NPTE-PT Pediatric Physical Therapy 2 — Questions and Answers
Question 1: A child with spastic diplegic cerebral palsy demonstrates a scissoring gait pattern. Which muscle group is PRIMARILY responsible for this pattern?
- Hip abductors
- Hip adductors and internal rotators (Correct answer)
- Knee extensors (quadriceps)
- Ankle dorsiflexors
Correct answer: Hip adductors and internal rotators
Spasticity of the hip adductors and internal rotators causes the legs to cross midline during the swing phase, producing the characteristic scissoring pattern.
Question 2: A 3-year-old child presents with Erb's palsy following a brachial plexus birth injury at C5-C6. The CLASSIC resting posture of the affected arm is:
- Shoulder abduction, external rotation, elbow flexion, and forearm supination
- Shoulder adduction, internal rotation, elbow extension, and forearm pronation (Correct answer)
- Shoulder flexion, elbow flexion, and wrist extension
- Shoulder abduction, elbow flexion, and wrist flexion
Correct answer: Shoulder adduction, internal rotation, elbow extension, and forearm pronation
Loss of C5-C6 innervated muscles leaves the antagonists unopposed, producing the classic 'waiter's tip' posture: shoulder adduction/internal rotation, elbow extension, and forearm pronation.
Question 3: Which intervention is MOST appropriate as first-line treatment for an infant diagnosed with congenital muscular torticollis (CMT)?
- Surgical release of the sternocleidomastoid at 3 months of age
- Passive cervical stretching, active range of motion facilitation, and caregiver education in positioning (Correct answer)
- Mechanical cervical traction applied by the physical therapist
- Strengthening of the ipsilateral sternocleidomastoid to balance tension
Correct answer: Passive cervical stretching, active range of motion facilitation, and caregiver education in positioning
Conservative management with passive stretching, active movement facilitation, and caregiver education in positioning and carrying is the evidence-based first-line treatment for CMT.
Question 4: A child with Duchenne muscular dystrophy (DMD) demonstrates Trendelenburg gait and compensatory lumbar lordosis. These findings are MOST directly caused by weakness of the:
- Hip flexors and knee extensors
- Hip abductors (gluteus medius) and hip extensors (gluteus maximus) (Correct answer)
- Ankle plantar flexors bilaterally
- Hip adductors and knee flexors
Correct answer: Hip abductors (gluteus medius) and hip extensors (gluteus maximus)
Weak gluteus medius produces the Trendelenburg sign during single-limb stance, while weak gluteus maximus combined with hip flexor tightness leads to compensatory lumbar lordosis in DMD.
Question 5: Which intervention is CONTRAINDICATED for a child with juvenile idiopathic arthritis (JIA) during an acute joint flare?
- Gentle active-assisted range of motion exercises within a pain-free range
- Resting splints to maintain optimal joint alignment
- High-intensity resistive exercises targeting the acutely inflamed joint (Correct answer)
- Warm water aquatic therapy at a comfortable temperature
Correct answer: High-intensity resistive exercises targeting the acutely inflamed joint
High-intensity resistive exercise targeting an acutely inflamed joint increases intra-articular stress and worsens synovial inflammation, risking further joint damage.
Question 6: A physical therapist is treating a 5-year-old with autism spectrum disorder (ASD) who has significant tactile hypersensitivity. Which approach is MOST appropriate?
- Apply unexpected deep pressure to help the child habituate quickly
- Use a sensory integration framework with predictable, structured tactile activities graded to the child's tolerance (Correct answer)
- Eliminate all sensory input during therapy sessions to prevent overload
- Focus exclusively on vestibular stimulation to override tactile hypersensitivity
Correct answer: Use a sensory integration framework with predictable, structured tactile activities graded to the child's tolerance
A sensory integration approach using graded, predictable, and child-directed sensory experiences supports self-regulation and gradually reduces hypersensitivity in children with ASD.
Question 7: A child with myelomeningocele at the L4-L5 level is evaluated for community ambulation. Which orthotic is MOST appropriate?
- Hip-knee-ankle-foot orthosis (HKAFO)
- Knee-ankle-foot orthosis (KAFO)
- Ankle-foot orthosis (AFO) (Correct answer)
- Thoracic-lumbar-sacral orthosis (TLSO) without lower extremity component
Correct answer: Ankle-foot orthosis (AFO)
An L4-L5 lesion preserves hip flexion, knee extension, and partial ankle dorsiflexion; AFOs provide the necessary ankle-foot stability for community ambulation without requiring more proximal support.
NPTE-PT Pediatric Physical Therapy 2
A child with spastic diplegic cerebral palsy demonstrates a scissoring gait pattern.
Which muscle group is PRIMARILY responsible for this pattern?