Please complete the accompanying Posttest and Evaluation Form. Return the completed Answer Sheet and Evaluation Form to: University of California, Irvine School of Medicine
(Answer sheet below)
1. Which of the following is not a positive sign of the upper motor neuron syndrome a. Co-contraction b. Spastic dystonia c. Loss of finger dexterity d. Associated reactions a. Disinhibited flexor reflex b. Velocity-dependent increase in muscle tone during passive stretching c. A form of exaggerated phasic stretch reflex d. Tonic muscle contraction at rest 3. In the UMNS, common limb deformities, such as flexed wrist, result from: a. Muscle overactivity b. Weakness c. Contractures d. All of the above 4. The Ashworth Scale (or Modified Ashworth Scale) is an assessment tool that a. Spasm frequency b. Muscle stiffness/tone c. Pain d. Degree of disfigurement 5. Which of the following are valid reasons for treating the patient with a. Spasticity interferes with active function b. Spasticity is of no benefit to the patient c. Treatment reduces burden of care d. All of the above 6. The following is not an example of systemic/central treatment options for a. Clonidine b. Phenol c. Intrathecal baclofen d. Tizanidine 7. The rationale for chemodenervation is: a. It is a focally acting, targeted therapy b. Chemodenervation reduces the tone of overactive muscles c. It improves stretch, increases resting length, and may reduce contractures d. All of the above 8. Which of the following correctly describes the mechanism of action of botulinum a. Interferes with calcium release from the sarcoplasmic reticulum b. Denatures protein and demyelinates neuronal axons, thereby degenerating c. Binds to GABA receptors at the presynaptic terminal d. Selectively blocks acetylcholine release at the neuromuscular junction 9. When calculating the dose of botulinum neurotoxin, it may be more relevant to 10. Electromyographic monitoring is a useful technique for muscle localization before injection in patients with some degree of motor control.
Posttest Answer Sheet
1) Use this Answer Sheet to answer the test questions. There is no fee for this program. To receive 3 AMA PRA Category 1 credits™, please
return this completed Answer Sheet and Evaluation Form by November 30, 2010. The
posttest answers will be graded and, after successfully answering at least 70% of the
questions correctly, you will be sent the CME certificate within 60 days of submission.
Participants are allowed 2 attempts to pass the test.
Treatment of the Upper Motor Neuron Syndrome With Botulinum Neurotoxin:
Outcome-Focused Case Studies in the Management of Muscle Overactivity
Evaluation Form
Educational Objectives:

• Describe the etiology and pathophysiology of spasticity and problematic muscle • Describe the various forms of muscle overactivity and common limb patterns associated with the UMNS and their functional and clinical implications • Understand key management goals for treating muscle overactivity • Identify the rationale for patient selection, treatment, and goal-setting in clinical • Describe the various treatment options for management of muscle overactivity • Understand the mechanism of action and clinical benefits of therapy with • Discuss techniques for muscle selection and injection in various muscle 1. Did the program meet the stated objectives? Yes No 2. Was there any evidence of commercial bias? Yes No
3. I have viewed the program Treatment of the Upper Motor Neuron Syndrome With
Botulinum Neurotoxin: Outcome-Focused Case Studies in the Management of Muscle

This CME activity was:
Extremely useful Somewhat useful Minimally useful
4. The overall quality of the program was: ____ Excellent ____ Good ____ Fair 5. I feel the program could be improved by: 6. Suggestions for future programs/overall comments: 7. I would recommend this CME activity to my colleagues for study: Yes No 8. How long did it take you to view the video and complete the Self-Assessment Test and 9. Do you anticipate making any changes to your patient care practice as a result of this ________________________
10. Which educational formats do you prefer? Please rank in order of preference with 1 being the most preferred and 6 the least preferred. Audio conference Multimedia (online/CD-ROM) 11. Please indicate your willingness to participate in a follow-up survey to evaluate the


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