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HTCC CCE practice questions

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Question 1Upper limb rehabilitation clinical skills and theory

In the context of upper limb rehabilitation, what does the term 'facilitation' most precisely refer to?

  1. Passive stretching of a muscle to lengthen shortened tissue
  2. Surgical release of a joint contracture
  3. Techniques that enhance a patient's ability to initiate or sustain a voluntary muscle contraction Correct answer.
  4. Application of ice to reduce spasticity before exercise

Explanation

Facilitation refers to the use of sensory, proprioceptive or handling inputs that make it easier for a patient to recruit and sustain voluntary muscle activity. It is a therapeutic handling concept, not a passive stretch or a surgical or thermal intervention.

Question 2Upper limb rehabilitation clinical skills and theory

Which Brunnstrom stage of upper limb recovery is characterised by the appearance of spasticity and the ability to move the limb only in mass synergy patterns?

  1. Stage 3 Correct answer.
  2. Stage 2
  3. Stage 1
  4. Stage 6

Explanation

Brunnstrom stage 3 is defined by spasticity that is at its peak and voluntary movement that occurs only within the flexor or extensor synergy. Stage 2 shows minimal voluntary movement with beginning spasticity, and stage 6 shows near-normal isolated movement with minimal spasticity.

Question 3Upper limb rehabilitation clinical skills and theory

A therapist wants to encourage active wrist extension in a patient with hemiplegia. Which handling approach is most consistent with a neurodevelopmental facilitation rationale?

  1. Passively flexing the wrist to end range and holding for 30 seconds
  2. Taping the wrist into flexion to prevent extension
  3. Applying firm pressure through the extended wrist while asking the patient to hold the position Correct answer.
  4. Instructing the patient to relax while the therapist performs all movement

Explanation

Firm manual pressure through the weight-bearing extended wrist provides proprioceptive input that supports recruitment of wrist extensors, a common neurodevelopmental facilitation strategy. Passive end-range flexion, taping into flexion, or fully passive movement would not encourage active extension.

Question 4Upper limb rehabilitation clinical skills and theory

Which outcome measure is specifically designed to assess upper limb capacity in stroke survivors using a 0-57 scale of arm and hand tasks?

  1. Modified Ashworth Scale
  2. Functional Independence Measure
  3. Box and Block Test
  4. Action Research Arm Test Correct answer.

Explanation

The Action Research Arm Test scores 19 upper limb tasks on a 0-3 scale for a total of 57, making it a capacity measure of arm and hand function. The Modified Ashworth Scale grades resistance to passive movement, the FIM measures global independence, and the Box and Block Test counts blocks transferred in a time limit.

Question 5Upper limb rehabilitation clinical skills and theory

A patient with a C6 tetraplegia wishes to feed independently. Which tenodesis grasp pattern is most relevant to train?

  1. Passive finger extension created by wrist flexion
  2. Passive finger flexion created by wrist extension Correct answer.
  3. Active finger extension with wrist flexion
  4. Active finger flexion with wrist extension

Explanation

In C6 tetraplegia, active wrist extension can be used to generate a passive tenodesis grasp because the long finger flexors are stretched as the wrist extends, causing the fingers to flex. Training focuses on using this mechanically produced grasp rather than on active finger flexion.

Question 6Upper limb rehabilitation clinical skills and theory

When performing constraint-induced movement therapy, which parameter best reflects the original protocol's emphasis on massed practice?

  1. Using a sling only at night to prevent shoulder subluxation
  2. Restraining the less affected arm for most waking hours over consecutive days with intensive task practice Correct answer.
  3. Restraining the less affected arm for 30 minutes twice weekly
  4. Practising tasks only during therapy sessions with no restraint

Explanation

The original constraint-induced movement therapy protocol combines restraint of the less affected upper limb for a large portion of waking hours with intensive, repetitive task practice over consecutive days. Brief or intermittent restraint without massed practice does not capture the core principle of overcoming learned non-use.

Question 7Upper limb rehabilitation clinical skills and theory

A patient reports shoulder pain on the hemiplegic side after being hoisted with the affected arm unsupported. Which precaution most directly prevents this mechanism of injury?

  1. Applying heat before every transfer to relax the shoulder
  2. Encouraging the patient to bear weight through the affected arm during transfers
  3. Supporting the affected arm during all transfers and avoiding traction on the hemiplegic shoulder Correct answer.
  4. Restricting all shoulder movement for six weeks

Explanation

The hemiplegic shoulder is vulnerable to traction and inferior subluxation when the arm is left unsupported during hoisting or transfers. Supporting the arm and avoiding pulling on it reduces this mechanical stress. Heat and prolonged immobilisation do not address the traction mechanism.

Question 8Upper limb rehabilitation clinical skills and theory

Which muscle is the primary target when training scapular upward rotation during elevation of the arm?

  1. Rhomboid major
  2. Pectoralis minor
  3. Serratus anterior Correct answer.
  4. Latissimus dorsi

Explanation

Serratus anterior drives scapular upward rotation and posterior tilt, which are essential for full arm elevation and for maintaining subacromial space. Pectoralis minor and rhomboids tend to depress and retract the scapula, and latissimus dorsi depresses the humerus.

Question 9Upper limb rehabilitation clinical skills and theory

A patient with adhesive capsulitis is in the freezing stage with high pain. Which exercise approach is most appropriate?

  1. High-load resistance training at end range
  2. Pain-free low-grade mobility and gentle active-assisted range within comfort Correct answer.
  3. Aggressive end-range stretching to regain range quickly
  4. Manipulation under anaesthesia immediately

Explanation

During the painful freezing stage, treatment should respect irritability and use gentle pain-free mobility and active-assisted range to maintain movement without provoking inflammation. Aggressive or high-load end-range work and immediate surgical options are not first-line in this irritable phase.

Question 10Upper limb rehabilitation clinical skills and theory

Which grip is being assessed when a patient is asked to hold a key or coin between the radial side of the index finger and the thumb pad?

  1. Palmar grasp
  2. Tip pinch
  3. Spherical grasp
  4. Lateral pinch Correct answer.

Explanation

Lateral pinch, also called key pinch, uses the pad of the thumb against the radial side of the index finger to hold a flat object. Tip pinch uses thumb tip to fingertip, palmar grasp wraps the whole hand, and spherical grasp conforms to a round object.

Question 11Upper limb rehabilitation clinical skills and theory

In mirror therapy for the upper limb after stroke, which instruction best preserves the intended therapeutic mechanism?

  1. Move both hands symmetrically while watching the mirror image of the less affected hand
  2. Move the less affected hand while the affected hand remains still behind the mirror Correct answer.
  3. Watch the mirror without moving either hand
  4. Move only the affected hand while looking away from the mirror

Explanation

Mirror therapy relies on watching the reflection of the less affected hand moving while the affected hand rests hidden behind the mirror, creating a visual illusion of normal movement. Moving both hands symmetrically or moving the affected hand changes the visual feedback that drives the illusion.

Question 12Upper limb rehabilitation clinical skills and theory

Which statement about the role of the corticospinal tract in upper limb reaching is most accurate?

  1. It primarily regulates posture of the trunk
  2. It enables fractionated, skilled distal movements of the hand Correct answer.
  3. It controls pupillary responses to light
  4. It mediates the stretch reflex arc at the spinal level

Explanation

The corticospinal tract, especially its lateral component, is critical for fractionated and skilled distal movements such as individuated finger control during reaching and grasping. Trunk posture, spinal reflexes, and pupillary responses are mediated by other pathways.

Question 13Upper limb rehabilitation clinical skills and theory

A patient can lift the arm but cannot actively extend the elbow against gravity. Which muscle group should be the priority for facilitation and strengthening?

  1. Wrist flexors
  2. Elbow flexors
  3. Shoulder internal rotators
  4. Elbow extensors, particularly triceps brachii Correct answer.

Explanation

Active elbow extension against gravity depends primarily on triceps brachii. Strengthening and facilitating the elbow extensors directly targets the observed deficit, whereas the other muscle groups do not produce elbow extension.

Question 14Upper limb rehabilitation clinical skills and theory

When measuring active shoulder flexion with a goniometer, which alignment is correct?

  1. Stationary arm along the mid-axillary line of the thorax, moving arm along the lateral humerus Correct answer.
  2. Stationary arm along the humerus, moving arm along the forearm
  3. Stationary arm along the forearm, moving arm along the hand
  4. Stationary arm along the spine, moving arm along the clavicle

Explanation

For shoulder flexion, the goniometer fulcrum is placed at the acromion, the stationary arm aligns with the mid-axillary line of the trunk, and the moving arm follows the lateral aspect of the humerus. Other alignments measure elbow or wrist motion rather than shoulder flexion.

Question 15Upper limb rehabilitation clinical skills and theory

Which daily activity is the best example of a task-specific training goal for a patient recovering reach-to-grasp after stroke?

  1. Passive range of motion of the wrist by the therapist
  2. Listening to music during arm exercises
  3. Practising reaching for and drinking from a cup placed at varying distances Correct answer.
  4. Repeatedly squeezing a putty cylinder at the bedside

Explanation

Task-specific training uses functional, context-relevant tasks that resemble real activity, such as reaching and drinking from a cup at different distances. Putty squeezing, passive range, and music are adjuncts that lack the contextual reach-to-grasp demand.

Question 16Upper limb rehabilitation clinical skills and theory

A patient demonstrates increased tone that is velocity-dependent and catches during fast passive movement. Which scale is most appropriate to grade this?

  1. Manual Muscle Testing
  2. Nine-Hole Peg Test
  3. Modified Ashworth Scale Correct answer.
  4. Visual Analogue Scale

Explanation

The Modified Ashworth Scale grades resistance to passive movement and captures velocity-dependent catch, which is characteristic of spasticity. Manual muscle testing grades strength, the Nine-Hole Peg Test measures dexterity, and a visual analogue scale measures pain or other subjective intensity.

Question 17Upper limb rehabilitation clinical skills and theory

Which principle best explains why early upper limb mobilisation after stroke is emphasised in rehabilitation?

  1. Spasticity is eliminated by keeping the arm still
  2. Early movement prevents all contractures permanently
  3. Immobilisation always improves motor recovery
  4. Activity-dependent neuroplasticity is supported by early, repeated practice Correct answer.

Explanation

Early and repeated active practice supports activity-dependent neuroplastic reorganisation and helps preserve movement and reduce secondary complications. Immobilisation does not improve recovery, and no single approach eliminates spasticity or permanently prevents all contractures.

Question 18Upper limb rehabilitation clinical skills and theory

A patient with radial nerve palsy presents with wrist drop. Which orthotic goal is most appropriate?

  1. Hold the fingers in full flexion to prevent extension
  2. Position the elbow in full flexion at all times
  3. Immobilise the shoulder in internal rotation
  4. Support the wrist in neutral or slight extension to allow functional hand use Correct answer.

Explanation

A wrist-hand orthosis maintaining neutral or slight wrist extension substitutes for the lost wrist extensors and allows the fingers to function for grasp and release. Shoulder immobilisation, finger flexion positioning, and full elbow flexion do not address the wrist drop.

Question 19Upper limb rehabilitation clinical skills and theory

Which finding on the Nine-Hole Peg Test most likely indicates a clinically meaningful improvement in hand dexterity?

  1. Decreased time to complete the same task Correct answer.
  2. No change in time but increased pain
  3. Increased number of errors without timing change
  4. Increased time to complete the task

Explanation

The Nine-Hole Peg Test is timed, so a decrease in completion time for the same standardised task indicates faster dexterity performance. Increased time, errors, or pain without time change do not represent improved dexterity.

Question 20Upper limb rehabilitation clinical skills and theory

In proprioceptive neuromuscular facilitation, which technique involves an isometric contraction of the agonist followed by a voluntary contraction of the agonist?

  1. Slow reversal
  2. Rhythmic initiation
  3. Hold-relax Correct answer.
  4. Contract-relax

Explanation

Hold-relax uses an isometric hold of the agonist or the range-limiting muscle followed by relaxation and active contraction of the agonist, promoting relaxation and increased range. Rhythmic initiation uses passive-to-active-assisted movement, slow reversal alternates agonist and antagonist, and contract-relax uses a concentric contraction before relaxation.

Question 21Upper limb rehabilitation clinical skills and theory

A patient with hemiplegia shows strong flexor synergy when attempting to reach forward. Which strategy best promotes more isolated reaching?

  1. Encouraging maximal effort to push through the synergy
  2. Adding resistance to the flexor pattern to strengthen it
  3. Restraining the trunk to force arm movement
  4. Positioning to reduce unwanted flexion and cueing trunk and scapular alignment before reach Correct answer.

Explanation

Reducing unwanted flexor activity through positioning and cueing proximal alignment before reaching helps the patient escape synergy dominance and access more isolated movement. Pushing through the synergy or strengthening it reinforces the abnormal pattern, and restraining the trunk interferes with normal postural support.

Question 22Upper limb rehabilitation clinical skills and theory

Which statement best reflects the concept of learned non-use in upper limb rehabilitation?

  1. The unaffected limb is always weaker than the affected limb
  2. The affected limb is avoided after failed attempts, reinforcing further disuse Correct answer.
  3. Spasticity inevitably resolves without intervention
  4. Sensory loss cannot influence motor behaviour

Explanation

Learned non-use describes a cycle in which unsuccessful attempts with the affected limb lead the patient to rely on the less affected limb, further reducing use and reinforcing the deficit. It is not explained by unaffected limb weakness, spontaneous resolution of spasticity, or independence of sensory loss from motor behaviour.

Question 23Upper limb rehabilitation clinical skills and theory

When a patient with a flaccid upper limb is positioned in sitting, which arrangement best protects the shoulder?

  1. Arm hanging unsupported at the side
  2. Arm pulled across the chest by a sling under tension
  3. Arm elevated above the head for prolonged periods
  4. Arm supported on a lapboard or armrest with the forearm supported Correct answer.

Explanation

Supporting the flaccid arm on a lapboard or armrest prevents inferior traction on the shoulder capsule and reduces subluxation risk. An unsupported hanging arm or a tensioned sling pulling across the chest increases stress, and prolonged overhead elevation is not a protective resting position.

Question 24Upper limb rehabilitation clinical skills and theory

A therapist is deciding between massed and distributed practice for a patient with low endurance after stroke. Which consideration is most relevant?

  1. Only passive practice should be used when endurance is low
  2. Distributed practice with rest intervals may better preserve quality given fatigue Correct answer.
  3. Massed practice is always superior regardless of fatigue
  4. Practice schedule has no effect on motor learning

Explanation

When endurance is limited, distributed practice with planned rest intervals can maintain movement quality and reduce fatigue-related deterioration during upper limb training. Massed practice is not universally superior, practice scheduling does affect learning, and active practice should be preserved where feasible.

Question 25Upper limb rehabilitation clinical skills and theory

Which sign suggests that a patient's shoulder pain after stroke may involve subluxation rather than a soft tissue contracture?

  1. Warm, red, swollen hand with skin changes
  2. Pain only at end-range external rotation
  3. Palpable gap between the acromion and humeral head with downward displacement Correct answer.
  4. Pain reproduced by cervical rotation only

Explanation

Glenohumeral subluxation is identified by a palpable gap below the acromion with inferior displacement of the humeral head, often worsened when the arm is unsupported. End-range pain, a warm swollen hand, or pain with cervical rotation suggest other mechanisms such as contracture, complex regional pain syndrome, or cervical referral.

Question 26Upper limb rehabilitation clinical skills and theory

During upper limb rehabilitation, a therapist applies a gentle sustained stretch to the wrist flexors of a patient with hypertonia. Which neurophysiological mechanism is primarily engaged by this prolonged, low-load stretch?

  1. Reduction of muscle spindle sensitivity and Golgi tendon organ-mediated relaxation Correct answer.
  2. Increased gamma motor neuron firing to the stretched muscle
  3. Stretch reflex facilitation mediated by muscle spindle afferents
  4. Activation of the flexor withdrawal reflex arc

Explanation

A prolonged, low-load stretch reduces spindle sensitivity and engages Golgi tendon organ afferents, producing autogenic inhibition and a decrease in tone. This underpins sustained stretching as a tone-reduction technique. Fast, high-load stretch would instead provoke the stretch reflex.

Question 27Upper limb rehabilitation clinical skills and theory

A patient after stroke presents with a flaccid shoulder and is seated in a wheelchair for most of the day. Which positioning strategy best protects the hemiplegic upper limb?

  1. Position the arm across the chest with the elbow fully flexed for comfort
  2. Suspend the arm in full elevation using an overhead sling throughout the day
  3. Allow the arm to hang unsupported at the side to encourage spontaneous movement
  4. Support the arm on a lap tray or arm trough with the humerus in slight abduction and neutral rotation Correct answer.

Explanation

Supporting the limb against gravity with the humerus in slight abduction and neutral rotation reduces inferior glenohumeral traction and protects the capsule and plexus. An unsupported hanging arm increases the risk of subluxation and traction injury.

Question 28Upper limb rehabilitation clinical skills and theory

A therapist wishes to grade resistance during a manual muscle test of elbow flexion in a patient with grade 3 strength. Which testing position is most appropriate?

  1. Seated with the arm supported and the elbow flexed to 90 degrees Correct answer.
  2. Prone with the arm extended overhead
  3. Supine with the shoulder abducted to 90 degrees
  4. Side-lying with the arm dependent over the edge of the bed

Explanation

Grade 3 indicates movement against gravity without added resistance, so the limb must be positioned to move through the available range against gravity with the proximal segment stabilised. Seated with the arm supported and the elbow at 90 degrees allows observation of full-range flexion against gravity.

Question 29Upper limb rehabilitation clinical skills and theory

A patient with a complete C6 tetraplegia wishes to feed independently. Which orthotic or adaptive approach is most likely to enable self-feeding?

  1. A resting hand splint worn during meals
  2. A shoulder abduction sling
  3. A static wrist extension splint with a universal cuff holding the utensil Correct answer.
  4. A dynamic elbow flexion assist orthosis

Explanation

At C6, wrist extension is available but finger flexion is absent, so a wrist-driven tenodesis effect combined with a utensil holder enables grasp and release for feeding. A static splint holding the utensil in place capitalises on this remaining function.

Question 30Upper limb rehabilitation clinical skills and theory

When assessing grip strength with a dynamometer, which standardisation factor most directly affects the validity of the measurement?

  1. The colour of the dynamometer handle
  2. The patient's handedness only
  3. The time of day of the assessment
  4. The handle position and the standardised testing posture Correct answer.

Explanation

Grip strength norms depend on handle setting and a standardised posture with the shoulder adducted, elbow at 90 degrees, and forearm neutral. Without these controls, values cannot be compared to reference data.

Question 31Upper limb rehabilitation clinical skills and theory

A patient demonstrates the ability to move the arm into flexion synergy but cannot isolate elbow extension. Which intervention principle best guides the therapist?

  1. Encourage maximal effort in the strongest synergy to build strength
  2. Avoid all active movement until the synergy resolves
  3. Reinforce the synergy by practising full flexion patterns repeatedly
  4. Break the synergy by positioning to reduce flexion drive and practising extension in a modified context Correct answer.

Explanation

When flexor synergy dominates, positioning that reduces flexor drive, such as side-lying or supported reach, allows extension to be practised outside the synergy. This supports movement reorganisation toward more isolated control.

Question 32Upper limb rehabilitation clinical skills and theory

Which outcome measure is most appropriate for documenting change in upper limb capacity in a patient with mild hemiparesis who can perform grasp and release?

  1. Glasgow Coma Scale
  2. Modified Ashworth Scale
  3. Action Research Arm Test Correct answer.
  4. Functional Independence Measure motor subscale

Explanation

The Action Research Arm Test grades grasp, grip, pinch, and gross movement, making it sensitive to capacity change in patients with mild hemiparesis who have some hand function. It is a widely used upper limb capacity measure.

Question 33Upper limb rehabilitation clinical skills and theory

A patient with a distal radius fracture is 4 weeks post-fixation and reports stiffness. Which intervention is most appropriate at this stage to restore wrist mobility?

  1. Aggressive passive end-range mobilisation to the point of sharp pain
  2. Immobilisation for a further 6 weeks
  3. Immediate resisted strengthening through the full range
  4. Active-assisted range of motion exercises within a pain-free range Correct answer.

Explanation

At 4 weeks post-fixation, healing is not complete, so gentle active-assisted motion within a pain-free range promotes mobility without jeopardising the repair. Progression to strengthening follows once union is confirmed.

Question 34Upper limb rehabilitation clinical skills and theory

In a patient with a median nerve injury at the wrist, which functional limitation is most characteristic?

  1. Inability to extend the wrist
  2. Inability to abduct the shoulder
  3. Loss of thumb opposition and impaired precision pinch Correct answer.
  4. Loss of elbow flexion

Explanation

The median nerve supplies the thenar muscles, including opponens pollicis and abductor pollicis brevis, so opposition and precision pinch are impaired. Wrist extension is radial nerve function and shoulder abduction is axillary and suprascapular function.

Question 35Upper limb rehabilitation clinical skills and theory

A therapist plans a home programme for a patient with limited shoulder flexion after rotator cuff repair. Which progression principle is most appropriate?

  1. Begin with active-assisted range within the prescribed limit and progress gradually as healing allows Correct answer.
  2. Begin with passive end-range stretching to accelerate recovery
  3. Begin with resisted overhead pressing and progress to active range only
  4. Begin with plyometric throwing to restore power

Explanation

After tendon repair, range must respect the repair's healing constraints, so active-assisted motion within prescribed limits is started and progressed as tissue tolerance increases. Resisted and high-load activities are introduced later in the rehabilitation timeline.

Question 36Upper limb rehabilitation clinical skills and theory

Which treatment technique uses repeated, quick stretches of a muscle followed by resisted contraction of the same muscle to increase range?

  1. Hold-relax
  2. Rhythmic initiation
  3. Contract-relax Correct answer.
  4. Alternating isometrics

Explanation

Contract-relax is a proprioceptive neuromuscular facilitation technique in which the patient performs an isotonic contraction of the agonist against resistance, then relaxes, allowing increased range. Hold-relax uses an isometric contraction of the agonist before relaxation.

Question 37Upper limb rehabilitation clinical skills and theory

A patient with early-stage Parkinson's disease shows reduced arm swing during gait. Which intervention most directly addresses this upper limb limitation?

  1. Static stretching of the shoulder flexors
  2. Rhythmic auditory cueing combined with exaggerated arm swing practice Correct answer.
  3. Passive range of motion of the wrist
  4. Strengthening of the wrist extensors in isolation

Explanation

Reduced arm swing in Parkinson's disease reflects bradykinesia and diminished amplitude, so external cueing with exaggerated amplitude practice targets the underlying motor control deficit. Isolated passive interventions do not address the amplitude regulation problem.

Question 38Upper limb rehabilitation clinical skills and theory

A patient with a painful arc between 60 and 120 degrees of shoulder abduction and a positive Neer impingement sign is being assessed. Which finding is most consistent with subacromial impingement?

  1. Pain reproduced by resisted wrist extension
  2. Pain reproduced by resisted external rotation at the side
  3. Pain reproduced by cervical side flexion
  4. Pain reproduced by passive elevation with the scapula stabilised Correct answer.

Explanation

The Neer sign reproduces subacromial impingement by passively elevating the arm while stabilising the scapula, narrowing the subacromial space. A painful arc in mid-range abduction is consistent with this diagnosis.

Question 39Upper limb rehabilitation clinical skills and theory

Which anatomical structure is most at risk when a patient receives an intramuscular injection in the deltoid at a site too inferior on the arm?

  1. Median nerve at the cubital fossa
  2. Axillary nerve and posterior circumflex humeral artery Correct answer.
  3. Radial nerve in the spiral groove
  4. Ulnar nerve at the cubital tunnel

Explanation

The axillary nerve and posterior circumflex humeral artery pass through the quadrangular space near the surgical neck of the humerus, below the usual safe deltoid injection zone. Injections placed too low risk nerve injury and vascular compromise.

Question 40Upper limb rehabilitation clinical skills and theory

A patient with complex regional pain syndrome of the hand shows allodynia and guarded movement. Which intervention approach is most appropriate initially?

  1. Prolonged immobilisation in a resting splint
  2. High-intensity strengthening of the intrinsic muscles
  3. Graded motor imagery and gentle desensitisation with pain-contingent pacing Correct answer.
  4. Aggressive joint mobilisation to prevent contracture

Explanation

In complex regional pain syndrome, the nervous system is sensitised, so graded motor imagery and desensitisation with pacing are used to reduce threat and gradually restore function. Aggressive or painful interventions can exacerbate the condition.

Question 41Upper limb rehabilitation clinical skills and theory

Which muscle acts as the primary external rotator of the shoulder and is commonly affected in rotator cuff pathology?

  1. Teres minor Correct answer.
  2. Latissimus dorsi
  3. Pectoralis major
  4. Teres major

Explanation

Teres minor is one of the rotator cuff muscles and acts as an external rotator and adductor of the shoulder. Its involvement is common in posterosuperior cuff pathology.

Question 42Upper limb rehabilitation clinical skills and theory

A patient who had a stroke 3 months ago can grasp a cup but releases it only with great difficulty. Which impairment most likely explains this difficulty?

  1. Impaired finger extension and reciprocal inhibition Correct answer.
  2. Weakness of the finger flexors
  3. Sensory loss over the shoulder
  4. Reduced shoulder abduction strength

Explanation

Difficulty releasing a grasp after stroke typically reflects impaired finger extension and disrupted reciprocal inhibition, so the flexors cannot be switched off. Grasp strength may be preserved while release is impaired.

Question 43Upper limb rehabilitation clinical skills and theory

Which principle best explains why task-specific practice is emphasised over impairment-focused exercise alone in upper limb neurorehabilitation?

  1. Strength training always transfers automatically to functional tasks
  2. Impairment-focused exercise has no effect on motor recovery
  3. Motor learning is enhanced when practice resembles the target task and provides meaningful feedback Correct answer.
  4. Passive movement is sufficient to drive cortical reorganisation

Explanation

Task-specific practice aligns practice conditions with the goal task, engaging the same sensorimotor networks and feedback processes used in daily performance. This supports transfer and motor learning more effectively than impairment-focused exercise alone.

Question 44Upper limb rehabilitation clinical skills and theory

A patient with a healed distal radius fracture has limited wrist extension. Which manual technique is most appropriate to improve wrist extension range?

  1. Anterior-to-posterior glide of the radiocarpal joint
  2. Posterior-to-anterior glide of the radiocarpal joint with the wrist positioned to stretch the capsule Correct answer.
  3. Transverse friction over the extensor tendons
  4. Long-axis traction of the elbow

Explanation

To increase wrist extension, the radiocarpal joint is positioned near end-range extension and a mobilisation directed to stretch the restricting capsule is applied. This follows the convex-concave and close-packed principles for the wrist.

Question 45Upper limb rehabilitation clinical skills and theory

A therapist is teaching a patient with a flaccid hand to perform a tenodesis grasp. Which movement produces this grasp?

  1. Active thumb opposition with the wrist neutral
  2. Active finger extension with the wrist extended
  3. Active finger flexion with the wrist flexed
  4. Active wrist extension causing passive finger flexion Correct answer.

Explanation

Tenodesis grasp depends on the passive tension of the finger flexor tendons when the wrist extends, drawing the fingers into flexion. Releasing the wrist extension allows the fingers to open.

Question 46Upper limb rehabilitation clinical skills and theory

Which assessment finding most strongly suggests a rotator cuff tear rather than adhesive capsulitis in a patient with shoulder pain?

  1. Marked loss of passive external rotation
  2. Preserved passive range with weak active elevation Correct answer.
  3. Pain at end-range in all planes
  4. Global capsular restriction in all directions

Explanation

A rotator cuff tear typically produces weakness of active elevation with relatively preserved passive range, whereas adhesive capsulitis produces global capsular restriction, especially of external rotation. Differentiating active from passive range is key.

Question 47Upper limb rehabilitation clinical skills and theory

A patient with a radial nerve palsy is fitted with a wrist extension splint. Which additional component best supports functional grasp?

  1. Thumb spica to immobilise the thumb
  2. Shoulder abduction pillow
  3. Finger flexion assist to enable grasp Correct answer.
  4. Elbow flexion block

Explanation

With wrist extension supported, the patient still lacks active finger and thumb extension, so grasp can be assisted while extension is provided by the splint. A finger flexion assist component complements the wrist extension splint for functional grasp.

Question 48Upper limb rehabilitation clinical skills and theory

Which statement best describes the role of the mirror neuron system in action observation therapy for upper limb rehabilitation?

  1. Mirror neurons directly generate muscle contraction in the observed limb
  2. Mirror neurons are only active during passive movement
  3. Action observation replaces the need for any active practice
  4. Observing an action activates similar cortical networks as performing it, supporting motor relearning Correct answer.

Explanation

Action observation engages parietofrontal networks that overlap with those used in execution, providing a priming effect for motor relearning. It is used as an adjunct to, not a replacement for, active practice.

Question 49Upper limb rehabilitation clinical skills and theory

A patient reports numbness in the thumb, index, and middle fingers that worsens at night. Which condition is most likely?

  1. Dupuytren contracture
  2. Cubital tunnel syndrome
  3. de Quervain tenosynovitis
  4. Carpal tunnel syndrome Correct answer.

Explanation

Nocturnal numbness in the thumb, index, and middle fingers follows the median nerve distribution and is classic for carpal tunnel syndrome. Symptoms are often provoked by wrist flexion during sleep.

Question 50Upper limb rehabilitation clinical skills and theory

A therapist is selecting a measure to evaluate spasticity of the elbow flexors in a patient after stroke. Which approach is most appropriate?

  1. Observation of resting elbow posture only
  2. Assessment of two-point discrimination over the forearm
  3. Passive movement at varying speeds with grading of resistance using the Modified Ashworth Scale Correct answer.
  4. Active resisted elbow flexion measured with a dynamometer

Explanation

Spasticity is velocity-dependent increased resistance to passive movement, so it is graded by moving the joint at varying speeds and rating resistance. The Modified Ashworth Scale is the standard clinical tool for this purpose.