MIDTERMS: Pedia (+Reflexes)

Question 1

What is the Neuromaturational Theory?

Answer 1

What is the Neuromaturational Theory?

Question 2

: Explain the cephalo-caudal and proximo-distal principles of motor development

Answer 2

Development begins at the head (cephalo-caudal) and progresses towards the feet. Proximo-distal refers to development starting from the center of the body (head, trunk) before extending to peripheral areas like hands and feet.

Question 2

What does the Reflex-hierarchical Theory suggest about motor development?

Answer 2

suggests that development occurs through the maturation of the CNS, leading to corresponding motor skills.

Question 2

What are the key components of the Dynamic Systems Theory in motor development?

Answer 2

The Dynamic Systems Theory considers the interaction between the person (subsystem), the task, and the environment in motor development.

Question 2

What is the importance of setting goals in pediatric physical therapy?

Answer 2

Goals should balance caregiver expectations with what is realistic and achievable, possibly revisiting goals over time, especially if initial ones seem unachievable.

Question 2

Why is the chief complaint important in pediatric evaluation?

Answer 2

It helps identify the patient’s main problem and determines if a referral to another professional is needed or if PT treatment is sufficient.

Question 2

What is a poor prognosis indicator for walking in CP patients?

Answer 2

A poor prognosis for walking is if the child cannot sit independently by 2 years old.

Question 2

A mother is pregnant with her 5th child. Her obstetric history includes 3 full-term deliveries, 1 pre-term delivery, 1 abortion, and all previous children are alive. What is her obstetric score using GP(FPAL)?

Answer 2

Gravida (G): 5 (since she is pregnant with her 5th child)
Parity (P): 4 (3 full-term and 1 pre-term deliveries)
Full Term (F): 3 (three full-term pregnancies)
Pre Term (P): 1 (one pre-term pregnancy)
Abortion (A): 1 (one abortion)
Living children (L): 4 (all four previous children are alive)
Obstetric Score (GP(FPAL)): G5P4(3114)

Question 3

What does the Obstetric Score GP(FPAL) stand for?

Answer 3

Gravida: number of pregnancies, Parity: number of deliveries. FPAL refers to Full-term, Pre-term, Abortion, and Live births.

Question 3

Case: A mother is currently pregnant with her 4th child. Her obstetric history includes 2 full-term deliveries, 1 pre-term delivery, 2 abortions, and 2 living children. What is her obstetric score using GP(FPAL)?

Answer 3

Gravida (G): 4 (she is currently pregnant with her 4th child)
Parity (P): 3 (2 full-term and 1 pre-term deliveries)
Full Term (F): 2 (two full-term pregnancies)
Pre Term (P): 1 (one pre-term pregnancy)
Abortion (A): 2 (two abortions)
Living children (L): 2 (two living children)
Obstetric Score (GP(FPAL)): G4P3(2112)

Question 3

What are teratogens?

Answer 3

Teratogens are agents that cause birth defects.

Question 3

What are Placenta Previa and Abruptio Placenta?

Answer 3

: Placenta Previa occurs when the placenta is near the cervix, and Abruptio Placenta is when the placenta detaches prematurely.

Question 3

A newborn was delivered via emergency cesarean section after prolonged labor due to cephalopelvic disproportion. The baby’s APGAR score was 6 at 1 minute and 8 at 5 minutes. The baby aspirated meconium during delivery. What are the key perinatal factors to document?

Answer 3

Delivery type: Emergency C-section due to cephalopelvic disproportion
Labor: Prolonged, leading to fetal distress
APGAR score: Moderate initial distress (6 at 1 minute), improved to 8 at 5 minutes
Complication: Meconium aspiration, which could affect respiratory health.

Question 4

A 32-year-old mother is pregnant with her second child. During this pregnancy, she was diagnosed with gestational diabetes. She also had irregular OB-Gyne visits and smoked 1 pack of cigarettes per day for 10 years prior to pregnancy. What would be the key prenatal factors to consider for this patient?

Answer 4

Medical condition: Gestational diabetes (requires close monitoring of blood glucose)
Irregular OB-Gyne visits: Possible gaps in monitoring
Vices: Smoking (pack years = 1 pack/day × 10 years = 10 pack years)
Risk factors: Smoking can lead to low birth weight, premature birth, or respiratory issues.

Question 4

An infant, aged 6 months, is being evaluated for developmental concerns. During testing, the baby does not follow a red toy with their eyes when moved slowly and does not turn towards the source of sound when a bell is rung. What could these observations indicate?

Answer 4

Visual Tracking: Lack of ability to follow a red toy indicates potential visual impairment or developmental delay.
Auditory Localization: Not turning towards the sound suggests possible hearing impairment or auditory processing issues.
Next steps: Further assessment by an audiologist or ophthalmologist is recommended

Question 5

: A child was referred to physical therapy at 12 months old after failing to meet motor milestones such as sitting unsupported or rolling over. The child has had no major health issues since birth. What postnatal factors are important in this case?

Answer 5

Motor milestones: Delays in sitting unsupported and rolling over (should occur earlier)
Referral timing: Child referred at 12 months, but issues may have been present earlier
No major medical conditions: Absence of trauma or illness suggests developmental delay may not be linked to underlying medical issues.

Question 6

A 4-month-old infant demonstrates persistence of the Moro reflex and other primitive reflexes that typically disappear by 3 months. What could this indicate?
Back:

Answer 6

Primitive reflex persistence: Moro reflex should disappear by 3-4 months; persistence could indicate neurological issues.
Possible diagnoses: Cerebral palsy, developmental delay, or other CNS disorders.
Next steps: Further neurological assessment and early intervention may be necessary.

Question 7

A 7-month-old infant presents with inconsolable crying after a fall. You assess the pain using the FLACC scale. The infant has a grimace, legs pulled to the abdomen, little movement, intermittent crying, and requires comfort from the caregiver. What is the FLACC score?

Answer 7

FLACC score components:
Face: Grimace (1 point)
Legs: Pulled up (2 points)
Activity: Little movement (1 point)
Cry: Intermittent (1 point)
Consolability: Requires comfort (1 point)
Total FLACC score: 6/10, indicating moderate pain.

Question 8

A 2-year-old child is being assessed for motor development. The child can pull to stand and cruise along furniture but is unable to walk independently. They also perform a “step-to” pattern when climbing stairs. What functional assessments should be documented?
Back:

Answer 8

Standing: Pull to stand is achieved, but independent walking not yet developed.
Walking: Cruises along furniture, indicating partial development of walking.
Stair negotiation: Uses a “step-to” pattern, typical for a 2-year-old.
Next focus: Encourage independent walking and progression to alternating stair steps as the child approaches 3 years old.

Question 9

A 28-year-old mother is pregnant for the first time. She experienced pre-eclampsia during pregnancy, which was managed with medication. She also had an irregular diet, with low folic acid intake, and smoked occasionally. What key factors from the maternal history should be considered?

Answer 9

Pre-eclampsia: Could lead to complications like preterm birth or low birth weight.
Diet: Low folic acid intake raises the risk of neural tube defects like spina bifida.
Smoking: Even occasional smoking during pregnancy increases the risk of respiratory issues for the baby.

Question 10

A mother gave birth via vaginal delivery after a prolonged labor that lasted 20 hours. The baby presented with shoulder dystocia, requiring forceps extraction, and had an APGAR score of 5 at 1 minute and 7 at 5 minutes. What are the key concerns in this case?

Answer 10

Shoulder dystocia: Can cause brachial plexus injury (e.g., Erb’s palsy) or other birth trauma.
Forceps extraction: Increases the risk of birth injury, particularly to the head and neck.
Low APGAR score: Indicates possible asphyxia or trauma at birth; close monitoring needed.

Question 11

A 3-month-old infant still shows a strong rooting reflex when touched on the cheek and continues to display the Moro reflex when startled. What does the persistence of these reflexes suggest?

Answer 11

Rooting reflex persistence: Typically disappears by 4 months; persistence may suggest developmental delay.
Moro reflex persistence: Should diminish by 3-4 months. Prolonged presence could indicate CNS issues.
Follow-up: Referral for a neurological evaluation might be necessary.

Question 12

A 5-year-old child with spastic diplegia uses a walker for ambulation. He can ascend stairs with assistance using a “step-to” pattern but cannot descend without help. What functional mobility considerations should be documented?

Answer 12

Walker use: Child relies on a walker for ambulation, indicating limitations in independent walking.
Stair negotiation: Uses “step-to” pattern for ascent but cannot descend independently.
Spastic diplegia: Document spasticity in lower limbs, affecting stair mobility.
Next goals: Focus on strengthening lower limbs and improving coordination for independent stair descent.

Question 13

A 2-year-old child presents with delayed gross motor development. The child struggles with basic motor tasks such as sitting and crawling. Which outcome measure is most appropriate for assessing this child’s motor abilities?

Answer 13

Peabody Developmental Motor Scales (PDMS-2)

Age Range: 0-6 years old
Domains: Reflexes, Stationary (sitting), Locomotion (crawling), Object Manipulation
Use: To assess gross and fine motor skills in children with developmental delays.

Question 14

7-year-old child has difficulties with coordination and strength, especially when playing sports. The child’s teacher has noticed that they struggle with balance during gym class. Which test would best assess the child’s motor proficiency?

Answer 14

Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)

Age Range: 4-12 years old
Domains: Stability, Mobility, Strength, Coordination, Object Manipulation
Use: Ideal for assessing fine and gross motor skills in school-aged children.

Question 15

A 4-year-old child with cerebral palsy is being evaluated for therapy services. The parents are concerned about the child’s ability to perform self-care tasks such as dressing and eating. What is the most appropriate outcome measure to use?

Answer 15

Pediatric Evaluation of Disability Inventory (PEDI)

Age Range: 6 months to 7.5 years (or older if functional ability is comparable)
Domains: Self-care, Mobility, Social Function
Use: To evaluate functional abilities and track progress over time in children with disabilities.

Question 16

A 3-year-old child with cerebral palsy (CP) is undergoing a therapy evaluation to assess progress in motor skills. The child can crawl but struggles with standing independently. What outcome measure should be used?

Answer 16

Gross Motor Function Measure (GMFM-66/GMFM-88)

Age Range: 5 months to 16 years
Domains: Lying & Rolling, Sitting, Crawling & Kneeling, Standing, Walking, Running, and Jumping
Use: Specifically designed for children with CP to assess gross motor function improvements.

Question 17

A 12-year-old child with cerebral palsy uses crutches for ambulation. They can walk short distances independently but struggle with longer distances. What scale should be used to assess walking ability?

Answer 17

Functional Mobility Scale (FMS)

Age Range: 4-18 years
Domains: Assesses walking ability over 5, 50, and 500 meters
Use: To gauge mobility and walking function, especially in children with CP.

Question 18

A 6-year-old child with spastic cerebral palsy has difficulty using their hands for fine motor tasks, such as picking up objects or feeding themselves. What classification system is most suitable for assessing their manual abilities?

Answer 18

Manual Ability Classification System (MACS)

Age Range: 4-18 years
Domains: Manual abilities in handling objects
Use: Specifically for children with CP to classify hand function and abilities.

Question 19

A 5-year-old child with spina bifida is being assessed for functional independence. The therapist wants to evaluate the child’s ability to perform self-care, mobility, and cognitive tasks. What outcome measure should be used?

Answer 19

Pediatric Functional Independence Measure (WeeFIM)

Age Range: 6 months to 7 years
Domains: Self-care, Mobility, Cognition
Use: Measures the severity of disability and functional independence in children.

Question 20

A 10-year-old child with developmental coordination disorder has difficulty maintaining balance during activities like standing on one foot or climbing stairs. What outcome measure can assess balance?

Answer 20

Pediatric Balance Scale

Age Range: 4-18 years
Domains: Balance in functional tasks
Use: Adapted from the Berg Balance Scale to measure balance in children during everyday activities.

Question 21

A 7-year-old child with cerebral palsy is classified as having difficulty walking without assistive devices but can ambulate with a walker on level surfaces. What classification system is being used to describe this child’s motor abilities?

Answer 21

Gross Motor Function Classification System (GMFCS-E&R)

Age Range: Birth to 18 years
Domains: Self-initiated movement, walking, mobility
Use: Classifies motor function in children with CP into five levels, ranging from independent walking to requiring significant assistance.

Question 22

During an assessment of a 3-year-old child with spastic diplegia, the therapist wants to measure the quality of the child’s muscle tone and resistance to passive movement. What scale should the therapist use?

Answer 22

Tardieu Scale

Components: Measures the quality of movement and resistance to passive motion at three velocities (V1, V2, V3) and the angles of resistance (R1, R2).
Use: Assesses spasticity and its impact on functional movements.

Question 23

What is the stimulus and response for the Traction Reflex, and when does it disappear?

Answer 23

Stimulus: Grasp infant’s forearms and pull to sit.
Response: Flexion of shoulders, elbows, wrists, and fingers.
Suppression: 2-5 months.
Function: Enhances reflexive grasp and helps stabilize the head when pulled to sit.

Question 24

What happens in the Crossed Extension Reflex and what is its function?

Answer 24

Stimulus: Apply pressure to the sole of the foot.
Response: Opposite leg flexes, adducts, then extends.
Onset: 1-2 months.
Function: Protective reflex, prepares for reciprocal movements in walking.

Question 24

What is the Moro Reflex and its function?

Answer 24

Stimulus: Sudden head drop backward.
Response: Extension/abduction of arms, followed by flexion/adduction.
Suppression: 4-6 months.
Function: Helps develop the ability to react to sudden loss of support or balance.

Question 25

When does the Stepping Reflex appear and what is its purpose?

Answer 25

Stimulus: Hold infant upright with feet on a surface.
Response: Rhythmic stepping movements.
Onset: 28 weeks AOG.
Suppression: 9 months.
Function: Prepares the legs for walking by promoting coordination of the lower extremities.

Question 25

What is the Startle Reflex, and what is its purpose?

Answer 25

What is the Startle Reflex, and what is its purpose?

Question 26

What is the Rooting Reflex and when does it disappear?

Answer 26

Stimulus: Stroke cheek near mouth.
Response: Turns head toward stimulus and opens mouth.
Suppression: 4 months.
Function: Helps infant find food by turning toward the source of the stimulus.

Question 26

What is the Palmar Grasp Reflex and its purpose?

Answer 26

Stimulus: Pressure on the palm of the hand.
Response: Flexion of fingers, strong grip.
Suppression: 5-6 months.
Function: Prepares the hand for voluntary grasping and supports early sensorimotor development

Question 26

What is the Flexor Withdrawal Reflex?

Answer 26

Stimulus: Noxious stimulus to the sole of the foot.
Response: Withdrawal of the stimulated leg.
Onset: 28 weeks AOG.
Function: Protective reflex to avoid harmful stimuli.

Question 26

What is the Body Righting Reflex?

Answer 26

Stimulus: Rotate infant’s hips.
Response: Segmental rolling of body, trunk, and legs.
Onset: 4-5 months.
Function: Facilitates rolling and promotes segmental body movement.

Question 27

What is the Tonic Labyrinthine Reflex (TLR), and how does it affect movement?

Answer 27

Stimulus: Change in head position (supine or prone).
Response:
Supine: Extension of extremities.
Prone: Flexion of extremities.
Function: Aids in head and postural control and is critical for developing muscle tone.

Question 27

What happens in the Positive Supporting Reflex?

Answer 27

Stimulus: Hold infant upright with feet on a surface.
Response: Legs extend to support weight.
Suppression: 6 months.
Function: Prepares lower extremities for weight-bearing and standing.

Question 28

What does the Optical Righting Reflex help with?

Answer 28

Stimulus: Vision, head orientation.
Response: Head orients to vertical position.
Onset: 2 months.
Function: Helps maintain proper head positioning in space.

Question 28

What is the STNR and its role in movement development?

Answer 28

Stimulus: Head flexion or extension.
Response:
Head flexion: Arms flex, legs extend.
Head extension: Arms extend, legs flex.
Suppression: 8-12 months.
Function: Prepares the body for crawling and assists in upper/lower body coordination.

Question 29

Describe the ATNR and its function.

Answer 29

Stimulus: Turn head to one side.
Response: Extension of arm/leg on the face side, flexion of arm/leg on the skull side.
Suppression: 6-7 months.
Function: Assists with hand-eye coordination and aids in reaching.

Question 29

What is the stimulus and response in the Head Righting Reflex (Neck Righting)?

Answer 29

Stimulus: Turn head to one side.
Response: The infant’s body follows head in a log roll.
Onset: 2 months.
Function: Facilitates rolling and body alignment, assisting in postural control.