Questions & explanations
1. Compare the rehabilitation goals for a person with a traumatic amputation versus one with a planned amputation due to diabetes.
A person with a traumatic amputation, like from an accident, may be young and have strong muscles, so the goal is often to return to high-level activities like running. Rehabilitation focuses on quick strengthening and advanced gait training. In contrast, a person with diabetes-related amputation often has poor blood flow and slower healing. The goals are more about preventing further injury and maintaining basic mobility. For example, the diabetic patient may need careful skin checks to avoid sores. The therapist also teaches energy-saving walking techniques because the patient may tire easily. Both need psychological support, but the pace and intensity differ.
2. What is a key safety consideration when prescribing exercise for a patient with spinal cord injury and chronic pain?
A key safety consideration is avoiding overuse injuries in joints above the injury level, such as shoulders and wrists, because these areas bear extra weight during transfers and wheelchair use. Exercises should be low-impact and gradually increased. Patients with loss of sensation below the injury may not feel pain from overstretching or pressure, so they must be taught to check skin for redness. Proper positioning and using supportive equipment can prevent injuries. A physical therapist should design a program that strengthens without causing harm. Monitoring for signs of autonomic dysreflexia, a dangerous rise in blood pressure, is also important.
3. How does the treatment for childhood apraxia of speech differ from treatment for a phonological disorder?
Treatment for CAS focuses on motor planning, so it uses many repetitions of the same word with cues like touch or slowing down. For example, the therapist might have the child say 'pop' 20 times while tapping the lips. In contrast, treatment for a phonological disorder targets patterns, like teaching that 'k' sounds are made in the back of the mouth. For CAS, the goal is to build automatic movement sequences, while for phonological disorders, the goal is to learn sound rules. CAS treatment often uses a hierarchy from simple to complex syllables, whereas phonological treatment might use minimal pairs like 'tea' vs. 'key' to highlight sound contrasts.
4. How does a speech therapist decide whether to use a compensatory strategy or a rehabilitative exercise for a patient?
The therapist considers the patient's overall health and goals. If the patient is very weak or has a temporary problem, like after a stroke, the therapist might start with compensatory strategies to keep them safe while eating right away. For example, a chin tuck can be used immediately. If the patient is stable and able to participate, the therapist adds rehabilitative exercises to improve the swallow over time. For a patient with a progressive disease like ALS, compensatory strategies may be the main focus because the muscles will continue to weaken. The choice also depends on the patient's ability to follow instructions and do exercises.
5. What is a key characteristic of childhood apraxia of speech (CAS) that helps tell it apart from other speech disorders?
A key characteristic of CAS is inconsistent errors on the same word, especially with longer or more complex words. For example, a child might say 'banana' correctly one time but 'nana' or 'bamana' the next. This happens because the brain has trouble planning the movements for speech, not because of muscle weakness. In contrast, children with articulation disorders make the same error every time, like always saying 'wabbit' for 'rabbit'. CAS also often shows difficulty with smooth transitions between sounds, leading to groping or searching mouth movements. These signs help speech therapists diagnose CAS and separate it from other problems.
6. Compare home health physical therapy for an elderly patient after hip surgery versus workplace therapy for an office worker with back pain.
Home health therapy for an elderly patient after hip surgery focuses on safe movement at home, like getting in and out of bed, using the bathroom, and walking with a walker. The therapist may remove trip hazards and teach the family how to assist. Workplace therapy for an office worker with back pain aims to improve posture and reduce strain. The therapist might adjust the chair and desk height, teach stretching breaks, and suggest lifting techniques. Both settings tailor therapy to the patient's daily environment, but home health emphasizes safety and independence, while workplace therapy targets ergonomics and injury prevention.
7. Give an example of an evidence-based treatment for childhood apraxia of speech and explain how it works.
One evidence-based treatment is the PROMPT method, where the therapist uses touch on the child's face and jaw to guide correct movement. For example, the therapist might gently tap under the chin to help the child make the 'k' sound. This gives the child extra feedback about where to move their mouth. The treatment focuses on practicing words many times with the touch cues, then slowly removing them. Studies show this helps children with CAS improve speech clarity and consistency. Another approach is integral stimulation, where the child watches and listens to the therapist say a word, then tries to copy it with many repetitions.
8. How does a speech therapist tell apart a feeding disorder caused by a physical problem from one caused by a behavior problem?
The therapist looks for signs of physical difficulty, like coughing, choking, or wet voice during meals, which suggest a swallowing problem. They also check for medical issues like reflux or allergies. If the child has no physical signs but refuses foods or has strong negative reactions, it may be behavioral. A child with a physical problem often eats a limited variety but accepts purees or liquids, while a child with a behavioral problem may refuse entire categories like all solids. The therapist may do a trial with different textures and observe whether the child's difficulty is consistent or changes with the feeder or setting.
9. How does action observation therapy differ from mirror therapy?
Action observation therapy uses videos or live demonstrations of another person moving, while mirror therapy uses a mirror to show the patient's own unaffected limb as if it were the affected one. In AOT, the patient watches a model and then imitates; in mirror therapy, the patient moves the unaffected limb while seeing its reflection. AOT activates mirror neurons through observation of others, while mirror therapy uses visual feedback of self-movement. Both help with motor learning, but AOT may be better for learning new movement sequences, and mirror therapy for reducing pain or neglect. Some therapists combine both approaches.
10. Compare the rehabilitation approach for a throwing athlete with shoulder impingement versus a runner with patellofemoral pain syndrome.
For a throwing athlete with shoulder impingement, therapy focuses on rotator cuff and scapular strengthening to improve shoulder mechanics. They avoid overhead throwing initially and practice exercises like external rotation with a band. For a runner with patellofemoral pain (pain around the kneecap), therapy strengthens the quadriceps and hips, especially the vastus medialis oblique (VMO). The runner may need to reduce mileage and run on softer surfaces. Both require correcting movement patterns: the thrower works on throwing technique, the runner on stride and foot strike. Both gradually increase activity as symptoms allow.
11. How does a speech therapist use dynamic assessment to diagnose childhood apraxia of speech?
Dynamic assessment means the therapist tests how well a child can learn new speech sounds with help. For CAS, the child may need many tries and cues to say a new word correctly, and even then might not keep the improvement. The therapist might show a sound, then ask the child to copy it, giving more support if needed. A child with CAS often improves slowly and inconsistently, while a child with a different disorder learns faster. This method helps confirm CAS because it shows the core problem is motor planning, not just learning sounds. The therapist also notes if the child's errors change each time, which is typical of CAS.
12. How does mental practice (imagining movements) help stroke patients improve real movement?
Mental practice means a patient imagines performing a movement without actually doing it, like picturing themselves reaching for a cup. This activates the same brain areas as real movement, strengthening neural pathways. After a stroke, mental practice can improve motor planning and coordination. It is often combined with physical therapy: the patient imagines the movement first, then tries to do it. Studies show that regular mental practice (10-20 minutes daily) can lead to better arm function, walking, or daily tasks. It is safe and can be done at home. The key is to imagine the movement vividly and in first-person view.