CSRS ACTUAL 2026 EXAM QUESTIONS AND SOLUTIONS
RATED A+
✔✔Developmental Plasticity - ✔✔Changes in neural connection as a result of
interactions with the environment (our experiences during childhood) as a consequence
of developmental processes (e.g development of visual cortex)
-Occurs in response to (pre-determined) it occurs in response to the initial processing of
sensory information by the immature brain
-Neuronal changes: synaptogenesis, synaptic pruning, neural migration, myelination
-occurs over the lifespan, but diminishes with age
✔✔Adaptive Plasticity - ✔✔The brains ability to compensate for loss functionality due to
brain damage as well as in response to interaction with the environment by reorganizing
its structure
-This occurs in response to compensation for the brain injury and in "adjustment to new
experiences"
-Neural changes are "sprouting & rerouting"
-Occurs over the lifespan but is more efficient and effective during infancy/early
childhood
✔✔Clinical Importance of Adaptive Plasticity in Stroke - ✔✔The goal of rehab is to
restore
(change compensation to restoration)
What we measure:
(functional measures & brain based measures (MRI)
-personalize & adjust therapy based on the patient . integrate the patient into recovery
✔✔Sprouting/ Dendritic Arborization - ✔✔The growth of additional branches on axons
or dendrites to enable new connections
-Stroke triggers axonal sprouting in the cortical areas adjacent or connected to the
infarct. This can be detected with anatomical mapping of cortical circuits as early as
three weeks after stroke (Carmichael et al., 2001) and is robustly present one month
after the stroke (Li et al., 2010; Li et al
✔✔Rerouting (unmaking of silent synapses) - ✔✔when an undamaged neuron that has
lost a connection with an active neuron seeks a new active neuron and connects with it
instead
-Neurons near damaged areas seek active connections with healthy neurons
-Denervation hypersensitivity: new receptor sites develop on postsynaptic membrane
-Why? less neurotransmitter development of additional receptor sites cause receipts of
neurotransmitters from adjacent sites
✔✔Denervation Hypersensitivity - ✔✔stroke: if a presynaptic neuron dies the post-
synaptic neuron will re-route using denervation hypersensitivity by developing additional
,channels from adjacent presynaptic neurons that can innervate it becoming
hypersensitive so the action potential can continue
-Hypersensitivity: A sharp increase of sensitivity of post-synaptic membranes to a
chemical transmitter after denervation (loss of nerve supply) (e.g a nerve that has been
compromised or chnaged0
✔✔What are the conditions under which "Adaptive Plasticity" occurs?
(Principles 1-10) - ✔✔1. Use it or lose it
2. Use it or improve it
3. Specificity
4. Repetition Matters
5. intensity Matters
6. Time Matters
7. Salience Matters
8. Age Matters
9. Transference
10. Interference
✔✔What are some interventions that promote "Adaptive Neuroplasticity" - ✔✔1.
Functional task training
2. MCI Modified Constraint Induced Movement Therapy
3. Some Robot-assisted therapies
4. Repetitive Task Training
5. Circuit Training for the UE/LE
-Note Other Factors to Consider
1. Environmental Stimulation & Aerobic Exercises significantly influences neuroplasticity
changes in the brain
Exercises should include: 30 min or more aerobic & resistance exercises, training
intensity of approx. 70% heartrate maximum. frequency of 4 days per/wk.
✔✔What are some interventions that inhibit "Adaptive Neuroplasticity" - ✔✔1.
Facilitation
2. Stretching
3. Strengthening
-Note: Be thoughtful about your rationale for using the above approaches, and the
amount of time allotted to them
✔✔Take Home Points: Introduction to Neuroplasticity - ✔✔1. Adaptive neuroplasticity is
skills and motor learning dependent
2. "DO NOT" incorporate strategies that focus on mere repetition, facilitation, and/or
positioning to induce functional reorganization
3. Strengthening "DOES NOT" induce functional reorganization
,4. Aerobic Exercises complemented by "strengthening" increases effective participation
in ADLs
✔✔Motor Learning - ✔✔Integration of motor control processes through practice and
experience, leading to a relatively permanent change in the capacity to produce skilled
movements.
-The brain changes both anatomically and physiologically with resultant changes in:
-growth of new connections
-membrane excitability
-unmaking of pre-existing connections
1. Setting up our environment
2. Modifying the task
3. Choosing whole vs. part practice
4. Choosing massed vs. distributed practice
5. Choosing blocked vs. random practice
(ie. massed practice, dosage, structured practice, task-specific practice, variable
practice, multisensory stimulation, increasing difficulty, explicit feedback/knowledge of
results, implicit feedback/knowledge of performance, movement representation, and
promotion of the use of the affected limb
Note: Adult brain need to attend to stimuli and actively part of the activity for change to
occur
✔✔What are the key aspects of promoting "Neuroplasticity" - ✔✔1. Task specific :
Choose a task that is relevant and interesting to the patient
2. High Repetition: repeat, repeat, repeat with meaning and motivation
3. Challenging: Use a problem-based learning situation that uses the environment to
promote active participation of the patient
✔✔What are the key aspects of promoting "Motor Learning" - ✔✔Motor leaning is the
study of acquisition of motor skills, the performance enhancement of learning or highly
experienced motor skills, or the reacquisition of skills that are difficult to perform or
cannot be performed because of injury. This results in a persistent ( or permanent)
change that occurs over long term practice.
For optimal "Motor Learning" during therapy session you should...
1. Enhance expectancies: Diminishing the perceived difficulty (.ie. the way we present
this to our patient
"I am confident you will do a great job with this activity"
2. Autonomy: Giving out patient more choice
3. External Focus: Focus on intended outcomes
, ✔✔MIA Concept - ✔✔Motivation:
- Salience/Task Specificity
-Feedback, Enhanced Expectancy, Autonomy
Intensity:
-Physiologic and Balance
-Increasing Challenge
Attention:
-Knowledge of Results
-External Cues
✔✔Motor Learning "The Just-Right Challenge" - ✔✔Promote learning through
manipulation of conditions of practice to modify task difficulty that is the interaction of
the skill of the learner and the difficulty of the task to be learned
-If the patient is reaching a goal of 80-100% accuracy than the task needs to be more
challenging to promote neuroplasticity in the brain
-The therapist should than modify the task difficulty and manipulation the conditions of
practice
Increase the difficulty of the task to improve the patients outcomes "QUICKER,
BETTER, FASTER"
-REFLECT: How did you decide to challenge/motivate the patient and what type of
feedback did you give ?
Remember: Have a variety of challenges ready to make adjustments to try and find the
just-right level of challenge: feedback, weighted vest, eye closed, dual-task,
environment, speed/accuracy, practice, ERROR
✔✔Motivation (MIA)
Salience/Task Specificity
Feedback, Enhance Expectancy, Autonomy - ✔✔"We do this automatically"
-Be "Task Specific" Set-up the session to complete task that make sense to the patient,
and address their impairments
Remember: Motivation and behavioral aspects are key to learning a new task
-Salience "The nature of training dictates the nature of the plasticity.
Ask: What do you want to accomplish in therapy top 2-3 goals, things the patient really
cares about and/or how confident they are to complete those things
-Autonomy: "What do you want to do, and how many do you think you can do?"
Provide the patient with some aspect of control, and increase the opportunity for self-
control
-increase intrinsic motivation and engagement with improved perception of competence
-Self-Efficacy: "You many step/time do you thing you can/need to to this task before you
feel more confident?
RATED A+
✔✔Developmental Plasticity - ✔✔Changes in neural connection as a result of
interactions with the environment (our experiences during childhood) as a consequence
of developmental processes (e.g development of visual cortex)
-Occurs in response to (pre-determined) it occurs in response to the initial processing of
sensory information by the immature brain
-Neuronal changes: synaptogenesis, synaptic pruning, neural migration, myelination
-occurs over the lifespan, but diminishes with age
✔✔Adaptive Plasticity - ✔✔The brains ability to compensate for loss functionality due to
brain damage as well as in response to interaction with the environment by reorganizing
its structure
-This occurs in response to compensation for the brain injury and in "adjustment to new
experiences"
-Neural changes are "sprouting & rerouting"
-Occurs over the lifespan but is more efficient and effective during infancy/early
childhood
✔✔Clinical Importance of Adaptive Plasticity in Stroke - ✔✔The goal of rehab is to
restore
(change compensation to restoration)
What we measure:
(functional measures & brain based measures (MRI)
-personalize & adjust therapy based on the patient . integrate the patient into recovery
✔✔Sprouting/ Dendritic Arborization - ✔✔The growth of additional branches on axons
or dendrites to enable new connections
-Stroke triggers axonal sprouting in the cortical areas adjacent or connected to the
infarct. This can be detected with anatomical mapping of cortical circuits as early as
three weeks after stroke (Carmichael et al., 2001) and is robustly present one month
after the stroke (Li et al., 2010; Li et al
✔✔Rerouting (unmaking of silent synapses) - ✔✔when an undamaged neuron that has
lost a connection with an active neuron seeks a new active neuron and connects with it
instead
-Neurons near damaged areas seek active connections with healthy neurons
-Denervation hypersensitivity: new receptor sites develop on postsynaptic membrane
-Why? less neurotransmitter development of additional receptor sites cause receipts of
neurotransmitters from adjacent sites
✔✔Denervation Hypersensitivity - ✔✔stroke: if a presynaptic neuron dies the post-
synaptic neuron will re-route using denervation hypersensitivity by developing additional
,channels from adjacent presynaptic neurons that can innervate it becoming
hypersensitive so the action potential can continue
-Hypersensitivity: A sharp increase of sensitivity of post-synaptic membranes to a
chemical transmitter after denervation (loss of nerve supply) (e.g a nerve that has been
compromised or chnaged0
✔✔What are the conditions under which "Adaptive Plasticity" occurs?
(Principles 1-10) - ✔✔1. Use it or lose it
2. Use it or improve it
3. Specificity
4. Repetition Matters
5. intensity Matters
6. Time Matters
7. Salience Matters
8. Age Matters
9. Transference
10. Interference
✔✔What are some interventions that promote "Adaptive Neuroplasticity" - ✔✔1.
Functional task training
2. MCI Modified Constraint Induced Movement Therapy
3. Some Robot-assisted therapies
4. Repetitive Task Training
5. Circuit Training for the UE/LE
-Note Other Factors to Consider
1. Environmental Stimulation & Aerobic Exercises significantly influences neuroplasticity
changes in the brain
Exercises should include: 30 min or more aerobic & resistance exercises, training
intensity of approx. 70% heartrate maximum. frequency of 4 days per/wk.
✔✔What are some interventions that inhibit "Adaptive Neuroplasticity" - ✔✔1.
Facilitation
2. Stretching
3. Strengthening
-Note: Be thoughtful about your rationale for using the above approaches, and the
amount of time allotted to them
✔✔Take Home Points: Introduction to Neuroplasticity - ✔✔1. Adaptive neuroplasticity is
skills and motor learning dependent
2. "DO NOT" incorporate strategies that focus on mere repetition, facilitation, and/or
positioning to induce functional reorganization
3. Strengthening "DOES NOT" induce functional reorganization
,4. Aerobic Exercises complemented by "strengthening" increases effective participation
in ADLs
✔✔Motor Learning - ✔✔Integration of motor control processes through practice and
experience, leading to a relatively permanent change in the capacity to produce skilled
movements.
-The brain changes both anatomically and physiologically with resultant changes in:
-growth of new connections
-membrane excitability
-unmaking of pre-existing connections
1. Setting up our environment
2. Modifying the task
3. Choosing whole vs. part practice
4. Choosing massed vs. distributed practice
5. Choosing blocked vs. random practice
(ie. massed practice, dosage, structured practice, task-specific practice, variable
practice, multisensory stimulation, increasing difficulty, explicit feedback/knowledge of
results, implicit feedback/knowledge of performance, movement representation, and
promotion of the use of the affected limb
Note: Adult brain need to attend to stimuli and actively part of the activity for change to
occur
✔✔What are the key aspects of promoting "Neuroplasticity" - ✔✔1. Task specific :
Choose a task that is relevant and interesting to the patient
2. High Repetition: repeat, repeat, repeat with meaning and motivation
3. Challenging: Use a problem-based learning situation that uses the environment to
promote active participation of the patient
✔✔What are the key aspects of promoting "Motor Learning" - ✔✔Motor leaning is the
study of acquisition of motor skills, the performance enhancement of learning or highly
experienced motor skills, or the reacquisition of skills that are difficult to perform or
cannot be performed because of injury. This results in a persistent ( or permanent)
change that occurs over long term practice.
For optimal "Motor Learning" during therapy session you should...
1. Enhance expectancies: Diminishing the perceived difficulty (.ie. the way we present
this to our patient
"I am confident you will do a great job with this activity"
2. Autonomy: Giving out patient more choice
3. External Focus: Focus on intended outcomes
, ✔✔MIA Concept - ✔✔Motivation:
- Salience/Task Specificity
-Feedback, Enhanced Expectancy, Autonomy
Intensity:
-Physiologic and Balance
-Increasing Challenge
Attention:
-Knowledge of Results
-External Cues
✔✔Motor Learning "The Just-Right Challenge" - ✔✔Promote learning through
manipulation of conditions of practice to modify task difficulty that is the interaction of
the skill of the learner and the difficulty of the task to be learned
-If the patient is reaching a goal of 80-100% accuracy than the task needs to be more
challenging to promote neuroplasticity in the brain
-The therapist should than modify the task difficulty and manipulation the conditions of
practice
Increase the difficulty of the task to improve the patients outcomes "QUICKER,
BETTER, FASTER"
-REFLECT: How did you decide to challenge/motivate the patient and what type of
feedback did you give ?
Remember: Have a variety of challenges ready to make adjustments to try and find the
just-right level of challenge: feedback, weighted vest, eye closed, dual-task,
environment, speed/accuracy, practice, ERROR
✔✔Motivation (MIA)
Salience/Task Specificity
Feedback, Enhance Expectancy, Autonomy - ✔✔"We do this automatically"
-Be "Task Specific" Set-up the session to complete task that make sense to the patient,
and address their impairments
Remember: Motivation and behavioral aspects are key to learning a new task
-Salience "The nature of training dictates the nature of the plasticity.
Ask: What do you want to accomplish in therapy top 2-3 goals, things the patient really
cares about and/or how confident they are to complete those things
-Autonomy: "What do you want to do, and how many do you think you can do?"
Provide the patient with some aspect of control, and increase the opportunity for self-
control
-increase intrinsic motivation and engagement with improved perception of competence
-Self-Efficacy: "You many step/time do you thing you can/need to to this task before you
feel more confident?
