video. As you could tell the nystagmus is torsional and upbeating. On our screens, the fast phase is going to the right, which is the patient’s left. The patient has upbeating and left torsional nystagmus, consistent with left posterior canal involvement.
This nystagmus is more subtle than some of the other examples. Finding a specific point on the patient’s eye can lend some clarity on what is actually happening. In this case, I think some of the markings right around the pupil are the easiest to identify the nystagmus’ characteristics.
You can think of it as clockwise and counterclockwise, but this can easily be converted to left/right (personally, I find it simpler to think in terms of left/right). CW/CCW would still be from the patient’s vantage point. Clockwise nystagmus would be torsional with the fast phase to the patient’s right. Counterclockwise would be torsional with the fast phase to the patient’s left. This patient has CCW upbeating nystagmus.
Chrissy
