Neurologic Certification (NCS) Prep

Our NCS Prep Program provides all of the tools you'll need to pass the board specialization test, develop your clinical skill set, and elevate your career - all while earning CEUs. With advanced certification, you'll set yourself apart as a distinguished professional equipped to provide an advanced level of care.

We can help you get there faster.

In this program you will study advanced topics taught by the best instructors in neurologic therapy. With over 300 practice questions, this 20-week program will have you well-prepared for success on test day.

Acute Brain Injury and Disorders of Consciousness: Assessment and Intervention

Presented by Mary Beth Osborne, PT, DPT, NCS

Cognitive Impairments: Executive Function

Presented by Karen L. McCulloch, PhD, PT, MS, NCS(E), FAPTA

Neuroimaging and Stimulation for Rehabilitation Part 1: Brain Imaging

Presented by Michael Borich, DPT, PhD

Central Vestibular System: Normal Anatomy and Physiology

Presented by Laura Morris, PT, NCS

Advanced Physical Therapy Examination of Clients with Huntington's Disease

Presented by Anne Kloos, PT, PhD, NCS

Considerations of Cognition: Mobility and Relation of Exercise to Cognitive Function

Presented by Deb Kegelmeyer, PT, DPT, MS, GCS

Treatment Maneuvers for BPPV

Presented by Jeff Walter, DPT, NCS

Identification and Management of Unilateral Vestibular Disorders

Presented by Jeff Walter, DPT, NCS

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Case Excerpt:

A 76-year-old male is admitted to an inpatient rehabilitation hospital 20 days after a left middle cerebral artery ischemic cerebrovascular accident (CVA). He underwent tissue plasminogen activator (TPA) treatment, but his hospital course was complicated by the emergence of shingles on his left flank, and MRSA in his urine. His past medical history includes atrial fibrillation, degenerative joint disease, osteoporosis, coronary artery disease, hypertension, myocardial infarction, peripheral vascular disease (PVD), coronary artery bypass graft x2, abdominal aortic aneurysm repair, and a history of smoking 1 pack per day for many years. He currently has a 2-cm unstageable ulcer on his right heel. He lives with his wife in a 2-story home and has 2 sons who live in a neighboring town. He is a retired police officer. Prior to his stroke, he walked with a cane and was able to walk 10-15 minutes before tiring. He enjoys puzzles of any kind—crossword, word search, jigsaw, etc. His wife is 10 years younger than he is, works part-time at a discount store, and is in good health.

Question:

An initial examination of this patient’s ambulation reveals the following:

assistance required: minimal
HR changes: 72–96 bpm after 100'
distance at which motor components of gait begin to deteriorate: 100'
walking speed: 0.3 m/s
qualitative analysis: lack of R push-off and reduced R foot clearance during R swing phase; R hip flexion and mild knee hyperextension during R stance phase; asymmetrical step length R > L

Impairment in which muscle group is the most likely contributor to this patient’s slow walking speed?

Correct! Incorrect! Subscribe to access over 300 more questions like this one.

The correct answer is "weak right plantarflexors"

The neurologic clinical specialist is expected to be familiar with common gait deviations and their causes post- stroke, as well as musculoskeletal contributions to slow vs. faster walking speed. Ankle plantarflexors are important for forward propulsion and paretic leg weakness in these muscles is a common occurrence after stroke. This patient exhibits decreased push-off, consistent with such weakness. Further, plantarflexor weakness is associated with slow walking in both healthy individuals and those poststroke. The quadriceps do contribute to forward progression during gait in healthy individuals but these do not appear to be significantly weak in this patient since the knee is stable in stance phase. Muscle tightness represents a passive restriction rather than an active muscle contraction and, therefore, would not be a likely contributor to reduced walking speed.

tight right plantarflexors

Incorrect.
tight right quadriceps

Incorrect.
weak right plantarflexors

Correct. The neurologic clinical specialist is expected to be familiar with common gait deviations and their causes post- stroke, as well as musculoskeletal contributions to slow vs. faster walking speed. Ankle plantarflexors are important for forward propulsion and paretic leg weakness in these muscles is a common occurrence after stroke. This patient exhibits decreased push-off, consistent with such weakness. Further, plantarflexor weakness is associated with slow walking in both healthy individuals and those poststroke. The quadriceps do contribute to forward progression during gait in healthy individuals but these do not appear to be significantly weak in this patient since the knee is stable in stance phase. Muscle tightness represents a passive restriction rather than an active muscle contraction and, therefore, would not be a likely contributor to reduced walking speed.
weak right quadriceps

Incorrect.