NCS Certification Exam Prep 2026 Updated Practice
Questions, Comprehensive Neurologic Therapy
Specialist Review, Detailed Explanations, Verified
Answers, Complete Success Workbook
The Patient & Client Management Model dominates the blueprint at 65%,
with Examination and Intervention each at 30% . Major topics include stroke,
spinal cord injury, traumatic brain injury, Parkinson's disease, multiple sclerosis,
vestibular rehabilitation, and neuroplasticity .
Domain 1: Patient & Client Management Model — Examination (30%)
1. A 68-year-old presents to outpatient PT 6 weeks post-left MCA ischemic
stroke. NIHSS is 9, right hemiparesis (Fugl-Meyer UE 28/66, LE 22/34), Berg
Balance Scale 32/56. Per the APTA Stroke CPG, which intervention has
Grade A evidence for improving lower-extremity recovery?
A) Passive ROM only
B) Bed rest until spontaneous recovery completes
C) Body-weight-supported treadmill training (BWSTT) and overground task-
specific gait training at high intensity
D) Functional electrical stimulation only as monotherapy
Rationale: The APTA Stroke CPG and AHA/ASA guidelines give strong
recommendations (Grade A) for high-intensity, task-specific, repetitive gait
training (BWSTT, overground walking with progression in
speed/duration/complexity) for chronic and subacute stroke. Dose and intensity
matter for motor learning and recovery. Passive ROM and bed rest are not
supported by evidence, and FES as monotherapy is less effective than task-specific
training .
2. A patient presents 3 months post complete C6 SCI (ASIA A). Which
functional independence outcome can typically be expected with optimal
rehabilitation?
,A) Independent ambulation with no assistive device
B) Independent manual wheelchair propulsion on level surfaces, transfers
with sliding board, modified independence with feeding/grooming, and
tenodesis grasp for ADLs
C) Complete independence with all stair climbing
D) Return to community ambulation without bracing
Rationale: Per SCI level-by-level functional expectations (Bromley, ASIA): C6
complete SCI typically achieves independent manual wheelchair propulsion on
level surfaces, transfers (often with sliding board), modified independence with
feeding/grooming using tenodesis grasp, and need for assistance with most lower
body ADLs . Independent ambulation is not expected with complete C6 SCI.
3. Which finding is most consistent with autonomic dysreflexia in a patient
with T4 SCI?
A) Headache, severe hypertension (SBP >20-40 mmHg above baseline),
bradycardia, flushing/sweating above the level of lesion, often with bladder
distension as trigger
B) Hypotension and tachycardia at rest
C) Generalized weakness only
D) Hypoglycemia
Rationale: Autonomic dysreflexia (in SCI at T6 or above) presents with severe
hypertension (SBP >20-40 above baseline), pounding headache, bradycardia,
flushing/sweating above the lesion, and cool/pale below . It is a medical
emergency requiring immediate identification and removal of the triggering
stimulus (most commonly bladder distension).
4. A patient with a complete T10 SCI is being evaluated for functional
mobility. Which of the following is the MOST likely expected outcome?
A) Independent ambulation with a reciprocating gait orthosis
B) Independent wheelchair mobility and independent transfers
C) Independent ambulation without assistive devices
D) Complete dependence for all mobility
,Rationale: A T10 SCI (paraplegia) typically allows for independent wheelchair
mobility and independent transfers. Ambulatory potential is limited with a
complete T10 injury, though some patients may achieve household ambulation
with extensive bracing and assistive devices. The most realistic expected outcome
is independent wheelchair mobility and transfers .
5. Which outcome measure is MOST appropriate to assess balance in a
patient with chronic stroke?
A) Fugl-Meyer Assessment
B) Berg Balance Scale
C) Modified Ashworth Scale
D) Stroke Impact Scale
Rationale: The Berg Balance Scale is a performance-based measure specifically
designed to assess balance in older adults and neurologic populations, including
stroke. The Fugl-Meyer Assessment quantifies motor impairment, the Modified
Ashworth Scale assesses spasticity, and the Stroke Impact Scale measures quality
of life .
6. A patient with Parkinson's disease is being evaluated. Which outcome
measure is MOST appropriate to assess disease-specific functional status?
A) Unified Parkinson's Disease Rating Scale (UPDRS)
B) Berg Balance Scale
C) Functional Independence Measure
D) Dynamic Gait Index
Rationale: The UPDRS is the gold standard for assessing disease severity and
functional status in Parkinson's disease, covering motor and non-motor symptoms.
The Berg Balance Scale and Dynamic Gait Index assess balance and gait but are
not disease-specific. The FIM assesses functional independence but is not specific
to PD.
, 7. A patient with a vestibular disorder is being evaluated. Which test is
considered the gold standard for determining the intactness of the peripheral
vestibular system?
A) Head impulse test (head thrust)
B) Dix-Hallpike test
C) Romberg test
D) Fukuda stepping test
Rationale: The head impulse test (head thrust) is the gold standard for determining
the intactness of the peripheral vestibular system (specifically the vestibulo-ocular
reflex). The Dix-Hallpike test assesses for BPPV, the Romberg test assesses
proprioceptive contribution to balance, and the Fukuda stepping test assesses
vestibular-spinal function .
8. A patient with a CVA presents with left-sided neglect. Which assessment is
MOST appropriate to document this impairment?
A) Line bisection test
B) Line bisection test and cancellation tasks
C) Fugl-Meyer Assessment
D) Modified Ashworth Scale
Rationale: The line bisection test and cancellation tasks (e.g., Star Cancellation
Test) are standardized assessments for hemispatial neglect. The Fugl-Meyer
Assessment quantifies motor impairment, and the Modified Ashworth Scale
assesses spasticity.
9. A patient with MS reports fatigue that significantly limits daily activities.
Which outcome measure is MOST appropriate to assess fatigue?
A) Modified Fatigue Impact Scale (MFIS)
B) Expanded Disability Status Scale (EDSS)
C) Berg Balance Scale
D) Timed 25-Foot Walk
Questions, Comprehensive Neurologic Therapy
Specialist Review, Detailed Explanations, Verified
Answers, Complete Success Workbook
The Patient & Client Management Model dominates the blueprint at 65%,
with Examination and Intervention each at 30% . Major topics include stroke,
spinal cord injury, traumatic brain injury, Parkinson's disease, multiple sclerosis,
vestibular rehabilitation, and neuroplasticity .
Domain 1: Patient & Client Management Model — Examination (30%)
1. A 68-year-old presents to outpatient PT 6 weeks post-left MCA ischemic
stroke. NIHSS is 9, right hemiparesis (Fugl-Meyer UE 28/66, LE 22/34), Berg
Balance Scale 32/56. Per the APTA Stroke CPG, which intervention has
Grade A evidence for improving lower-extremity recovery?
A) Passive ROM only
B) Bed rest until spontaneous recovery completes
C) Body-weight-supported treadmill training (BWSTT) and overground task-
specific gait training at high intensity
D) Functional electrical stimulation only as monotherapy
Rationale: The APTA Stroke CPG and AHA/ASA guidelines give strong
recommendations (Grade A) for high-intensity, task-specific, repetitive gait
training (BWSTT, overground walking with progression in
speed/duration/complexity) for chronic and subacute stroke. Dose and intensity
matter for motor learning and recovery. Passive ROM and bed rest are not
supported by evidence, and FES as monotherapy is less effective than task-specific
training .
2. A patient presents 3 months post complete C6 SCI (ASIA A). Which
functional independence outcome can typically be expected with optimal
rehabilitation?
,A) Independent ambulation with no assistive device
B) Independent manual wheelchair propulsion on level surfaces, transfers
with sliding board, modified independence with feeding/grooming, and
tenodesis grasp for ADLs
C) Complete independence with all stair climbing
D) Return to community ambulation without bracing
Rationale: Per SCI level-by-level functional expectations (Bromley, ASIA): C6
complete SCI typically achieves independent manual wheelchair propulsion on
level surfaces, transfers (often with sliding board), modified independence with
feeding/grooming using tenodesis grasp, and need for assistance with most lower
body ADLs . Independent ambulation is not expected with complete C6 SCI.
3. Which finding is most consistent with autonomic dysreflexia in a patient
with T4 SCI?
A) Headache, severe hypertension (SBP >20-40 mmHg above baseline),
bradycardia, flushing/sweating above the level of lesion, often with bladder
distension as trigger
B) Hypotension and tachycardia at rest
C) Generalized weakness only
D) Hypoglycemia
Rationale: Autonomic dysreflexia (in SCI at T6 or above) presents with severe
hypertension (SBP >20-40 above baseline), pounding headache, bradycardia,
flushing/sweating above the lesion, and cool/pale below . It is a medical
emergency requiring immediate identification and removal of the triggering
stimulus (most commonly bladder distension).
4. A patient with a complete T10 SCI is being evaluated for functional
mobility. Which of the following is the MOST likely expected outcome?
A) Independent ambulation with a reciprocating gait orthosis
B) Independent wheelchair mobility and independent transfers
C) Independent ambulation without assistive devices
D) Complete dependence for all mobility
,Rationale: A T10 SCI (paraplegia) typically allows for independent wheelchair
mobility and independent transfers. Ambulatory potential is limited with a
complete T10 injury, though some patients may achieve household ambulation
with extensive bracing and assistive devices. The most realistic expected outcome
is independent wheelchair mobility and transfers .
5. Which outcome measure is MOST appropriate to assess balance in a
patient with chronic stroke?
A) Fugl-Meyer Assessment
B) Berg Balance Scale
C) Modified Ashworth Scale
D) Stroke Impact Scale
Rationale: The Berg Balance Scale is a performance-based measure specifically
designed to assess balance in older adults and neurologic populations, including
stroke. The Fugl-Meyer Assessment quantifies motor impairment, the Modified
Ashworth Scale assesses spasticity, and the Stroke Impact Scale measures quality
of life .
6. A patient with Parkinson's disease is being evaluated. Which outcome
measure is MOST appropriate to assess disease-specific functional status?
A) Unified Parkinson's Disease Rating Scale (UPDRS)
B) Berg Balance Scale
C) Functional Independence Measure
D) Dynamic Gait Index
Rationale: The UPDRS is the gold standard for assessing disease severity and
functional status in Parkinson's disease, covering motor and non-motor symptoms.
The Berg Balance Scale and Dynamic Gait Index assess balance and gait but are
not disease-specific. The FIM assesses functional independence but is not specific
to PD.
, 7. A patient with a vestibular disorder is being evaluated. Which test is
considered the gold standard for determining the intactness of the peripheral
vestibular system?
A) Head impulse test (head thrust)
B) Dix-Hallpike test
C) Romberg test
D) Fukuda stepping test
Rationale: The head impulse test (head thrust) is the gold standard for determining
the intactness of the peripheral vestibular system (specifically the vestibulo-ocular
reflex). The Dix-Hallpike test assesses for BPPV, the Romberg test assesses
proprioceptive contribution to balance, and the Fukuda stepping test assesses
vestibular-spinal function .
8. A patient with a CVA presents with left-sided neglect. Which assessment is
MOST appropriate to document this impairment?
A) Line bisection test
B) Line bisection test and cancellation tasks
C) Fugl-Meyer Assessment
D) Modified Ashworth Scale
Rationale: The line bisection test and cancellation tasks (e.g., Star Cancellation
Test) are standardized assessments for hemispatial neglect. The Fugl-Meyer
Assessment quantifies motor impairment, and the Modified Ashworth Scale
assesses spasticity.
9. A patient with MS reports fatigue that significantly limits daily activities.
Which outcome measure is MOST appropriate to assess fatigue?
A) Modified Fatigue Impact Scale (MFIS)
B) Expanded Disability Status Scale (EDSS)
C) Berg Balance Scale
D) Timed 25-Foot Walk
