TEST BANK
Spinal Cord Injury: Functional Rehabilitation
Martha Freeman Somers, and Jade J. Bender-Burnett
4th Edition
,Table of Contents
Chapter 02 Spinal Cord Injuries 1
Chapter 03 Medical and Surgical Management 7
Chapter 04 Psychosocial Issues 12
Chapter 05 Skin Care 17
Chapter 06 Respiratory Rehabilitation 23
Chapter 07 Physical Therapy Examination, Evaluation, and Goal Setting 29
Chapter 08 Strategies for Functional Rehabilitation 35
Chapter 09 Functional Mat Skills 41
Chapter 10 Transfer Skills 47
Chapter 11 Wheelchairs and Wheelchair Skills 53
Chapter 12 Ambulation 59
Chapter 13 Sexuality and Sexual Functioning 65
Chapter 14 Bladder and Bowel Management 71
Chapter 15 Architectural Adaptations 76
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Test Bank - Spinal Cord Injury: Functional Rehabilitation, 4th Edition (Somers, 2024)
Chapter 2. Spinal Cord Injuries
MULTIPLE CHOICE
1. A patient has a spinal cord injury. The motor levels are right C5 and left C6. The sensory
levels are right C7 and left C8. What is the single neurological level of injury?
a. C5
b. C6
c. C7
d. C8
ANS: A
Feedback
A If a lesion is asymmetrical, a person may have as many as four sensory and
motor levels: right sensory, left sensory, right motor, and left motor. The single
neurological level of injury (NLI) is the most rostral (highest) of these four
levels. In this case, C5 is the most rostral of the patient’s motor and sensory
levels.
B C6 is not the most rostral of the patient’s motor and sensory levels.
C C7 is not the most rostral of the patient’s motor and sensory levels.
D C8 is not the most rostral of the patient’s motor and sensory levels.
2. A patient who has a spinal cord injury tests 0 in all key muscles, as well as all key sensory
points, on both sides of the body. They are able to contract the anus voluntarily and can
sense deep anal pressure. What is the correct American Spinal Injury Association (ASIA)
Impairment Scale (AIS) classification for this patient’s lesion?
a. A
b. B
c. C
d. D
ANS: C
Feedback
A The AIS A classification requires absent motor and sensory sparing in the lowest
sacral segment. This patient has both motor (voluntary anal contraction) and
sensory (deep anal pressure) sparing.
B The AIS B classification requires that no motor function is preserved more than
three levels below the motor level on either side of the body. The voluntary
motor function shown with voluntary anal contraction indicates that the AIS
classification is C, not B.
C Because the patient exhibits motor sparing in the lowest sacral segment
(voluntary anal contraction), the AIS classification is C.
D The AIS D classification requires at least half of key muscle functions below the
NLI to have a muscle grade of 3 or greater. This patient exhibits 0 strength in all
key muscles.
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Test Bank - Spinal Cord Injury: Functional Rehabilitation, 4th Edition (Somers, 2024)
3. Of the following options, which is MOST likely to trigger an episode of autonomic
dysreflexia?
a. Moving from supine to sitting
b. Moving from sitting to supine
c. Fatigue
d. Full bladder
ANS: D
Feedback
A Change in position is not a noxious stimulus below the lesion. Moving from
supine to sitting can cause orthostatic hypotension (OH), not AD.
B Change in position is not a noxious stimulus below the lesion.
C Fatigue is not a noxious stimulus below the lesion.
D Any noxious stimulus below the lesion can cause autonomic dysreflexia (AD).
Common origins of this noxious stimulus include bladder or rectal distention,
urinary tract infection, and bowel impaction.
4. A patient has more severe weakness in the upper extremities than in the lower extremities.
These findings are MOST consistent with
a. Brown-Séquard syndrome
b. Anterior cord syndrome
c. Central cord syndrome
d. Posterior cord syndrome
ANS: C
Feedback
A People with Brown-Séquard syndrome exhibit more severe motor and
proprioceptive deficits on the side of the lesion and more severe loss of
sensitivity to pin prick and temperature on the contralateral side.
B Anterior cord syndrome is associated with preserved proprioception and light
touch combined with variable loss of motor function and pain and temperature
sensation.
C People with central cord syndrome exhibit more pronounced weakness in their
upper extremities than in their lower extremities.
D Posterior cord syndrome is associated with loss of proprioception, vibratory
sensation, and two-point discrimination. Deep pressure may also be impaired.
5. Which of the following muscles or muscle groups is the C6 key muscle for International
Standards for Neurological Classification of Spinal Cord Injuries (ISNCSCI) classification?
a. Elbow extensors
b. Wrist extensors
c. Finger flexors
d. Elbow flexors
ANS: B
Feedback
A Elbow extensors are the C7 key muscles.
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Test Bank - Spinal Cord Injury: Functional Rehabilitation, 4th Edition (Somers, 2024)
B Wrist extensors are the C6 key muscles.
C Finger flexors are the C8 key muscles.
D Elbow flexors are the C5 key muscles.
6. A patient has T3 paraplegia resulting from an injury 1 week ago. After the therapist assists
them into a short-sitting position at the edge of the bed, the patient reports feeling as if they
are about to pass out. Which of the following conditions should the therapist suspect based
on the patient’s report?
a. Autonomic dysreflexia
b. Reduced exercise tolerance
c. Myocardial infarction
d. Orthostatic hypotension
ANS: D
Feedback
A Autonomic dysreflexia (AD) is triggered by a noxious stimulus below the lesion,
not a change in position as described in this question. Symptoms of AD include
a pounding headache, blurred vision, spots in the visual fields, nasal congestion,
paresthesias in the neck and shoulders, and anxiety. Typically, AD first appears
6 or more months after the injury. The patient’s reported symptoms, time since
injury, and apparent triggering by a change of position are all consistent with
OH, not AD.
B This patient’s symptoms are brought on by a change in position, not exercise.
C The patient’s reported symptoms, time since injury, and apparent triggering by a
change of position are all consistent with OH. Although lightheadedness and
sudden dizziness can be associated with myocardial infarction (MI), this
question does not describe any other signs or symptoms that could indicate an
MI.
D Orthostatic hypotension (OH) is characterized by a drop in blood pressure that
occurs when the individual moves from a horizontal to an upright position. A
person with OH may experience, among other things, dizziness, lightheadedness,
ringing in the ears, and loss of consciousness. OH typically is transient and
resolves within a few weeks of injury. The patient’s reported symptoms, time
since injury, and apparent triggering by a change of position are all consistent
with OH.
7. Which of the following options BEST describes spinal shock?
a. Demyelination of axons in the peripheral portion of the spinal cord
b. Destruction of cell bodies in the central portion of the spinal cord
c. Permanent cessation of spinal cord function below the lesion
d. Temporary cessation of spinal cord function below the lesion
ANS: D
Feedback
A Demyelination of axons is one of the mechanisms of secondary tissue
destruction that follows spinal cord injury, but it is not an accurate description of
spinal shock.
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Test Bank - Spinal Cord Injury: Functional Rehabilitation, 4th Edition (Somers, 2024)
B Destruction of cell bodies within the spinal cord is a mechanism of the primary
injury to the cord caused by blunt trauma, but it is not an accurate description of
spinal shock.
C Spinal shock involves temporary, not permanent, cessation of spinal cord
function below the lesion.
D Spinal shock is a transient phenomenon that occurs after trauma to the spinal
cord. Spinal reflexes, voluntary motor and sensory function, and autonomic
control are absent or depressed caudal to the lesion during spinal shock.
8. Case-Based Scenario: A patient who has sustained a traumatic spinal cord injury presents
with the following motor and sensory examination results.
Voluntary Motor Function:
R L R L
Quadriceps 3/5 4/5 Gluteus maximus 0/5 0/5
5/5 5/5 Anterior tibialis 2/5 3/5
Plantar flexors 0/5 0/5 Hamstrings 0/5 0/5
Long toe extensors 0/5 0/5 Gluteus medius 0/5 0/5
• All upper extremity muscle strength is 5/5.
• Rectus abdominis contraction is palpable from the ribs to the pubis.
• Voluntary anal contraction is absent.
Sensation:
• In key sensory points bilaterally, light touch and pin prick are intact in C1 to L4,
diminished in L5, and absent below L5. Deep anal pressure sensation is absent.
What are the patient’s motor levels using ISNCSCI classification?
a. Right L2, left L2
b. Right L3, left L3
c. Right L2, left L3
d. Right L3, left L4
ANS: B
Feedback
A On both the right and left, the L3 key muscles (knee extensors), not the L2 key
muscles (hip flexors), are the most caudally innervated muscles that exhibit
grade 3 or higher muscle strength with all key muscles rostral to that level
exhibiting grade 5 strength.
B On both the right and left, the L3 key muscles (knee extensors) are the most
caudally innervated muscles that exhibit grade 3 or higher muscle strength with
all key muscles rostral to that level (hip flexors, upper extremity muscles)
exhibiting grade 5 strength.
C L2 on the right is incorrect because the L3 key muscle on that side has grade 3
strength and all key muscles rostral to L3 have grade 5 strength.
D L4 on the left is incorrect because, although the L4 key muscle (dorsiflexors) test
grade 3, the next more rostral muscle (quadriceps, L3) exhibits only grade 4
strength.
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Spinal Cord Injury: Functional Rehabilitation
Martha Freeman Somers, and Jade J. Bender-Burnett
4th Edition
,Table of Contents
Chapter 02 Spinal Cord Injuries 1
Chapter 03 Medical and Surgical Management 7
Chapter 04 Psychosocial Issues 12
Chapter 05 Skin Care 17
Chapter 06 Respiratory Rehabilitation 23
Chapter 07 Physical Therapy Examination, Evaluation, and Goal Setting 29
Chapter 08 Strategies for Functional Rehabilitation 35
Chapter 09 Functional Mat Skills 41
Chapter 10 Transfer Skills 47
Chapter 11 Wheelchairs and Wheelchair Skills 53
Chapter 12 Ambulation 59
Chapter 13 Sexuality and Sexual Functioning 65
Chapter 14 Bladder and Bowel Management 71
Chapter 15 Architectural Adaptations 76
,______________________________________________________________________________________________
Test Bank - Spinal Cord Injury: Functional Rehabilitation, 4th Edition (Somers, 2024)
Chapter 2. Spinal Cord Injuries
MULTIPLE CHOICE
1. A patient has a spinal cord injury. The motor levels are right C5 and left C6. The sensory
levels are right C7 and left C8. What is the single neurological level of injury?
a. C5
b. C6
c. C7
d. C8
ANS: A
Feedback
A If a lesion is asymmetrical, a person may have as many as four sensory and
motor levels: right sensory, left sensory, right motor, and left motor. The single
neurological level of injury (NLI) is the most rostral (highest) of these four
levels. In this case, C5 is the most rostral of the patient’s motor and sensory
levels.
B C6 is not the most rostral of the patient’s motor and sensory levels.
C C7 is not the most rostral of the patient’s motor and sensory levels.
D C8 is not the most rostral of the patient’s motor and sensory levels.
2. A patient who has a spinal cord injury tests 0 in all key muscles, as well as all key sensory
points, on both sides of the body. They are able to contract the anus voluntarily and can
sense deep anal pressure. What is the correct American Spinal Injury Association (ASIA)
Impairment Scale (AIS) classification for this patient’s lesion?
a. A
b. B
c. C
d. D
ANS: C
Feedback
A The AIS A classification requires absent motor and sensory sparing in the lowest
sacral segment. This patient has both motor (voluntary anal contraction) and
sensory (deep anal pressure) sparing.
B The AIS B classification requires that no motor function is preserved more than
three levels below the motor level on either side of the body. The voluntary
motor function shown with voluntary anal contraction indicates that the AIS
classification is C, not B.
C Because the patient exhibits motor sparing in the lowest sacral segment
(voluntary anal contraction), the AIS classification is C.
D The AIS D classification requires at least half of key muscle functions below the
NLI to have a muscle grade of 3 or greater. This patient exhibits 0 strength in all
key muscles.
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Test Bank - Spinal Cord Injury: Functional Rehabilitation, 4th Edition (Somers, 2024)
3. Of the following options, which is MOST likely to trigger an episode of autonomic
dysreflexia?
a. Moving from supine to sitting
b. Moving from sitting to supine
c. Fatigue
d. Full bladder
ANS: D
Feedback
A Change in position is not a noxious stimulus below the lesion. Moving from
supine to sitting can cause orthostatic hypotension (OH), not AD.
B Change in position is not a noxious stimulus below the lesion.
C Fatigue is not a noxious stimulus below the lesion.
D Any noxious stimulus below the lesion can cause autonomic dysreflexia (AD).
Common origins of this noxious stimulus include bladder or rectal distention,
urinary tract infection, and bowel impaction.
4. A patient has more severe weakness in the upper extremities than in the lower extremities.
These findings are MOST consistent with
a. Brown-Séquard syndrome
b. Anterior cord syndrome
c. Central cord syndrome
d. Posterior cord syndrome
ANS: C
Feedback
A People with Brown-Séquard syndrome exhibit more severe motor and
proprioceptive deficits on the side of the lesion and more severe loss of
sensitivity to pin prick and temperature on the contralateral side.
B Anterior cord syndrome is associated with preserved proprioception and light
touch combined with variable loss of motor function and pain and temperature
sensation.
C People with central cord syndrome exhibit more pronounced weakness in their
upper extremities than in their lower extremities.
D Posterior cord syndrome is associated with loss of proprioception, vibratory
sensation, and two-point discrimination. Deep pressure may also be impaired.
5. Which of the following muscles or muscle groups is the C6 key muscle for International
Standards for Neurological Classification of Spinal Cord Injuries (ISNCSCI) classification?
a. Elbow extensors
b. Wrist extensors
c. Finger flexors
d. Elbow flexors
ANS: B
Feedback
A Elbow extensors are the C7 key muscles.
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Test Bank - Spinal Cord Injury: Functional Rehabilitation, 4th Edition (Somers, 2024)
B Wrist extensors are the C6 key muscles.
C Finger flexors are the C8 key muscles.
D Elbow flexors are the C5 key muscles.
6. A patient has T3 paraplegia resulting from an injury 1 week ago. After the therapist assists
them into a short-sitting position at the edge of the bed, the patient reports feeling as if they
are about to pass out. Which of the following conditions should the therapist suspect based
on the patient’s report?
a. Autonomic dysreflexia
b. Reduced exercise tolerance
c. Myocardial infarction
d. Orthostatic hypotension
ANS: D
Feedback
A Autonomic dysreflexia (AD) is triggered by a noxious stimulus below the lesion,
not a change in position as described in this question. Symptoms of AD include
a pounding headache, blurred vision, spots in the visual fields, nasal congestion,
paresthesias in the neck and shoulders, and anxiety. Typically, AD first appears
6 or more months after the injury. The patient’s reported symptoms, time since
injury, and apparent triggering by a change of position are all consistent with
OH, not AD.
B This patient’s symptoms are brought on by a change in position, not exercise.
C The patient’s reported symptoms, time since injury, and apparent triggering by a
change of position are all consistent with OH. Although lightheadedness and
sudden dizziness can be associated with myocardial infarction (MI), this
question does not describe any other signs or symptoms that could indicate an
MI.
D Orthostatic hypotension (OH) is characterized by a drop in blood pressure that
occurs when the individual moves from a horizontal to an upright position. A
person with OH may experience, among other things, dizziness, lightheadedness,
ringing in the ears, and loss of consciousness. OH typically is transient and
resolves within a few weeks of injury. The patient’s reported symptoms, time
since injury, and apparent triggering by a change of position are all consistent
with OH.
7. Which of the following options BEST describes spinal shock?
a. Demyelination of axons in the peripheral portion of the spinal cord
b. Destruction of cell bodies in the central portion of the spinal cord
c. Permanent cessation of spinal cord function below the lesion
d. Temporary cessation of spinal cord function below the lesion
ANS: D
Feedback
A Demyelination of axons is one of the mechanisms of secondary tissue
destruction that follows spinal cord injury, but it is not an accurate description of
spinal shock.
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Test Bank - Spinal Cord Injury: Functional Rehabilitation, 4th Edition (Somers, 2024)
B Destruction of cell bodies within the spinal cord is a mechanism of the primary
injury to the cord caused by blunt trauma, but it is not an accurate description of
spinal shock.
C Spinal shock involves temporary, not permanent, cessation of spinal cord
function below the lesion.
D Spinal shock is a transient phenomenon that occurs after trauma to the spinal
cord. Spinal reflexes, voluntary motor and sensory function, and autonomic
control are absent or depressed caudal to the lesion during spinal shock.
8. Case-Based Scenario: A patient who has sustained a traumatic spinal cord injury presents
with the following motor and sensory examination results.
Voluntary Motor Function:
R L R L
Quadriceps 3/5 4/5 Gluteus maximus 0/5 0/5
5/5 5/5 Anterior tibialis 2/5 3/5
Plantar flexors 0/5 0/5 Hamstrings 0/5 0/5
Long toe extensors 0/5 0/5 Gluteus medius 0/5 0/5
• All upper extremity muscle strength is 5/5.
• Rectus abdominis contraction is palpable from the ribs to the pubis.
• Voluntary anal contraction is absent.
Sensation:
• In key sensory points bilaterally, light touch and pin prick are intact in C1 to L4,
diminished in L5, and absent below L5. Deep anal pressure sensation is absent.
What are the patient’s motor levels using ISNCSCI classification?
a. Right L2, left L2
b. Right L3, left L3
c. Right L2, left L3
d. Right L3, left L4
ANS: B
Feedback
A On both the right and left, the L3 key muscles (knee extensors), not the L2 key
muscles (hip flexors), are the most caudally innervated muscles that exhibit
grade 3 or higher muscle strength with all key muscles rostral to that level
exhibiting grade 5 strength.
B On both the right and left, the L3 key muscles (knee extensors) are the most
caudally innervated muscles that exhibit grade 3 or higher muscle strength with
all key muscles rostral to that level (hip flexors, upper extremity muscles)
exhibiting grade 5 strength.
C L2 on the right is incorrect because the L3 key muscle on that side has grade 3
strength and all key muscles rostral to L3 have grade 5 strength.
D L4 on the left is incorrect because, although the L4 key muscle (dorsiflexors) test
grade 3, the next more rostral muscle (quadriceps, L3) exhibits only grade 4
strength.
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