National Physical Therapy Examination (NPTE) Practice Exam

A patient with a left cerebral vascular accident (CVA) exhibits right hemiparesis. Which activity is best to break up the associated hemiplegic synergies in the lower extremity?

1. Foot tapping in a sitting position

2. Supine, PNF D2F with knee flexing and D2E with knee extending

3. Supine lying, hip extension with adduction

4. Bridging, pelvic elevation

The correct answer is: Bridging, pelvic elevation

Breaking up hemiplegic synergies in patients who have experienced a stroke involves facilitating more normal movement patterns and reducing the influence of abnormal postural reflexes. In the case of a patient with left CVA resulting in right hemiparesis, an effective approach would involve activities that engage the lower extremities while allowing for the redistribution of weight and the use of postural control. Engaging in bridging and pelvic elevation specifically targets muscles of the lower extremities, including the glutes and hamstrings, while promoting the activation of the core muscles. This activity is particularly beneficial because it allows for contractions of the affected side, which can facilitate the mobilization of the hip and knee without being restricted by synergy patterns typical after a stroke. By elevating the pelvis, the patient is encouraged to initiate movement from the affected side, thereby promoting a more normalized movement pattern and breaking the synergy. Additionally, bridging encourages weight shifting and helps the patient develop control and strength in the involved lower extremity by requiring the activation of both sides in coordination, potentially leading to improved functional mobility. This choice promotes integrating functional tasks that can assist in the recovery of motor function. In contrast, the other options may not provide the same level of engagement or efficacy in breaking up