1. Answer C. (MN-157) Task practice is a well-studied and moderately effective therapy for motor weakness after stroke. Transcranial magnetic stimulation remains under study as a potential facilitator of motor recovery, with mixed results to date. Fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) have been found ineffective for motor recovery after stroke in large well-controlled randomized trials and are not recommended for this purpose. Peripheral nerve stimulation has mixed evidence of efficacy for motor recovery. Novel stroke recovery strategies including epidural spinal cord stimulators are in development and hold some promise.

2. Answer A. (MN-157) Overall, there remains substantial uncertainty about the optimal timing, intensity, and duration of motor retraining after stroke. However, there are data that engagement in rehabilitation sessions several times daily holds the most benefit. Compensation teaches techniques that leverage preserved neurologic function to adapt and manage neurologic impairment. Enhancing neurologic recovery entails the augmentation of endogenous neuroplastic processes and the facilitation of functional return. There is evidence that intense high-dose motor retraining initiated within the first 24 hours after a stroke may actually inhibit recovery. Conversely, delaying all rehabilitation therapy for 2 weeks would miss a key opportunity to engage injury-related neuroplasticity and is not recommended. While continuing therapy for 6 months may be appropriate for some stroke survivors, there is no specific evidence that this should represent the standard practice.

3. Answer D. (MN-157) Bladder dysfunction is very common after spinal cord injury and often involves complex issues, such as detrusor-sphincter dyssynergia, where there is a loss of normal coordination between bladder contraction and sphincter relaxation. For this reason, antispasmodics are often insufficient as monotherapy to manage bladder issues in this population. The use of indwelling Foley catheters is associated with a high rate of recurrent urinary tract infections and is to be avoided whenever possible, in favor of intermittent catheterization if spontaneous bladder emptying is ineffective.

4. Answer D. (MN-157) Inpatient rehabilitation units/hospitals provide a very different care environment than most skilled nursing facilities with regard to physician involvement, nursing care, and rehabilitation therapies. Daily physician visits, higher nursing ratios, and at least 3 hours of rehabilitation therapies (physical, occupational, and speech therapy) are typical in rehabilitation units/hospitals. Skilled nursing facilities provide less frequent physician visits, have lower ratios of nurses to patients, and typically provide 0.5 to 2 hours of rehabilitation therapy per day.

5. Answer E. (MN-158) Many patients with dysphagia from neurological disorders can continue to rely on oral nutrition with modifications of their diet (eg, thickened liquids) and other swallowing strategies. While a bedside clinical evaluation is a key component of screening for dysphagia after stroke and other neurological disorders, it provides limited information about swallowing safety, and individuals with dysphagia identified at bedside frequently require a video fluoroscopic or flexible endoscopic evaluation of swallowing to further characterize their dysphagia and determine the most appropriate management strategy. Gastrostomy tubes are needed for some individuals with more severe dysphagia, and use varies by underlying disorders, anticipated duration of gastrostomy, and patient/family preference. Swallowing therapy is typically provided primarily by speech/language pathologists in the United States, not physical therapists.