USAHS NEURO COMPETENCY EXAM
Q&A
MCA Performance Skills/ Client factors Affected - ANSWER -Body functions: visual
functions (visual field deficit), movement functions (motor loss on one side, gait pattern,
control of voluntary movement, muscle power, endurance), proprioceptive functions
(spatial awareness)
Performance skills: process skills (reaching in UE), motor skills, social interaction skills,
communication skills if L MCA, proprioception (spatial awareness) if R MCA
MCA Occupations Impacted - ANSWER -bathing, dressing, personal hygiene, social
participation, work, education, meal preparation
MCA Screenings - ANSWER -Aphasia screen (do command then ask question) for L
MCA: show us if they have aphasia or difficulty speaking
Unilateral neglect (fold piece of paper) or apraxia test (ask them to perform movement)
for R MCA: show us if they have neglect or apraxia
Vision: visual field test
Light touch on contralateral side in face or UE: show us if they have positive signs for
hemisensory loss
Motor screening in face (you could test for CN 7)
MCA Referrals - ANSWER -Speech, PT, psych/ social work, stroke support group
ACA- Anterior Cerebral Artery Description - ANSWER -Personality changes
Cognitive changes (divergent thinking specifically)
Perseveration
Gait apraxia
Caused by lack of blood supply to the deep branches of the anterior cerebral artery &
resulting damage to the anterior putamen and to the motor axons from the pons.
Contralateral hemiplegia
Loss of fine touch sensation
Hemiplegia and fine touch loss are more severe in the lower limb than the upper limb
because the medial sensorimotor cortex and adjacent white matter are affected
ACA Performance Skills/ Client factors Affected - ANSWER -Body functions: touch
functions (loss of fine touch in LE), movement functions (gait patterns), mental functions
(sequencing and executive functioning)
Performance skills: process skills (organizing and timing and sequencing), motor skills
(positioning the body bc of hemiplegia and holding objects, walking, and coordination),
social interaction skills (bc of personality changes)
ACA Occupations Impacted - ANSWER -dressing, social participation, functional
mobility, bathing, toileting
, ACA Screenings - ANSWER -Cognitive: probably high level
Sensory: light touch in LE
Motor: Observe walking to assess gait apraxia or due MMT in LE
ACA Referrals - ANSWER -psych, social work, stroke support group
SCI - ANSWER -Complete injury = lack of sensory and motor function in the lowest
sacral segment
Incomplete injury= preservation f sensory and/or motor function in the lowest sacral
segment
Neurologic level of injury
Lowest (most caudal) level with normal sensory and motor function bilaterally
Myotomes - ANSWER -Tested bilaterally
PCA- Posterior Cerebral Artery Description - ANSWER -Hemisensory loss
Eye movement problems
Cortical blindness (loss of vision)
Homonymous hemianopia (visual field loss deficit)
Visual agnosia (inability to recognize objects by sight)q
PCA Performance skills/ Client factors affected - ANSWER -Body functions: visual
functions (visual field, oculomotor functions, acuity), touch functions (numbness), pain
Performance skills: process skills (search/locate), motor skills related to movement of
the eye
PCA Occupations Impacted - ANSWER -bathing, dressing, personal hygiene, driving,
work
PCA Screenings - ANSWER -Visual pursuit/ tracking: we would see they would have
problems moving their eyes
Visual agnosia: We would see they would not be able to recognize an object
Proprioception or light touch: We would see hemisensory loss
Can also do quick motor or cognitive screening
PCA Referrals - ANSWER -ophthalmologist, social work/ psych, stroke support group
MCA- Middle Cerebral Artery Description - ANSWER --Contralateral homonymous
hemianopia
-Contralateral hemiplegia & hemisensory loss
Upper limb and face are more affected than lower limb because neurons regulating
movement and processing conscious sensation of the upper body are located in the
lateral cerebral cortex
Loss of blood supply to deep branches may result in contralateral hemiplegia that
affects upper and lower extremities equally
Q&A
MCA Performance Skills/ Client factors Affected - ANSWER -Body functions: visual
functions (visual field deficit), movement functions (motor loss on one side, gait pattern,
control of voluntary movement, muscle power, endurance), proprioceptive functions
(spatial awareness)
Performance skills: process skills (reaching in UE), motor skills, social interaction skills,
communication skills if L MCA, proprioception (spatial awareness) if R MCA
MCA Occupations Impacted - ANSWER -bathing, dressing, personal hygiene, social
participation, work, education, meal preparation
MCA Screenings - ANSWER -Aphasia screen (do command then ask question) for L
MCA: show us if they have aphasia or difficulty speaking
Unilateral neglect (fold piece of paper) or apraxia test (ask them to perform movement)
for R MCA: show us if they have neglect or apraxia
Vision: visual field test
Light touch on contralateral side in face or UE: show us if they have positive signs for
hemisensory loss
Motor screening in face (you could test for CN 7)
MCA Referrals - ANSWER -Speech, PT, psych/ social work, stroke support group
ACA- Anterior Cerebral Artery Description - ANSWER -Personality changes
Cognitive changes (divergent thinking specifically)
Perseveration
Gait apraxia
Caused by lack of blood supply to the deep branches of the anterior cerebral artery &
resulting damage to the anterior putamen and to the motor axons from the pons.
Contralateral hemiplegia
Loss of fine touch sensation
Hemiplegia and fine touch loss are more severe in the lower limb than the upper limb
because the medial sensorimotor cortex and adjacent white matter are affected
ACA Performance Skills/ Client factors Affected - ANSWER -Body functions: touch
functions (loss of fine touch in LE), movement functions (gait patterns), mental functions
(sequencing and executive functioning)
Performance skills: process skills (organizing and timing and sequencing), motor skills
(positioning the body bc of hemiplegia and holding objects, walking, and coordination),
social interaction skills (bc of personality changes)
ACA Occupations Impacted - ANSWER -dressing, social participation, functional
mobility, bathing, toileting
, ACA Screenings - ANSWER -Cognitive: probably high level
Sensory: light touch in LE
Motor: Observe walking to assess gait apraxia or due MMT in LE
ACA Referrals - ANSWER -psych, social work, stroke support group
SCI - ANSWER -Complete injury = lack of sensory and motor function in the lowest
sacral segment
Incomplete injury= preservation f sensory and/or motor function in the lowest sacral
segment
Neurologic level of injury
Lowest (most caudal) level with normal sensory and motor function bilaterally
Myotomes - ANSWER -Tested bilaterally
PCA- Posterior Cerebral Artery Description - ANSWER -Hemisensory loss
Eye movement problems
Cortical blindness (loss of vision)
Homonymous hemianopia (visual field loss deficit)
Visual agnosia (inability to recognize objects by sight)q
PCA Performance skills/ Client factors affected - ANSWER -Body functions: visual
functions (visual field, oculomotor functions, acuity), touch functions (numbness), pain
Performance skills: process skills (search/locate), motor skills related to movement of
the eye
PCA Occupations Impacted - ANSWER -bathing, dressing, personal hygiene, driving,
work
PCA Screenings - ANSWER -Visual pursuit/ tracking: we would see they would have
problems moving their eyes
Visual agnosia: We would see they would not be able to recognize an object
Proprioception or light touch: We would see hemisensory loss
Can also do quick motor or cognitive screening
PCA Referrals - ANSWER -ophthalmologist, social work/ psych, stroke support group
MCA- Middle Cerebral Artery Description - ANSWER --Contralateral homonymous
hemianopia
-Contralateral hemiplegia & hemisensory loss
Upper limb and face are more affected than lower limb because neurons regulating
movement and processing conscious sensation of the upper body are located in the
lateral cerebral cortex
Loss of blood supply to deep branches may result in contralateral hemiplegia that
affects upper and lower extremities equally
