Chrissy Durrough Lugge
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Hi Karen,
I think the thumbnail image on the posterior cord syndrome slide might be deceiving. Posterior cord syndrome is a lesion isolated to the area of distribution of the posterior spinal artery, which is really just the dorsal column-medial lemniscus tracts.In practice, things are rarely that clean and other tracts may be affected by a traumatic injury – but true posterior cord syndrome is isolated to sensory changes.
Chrissy
I’ll let you know if I find anything else and may add another example as I am updating the course for 2024-25!
VAC is a motor assessment and DAP is a measure of sensation. Motor control only requires voluntary anal contraction.
Regarding additional practice videos, I found a couple on YouTube:
1. https://www.youtube.com/watch?v=LErgPVcgHW0
2. https://www.youtube.com/watch?v=ewv3haxxDCcI haven’t watched either of these in their entirety, but they seem to walk through some more examples of ISNCSCI exams.
Thanks for this question! Remember – nystagmus is named for the FAST phase relative to the patient. In this case, the fast beat is actually toward the nose (since it is the left eye, the fast phase is to the right). Watch the video again and see if you can pick up on it. At the 6-second mark, you will see horizontal nystagmus with a fast phase going to the patient’s right. We are looking at the patient’s eyes, so the viewer will see nystagmus beating across our screen to the left, which is the patient’s right.
Chrissy
Hi Will,
The difference between AIS B (sensory incomplete) and AIS C (motor incomplete) is the preservation of motor function below the neurological level of injury.The difference between AIS C and AIS D is how much motor function is spared.
You can find more details about the specific classifications on the second page of the ISNCSCI handouts in the middle column.
In this case, the patient has voluntary anal contraction, so we know they have a motor incomplete injury and their level will be C, D, or E. The NLI is C6. Below C6, only 3 out of 16 testable muscles bilaterally have MMT scores of 3 or greater (right elbow extensors and finger flexors, left elbow extensors). This is less than half, so the injury is classified as AIS C.
Let me know if you have any other questions!
Chrissy
Hi Anthony,
I sent an email with your certificate of completion on Tuesday morning. Let me know if you didn’t receive it.Hi Karen,
It is tricky wording! Basically, if deep anal pressure sensation (DAP) is present, then there is NO sensory ZPP. And if voluntary anal contraction (VAC) is present, then there is NO motor ZPP. If either is absent, then there is a ZPP.
Sensory:
– DAP present = ZPP not applicable
– DAP absent = ZPP is lowest dermatome on each side with some light touch or pinprick preservation (assuming LT and PP in S4-5 are scored as 0)Motor:
– VAC present = ZPP not applicable
– VAC absent = ZPP is lowest myotome on each side with some preservationHi Karen,
Both injury completeness and level can impact bowel and bladder function, but your question mostly has to do with level of injury. Injuries above the conus medullaris (upper motor neuron injuries) would cause bowel/bladder spasticity. Injuries distal to the conus medullaris (lower motor neuron injuries) would cause flaccidity.
Individuals with incomplete spinal cord injuries likely have more strength and sensation – and therefore fewer bowel/bladder problems than individuals with complete SCIs.
Chrissy
Hi Alyson!
Great question! The strength of recommendations in this CPG can be strong, moderate, weak, theoretical, best practice, or research. You can see all of them summarized on Table 2 (page 54) in the CPG article: https://journals.lww.com/jnpt/Fulltext/2020/01000/Clinical_Practice_Guideline_to_Improve_Locomotor.8.aspx (let me know if you need me to email you a copy!)
Strong evidence has a high level of certainty of moderate to substantial benefit, harm or cost, or a moderate level of certainty for substantial benefit, harm, or cost based on a preponderance of level 1 or 2 evidence. It is associated with the language “should” and “should not”.
So, there can be strong evidence (or moderate or weak) in support of or NOT in support of each intervention.
Similarly, “weak evidence” does not mean negative effects of an intervention or poor outcomes. It refers to our level of certainty. “Strong evidence” means we have a pretty high level of certainty that a specific outcome will occur – whether it be a positive or negative outcome. Weak evidence means we have a lower level of certainty of the outcome.
For the specific interventions you mentioned, there is strong evidence that they do not improve walking speed or distance in the population studied (ambulatory patients who are at least six months out from CVA, TBI, or iSCI). Keep this narrow scope of specific outcomes and patients in mind as you are analyzing the recommendations. The authors are not saying that these “should not” interventions are bad – just that they are ineffective for improving walking speed and distance in patients with chronic CVA/TBI/iSCI who can walk without manual assistance. If we were looking at other metrics – say balance confidence or falls risk – balance training would likely be recommended. If we were looking at a different patient population – say non-ambulatory individuals – the recommendations for treadmill training and robotics may be different.
Hope this helps!
Chrissy
Hi Emilia,
There are some good resources from the ANPT that you can find here: https://neuropt.org/practice-resources/anpt-clinical-practice-guidelines/AFO_FES-post-strokeSpecifically, the “AFO Type” and “AFO Feature” documents may be helpful.
Chrissy
Thanks, Emilia and Candice, for this updated information! I love when others who are actively preparing for the NCS exam jump in here because you have the most current info! 🙂
Hi Karen,
I wouldn’t invest a ton of time in memorizing the ins and outs of every test, but anything is fair game (though not worth the time it would take away from learning other bigger concepts). I recommend being generally familiar with what the outcome measures assess, the score range, and rough interpretations (e.g., are high or low scores better?).Chrissy
Hi Karen,
Exam scheduling information will be issued on January 16. An email will be sent with information on how to schedule the date and location to sit for your exam. (https://specialization.apta.org/)Chrissy
Hi Chelsea,
Thanks for this question! Per the standardized administration guidance provided by the ANPT (https://neuropt.org/practice-resources/anpt-clinical-practice-guidelines/core-outcome-measures-cpg), patients walk two trials at their comfortable speed then two trials at their fastest speed. The two times for the comfortable speed are averaged to calculate comfortable walking speed in meters/second. The two trials for the fast speed are also averaged to calculate fast walking speed in m/s. So, two walking speeds are documented (comfortable and fast). I am in the process of updating the lecture handouts to reflect the new instructions.Let me know if you have any other questions!
Chrissy
