NPTE-PT Pediatric Physical Therapy 1 — Questions and Answers
Question 1: A physical therapist is assessing a 10-month-old child who cannot sit independently. According to normal developmental milestones, this finding is:
- Within normal limits, as independent sitting occurs at 12 months
- Delayed, as independent sitting typically occurs by 6-8 months (Correct answer)
- Within normal limits, as independent sitting occurs at 10-12 months
- Delayed, as independent sitting typically occurs by 4-5 months
Correct answer: Delayed, as independent sitting typically occurs by 6-8 months
Independent sitting typically develops between 6-8 months, so inability to sit independently at 10 months represents a gross motor delay requiring further evaluation.
Question 2: Which standardized assessment tool is MOST appropriate for evaluating gross and fine motor development in a 6-month-old infant?
- Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)
- Peabody Developmental Motor Scales, 2nd Edition (PDMS-2) (Correct answer)
- Functional Independence Measure for Children (WeeFIM)
- Berg Balance Scale
Correct answer: Peabody Developmental Motor Scales, 2nd Edition (PDMS-2)
The PDMS-2 is normed from birth through 5 years and assesses both gross and fine motor skills, making it the most appropriate tool for a 6-month-old infant.
Question 3: A child with cerebral palsy is classified as GMFCS Level III. Which functional description BEST applies to this child?
- Walks without limitations in all community settings
- Walks using a hand-held mobility device indoors and uses wheeled mobility for longer community distances (Correct answer)
- Achieves self-mobility primarily using a powered wheelchair
- Has no means of independent self-mobility and is transported in a manual wheelchair
Correct answer: Walks using a hand-held mobility device indoors and uses wheeled mobility for longer community distances
GMFCS Level III describes children who walk with a hand-held assistive device indoors but rely on wheeled mobility for longer distances or uneven terrain.
Question 4: A physical therapist evaluates a premature infant born at 28 weeks gestation who is now 4 months old (chronological age). When assessing developmental milestones, the therapist should use:
- Chronological age of 4 months
- Corrected age of approximately 1 month (Correct answer)
- Gestational age of 28 weeks only
- Average of the chronological and corrected age
Correct answer: Corrected age of approximately 1 month
Corrected age = chronological age minus weeks premature; born at 28 weeks is 12 weeks (3 months) premature, yielding a corrected age of approximately 1 month.
Question 5: Which of the following NORMALLY persists beyond 6 months of age in a neurologically intact infant?
- Moro reflex
- Asymmetric tonic neck reflex (ATNR)
- Symmetric tonic neck reflex (STNR)
- Parachute (protective extension) reflex (Correct answer)
Correct answer: Parachute (protective extension) reflex
The parachute reflex emerges around 6-9 months and remains present throughout life as a protective postural response; the Moro, ATNR, and STNR all integrate by 4-6 months.
Question 6: A child with Down syndrome is referred for PT evaluation. Which musculoskeletal finding is MOST commonly expected?
- Muscle hypertonia and joint stiffness throughout all extremities
- Ligamentous laxity and generalized hypotonia (Correct answer)
- Spasticity primarily in the lower extremities
- Rigid cervical spine with severely limited rotation
Correct answer: Ligamentous laxity and generalized hypotonia
Down syndrome (trisomy 21) is characteristically associated with generalized hypotonia and ligamentous laxity, contributing to delayed motor milestones and joint instability.
Question 7: An 18-month-old child demonstrates consistent toe-walking bilaterally with no history of prematurity. The MOST appropriate FIRST clinical step is to:
- Recommend immediate surgical lengthening of the Achilles tendon
- Assess for spasticity, calf muscle tightness, and neurological signs to identify the underlying cause (Correct answer)
- Prescribe bilateral AFOs without further evaluation
- Reassure parents that toe-walking always resolves spontaneously and requires no assessment
Correct answer: Assess for spasticity, calf muscle tightness, and neurological signs to identify the underlying cause
A thorough assessment to differentiate idiopathic toe-walking from neurological causes such as cerebral palsy or autism spectrum disorder must precede any intervention.
NPTE-PT Pediatric Physical Therapy 1
A physical therapist is assessing a 10-month-old child who cannot sit independently.
According to normal developmental milestones, this finding is: