Meeting The Physical Therapy Needs of Children 1st Edition by Susan K. Effgen – Test Bank

Meeting The Physical Therapy Needs of Children 1st Edition by Susan K. Effgen – Test Bank

Chapter 6. Musculoskeletal System: Consideration and Interventions for Specific Pediatric Pathologies

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. Select the most accurate statement about exercise and children.
A. Children with Duchenne muscular dystrophy should participate in intense regular exercise to improve muscle bulk and slow the progression of the disease.
B. Children with juvenile idiopathic arthritis should only perform non–weight-bearing exercises to avoid increasing joint pain.
C. Children with cerebral palsy typically have poor aerobic and muscular endurance.
D. Children with Ehler’s Danlos syndrome should not participate in sports due to risk of joint damage.

____ 2. Select the correct statement(s) regarding Duchenne muscular dystrophy (DMD). Children with DMD
A. develop hypertrophy of the gastrocnemius as a method to compensate for progressive weakness.
B. should avoid resistive activities and eccentric contractions as this can cause further muscle breakdown.
C. require use of ankle foot orthoses to maintain walking past 12 years of age.
D. will not get muscle contractures if parents perform passive stretches weekly.

____ 3. A unilateral limitation in hip abduction could be an indication of
A. developmental hip dysplasia.
B. slipped capital femoral epiphysis.
C. Legg-Calvé-Perthes disease.
D. osteomyelitis of the hip.
E. All of the above

____ 4. Children with cerebral palsy
A. commonly retain neonatal levels of hip retroversion.
B. have atypical muscle composition so strengthening is not advocated.
C. have a higher incidence of scoliosis than the general population.
D. characteristically have intellectual disabilities.

____ 5. Select the correct statement regarding congenital muscular torticollis.
A. It can be associated with developmental dysplasia of the hip.
B. The muscle tightness will spontaneously resolve by 12 months of age.
C. It is characterized by tightness of the sternocleidomastoid muscle resulting in decreased lateral flexion and rotation to the same side.
D. Torticollis is caused by prematurity.

____ 6. Arthrogryposis
A. is characterized by an asymmetrical pattern of contractures and joint involvement.
B. typically has associated cognitive impairments.
C. may be related to a lack of fetal movement.
D. is a progressive disorder.

____ 7. Which following disorder can cause fractures early in life, and children younger than 3 are typically investigated for child abuse?
A. Osteogenesis imperfecta
B. Cerebral palsy
C. Legg-Calve-Perthes
D. Juvenile idiopathic arthritis

____ 8. Children with juvenile idiopathic arthritis in their hips
A. exacerbate (cause to flare up) their symptoms with exercise.
B. should lie in prone every day.
C. have lifelong joint inflammation.
D. should use a wheelchair as their main means of mobility.

____ 9. Which of the following is an unlikely cause of a leg length discrepancy?
A. Inflammatory hyperemia
B. Hemimelia
C. Joint contracture
D. Stress fracture of bone diaphysis

____ 10. Wayne Stuberg and colleagues demonstrated that a standing program could facilitate hip development in children with developmental disabilities. The program recommended was:
A. 30 min, 2 days per wk.
B. 30 min, 5 days per wk.
C. 60 min, 1 day per wk.
D. 60 min, 3 days per wk.

____ 11. Which of the following conditions can present as toe-walking?
A. Cerebral palsy
B. Duchenne muscular dystrophy
C. Idiopathic toe walking
D. All of the above

____ 12. Moderate exercise for children with juvenile idiopathic arthritis usually leads to
A. increased joint pain.
B. increased joint inflammation.
C. improved fitness.
D. increased joint bleeds.

____ 13. Children with Duchenne muscular dystrophy
A. will have increased base of support, lateral trunk sway, and toe-walking during the late ambulatory stage.
B. will have loss of upper extremity function, scoliosis, and contractures during the late nonambulatory stage.
C. will have increased lumbar lordosis and weakness in the hip extensors and ankle dorisflexors
D. All of the above

____ 14. Why should children with arthrogryposis be evaluated for an early intervention program?
A. Arthrogryposis is generally associated with intellectual impairment.
B. Arthrogryposis is a progressive, debilitating condition.
C. Weakness and contractures at birth may delay motor milestone acquisition and lead to disuse weakness.
D. Physical therapy intervention can correct the deformities.

____ 15. Young boys having Duchenne muscular dystrophy tend to use the Gower maneuver to rise from the floor because of weakness in
A. knee extensors and flexors.
B. hip extensors and flexors.
C. distal leg musculature.
D. upper extremity musculature.

____ 16. Pseudohypertrophy is commonly seen in children with
A. Duchenne muscular dystrophy.
B. Ehlers-Danlos syndrome.
C. juvenile idiopathic arthritis.
D. Blout disease.

____ 17. Methods to promote bone mineralization include
A. impact exercise.
B. weight-bearing exercise.
C. upright standing frames.
D. running.
E. All of the above

Short Answer

1. Name two pediatric diagnoses where limitation in range of motion is a common characteristic.

2. Name two diagnoses where heightened reaction to trauma is common.

3. Which type of juvenile idiopathic arthritis involves the most joints and is the most debilitating?

Chapter 6. Musculoskeletal System: Consideration and Interventions for Specific Pediatric Pathologies
Answer Section

MULTIPLE CHOICE

1. ANS: C
Rationale: Well-planned, regular exercise is beneficial for children with DMD and JIA working within the guidelines listed in the chapter. Children with EDS can participate in sporting activities; however, the therapist should work with the family to determine the sports that meet the child’s interest and prevent joint damage. Contact sports should be avoided. Children with CP typically move much less than able-bodied peers and therefore have poor endurance.

PTS: 1

2. ANS: B
Rationale: Resistive activities and eccentric contractions require increased muscle power and cause increased muscle damage.

PTS: 1

3. ANS: E
Rationale: Asymmetrical abduction is a common finding in all of the diseases.

PTS: 1

4. ANS: C
Rationale: Weak musculature and atypical/asymmetrical movement patterns are believed to be responsible for the higher incidence of scoliosis.

PTS: 1

5. ANS: A
Rationale: Torticollis is associated with developmental dysplasia of the hip as well as plagiocephaly.

PTS: 1

6. ANS: C
Rationale: The joint restrictions seen in arthrogryposis are believed to be due to a fetal muscular problem that decreases the amount of fetal movement. The lack of movement doesn’t break down the mesenchyme for joint formation. Arthrogryposis is a nonprogressive disorder, associated with a symmetrical pattern of muscle contractures and joint involvement. Cognitive impairments are not typically associated with this disorder.

PTS: 1

7. ANS: A
Rationale: OI is a genetic collagen mutation that results in fragile bones. More severe forms of OI present with multiple fractures as a result of the birthing process, whereas more mild forms may result in frequent fractures as a result of mild, seemingly insignificant injuries.

PTS: 1

8. ANS: B
Rationale: Hip extension range of motion is commonly lost in children with JIA. Prone lying encourages hip extension range of motion. Although some children may have lifelong degenerative changes, the inflammation associated with JIA will most likely go into remission.

PTS: 1

9. ANS: D
Rationale: Inflammatory hyperemia can cause bone overgrowth or early physeal closure. Hemimelia describes the congenital absence or shortening of a bone, which can cause bone or limb shortening. Joint contractures are one possible cause of apparent leg length discrepancy. A stress fracture of the diaphysis should not influence leg length, as it does not involve bone displacement.

PTS: 1

10. ANS: D
Rationale: 60 min of standing are needed 3 or more days a wk; 30 min has been found to be insufficient.

PTS: 1

11. ANS: D
Rationale: Children with cerebral palsy, Duchenne muscular dystrophy, or idiopathic toe walking can all present to the clinic with the report of consistent or intermittent toe walking.

PTS: 1

12. ANS: C
Rationale: Community-based exercise programs have been shown to improve endurance and decrease joint symptoms (Klepper, 1999). Eighty percent of the children with polyarticular JIA who participated in an 8-week program of low-impact aerobics, strengthening, and flexibility exercises reported a significant improvement in joint pain and all had improved endurance. There were no reports of increased joint pain or inflammation. Children with JIA do not have joint bleeds.

PTS: 1

13. ANS: D
Rationale: All of listed problems occur in children with DMD.

PTS: 1

14. ANS: C
Rationale: Arthrogryposis is not associated with intellectual impairment, nor is it progressively debilitating. However, the weakness and contractures present at birth can delay milestone acquisition and lead to weakness. Physical therapy might help reduce or delay deformities, but physical therapy by itself will not correct the deformities.

PTS: 1

15. ANS: B
Rationale: Proximal weakness is greater than distal weakness in children with DMD.

PTS: 1

16. ANS: A
Rationale: Pseudohypertrophy (enlargement without increased strength) of the calf muscles is commonly seen in those with Duchenne muscular dystrophy.

PTS: 1

17. ANS: E
Rationale: Impact exercise, such as running and jumping, can increase bone mineral density (Hind & Burrows, 2007; Vicente-Rodriguez et al., 2007; McKay et al., 2005). Improvements in bone mineralization were not seen in children who participated in non–weight-bearing exercise such as swimming (Grimston, Willows, & Hanley, 1993). Weight-bearing and intermittent weight-bearing programs also improve bone mineral density. Intermittent weight bearing with movement can be accomplished by partial weight-bearing ambulation through a use of a treadmill or gait trainer. Also, an upright standing frame that allows some weight shifting is beneficial.

PTS: 1

SHORT ANSWER

1. ANS:
Arthrogryposis, osteogenesis imperfecta, congenital muscular torticollis, hemophilia, JIA, late-stage DMD, etc.

PTS: 1

2. ANS:
Ehlers-Danlos syndrome, hemophilia, and osteogenesis imperfecta.

PTS: 1

3. ANS:
Systemic JIA is generally the most painful form of the disease (Adams & Lehman, 2005). The high number of joints involved, long duration of disease, and resulting orthopedic changes make this type of JIA one of the most debilitating.

PTS: 1