Case 5: NICU The therapist is performing initial evaluation. List order promoting optimal neurobehavioral organization during PT session. 1. observe infant's state, position, movement patterns 2. open incubator softly 3. provide contained touch 4. take note of vitals at rest and all lines/tubes What order should the above tasks be completed in?

4, 1, 2, 3 4. take note of vitals at rest and all lines/tubes 1. observe infant's state, position, movement patterns 2. open incubator softly 3. provide contained touch

Case Study Questions Review Flashcards by Kaylee Tang

Case 1: Brachial Plexus

Which nerve segments are most frequently injured in obstetric brachial plexus palsy?

A. C4-5
B. C5-6
C. C7-8
D. C8-T1

B. C5-6

OBPP typically involves the upper plexus which consists of C5-6 nerve roots

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Case 1: Brachial Plexus

Which of the following conditions is a risk factor for OBPP?

A. Decreased birth weight
B. Maternal hypoglycemia
C. Premature birth
D. Shoulder dystocia

D. Shoulder dystocia

Difficult delivery of the shoulder may result in pulling on nerves within the brachial plexus and is a risk factor for OBPP.

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Case 1: Brachial Plexus

The Assisting Hand Assessment is intended for use with children in which of the following age ranges?

A. 6 mos to 7.5 yrs
B. 18 mos to 12 yrs
C. birth to 5 yrs
D. birth to 19 yrs

B. 18 mos to 12 yrs

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Case 5: NICU

Which of the following increases risk of positional plagiocephaly in pre term infants?

A. 30 min/day of tummy time
B. chronic lung disease diagnosis
C. female sex
D. reduced time in swings/ infant seats

B. Chronic lung disease diagnosis
(MALE sex also increases positional plagiocephaly)

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Case 5: NICU

Which of the following strategies promotes behavioral organization in pre-term infant during PT sessions?

A. providing multimodal sensory input when infant is stressed
B. positioning infant in side-lying without 3 dimensional boundaries or nest
C. grading tactile input and allowing rest between positional changes
D. timing session between feeding times, when infant is in deep sleep

C. grading tactile input and allowing rest between positional changes

*do NOT schedule therapy when infant is in deep sleep
*don’t stress baby out too much

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Case 5: NICU

The therapist is performing initial evaluation. List order promoting optimal neurobehavioral organization during PT session.

observe infant’s state, position, movement patterns
open incubator softly
provide contained touch
take note of vitals at rest and all lines/tubes

What order should the above tasks be completed in?

4, 1, 2, 3

take note of vitals at rest and all lines/tubes
observe infant’s state, position, movement patterns
open incubator softly
provide contained touch

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Case 12: DCD

Which subtype of DCD explains most of motoric difficulties demonstrated by a child displaying gross motor difficulties along with fine motor ?

A. Fine motor deficits
B. Visual perceptual deficits
C. Mixed dyspraxia
D. Constructional dyspraxia

C. Mixed dyspraxia

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Case 12: DCD

Which of the following is the most appropriate tool for the physical therapist to choose to determine the extent of a child’s functional delays?

A. TGMD-2
B. MABC-2
C. PDMS-2
D. BOT-2

B. MABC-2

MABC-2 is the best and most research tool for the DCD population.

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Case 12: DCD

What is the most effective intervention strategy given this patient has mixed dyspraxia?

A. NDT
B. Sensory integration
C. Core stability training
D. CO-OP

D. CO-OP

Research supports the use of task-oriented training, which are concepts that are incorporated in the CO-OP program.

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Case 28: ITW

Which of the following statements regarding idiopathic toe walking is most accurate?

A. Most elementary-age children will grow out of the behavior independent of management.

B. Children with idiopathic toe walking may have delays in language skills or language disorders.

C. Idiopathic toe walking typically presents as an asymmetrical condition.

D. Idiopathic toe walking is more commonly observed in girls.

B. Children with idiopathic toe walking may have delays in language skills or language disorders.

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Case 28: ITW

Which of the following examination findings is most suggestive of a non-idiopathic origin for toe-walking behaviors?

A. The presence of a plantar flexion contracture

B. Toe walking that occurs >75% of the time

C. Presence of spasticity in the gastrocnemius muscle

D. A report of pain in the feet or legs

C. Presence of spasticity in the gastrocnemius muscle

spasticity = probably UMN

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Case 28: ITW

A 15-month-old boy is referred for a physical therapy examination due to concerns related to his intermittent toe walking. Other than the occasional toe-walking pattern, the examination does not reveal any significant findings. What is the most appropriate physical therapy recommendation?

A. Refer. The child potentially has cerebral palsy or other underlying medical condition that is resulting in the toe-walking behavior.

B. Keep. Ongoing physical therapy sessions are needed to address the child’s toe walking.

C. Monitor. Toe walking prior to the age of 2 years is a commonly reported gait deviation.

D. Keep and refer. The child requires intervention to address his toe walking and requires medical evaluation and testing to determine if an underlying medical condition is resulting in the toe-walking behavior.

C. Monitor. Toe walking prior to the age of 2 years is a commonly reported gait deviation.

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Case 17: CMT

Which of the following is NOT typically associated with CMT?

A. DDH
B. SCM fibrosis
C. abnormal muscle tone
D. plagiocephaly

C. Abnormal muscle tone

*DDH (hip dysplasia) is associated with CMT!!

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Case 17: CMT

A 5 month old infant with a 25 degree restriction of PROM L rotation and SCM mass is referred to PT.

CMT category is:

A. Grade 1 early mild
B. Grade 2 early moderate
C. Grade 3 early severe
D. grade 4 late mild

C. Grade 3 early severe

patient is under 6 months old, SCM mass present

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Case 17: CMT

What is Grade B evidence as the most common and effective intervention for CMT?

A. Passive cervical ROM
B. Facilitation of rolling away from the affected side
C. Active strengthening of the weaker cervical muscles
D. Prone positioning during play

A. Passive cervical ROM

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Case 26: Clubfoot

Which of the following best describes the anatomic position of a clubfoot that is not completely corrected?

A. elongated and plantarflexed first ray with DF beyond 10 degrees
B. prominent base of the fifth metatarsal on palpation
C. forefoot abduction beyond neutral and ability to squat with feet flat on floor
D. retracted and PF first ray, forefoot adduction that does not correct past neutral, and prominent base of the fifth met on palpation

D. retracted and PF first ray, forefoot adduction that does not correct past neutral, and prominent base of the fifth met on palpation

tight structures along medial aspect of foot –> great toe shortened through PF of first ray –> forefoot adducted

lateral column elongated, so base of fifth met (pinky toe) is visibly prominent

hindfoot is tight, resulting in inability to keep flat foot on floor when squatting

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Case 26: Clubfoot

Which of the following is a common gait pattern with relapsing clubfoot?

A. heel strike at IC and toe out through stance
B. Foot flat at IC, collapsing into pronation during stance phase
C. Early heel rise after IC with intoeing during stance phase
D. Steppage gait during swing phase

C. Early heel rise after IC with intoeing during stance phase

early heel rise on an internally rotated supinated foot

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Case 26: Clubfoot

Which of the following would be an appropriate activity for physical therapist to give a child with clubfeet as a home program?

A. Picking up marbles with toes
B. Balance on one foot
C. Heel raises
D. Standing on a slant board with heels down and knees in hyperextension

B. Balance on one foot

encourages foot flat with control

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Case 6: CP

A child with CP’s mother asks a PT if her child’s brain damage will get worse over time. The most appropriate response to the mother’s concern would be:

A. CP is an inherited genetic disorder that directly affects muscle

B. CP results from brain damage that will not change, and signs that child demonstrates no will not change over time

C. Children with CP have non-progressive damage to the brain although secondary changes in MSK system may progress over time

D. Children with CP have progressive brain damage worsening over time, resulting in increased MSK changes over time.

C. Children with CP have non-progressive damage to the brain although secondary changes in MSK system may progress over time

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Case 6: CP

What intervention is most important to initiate first with this 26 month old child who has diplegia spastic CP?

A. daily PROM for 20 min morning and evening
B. passive standing in prone stander daily
C. body weight supported treadmill
D. patterning done 6 hours a day

B. passive standing in prone stander daily

*LE WB through supported standing program is important to initiate to promote physiologic and psychosocial benefits

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Case 19: Spina Bifida

Which of the following is true about ambulation in children with spina bifida?

A. They are never able to ambulate and rely on wheeled mobility to access the community.

B. They can ambulate independently with an assistive device.

C. Their ability to ambulate is dependent on the level of the spinal cord lesion.

D. Their ability to ambulate is related to the presence of hydrocephalus

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C. Their ability to ambulate is dependent on the level of the spinal cord lesion.

Case 19: Spina Bifida

Children with spina bifida are at increased risk for all of the following except…

A. Hydrocephalus
B. Urinary tract infection
C. Latex allergy
D. Tuberculosis

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D. Tuberculosis

Case 7: CP Elementary School

A school-based physical therapist is working with a kindergarten student diagnosed with CP, GMFCS level III. The student is able to ambulate with rolling walker. She enjoys being with her classmates, but becomes frustrated when she has difficulty keeping up with classmates during PE class or while outside on the playground and school sports fields. The student is on grade level for all academic areas.*

Which of the following objective measures would be most appropriate to measure this student’s mobility and endurance?
A. 6-minute walk test (6MWT)
B. 30-second walk test
C. Early Activity Scale for Endurance
D. MobQues28

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A. 6-minute walk test (6MWT)

30-second walk test and MobQues28 measure mobility, not endurance
EASE measures endurance, not mobility in children

Case 7: CP Elementary School

Which tool would be MOST appropriate to measure student’s participation in the school setting and activity in school-related tasks?

A. Children’s Assessment of Participation and Enjoyment (CAPE)
B. Gross Motor Function Measure (GMFM)
C. Quality Function Measure (QFM)
D. School Function Assessment (SFA)

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D: School Function Assessment

criterion-referenced tool for kinder-6th grade. Measures participation in school and activity in physical and cognitive/behavioral tasks.

CAPE: measures children’s engagement and participation in recreation, not school
GMFM and QFM: gross motor performance

Case 7: CP Elementary School A school-based physical therapist is working with a kindergarten student diagnosed with CP, GMFCS level III. The student is able to ambulate with rolling walker. She enjoys being with her classmates, but becomes frustrated when she has difficulty keeping up with classmates during PE class or while outside on the playground and school sports fields. The student is on grade level for all academic areas. To address the student’s frustration with keeping up with her classmates during physical education and recess, which intervention is most important for the physical therapist to initiate? A. Convene a meeting with the student’s physical education teacher to provide the student with a separate physical education class. B. Help the student problem solve and identify strategies to increase her participation in physical education and recess. C. Increase lower extremity strength and balance. D. Request that the student’s teacher allow the student to play inside during recess.

B. It is important to include the student in addressing such issues, in order to help increase her independence, self-advocacy, and problem- solving ability regarding her disability. Options A and D would isolate the student and not allow her to integrate with her peers. Increasing her lower extremity strength and balance (option C) may help her keep up with her classmates, but it neither directly addresses the student’s current frustration, nor allows her the opportunity to problem-solve.

Case 13: ASD Motor impairments in children with ASD typically include all of the following, except: A. Low muscle tone B. Early difficulty with head control C. Early asymmetries in use of arms D. Spasticity

D. Spasticity (UMN)

Case 13: ASD A valid and reliable outcome measure for evaluating bilateral coordination in children with ASD is: A.Childhood Autism Rating Scale (CARS) B. Bruininks-Oseretsky Test of Motor Proficiency (2nd edition; BOT- 2) C. Movement Assessment Battery for Children, Second Edition (MABC-2) D.Children’s Assessment of Participation and Enjoyment/Preference for Activities of Children

B. Bruininks-Oseretsky Test of Motor Proficiency (2nd edition; BOT- 2) *bilateral coordination + gross and fine motor performance, balance, running speed, strength, agility, manual dexterity

Case 13: ASD Treatments that are effective for children with ASD in improving motor functioning include all except: A. Hippotherapy B. Aquatics C. Repetitive play activities D. Antidepressants

D. Antidepressants

Case 8: CP Post secondary education & transition into adulthood *An outpatient physical therapist is working with a 22-year-old young adult diagnosed with diplegic CP, GMFCS level III. She reports that she has been experiencing increased pain with ambulation, anterior knee pain, and decreased endurance, all of which have become more pronounced over the past year.* Which of the following tools would be most appropriate to measure this young woman’s cardiorespiratory fitness? A. Gross Motor Function Measure (GMFM) B. Progressive protocol test with a cycle ergometer C. Short Form 36 Version 2.0 (SF-36v2) D. Tinetti Performance Oriented Mobility Assessment

B. Progressive protocol test with a cycle ergometer A progressive protocol test using a cycle ergometer has been found to be an appropriate means to test cardiorespiratory fitness in adults with CP.

Case 8: CP Post secondary education & transition into adulthood Anterior knee pain in an adult with spastic diplegic CP is most likely to be the result of which of the following? A. Hip dysplasia B. Osgood-Schlatter disease C. Patella alta D. Spondylolysis

C. Patella Alta Patella alta in adults with spastic diplegic CP presents as anterior knee pain and occurs most frequently in individuals who use a crouch-type gait pattern. While hip dysplasia (option A) and spondylolysis (option D) are common in adults with CP, these conditions do not present as anterior knee pain. While anterior knee pain can be the result of Osgood-Schlatter disease (option B), it is not the most likely cause of this young woman’s knee pain.

Case 8: CP Post secondary education & transition into adulthood This young woman is interested in starting an exercise program for health promotion and wellness. Which of the following is the most appropriate recommendation for her? A.Progressive resistance exercise and aerobic exercise using a stationary bike or recumbent cross-trainer B. Exercise for health promotion is not recommended for this young woman, as secondary impairments will continue to progress with age. C. Passive stretching 20 minutes per day D. Walking 20 minutes per day in the community

A.Progressive resistance exercise and aerobic exercise using a stationary bike or recumbent cross-trainer Passive stretching (option C) will not improve health and wellness. Walking 20 minutes per day (option D) is not ideal for increasing or maintaining her aerobic fitness, given her ambulation status.

Case 10: Down Syndrome Children with down syndrome show delayed development of postural control that is most affected by: a. hydrocephalus b. smaller than normal cerebellum c. visual impairment d. tendency toward obesity

b. smaller than normal cerebellum

Case 10: Down Syndrome Which of the following has been shown to help a young child with DS learn to walk independently earlier? a. supramalleolar orthoses b. early intervention programming c. treadmill training d. aquatic therapy

c. treadmill training

Case 10: Down Syndrome Poor activity tolerance, as evidenced by the child's refusal to participate in active play for more than a few minutes, could be a symptom of inadequate management of: a. hypothyroidism b. visual deficits c. gastroesophageal reflux d. postural control deficits

a. hypothyroidism

Case 18: Osteogenesis Imperfecta The most appropriate progression from ambulating with a walker to ambulating without an assistive device for the child with osteogenesis imperfecta would be: A. transitioning child to axillary crutches B. having the child practice taking a few steps at a time with light hand-held assist in a controlled environment C. ensuring that the child can first walk community distances with the walker D. check that the child has at least 4/5 quadriceps strength as tested with MMT

B. having the child practice taking a few steps at a time with light hand-held assist in a controlled environment - axillary crutches and MMT should both be avoided for patients with OI

Case 18: Osteogenesis Imperfecta A physical therapist is creating a HEP for a child with osteogenesis imperfecta who has just begun weightbearing on land following a rodding revision surgery. Which is NOT appropriate A. sit-to-stand transfers from an elevated surface, using a walker for support B. standing quad sets using a walker for support C. short arc quads D. single leg squats holding a walker for support

D. single leg squats holding a walker for support

Case 18: Osteogenesis Imperfecta When would it be appropriate to utilize a partial-weightbearing gait therapy device as a therapy intervention for a child with OI who has recently begun weightbearing after a rodding surgery? A. As an alternative to weightbearing in the pool since a partial weightbearing gait therapy device can also provide unweighting of the LEs B. While ambulating on land instead of using a walker C. A child with OI should never be placed in a partial- weightbearing gait therapy device D. To increase standing tolerance prior to ambulating on land

C. A child with OI should never be placed in a partial- weightbearing gait therapy device - the harness used must be pulled snug to the torso and could cause a fracture to the child's ribs or pelvis

Case 4: Hemipolymicrogyria - Bracing for Gait T/F: The shaft to vertical angle is unaffected by the type of shoe the patient wears

F - it is affected

Case 4: Hemipolymicrogyria - Bracing for Gait All of the following are true regarding children with hemiplegia except: A. They have an asymmetrical gait pattern. B. They sometimes present with equinus deformity. C. They always need bracing to normalize gait. D. They have involvement of the arm and leg on the same side.

C. They always need bracing to normalize gait. NOT TRUE bracing may not always be needed, depending on amount of tone present

Case 4: Hemipolymicrogyria - Bracing for Gait Children who present with increased tone may benefit from all except: A. Medical management of tone B. Strengthening programs C. Bracing during movement D. Increasing tone for stability

D. Increasing tone for stability increasing tone in children with spasticity can lead to even MORE inefficient movements and increased energy expenditure

Case 4: Hemipolymicrogyria - Bracing for Gait A valid and reliable tool for measuring tone is: A. GMFM B. Modified Ashworth scale C. Manual muscle testing D. Palpation of the muscle

B: Modified Ashworth Scale (only tool listed that measures tone)

Case 11: DMD Which distinctive examination sign may be associated with the diagnosis of DMD? A. Babinski’s B. Thomas test C. Gowers’ D. Homan’s

C. The Gowers’ sign is a hallmark of DMD. *Babinskis: UMN, Thomas: hip flexor tightness, Homan's: DVT

Case 11: DMD Which of the following is appropriate to assess function and participation in the DMD population? A. Timed Up and Go B. Range of motion C. Functional Reach Test D. Egen Klassification Scale

D. Egen Klassification Scale - contains Functional measures

Case 11: DMD Based on the young male in the DMD case study, which of the following represent the most critical interventions? A.Preserve functional upper extremity use, monitor for worsening scoliosis and decreased respiratory function B. Preserve lower extremity use, stretching, accessing the environment C. Wheelchair mobility, home adaptations D. Emphasize re-acquiring ambulation within his home

A. Preserve functional upper extremity use, monitor for worsening scoliosis and decreased respiratory function

Case 25: Congenital Limb Deficiency: PFFD What is the most appropriate inpatient physical therapy intervention for a 6 year old male immediately after limb lengthening and application of unilateral external fixator? A. Active & active assisted hip, knee, and ankle ROM, bed mobility and transfers, &. weightbearing to tolerance using AD B. Bed mobility and transfers with nonweightbearing gait using AD. Hip, knee, and ankle ROM initiated one week after surgery during the first acute OP PT session C. Passive ROM only, bed mobility and transfers, and nonweightbearing 3-point gait D. Active ROM within pain tolerance, bed mobility and transfers, nonweightbearing 3-point gait until patient is pain-free

A. Active & active assisted hip, knee, and ankle ROM, bed mobility and transfers, &. weightbearing to tolerance using AD -early weigthbearing is important for bone healing

Case 25: Congenital Limb Deficiency: PFFD The most common first intervention for a 14month old toddler with left Aitken Type C PFFD is: A. Surgical amputation of the left foot with knee fusion B. Shoe lift with AFO C. Extension prosthesis with prosthetic knee D. Femoral osteotomy with knee fusion

C. Extension prosthesis with prosthetic knee - equalizing limb lengths & offering the patient knee function is important for normalizing development allowing toddler to transition to into and out of sitting and standing

Case 2: SCI Which of the following does not contribute to the potential for SCIWORA? (SCI without radiologic abnormalities) A. Kyphoscoliosis in young child B. Disproportionately large head relative to the child’s body C. Horizontally oriented facet joints in a child D. Motor vehicle collision

D. Motor vehicle collision (injuries from MVC can be seen on MRI) SCIWORA, are common in children due to the immaturity of the child’s spine (option A). Characteristics of spinal immaturity include ligamentous laxity, horizontally oriented facet joints (option C), and inherent elasticity along with the disproportionately large head of a young child (option B). These features render the child’s spine vulnerable to deforming forces and damage that may not be evident on imaging.

Case 2: SCI Which of the following tests is used to determine the level and severity of SCI in the pediatric population? A. WeeFIM B. Spinal Cord Independence Measure (SCIM) C. International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) D. Functional Independence Measure (FIM)

C. International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) The ISNCSCI is the most common method for determining the level and severity of an SCI in the pediatric population. The WeeFIM, SCIM, and FIM are measures of function, not of level or severity of SCI.

Case 2: SCI Which of the following is a TRUE statement regarding autonomic dysreflexia? A. It is always characterized by an increase in blood pressure and a decrease in heart rate. B. It most commonly affects patients with SCI level at or above T12. C. Distention of the bowel or bladder is a common cause. D. Signs and symptoms are more obvious in younger children than in adolescents and adults.

C. Distention of the bowel or bladder is a common cause. (AD is commonly caused by distention of the bowel or bladder) - It is most commonly experienced by patients with SCI at or ABOVE T6 (option B) - is characterized by an increase in blood pressure with either bradycardia or tachycardia (option A). - Signs and symptoms are typically more subtle in infants and young children than in older children and adults (option D).

Case 3: Cerebral Hemispherectomy The most common indication for a cerebral hemispherectomy is: A. cortical tumor B. medically intractable seizures C. infarcts leading to hemiplegic CP D. seizures arising from several areas of the brain in both hemispheres

B. most commonly used for intractable seizures resistant to medications

Case 3: Cerebral Hemispherectomy Typical clinical presentation of children status/post hemispherectomy includes: A. Increased spasticity with more involvement in the involved lower extremity as compared to the involved upper extremity B. Visual field cut without sensory deficits in the upper extremity C. Global delays in all areas with more involvement in the involved distal upper extremity D. Increased difficulty in walking recovery for children who walked previous to surgery

C. typically has spasticity with motor involved in lower extremity, however **MOST involvement is distal upper extremity **due to decreased subcortical innervation and/or etiology

Case 3: Cerebral Hemispherectomy Physical therapy interventions for children status/post hemispherectomy: A. should be novel, task-specific, intense, and repetitive. B. are unlikely to change deficits due to complete disconnection of the involved cerebral hemisphere. C. are only necessary in the acute phase of recovery. D. have been shown to be ineffective when presented in massed blocked sessions.

A. should be novel, task-specific, intense, and repetitive. Although more research is required regarding the effectiveness and dosage of physical therapy in clients status/post hemispherectomy, strategies implementing motor learning techniques (novel, massed practice) are feasible options for this population and positive changes may occur. Due to the younger ages of certain etiologies such as cortical dysplasia, children status/post cerebral hemispherectomy are aging with a chronic disability and would likely benefit from physical therapy throughout their lifespan.

Case Study Questions Review Flashcards

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