Test Bank for Meeting the Physical Therapy Needs of Children, 2nd Edition, Susan K.

Effgen,

Test Bank for Meeting the Physical Therapy Needs of

Children, 2nd Edition, Susan K. Effgen,

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Chapter 7. Neuromuscular System: Examination, Evaluation, Diagnoses

Matching

Match the component of the physical therapy model of practice with its definition. (Note: Not all
options may be used.)
A. Amount of time required to reach optimal improvement
B. Clinical judgments based on examination findings
C. Coordination, communication, and documentation
D. Organization of examination findings into defined categories or syndromes
E. Process of obtaining history and selecting specific tests and measures to obtain
data
____ 1. Examination
____ 2. Evaluation
____ 3. Diagnosis/prognosis

Match the clinical sign with the body structure most likely involved. (Note: Not all options may be
used.)
A. Basal ganglia
B. Cerebellum
C. Prefrontal association cortex
D. Supplementary motor area
____ 4. Problems with timing of movement (coordination)
____ 5. Involuntary movements (dyskinesia)

Match the theory of motor control with its major focus. (Note: Not all options may be used.)
A. Control of movement shifts among systems following a principle of
self-organization between the components that make up the individual and the
surrounding environment.
B. Motor responses can be activated by either sensory stimuli or by central processes.
C. Movements emerge from the interaction of many systems, each contributing to
different aspects of motor control, with no single focus of control; the “control”
shifts among systems depending on the individual’s internal state, the specific
motor task, and the environmental conditions.
D. Task-specific motor synergies that allow for the adaptability and flexibility
inherent to voluntary movement
____ 6. Dynamic system theory
____ 7. Systems theory
____ 8. Uncontrolled manifold theory

Match the outcome measure with the related test category. (Note: Not all options may be used.)
 A. Gross Motor Function Measure
B. School Functional Assessment
C. Test of Infant Motor Performance
____ 9. Screening
____ 10. Developmental
____ 11. Participation

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

____ 1. Which component of the International Classification of Functioning, Disability, and Health would
include the assessment of ROM, motor function, and sensation?
A. Activities
B. Body functions and structures
C. Health condition
D. Participation
____ 2. Which component of the International Classification of Functioning, Disability, and Health would
include the assessment of bed mobility, communication, and self-care?
A. Activities
B. Body functions and structures
C. Health condition
D. Participation
____ 3. Which theory of motor control underlies the use of proprioceptive neuromuscular facilitation quick
stretch of the biceps to facilitate elbow flexion?
A. Dynamic systems theory
B. Hierarchical theory
C. Motor programming theory
D. Reflex theory
____ 4. What postural control problem would best explain a decreased ability to lift heavy objects, lean
over to retrieve things from the floor, step up onto surfaces without support, step forward, or
maintain stance stability with rotation of head and trunk?
A. Adaptive control
B. Proactive control
C. Reactive control
D. Steady-state balance
____ 5. Which of the following statements most accurately defines spasticity?
A. Constant resistance to passive movement
B. Hyperreflexia associated with increased resistance to passive movement
C. Upper motor neuron syndrome
D. Velocity-dependent increased resistance to passive movement
____ 6. What aspect of postural control is specifically tested by the Functional Reach Test?
 A. Anticipatory postural control
B. Feedback postural control
C. Reactive postural control
D. Steady-state postural control
____ 7. Which of the following postural strategies would be typically used to maintain balance during a
challenging activity?
A. Bilateral ankle dorsiflexion primarily
B. Recruitment of the abdominal muscles prior to that of the tibialis anterior
C. Recruitment of the tibialis anterior prior to that of the abdominal muscles
D. Use of the ankle strategy
____ 8. Which of the following health conditions would be the most likely diagnosis for a child
demonstrating difficulty with socialization, communication, and behavior?
A. Autism spectrum disorder
B. Cerebral palsy
C. Developmental coordination disorder
D. Down syndrome
____ 9. When performing a well-child screening for a 1-year old, which of the following signs could
indicate a potential diagnosis of autism spectrum disorder?
A. Inability to independently dress
B. Inability to jump down off step
C. Inability to say “ball”
D. Inability to say “Daddy help”
____ 10. Which of the following impairments of body function would you expect in a child with Down
syndrome?
A. Hypotonicity
B. Muscle atrophy
C. Seizures
D. Spasticity
____ 11. Which of the following would best describe a typical posture for a child with Down syndrome?
A. Ankle plantar flexion, hip internal rotation, and hip adduction
B. Flat feet, wide base of support, and hyperextended knees
C. Hip external rotation, knee flexion, and ankle dorsiflexion
D. Narrow base of support, hip internal rotation anterior pelvic tilt
____ 12. Which of the following is a higher risk for adults with Down syndrome than the normal
population?
A. Bladder infections
B. Patellofemoral instability
C. Cataracts
D. Rheumatoid arthritis
____ 13. A 4-year-old child is diagnosed with Down syndrome. Which of the following pediatric
standardized tests would be most appropriate to administer if the child and family’s goal was to
improve ability to transfer into and out of a car, walk up and down stairs safely, brush teeth and
dress independently, and play interact with peers?
A. Alberta Infant Motor Scale
B. Gross Motor Function Measure
C. Peabody Developmental Motor Scales–2
D. Pediatric Evaluation of Disability Inventory
____ 14. Which is the most likely diagnosis for a child presenting with mild hypotonia, muscle weakness
that is most pronounced in the hands, poor postural control, motor coordination difficulties, and
delayed motor milestone acquisition without cognitive deficits?
A. Cerebral palsy
B. Developmental coordination disorder
C. Down syndrome
D. Hydrocephalus
____ 15. Which of the following activities would be more difficult for a 6-year-old child with
developmental coordination disorder at school?
A. Interacting with peers
B. Jumping jacks in physical education class
C. Putting on a coat
D. Sitting in a chair
____ 16. Which of the following diagnostic pediatric standardized tests would be most appropriate to
administer to a 7-year-old child to assist in confirming a diagnosis of developmental coordination
disorder?
A. Bruininks-Oseretsky Test of Motor Proficiency–2
B. Developmental Coordination Disorder Questionnaire
C. Movement Assessment Battery for Children
D. Peabody Developmental Motor Scales–2
____ 17. Based upon the available evidence, which of the following interventions would be most effective
for an 8-year-old child with developmental coordination disorder working on kicking a ball and
hitting a target?
A. Kicking a ball into a goal inside, outside, and outside with peers
B. Kicking a large ball into a small goal
C. Riding a bike around the park
D. Running around obstacles
____ 18. Which of the following home exercise programs would be most effective for children with Down
syndrome and developmental coordination disorder to prevent secondary conditions including type
2 diabetes and cardiovascular disease?
A. Baseball
B. Gymnastics
C. Soccer
D. Swimming
____ 19. Which of the following changes in body structures most likely explain the muscle weakness
observed in children with cerebral palsy?
A. Decreased type I fast twitch fibers
B. Decreased type II slow twitch fibers
C. Increased number of cross bridges
D. Shortened sarcomeres
____ 20. An 8-year-old child diagnosed with cerebral palsy independently walks with bilateral forearm
crutches indoors at all times and independently propels a manual wheelchair for long distances
outside. He sits in a chair with minimal trunk support at school but is unable to hop, jump, or run.
Which of the following Gross Motor Function Classification System levels best describes this
child’s cerebral palsy?
A. Level I
B. Level II
C. Level III
D. Level IV
____ 21. The Glasgow Coma Scale and the Rancho Los Amigos Scale–Levels of Cognitive Functioning are
two tests used to measure the child’s ability to follow directions, process sensory stimulation, and
determine overall basic cognitive and behavioral function in what patient population?
A. Cerebral palsy
B. Down syndrome
C. Myelomeningocele
D. Traumatic brain injury
____ 22. A 9-year-old child diagnosed with myelomeningocele and hydrocephalus presents with blurred
vision, headache, increased spasticity, and lethargy. What is most likely causing these symptoms?
A. Bladder infection
B. Flu
C. Tethered cord
D. Ventricular peritoneal shunt infection/malfunction
____ 23. When working with a child with myelomeningocele, you need to remember that there is an
increased prevalence of allergy to which of the following items?
A. Latex
B. Milk
C. Peanut
D. Pollen
Chapter 7. Neuromuscular System: Examination, Evaluation, Diagnoses
Answer Section

MATCHING

1. ANS: E PTS: 1
2. ANS: B PTS: 1
3. ANS: D PTS: 1

4. ANS: B PTS: 1
5. ANS: A PTS: 1

6. ANS: A PTS: 1
7. ANS: C PTS: 1
8. ANS: D PTS: 1

9. ANS: C PTS: 1
10. ANS: A PTS: 1
11. ANS: B PTS: 1

MULTIPLE CHOICE

1. ANS: B
Rationale: ROM, motor function, and sensation fall under the body functions and structures
category of the ICF model that is defined as physiological functions of body systems or anatomical
elements such as organs and limbs and their associated impairments.

PTS: 1
2. ANS: A
Rationale: Bed mobility, communication, and self-care would fall under the ICF component of
activities, which, by definition, includes execution of specific tasks or actions by an individual.

PTS: 1
3. ANS: D
Rationale: The reflex theory of motor control proposes that sensory inputs are responsible for
triggering all movement and are thus essential to movement generation. Reflex theory assumes that
reflexes are the basis for all movement and that an external stimulus, in this case a quick stretch of
the biceps, leads to movement such as elbow flexion.

PTS: 1
4. ANS: B
 Rationale: Proactive control or postural commands actually precede the primary movement and
ensure that posture is adequately controlled before the coordinated movement starts. In this case,
the patient is unable to adequately stabilize the trunk prior to lifting, leaning, stepping, or rotation
because he does not demonstrate proactive postural control.

PTS: 1
5. ANS: D
Rationale: The definition of spasticity is velocity-dependent increased resistance to passive
movement. Rigidity is defined as constant resistance to passive movement. Upper motor neuron
syndrome is a combination of positive Babinski, clonus, and spasticity, indicating a lesion in the
brain or spinal cord.

PTS: 1
6. ANS: A
Rationale: Anticipatory postural control allows the patient to stabilize proximally, including the
trunk, prior to reaching forward. If anticipatory control was not intact, the patient may fall when
reaching forward.

PTS: 1
7. ANS: B
Rationale: As seen in Figure 7.3B, a hip strategy will be used during challenging balance activities.
This strategy requires activation of musculature in the following sequence: proximal to distal
sequential activation of the abdominals, quadriceps, and tibialis anterior muscles.

PTS: 1
8. ANS: A
Rationale: The terms autism spectrum disorders and pervasive developmental disorders are used to
indicate behavior conditions that exist on a continuum ranging from mild to severe involvement in
the areas of socialization, communication, and behavior.

PTS: 1
9. ANS: C
Rationale: An inability to speak one (1) word by 1 year of age is indicative of possible autism
spectrum disorder. The gross and fine motor descriptions of jumping and dressing are not age
appropriate for a 1-year old; they are more appropriate for an older child (2 to 4 years of age). We
wouldn’t expect a child to put two words together such as “Daddy help” until 2 years of age.

PTS: 1
10. ANS: A
Rationale: A classic element of Down syndrome includes hypotonicity.

PTS: 1
11. ANS: B
Rationale: Children with Down syndrome have hypotonicity, muscle weakness, and ligamentous
laxity, which can result in flat feet. To promote stability, the child will adopt a wide base of
support and will hyperextend (lock) his knees.
 PTS: 1
12. ANS: B
Rationale: The presence of hypotonicity, joint laxity, and muscle weakness causes excessive wear
on the joint over time and therefore frequently cause patellofemoral instability and knee pain.

PTS: 1
13. ANS: D
Rationale: The PEDI is an age appropriate test (1 month to 6 years of age) for this child and takes
into account all of the areas of concern of the family/child at the activity/participation level
including self-care, motor, and social function. The other tests primarily assess gross/fine motor
skills and do not look at self-care or social areas.

PTS: 1
14. ANS: B
Rationale: The clinical presentation of a child with DCD is in the text. A child with Down
syndrome may have a similar presentation except muscle weakness is usually more generally
distributed throughout the entire body and cognitive deficits are typically present.

PTS: 1
15. ANS: B
Rationale: Children with DCD have poor coordination, motor planning, and postural control that
could lead to difficulty at the activity level in physical education class, including performing
coordinated jumping jacks.

PTS: 1
16. ANS: C
Rationale: The M-ABC is a standardized diagnostic norm-referenced pediatric test for children (3
to 12 years of age) to assess movement problems consistent with DCD. The Developmental
Coordination Disorder Questionnaire is a screening tool and NOT a diagnostic tool. The PDMS–2
is only norm referenced for children up to 6 years of age and does not specifically assess
coordination issues. The BOT–2 is norm reference for 7-year-old children but was designed to
assess gross motor skill and motor delay, which can be different from developmental coordination
disorder.

PTS: 1
17. ANS: A
Rationale: Based upon the evidence, task-specific intervention practicing in varied environments
can be effective in improving motor/functional skills.

PTS: 1
18. ANS: D
Test Bank for Meeting the Physical Therapy Needs of Children, 2nd Edition, Susan K. Effgen,

Rationale: Lifelong fitness and physical activity is important to reduce cardiovascular disease,
particularly in specific patient populations where a sedentary lifestyle (Down syndrome and DCD)
can develop. Gymnastics and soccer may not be appropriate for children with Down syndrome due
to the potential hyperextension injuries (tumbling and heading a soccer ball) and the atlanto-axial
instability that may be present.

PTS: 1
19. ANS: A
Rationale: In addition to neural changes caused by cerebral palsy, muscle tissue changes including
decreased type I fast twitch fibers can lead to muscle weakness.

PTS: 1
20. ANS: C
Rationale: This child is unable to walk without his assistive device, requires minimal seating
modifications, but yet is independent with walking with an assistive device and propelling his own
wheelchair versus being pushed by someone else. Table 7.8 illustrates the various motor abilities
of children diagnosed with cerebral palsy.

PTS: 1
21. ANS: D
Rationale: These two tests are used to determine the level of the coma and cognitive functioning in
a child with a traumatic brain injury (review Table 7.9).

PTS: 1
22. ANS: D
Rationale: The signs of ventricular peritoneal shunt infection, which include blurred vision,
headache, increased spasticity, and lethargy, are listed in Table 7.10.

PTS: 1
23. ANS: A
Rationale: Children with myelomeningocele have a 0% to 22% increased rate of developing latex
allergies as compared to other children.

PTS: 1

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