DPT Pediatric Physical Therapy 2 — Questions and Answers
Question 1: A 6-month-old infant presents with persistent head tilt to the right and facial asymmetry. Which intervention is most appropriate for congenital muscular torticollis?
- Passive stretching of the right sternocleidomastoid (Correct answer)
- Passive stretching of the left sternocleidomastoid
- Cervical collar immobilization
- Surgical referral without PT trial
Correct answer: Passive stretching of the right sternocleidomastoid
Congenital muscular torticollis involves a shortened SCM on the side of the tilt, requiring stretching of that same muscle.
Question 2: Which reflex, normally integrated by 4-6 months, persists abnormally in children with cerebral palsy and interferes with rolling?
- Asymmetrical tonic neck reflex (ATNR) (Correct answer)
- Moro reflex
- Plantar grasp reflex
- Rooting reflex
Correct answer: Asymmetrical tonic neck reflex (ATNR)
Persistence of the ATNR obligates limb posture with head rotation, preventing the dissociation needed for rolling.
Question 3: A premature infant at 32 weeks corrected gestational age demonstrates signs of stress during handling. Which approach best guides intervention timing?
- Synactive theory of development — watch for autonomic and motor stress cues (Correct answer)
- Denver Developmental Screening — proceed if score is age-appropriate
- NDT principles — facilitate normal movement patterns regardless of state
- Rood approach — apply sensory stimulation to elicit responses
Correct answer: Synactive theory of development — watch for autonomic and motor stress cues
Als's synactive theory guides NICU care by recognizing behavioral stress cues (color change, hiccups, finger splaying) that signal the need to pause or modify handling.
Question 4: During gait analysis of a 3-year-old with spastic diplegic CP, you observe excessive hip internal rotation and 'scissoring.' What is the primary muscle group implicated?
- Hip adductors and medial hamstrings (Correct answer)
- Hip abductors and lateral rotators
- Quadriceps and iliopsoas
- Gastrocnemius-soleus complex
Correct answer: Hip adductors and medial hamstrings
Scissoring gait in spastic diplegia is driven by overactive hip adductors and medial hamstrings pulling the legs into adduction and internal rotation.
Question 5: A child with myelomeningocele at the L3 level will most likely have preserved function of which muscle group?
- Hip flexors and knee extensors (Correct answer)
- Ankle dorsiflexors
- Plantar flexors
- Hip extensors and abductors
Correct answer: Hip flexors and knee extensors
L3 innervates hip flexors (L1-L3) and knee extensors (L2-L4), so these are partially to fully preserved at an L3 lesion level.
Question 6: Which outcome measure is specifically designed to assess gross motor function in children with cerebral palsy across five functional levels?
- Gross Motor Function Classification System (GMFCS) (Correct answer)
- Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)
- Alberta Infant Motor Scale (AIMS)
- Peabody Developmental Motor Scales (PDMS-2)
Correct answer: Gross Motor Function Classification System (GMFCS)
The GMFCS classifies CP severity into five levels based on self-initiated movement and need for assistive technology.
Question 7: A 9-year-old with Duchenne muscular dystrophy can no longer rise from the floor without using his arms to 'walk up his legs.' This clinical sign is called:
- Gowers' sign (Correct answer)
- Trendelenburg sign
- Thomas sign
- Ober sign
Correct answer: Gowers' sign
Gowers' sign reflects proximal lower extremity weakness in DMD, requiring the child to use upper extremities to compensate when rising from the floor.
DPT Pediatric Physical Therapy 2
A 6-month-old infant presents with persistent head tilt to the right and facial asymmetry.
Which intervention is most appropriate for congenital muscular torticollis?