Harriet Hill
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Not sure if this is helpful, but I am using all three of these resources as well. I feel like my scores on the NCS advantage and medbridge practice exams tend to be similar (70s first attempt), and the Shepherd question absolutely destroy me (40s-50s). I have tried not to let that part get me down, but rather use that information from the Shepherd test questions to delve deeper into different concepts and research papers, and how to think critically and pull out details from their style of questions. I feel like some of their questions are pretty picky and super specific, and some I even just totally disagree with. I obviously haven’t taken the NCS yet to compare, but just hoping that it’s reassuring that somebody else is also finding the Shepherd questions very challenging,
Oops – just realized I meant this question to be referencing the AFO algorithm on page 3, NOT the long leg orthoses on page 2. Sorry about that!
Hi Chrissy! Thanks so much for your explanations. It is always helpful to talk it through with someone! I’m reviewing the Rancho ROADMAP again, and I have another quick question about part of the long leg algorithm and determining if a DF stop is indicated. I just want to make sure my general understanding of this is on track. It says a DF stop is indicated if PF strength </=4 and/or there is excessive DF/KF or PF/KE. Here is my understanding of why:
-PF weakness: reduced eccentric control of PFors during tibial advancement may cause excessive DF and result in buckling, so a DF stop would block this excessive tibial advancement and prevent buckling.
-Excessive DF: a DF stop would block this excessive tibial advancement and prevent buckling.
-Excessive PF: I would have thought excessive PF would indicate a PF stop, however I’m thinking maybe here excessive PF is a compensation d/t poor stance control (where excessive PF would results in knee hyperextension, as a compensation to prevent buckling). In this line of reasoning, providing the pt with a DF stop would prevent buckling and help them not have to compensate as much.
Just wondering if I’m on the right track with this reasoning, or if I’m missing something!Thanks SO much for these ideas and this ifno! I’ve never heard of the clock one, and I’ll definitely be trying it out. Love that it’s a portable mental image you can use anywhere!
Gotcha. So with the >.1 m/s cut off, this indicates that the individual is more likely to discharge directly to home vs. a SNF? I think my perspective is skewed because I work in IPR, so I use this gait speed cut off to inform my home vs. SNF discharge from IPR. Also hard to picture that he would make large gains during a 1-3 day acute rehab stay at 80+ years old to get him beyond a gait speed that didn’t place him at increased risk for adverse events and hospital readmission, but I don’t work in the acute setting either so maybe that is more frequent than I think. This is a very tricky question to answer without more information!
Hey Chrissy – I am also struggling with AFO types and I have another question about this. The question states this person has foot drop due to common peroneal nerve injury. To me, that would mean their ankle everters may also be affected since the common peroneal connects with both the superficial and deep peroneal nerves. Would this mean there is a chance this patient has lateral ankle instability too? How do I determine from this question that they do not, since a posterior leaf spring doesn’t seem to provide support for medial/lateral instability.
Yes! This does help a lot. I haven’t looked at the actual CPG yet, saving that for closer to the exam date. So knowing that, the answer makes lots of sense. My only remaining question is just some clarification on the dizziness symptom with unilateral hypofunction. If someone had vestibular neuritis, I believe I would expect them to have vertigo for days-weeks. Once the acute stage had resolved, I would expect them to be left with some residual oscillopsia and imbalance, but the vertigo/dizziness should have resolved. Sounds like I don’t quite have it right though. For reference, I also did the medbridge vestibular courses, so I am going off of what I learned there as well. Let me know what your thoughts are! Thank you so much!
