CMC Pediatric Mobility Solutions 3 — Questions and Answers
Question 1: A child with Duchenne muscular dystrophy is transitioning from ambulation to full-time wheelchair use. Which seating consideration is MOST critical at this stage?
- Maximizing seat height for peer-level eye contact
- Power tilt and recline to manage progressive trunk weakness and pressure relief (Correct answer)
- Ultra-lightweight manual frame for self-propulsion
- Rigid footrest configuration only
Correct answer: Power tilt and recline to manage progressive trunk weakness and pressure relief
As DMD progresses, trunk weakness increases rapidly, making power tilt and recline essential for positioning support, pressure relief, and respiratory positioning.
Question 2: Which funding pathway is specifically available for children under 21 under Medicaid to access medically necessary equipment beyond standard coverage limits?
- Medicare Part B
- EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) (Correct answer)
- CHIP Basic Plan only
- State vocational rehabilitation only
Correct answer: EPSDT (Early and Periodic Screening, Diagnostic, and Treatment)
EPSDT mandates that Medicaid cover any medically necessary service for individuals under 21, even if not typically covered, making it a critical pathway for pediatric complex rehab technology.
Question 3: A therapist recommends a custom-contoured seating system for a child with severe cerebral palsy. What documentation element is MOST important for prior authorization?
- A photograph of the child's bedroom
- Functional goals and trial results demonstrating failure of off-the-shelf alternatives (Correct answer)
- A letter from the school principal
- A list of previous equipment brands tried
Correct answer: Functional goals and trial results demonstrating failure of off-the-shelf alternatives
Payers require documentation showing that less expensive alternatives were trialed and failed, with functional goals justifying the custom system.
Question 4: What term describes the angle formed between the seat surface and the floor in pediatric seating, and how does increasing this angle anteriorly affect pelvic positioning?
- Seat rake; anterior tilt promotes posterior pelvic tilt
- Seat slope; anterior tilt promotes anterior pelvic tilt and upright trunk (Correct answer)
- Seat pitch; anterior tilt increases kyphosis
- Seat angle; anterior tilt has no effect on pelvis
Correct answer: Seat slope; anterior tilt promotes anterior pelvic tilt and upright trunk
Anterior seat slope (front lower than back) promotes anterior pelvic tilt, which facilitates upright trunk posture and active sitting in some children.
Question 5: For a child with spina bifida at L3-L4 level, which mobility device combination is MOST appropriate for functional community mobility?
- Manual wheelchair only, no ambulation expected
- KAFOs for household ambulation with a manual wheelchair for community distances (Correct answer)
- Power wheelchair exclusively
- Forearm crutches for all distances including community
Correct answer: KAFOs for household ambulation with a manual wheelchair for community distances
Children with L3-L4 spina bifida typically have functional hip flexors and knee extensors allowing household ambulation with KAFOs, while a manual wheelchair is more efficient for community distances.
Question 6: Which headrest configuration is indicated for a child with poor head control and a tendency toward lateral head drop?
- Occipital pad only
- Occipital pad with bilateral lateral supports and forehead strap if needed (Correct answer)
- Anterior head support only
- No headrest — positioning collar instead
Correct answer: Occipital pad with bilateral lateral supports and forehead strap if needed
An occipital pad with bilateral lateral supports addresses both posterior and lateral head control deficits, with a forehead strap added when anterior head control is also compromised.
Question 7: A child using a power wheelchair requires an alternative drive control due to limited hand function. Which assessment tool is commonly used to match control interface to motor ability?
- Ashworth Scale
- Pediatric Evaluation of Disability Inventory (PEDI)
- Switch Access to Powered Mobility (SAPM) framework (Correct answer)
- Functional Independence Measure for Children (WeeFIM)
Correct answer: Switch Access to Powered Mobility (SAPM) framework
The SAPM framework provides a systematic approach to assessing a child's motor access sites and matching them to appropriate switch or alternative drive control interfaces.
CMC Pediatric Mobility Solutions 3
A child with Duchenne muscular dystrophy is transitioning from ambulation to full-time wheelchair use.
Which seating consideration is MOST critical at this stage?