LE: Cerebral Palsy

Question 1

The first catch or lengthening of the muscle is the range that the child can access for function. Therapists can slowly and carefully stretch muscles beyond this point to the absolute range, which is the apparent length of the muscle that the child cannot actively access beyond the functional range.

Answer 1

Both statements are false

Question 2

An 11 month old child with cerebral palsy attempt to maintain a quadruped position. Which reflex would interfere with the activity if not integrated?

Answer 2

Symmetrical tonic neck reflex

Question 3

As a very observant physical therapist, you noticed your 10 year old athetoid cerebral palsy propelling his wheelchair with difficulty as he enters the treatment area. Which of the following could be a probable reason for this difficulty?

Answer 3

Seat width is too wide

Question 4

You are currently teaching a developmentally 3 month old child to crawl. As a well versed physical therapist, which of the following, if not integrated, will hinder your goal?

Answer 4

Tonic labyrinthine reflex

Question 5

You are currently assessing a 3 year old child diagnosed with spastic cerebral palsy. Which of the following is an unusual characteristic for the child? 
Distal fixing (toe-curling or fisting) 
Asymmetric posture Poor postural tone Inability to sustain a posture against gravity None of the above

Answer 5

Inability to sustain a posture against gravity

Question 6

You are currently treating a spastic quadriplegic cerebral palsy patient who is 2 years old, but is developmentally 4 months of age. You noticed that she kept on bending to the right and inferred that her right quadratus lumborum might be tight. How would you treat the patient?

Answer 6

Side lie the child on the left at the edge of the plinth

Question 7

A physical therapist uses the Modified Ashworth Scale when assessing a cerebral palsy patient. Which of the following assessment procedures would be the most appropriate when using this scale?

Answer 7

Passive range of motion

Question 8

A mother comes into the rehab center for a consult with the physician. You asked her for her reason for seeing the doctor. Her reply was, “I noticed my 7 month old son was able to stand whenever I held him upright, but now he is unable to do so.” As a very knowledgeable physical therapist, what would be your response?

Answer 8

“That is a normal response and there is nothing to be worried about.”

Question 9

Rh incompatibility could lead to a disease called nuclear neonatal jaundice of the brain. High levels of bilirubin in the subthalamic nucleus would predispose a child to athetoid cerebral palsy.

Answer 9

The first statement is true, while the second statement is false

Question 10

You are formulating your plan of care for a chronologically and developmentally 6 year old cerebral palsy patient who falls under GMFCS level 3. Which of the following will be an appropriate activity?

Answer 10

Navigating curbs and ramps using a wheelchair

Question 11

A physical therapist comes to you asking for advice regarding his 8 year old dystonic cerebral palsy patient who presents with difficulty in sensory processing. Which piece of equipment would you suggest the physical therapist use to best address the child’s dyspraxia?

Answer 11

Weighted vest

Question 12

Spasticity is hypertonia in which resistance to externally imposed movement increases with increasing speed of stretch and varies with the direction of joint movement. Dystonia is a movement disorder in which voluntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both.

Answer 12

First statement is true and the second statement is false

Question 13

During movement assessment of a 5 year old cerebral palsy patient’s knee flexion range of motion, you noticed a slight increase in muscle tone manifested by a catch followed by minimal resistance from 100° of knee flexion up to the end of available range of motion. Being the brilliant physical therapist you are, you document this as:

Answer 13

Grade 1+ as to modified ashworth scale

Question 14

As you assess a 2 year old child’s movement, you noticed the child crawls using his upper extremity mainly to reach his toy that is just right infront of him. What type of cerebral palsy is most linked with this feature?

Answer 14

Spastic diplegia

Question 15

As you do a postural assessment of your patient, you noticed several asymmetries to his posture as seen in the photo below. This is indicative of what type of deformity?

Answer 15

Windswept deformity of the hips described as an adduction deformity of the elevated hip and an abduction deformity of the opposite hip.

Question 16

Which of the following is not an intrauterine etiology for Cerebral Palsy

• Chorioamnionitis
• Maternal Fever > 38*C
• Difficulty Labor
• None of the above

Answer 16

-Difficulty Labor

Question 17

Which etiology is more appropriate for Athetoid CP

• Ischemia
• Premtaturity
• Kernicterus
• All of the above

Answer 17

-Kernicterus

Question 18

A child’s standing posture is characterized by a right thoracolumbar scoliosis. The scoliosis is not present when the child is in sitting position. Which of the following dysfunctions is most likely the cause of this child’s posture?

Answer 18

LLD

Question 19

The therapist is examining a patient with a diagnosis of CP. The PT notes that all of the extremities and the trunk are involved. Further assessment also reveals that the lower extremity is more involved than the upper extremity and that the right side is more involved than the left. The patient most likely has which classification of the cerebral palsy?

Answer 19

Spastic diplegia

Question 20

When helping a child with cerebral palsy into a standing position that has a low postural tone, which appropriate part of the body should the PT stabilize?

Answer 20

Pelvis

Question 21

Pediatric patients are told to avoid W-sitting because it will:

Answer 21

Increase femoral anteversion.

Question 22

Scissoring gait may be attribute to spasticity of:

Answer 22

Gracilis

Question 23

Orthotic intervention is usually recommended with a child with cerebral palsy with idiopathic scoliosis:

Answer 23

25 degrees

Question 24

The following are not typically features of hypotonic cerebral palsy patients except:

• Repositions lower extremities when sitting on the floor to help keep trunk upright.
• Decreased proprioception
• Uses a very wide base to move on the floor independently
• Joints may be hypomobile owing to poor reciprocal inhibition

Answer 24

-Repositions lower extremities when sitting on the floor to help keep trunk upright.

Question 25

A 17 year old child with a diagnosis of cerebral palsy was referred to your care. Upon evaluation you noticed a severe weakness of the right side of the body. Also, patient has contracture on the right elbow flexors and knee flexors. Upon seeing his medical history, the child has undergone tenotomy for his contracted right gastrocnemius at the age of 15. maintenance medication include phenytoin once a day. Which intervention may not be appropriate for the child for long term use.

Answer 25

facilitatory techniques on the weak side

Question 26

The following grades of intraventricular hemorrhage in the premature brain are paired correctly except: 1 - with parenchymal hemorrhage
2 - with normal vesicular size
4 - isolated to germinal matrix
None of the above

Answer 26

None of the above

Question 27

The following gait components are present in a true equinus gait, except

• Genu recurvatum
• Hip in extension
• Hypoactive dorsiflexors
• None of the above

Answer 27

-None of the above

Question 28

In the homunculus, which bodily enervation may be observed in the median longitudinal fissure?

Answer 28

Ankle

Question 29

There are three major criteria for diagnosis of cerebral palsy: A static brain lesion, an acquisition of the brain injury either before birth or in the first years of life, a neuromotor control deficit that alters movement or posture.

Answer 29

True

Question 30

Which medication for spasticity reduces the release of excitatory neurotransmitters and substance P by binding to the GABA-B receptor.

Answer 30

Baclofen