Neuromuscular Physical Therapy in Pediatrics
Exam Answer Key
Course Introduction
This course explores the principles and practices of neuromuscular physical therapy as applied to pediatric populations. Students will gain an in-depth understanding of common neuromuscular disorders affecting children, including cerebral palsy, muscular dystrophy, and spina bifida, as well as developmental and acquired conditions. Emphasis is placed on evidence-based assessment techniques, goal setting, treatment planning, and intervention strategies tailored to infants, children, and adolescents. The course integrates theoretical knowledge with practical skills, focusing on interdisciplinary collaboration, family-centered care, and the use of assistive technologies and adaptive equipment to enhance mobility, participation, and quality of life for pediatric clients.
Recommended Textbook
Meeting the Physical Therapy Needs of Children 1st Edition by Susan K. Effgen PhD PT
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Chapter 1: Serving the Needs of Children and Their Families
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Sample Questions
Q1) Which model of team interaction is most commonly used in early intervention programs?
A) Unidisciplinary model
B) Multidisciplinary model
C) Transdisciplinary model
D) Hierarchical model
Answer: C
Q2) Evidenced-based practice should include
A) expert opinion, continuing education, and personal experience.
B) intuition, unsystematic clinical experience.
C) explanations based on pathophysiology.
D) awareness, consultation, judgment, and creativity.
Answer: D
Q3) Chaining techniques work best
A) with those with a cognitive impairment.
B) as negative reinforcement.
C) as continuous reinforcement.
D) with discrete tasks having a clear beginning and end.
Answer: D
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Page 3
Chapter 2: Child Development
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Sample Questions
Q1) Play in young children might include
A) intrinsic motivation.
B) freedom to suspend reality.
C) performance for its own sake.
D) internal control.
E) All of the above
Answer: E
Q2) A full-term, typically developing neonate compared to a 12-month old will have the following range of motion:
A) Limitations in hip flexion and excessive plantar flexion.
B) Limitations in hip extension and excessive plantar flexion.
C) Limitations in plantar flexion and excessive hip flexion.
D) Limitations in hip extension and excessive dorisflexion.
Answer: D
Q3) Increased fitness, especially aerobic capacity, is associated with academic success.
A)True
B)False
Answer: True
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4
Chapter 3: Child Appraisal: Examination and Evaluation
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Sample Questions
Q1) Which assessment tool has been validated for use specifically with children with cerebral palsy and Down syndrome?
A) Peabody Developmental Motor Scales, 2nd ed.
B) Gross Motor Function Measure
C) Pediatric Inventory of Disability
D) All of the above
Answer: B
Q2) Which of the following statements is false?
A) Likelihood ratio indicates the probability of the existence of the diagnosis.
B) Sensitivity is the ability of a measure to detect dysfunction.
C) Specificity indicates the absence of a disorder.
D) Reliable measures measure what they are supposed to measure.
Answer: D
Q3) Quality of life
A) measures include a normal range and standard mean.
B) cannot be measured directly and is determined by a group of questions calculating the underlying dimension.
C) measures detect subtle facets of specific disorders.
D) is an assessment of well-being across one domain.
Answer: B
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Chapter 4: Family-Centered Care
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Sample Questions
Q1) John is a 4-year-old child with global developmental delay. His gross motor skills are approximately at the 8-month-old level and he does not have expressive communication. He attends a special preschool program. John has three older siblings. His parents both work. The mother has primary responsibility for John's caregiving and expresses concerns about stress and fatigue. The family is anxious for John to learn to walk. Based on this scenario, which statement least reflects a family-centered philosophy for physical therapy intervention?
A) Offer family options regarding social services including respite care.
B) Prescribe a daily home exercise program to improve John's muscle strength for preparation for ambulation.
C) Identify with the family their caregiving routines and provide consultation to assist family members and John.
D) Discuss with the family play activities in supported standing that could provide opportunities for some sibling interactions.
Q2) What are three common stresses associated with raising a child with a disability?
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Chapter 5: Musculoskeletal System: Structure, Function, and
Evaluation
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Sample Questions
Q1) Variability in joint angle or kinematic patterns during gait is most common in A) young independent walkers.
B) toddlers.
C) adolescents.
D) running.
Q2) Select the correct definition(s):
A) Antetorsion is a posterior rotation through the long axis of the femur.
B) Retrotorsion results in a posterior rotation of the neck of the femur in relation to the acetabulum.
C) Anteversion refers to the position of the head of the femur relative to its position in the acetabulum.
D) Retroversion places the leg into external rotation.
Q3) The spine of a newborn infant is initially in a A) scolotic position.
B) kyphotic position.
C) straight position.
D) lordotic position.
Q4) Cartilage provides the initial prenatal structure for the development of bone.
A)True
B)False
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Chapter 6: Musculoskeletal System: Considerations and
Interventions for Specific Pediatric Pathologies
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Sample Questions
Q1) Name two pediatric diagnoses where limitation in range of motion is a common characteristic.
Q2) Young boys having Duchenne muscular dystrophy tend to use the Gower maneuver to rise from the floor because of weakness in
A) knee extensors and flexors.
B) hip extensors and flexors.
C) distal leg musculature.
D) upper extremity musculature.
Q3) Select the correct statement(s) regarding Duchenne muscular dystrophy (DMD). Children with DMD
A) develop hypertrophy of the gastrocnemius as a method to compensate for progressive weakness.
B) should avoid resistive activities and eccentric contractions as this can cause further muscle breakdown.
C) require use of ankle foot orthoses to maintain walking past 12 years of age.
D) will not get muscle contractures if parents perform passive stretches weekly.
Q4) Name two diagnoses where heightened reaction to trauma is common.
Q5) Which type of juvenile idiopathic arthritis involves the most joints and is the most debilitating?
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Chapter 7: Neuromuscular System: Examination, Evaluation, and Diagnoses
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Sample Questions
Q1) An 8-year-old child diagnosed with cerebral palsy independently walks with bilateral forearm crutches indoors at all times and independently propels a manual wheelchair for long distances outside. He sits in a chair with minimal trunk support at school but is unable to hop, jump, or run. Which of the following Gross Motor Function Classification System levels best describes this child's cerebral palsy?
A) Level I
B) Level II
C) Level III
D) Level IV
Q2) A 9-year-old child diagnosed with myelomeningocele and hydrocephalus presents with blurred vision, headache, increased spasticity, and lethargy. What is most likely causing these symptoms?
A) Bladder infection
B) Flu
C) Tethered cord
D) Ventricular peritoneal shunt infection/malfunction
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9
Chapter 8: Neuromuscular System: the Plan of Care
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Sample Questions
Q1) Which of the following best describes the activity-focused interventions model for children with neurological diagnoses?
A) The primary emphasis in the plan of care is on impairments that limit the performance of functional activity.
B) The single focus of physical therapy interventions is on practice of functional activities.
C) The emphasis is on practice of functional activities that lead to participation changes, but interventions that address impairments in body functions and structures are also integreated into the plan of care.
D) None of the above
Q2) Select the practice scenario that is most likely to facilitate motor learning in a child with a neurological impairment.
A) Promoting error-free practice to avoid learning bad habits.
B) Practicing in the clinic setting to control external stimuli.
C) Varying the practice situation to include several versions of the task.
D) Provide a substantial amount of verbal rationale.
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Chapter 9: Cardiovascular and Pulmonary Systems
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Sample Questions
Q1) According to the perception-action framework, there is a reciprocal relationship between the individul and the environment and objects in the environment provide opportunities for movement. What are these objects in the environment called?
A) Extrinsic Rationale
B) Affordances
C) Variables
D) Reinforcers
Q2) Which is not a good guideline for the physical therapist to follow when providing augmented information to a child with a neurological condition during practice of a novel task?
A) Always use physical guidance at some point in practice.
B) Always monitor the effects of augmented information.
C) Consider the learning style of the child.
D) Consider how impairments might affect the process of learning.
Q3) There is emerging evidence that increased intensity of physical therapy interventions can improve physical therapy outcomes.
A)True
B)False
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Chapter 10: Integumentary System
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Sample Questions
Q1) A Stage I pressure ulcer is described as having
A) full thickness skin loss with extensive damage to underlying tissues.
B) full thickness skin loss that presents as a deep crater but does not damage adjacent tissue.
C) partial thickness skin loss that appears as an abrasion, blister, or shallow crater.
D) nonblanchable erythema of intact skin with warmth edema and discoloration.
E) discoloration that lasts longer than 60 min.
Q2) A wound dressing that contains gel-forming polymers and absorbs wound exudates, provides a moist wound environment, and conforms to the body shape is a A) film.
B) hydrogel.
C) alginate.
D) hydrocolloid.
Q3) In young children and adults, the body area for estimation of burns is relativity similar except for significant differences in the__________area.
Q4) A pressure ulcer that presents as a partial-thickness skin loss and can be a blister or shallow crater is a stage ________ulcer.
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Chapter 11: Early Intervention
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Sample Questions
Q1) Which technique(s) assist the therapist and family in integrating therapeutic objectives into the family's daily lives?
A) Intervention in the child's natural environment
B) Activity-based instruction
C) Use of catalogs and matrixes
D) All of the above
Q2) Early intervention should occur
A) in a center-based program.
B) in a physician's office.
C) in the child's natural environment.
D) in the public school setting.
Q3) Who should guide the focus of early intervention based on their priorities and concerns?
A) The physician
B) The family
C) The physical therapist
D) The primary service coordinator
Q4) Role release allows all therapists to complete the duties of all disciplines.
A)True
B)False
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Chapter 12: Schools
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Sample Questions
Q1) A child with a disability that substantially limits life activities, but who does NOT require special education, might be eligible for physical therapy in the schools through A) PL 94-142.
B) Section 504 of the Rehabilitation Act.
C) Individuals with Disabilities Education Improvement Act.
D) No Child Left Behind.
E) PL 101-336, Americans with Disabilities Act.
Q2) All of the following are true except
A) An individual family service program must include family input.
B) Use of a least-restrictive environment encourages generalization.
C) Specific methodologies should be included in the IEP document.
D) Assistive technology may include electric wheelchairs.
E) Children with disabilities should be educated with children who do not have disabilities.
Q3) Related services in schools are provided to
A) allow any student to achieve maximum potential.
B) assist a child with a disability to benefit from special education.
C) reduce the need for outpatient therapy services.
D) help the school system.
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Page 14
Chapter 13: Sports Settings for the School-Aged Child
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Sample Questions
Q1) What should be the emphasis of training programs for children?
A) Cooperation, fun, team play, and learning
B) Competitive spirit
C) Improvement of aerobic ability
D) All of the above
Q2) The primary goals of preseason training are
A) general improvement in muscle strength, coordination, aerobic endurance, and balance abilities.
B) focused improvement in balance and strength.
C) focused improvement in strength, balance, and cardiovascular demands of the activity and development of sports skills.
D) improvement in skills of the sport.
Q3) Which of the following has become a public health issue?
A) Children playing sports without proper supervision
B) Parental interference with sport
C) Lack of good coaching of children
D) Pediatric use of drugs
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Page 15
Chapter 14: Pediatric Acute Care Hospital
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Sample Questions
Q1) Removes fluid from the pleural cavity
A)Arterial line
B)Broviac
C)Chest tube
D)Endotracheal tube
E)Foley
F)Gastric tube
G)Jackson Pratt drain
Q2) A 15-year-old male adolescent is admitted to the emergency room with a head trauma. He now presents with an external ventriculostomy to monitor intracranial pressure. When working on bed mobility, what should the position of the drain be in relationship to the patient?
A) Above the level of the patient's head
B) Below the level of the patient's head
C) Even with the patient's head
D) The position of the drain does not impact patient care
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Chapter 15: Neonatal Intensive Care Unit
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Q1) Developmentally supportive care is individualized caregiving and is based on
A) the general routine in each specific NICU.
B) using specific methods to speed up the infant's tolerance to care-giving procedures.
C) the infant's physiological reactions, behavioral cues, and signs of stress in response to the immediate environment.
D) providing an individual caregiver for the infant so the infant may adapt to that person's approach.
Q2) Full-term infants are born
A) between 37 and 42 weeks gestation.
B) at 9 months gestation.
C) at 40 weeks gestation.
D) between 35 and 40 weeks gestation.
Q3) Physiological signs of stress in a neonate include
A) increased heart rate and skin color changes.
B) gaze aversion and leg extension.
C) increased respiration and oxygen saturation.
D) facial grimace and finger splays.
Q4) Describe the behavioral state of "quiet alertness."
Q5) Name three neonatal methods of self-calming.
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Chapter 16: Rehabilitation Settings
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Sample Questions
Q1) Pediatric rehabilitation is different from adult rehabilitation in that
A) there are no accrediting organizations to ensure safety and quality of care.
B) there are no standardized outcome measures for global independence in function.
C) caregivers require less training for discharge planning.
D) children often require a 1:1 staffing ratio during therapy sessions.
Q2) In an interdisciplinary team, the team members
A) maintain their own discipline-specific treatment and goals but report findings to other team members.
B) collaborate by incorporating suggestions from other professionals into their interventions.
C) assess the child and then delegate the treatments to a few key individuals.
D) maintain professional boundaries by not communicating specific treatment techniques.
Q3) Which of the following is not a characteristic of expert pediatric rehabilitation therapists?
A) Ability to approach child and family holistically
B) Decreased humility
C) Ability to prioritize what is most important
D) Broad sense of self-awareness
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Page 18
Chapter 17: Assistive Technology: Positioning and Mobility
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Sample Questions
Q1) During a physical examination for a seating system, physical therapists should begin by examining the child's
A) pelvic position.
B) hip range of motion.
C) trunk position.
D) knee range of motion.
Q2) You are evaluating a child with myelodysplasia (spina bifida) whose lesion is at L1-2. His parents are concerned that he is not able to keep up with his peers, even though he can walk with support of orthoses and forearm crutches. Your recommendation for mobility would include
A) continuing use of orthoses and forearm crutches in all environments so that he does not lose any additional abilities.
B) continued use of orthoses and forearm crutches indoors and a manual wheelchair that he can propel outdoors or over longer distances.
C) discontinuing use of orthoses and forearm crutches and using a manual wheelchair in all environments.
D) discontinuing use of orthoses and forearm crutches, using a manual wheelchair indoors, and using a power wheelchair outdoors.
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Chapter 18: Assistive Technology: Augmentative
Communication and Other Technologies
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Sample Questions
Q1) Johanna is a 6-year-old girl with cerebral palsy who is nonverbal. Her school team wants to try a picture symbols system with her. They think she will use eye gaze as a direct selection technique when she starts using a low-tech Augmentative Alternative Communication (AAC) system. How should Johanna's communication partners interact with her when she starts learning to use the AAC? The team should
A) anticipate her needs so she never has to ask for anything.
B) attach as many pictures as realistically possible to her tray to allow her to make choices.
C) model the picture symbols by pointing to them as they talk with her.
D) begin using the AAC system only in speech therapy so she is not overwhelmed.
Q2) Environmental control units consist of which of the following components?
A) Input device, switch, and the appliance
B) Output device, switch, and the appliance
C) Input device, control unit, and the appliance
D) Output device, control unit, and the switch
Q3) Children who have literacy skills below a third-grade level can benefit from a communication device that is "text-to-speech."
A)True
B)False
Page 20
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Chapter 19: Cerebral Palsy
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Q1) The Peabody Developmental Motor Scales-2nd edition is an appropriate tool for assessing the level of motor development of a child with cerebral palsy who is
A) 3 years old.
B) 7 years old.
C) 13 years old.
D) 21 years old.
Q2) A 6-year-old child with cerebral palsy who walks independently in the school environment using a wheeled, rear walker, would be classified in the Gross Motor Function Classification System as
A) Level I.
B) Level II.
C) Level III.
D) Level IV.
Q3) Evidence has shown that "participation" scores of children with cerebral palsy increase with
A) aerobic training programs.
B) Partial body weight-supported treadmill training.
C) Progressive resistance exercise training.
D) Passive range of motion and stretching.
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Page 21
Chapter 20: Cystic Fibrosis
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Q1) A child can have cystic fibrosis and have no pulmonary symptoms.
A)True
B)False
Q2) An 8-year-old child with cystic fibrosis presents to the clinic with a 1-wk history of persistent cough, increased sputum production, increased work of breathing, and weight loss. What steps should be taken next?
A) He should be sent to the emergency room of a local hospital for critical care.
B) He should most likely be admitted to the hospital for treatment of a pulmonary exacerbation.
C) He should be sent home on extra multivitamins and be seen for his next routine clinic visit in 6 months.
D) He should be sent home, his pulmonary hygiene program should be stopped, and his parents/caregivers should be instructed to focus on his nutrition for a few weeks.
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Chapter 21: Down Syndrome
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Q1) Which of the following age-related changes are common for individuals with Down syndrome showing signs of dementia?
A) Hypotension
B) Weight loss
C) Hypotonia
D) All of the above
Q2) Heart defects and cardiovascular pathology are a common complication in children with Down syndrome.
A)True
B)False
Q3) The Original Borg Scale
A) measures blood pressure.
B) tracks perceived exertion during exercise.
C) evaluates muscle strength.
D) assesses functional range of motion.
Q4) There is evidence to suggest that participation in sensorimotor group sessions improves motor outcomes in young children with Down syndrome.
A)True
B)False
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Chapter 22: Leukemia
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Q1) Intrathecal chemotherapy is administered directly into what area?
A) Muscle
B) Mouth
C) Vein
D) Cerebral spinal fluid
Q2) Common physical therapy interventions for a child with acute lymphoblastic leukemia include
A) orthotics.
B) stretching exercises.
C) age-appropriate strengthening exercises.
D) age-appropriate gross motor developmental activities.
E) All of the above.
Q3) Children with acute lymphoblastic leukemia frequently have chemotherapy (Vincristine)-induced peripheral neuropathy, thus causing range of motion limitations in A) shoulder flexion.
B) neck rotation.
C) spinal flexion.
D) ankle dorsiflexion.
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24
Chapter 23: Duchenne Muscular Dystrophy
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Q1) Among male births, the incidence of Duchenne muscular dystrophy is variably reported as 1 in:
A) 800 to 1,000.
B) 3,500 to 6,000.
C) 6,000 to 8,000.
D) 8,000 to 10,000.
Q2) The validity, reliability, and sensitivity of manual muscle testing, range of motion, testing, and timed function tests have been established in patients with Duchenne muscular dystrophy
A)True
B)False
Q3) Surgical correction of scoliosis and spinal stabilization are considered cosmetic procedures that do not improve function or longevity for boys with Duchenne muscular dystrophy.
A)True
B)False
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25
Chapter 24: Developmental Coordination Disorder
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Q1) A standardized assessment commonly used with children who have developmental coordination disorder is the
A) Bruininks-Oseretsky Test of Motor Proficiency-2nd Edition.
B) Peabody Developmental Gross Motor Scales-2nd Edition.
C) Batelle Developmental Inventory.
D) School Function Assessment.
Q2) Which of the following characteristics are typical of children with developmental coordination disorder?
A) Spasticity
B) Hyperactivity
C) Hypotonia
D) Decreased flexibility
Q3) Neuromotor task training incorporates motor learning concepts with A) motor task analysis.
B) problem-solving.
C) sensory processing activities.
D) kinesthetic input.
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Chapter 25: Myelodysplasia
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Q1) All of the following are environmental adaptations that might assist a child with mid-lumbar myelomeningocele in using the bathroom except
A) a sliding board.
B) grab bars.
C) a changing table.
D) a rolling stool.
Q2) What happens to the heart rate of children with low- and mid-lumbar myelomeningocele compared to nondisabled peers when walking?
A) Heart rate remains the same
B) Heart rate increases
C) Heart rate decreases
D) Heart rate varies
Q3) In the natural school environment, the physical therapist relies on the classroom staff to follow through with mobility and transfer activities on a daily basis for a child with a myelomeningocele.
A)True
B)False
Q4) Discuss what a child must learn when using a manual wheelchair in a natural school environment.
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