Anat says that she had a scan done of her head yesterday and that it was negative. She does not understand why she is still having problems. Explain the pathophysiology of a concussion to Anat, avoiding medical terminology/jargon. (1 point)

You have just completed your vestibular assessment with Juan (he/him), and have determined that he has an acute, unilateral vestibular hypofunction. You prescribe a set of gaze stabilization exercises for him to start doing at home. According to the newly updated clinical practice guideline on treating vestibular dysfunction (Hall et al. 2022), how should you advise Juan to dose his exercises?

History: Rick is a 38 y/o African American male who sustained a closed head injury 4 weeks ago as a result of falling off a ladder while working on home repairs. A neighbor saw him fall and immediately called the paramedics. Rick was unconscious when paramedics arrived 10 minutes later, and began to regain consciousness about an hour later. His initial GCS was 11 (3,4,4). MRI showed epidural hematoma with a slight midline shift. He now presents with left sided hemiparesis, impaired sensation, spasticity, and motor control deficits. He does not remember the day of the fall or the next two days. Social History: Rick lives with Joe, his partner of 10 years. Joe is a physician who works full time at a major hospital in Minneapolis. Rick owns a tax accounting business and works from home. Rick enjoys reading nonfiction, playing on his neighborhood softball team in the summer, and snowboarding in the winter. He and Joe have a standing dinner night on Tuesdays with a group of 6 other friends, rotating which home they go to each week.  Home Environment: Rick and Joe own a 2-level townhome that has 9 stairs to enter, with bilateral rails, and one flight of 12 steps inside with a left handrail. The master suite (bedroom/bathroom) are on the main level, but Rick’s home office is upstairs. Most of their friends’ homes have at least 2-3 stairs to enter with no handrails. PMH: Healthy with no comorbidities, remote h/o tobacco smoking (15-20 y/o). Alcohol consumption: average of 2 drinks per week with dinner. Medications: Keppra, Gabapentin, Colace, Tramadol PRN, Amantadine. PT Goals: “be myself again, get back to my life.” As you consider Rick’s prognosis, provide (3 points total – only the first three responses of each will be graded): a) 3 potential facilitators for Rick’s recovery b) 3 potential barriers to Rick’s recovery

Jerry is the PTA who works with you in an outpatient clinic in Minnesota. You completed an evaluation with your newest patient yesterday and your plan includes high intensity gait training. Jerry will be seeing the patient at their next appointment in 3 days. Can Jerry do high intensity activities with the patient at that time? 

Caleb is a 25 y/o male (he/him) who has been diagnosed with a C6 ASIA A SCI that was sustained in a motor vehicle accident 1 week ago after he fell asleep at the wheel and his car rolled over.  He sustained a C5 spinal fracture dislocation, as well as chest, facial, and upper extremity injuries. During your morning PT session, you arrive to find Caleb in bed, complaining of a pounding headache.  You check his BP and discover it is 180/80 at rest. His BP is normally 108/70. You also note that Caleb’s face is sweating profusely and he is very flushed. What do you think is the cause of these symptoms (name it)?   What would you do about it?  Name at least 3 things you would do to respond.  (2 points)

You are working with a person who recently sustained a T8 SCI and is learning to propel a manual wheelchair for the first time. Which of the following recommendations should you NOT include in your training? 

Additional information from Betsaida’s evaluation: Patient Goals: “I want to return to living in my own home.  I want to be able to get up, use the bathroom, take a shower, and walk by myself.”   Movement Analysis:  Bed mobility: Betsaida rolls onto her weaker side by pulling on a bedrail with her RUE, but is unable to do so without the rail.  Once she is on her left side, she requires assistance to place her LUE in a stable position for the initial push-up to sitting midline. Transfers: Betsaida sits with her weight shifted onto her right hip and RUE.  Her left UE rests across her lap, but when verbally cued, she can move it to rest her left hand on the mat next to her.  Her grip is weak and she cannot keep hold of the edge of the mat with her left hand.  She uses multiple forward/backward rocks to get momentum to stand, then requires Mod A for lift-off, balance, and knee stabilization when she is pivoting to sit in her wheelchair.  Gait/Stairs:  Betsaida walks short distances (10-20 feet) with her LBQC and the AFO she was given at the hospital.  Her daughter provides Min-Mod A because her gait is unsteady, and Betsaida fatigues quickly. Her L ankle is well supported by the AFO, but she has excess knee and hip flexion in stance phase and inadequate limb clearance in swing phase, resulting in a toe drag. She leans heavily on her cane. For stairs, she defaults to a step-to pattern, ascending with her stronger RLE and descending with the weaker LLE. Her daughter and son hold her up around her waist but her LLE continues to buckle and her L toe catches on the step. You are worried about their collective safety. Given Betsaida’s current status, identify one of the objective measures recommended by the CPG: Core Set of Outcome Measures for Adults with Neurological Conditions that you would complete with Betsaida during your evaluation. Provide specific justification as to why you chose this measure for Betsaida.

Smith et al. 2022 used imaging of two tracts after spinal cord injury to determine if the amount of tissue sparing of those tracts would predict sensory and motor outcomes. What did they find? 

James is a 16 y/o male (he/him) who sustained a concussion while playing ice hockey. His main goal for PT is to return to playing hockey in time for the championship game next month. You educate him that in order for him to return to play, he needs to:

Why is each organization’s structure and culture unique?