Ch. 30 - Pediatric Interventions
A seven-year-old child with cerebral palsy has severe spasticity that prevents good alignment and positioning for functional activities. Which medical interventions should be investigated as an option for managing the spasticity? A) Active range of motion exercises. B) Orthopedic surgery. C) Baclofen pump.
Baclofen pump.
A child has difficulty moving food from the front to the back of the mouth for swallowing. Which of the following activities is MOST LIKELY to improve the child's ability to swallow? A) Elevate the chin slightly to allow gravity to help pull the food back. B) Use a spoon with a small bowl so that the food is easier to get off the spoon. C) Place the spoon to the posterior portion of the mouth. D) Place the spoon to alternate sides of the mouth.
Place the spoon to alternate sides of the mouth.
An OT is evaluating an eight-year-old child with developmental dyspraxia. Which of the following activities are expected to be MOST DIFFICULT for the child? A) Planning motor sequencing. B) Tolerating tactile input. C) Completing routine activities. D) Tolerating vestibular input.
Planning motor sequencing.
An infant in the neonatal intensive care unit (NICU) was born at 33 weeks' gestation. Which of the following activities is MOST IMPORTANT to teach the parents? A) Position the infant in ways to support extension. B) Provide tactile and vestibular input to help increase the baby's alertness. C) Position the infant in ways to support flexion. D) Encourage the baby to reach for faces and toys.
Position the infant in ways to support flexion
An OT is playing a game that involves having a child hold several playing pieces in one hand while dropping them one at a time into a specific spot. Which specific grasp or pinch pattern is being addressed by this activity? A) Power grasp. B) Neat pincer. C) Lateral pinch.
Power grasp.
During evaluation of self-care skills, an OT observes a child feed independently with a fork, button three to four buttons in front, toilet independently, and put on shoes with tying assistance. What is the MINIMUM DEVELOPMENTAL AGE of the child? A) 2 years. B) 4 years. C) 6 years. D) 8 years.
4 years.
A 12-month-old infant with right hemiplegia is being seen in OT due to decreased grasping skills. The infant tends to grasp with the right hand by pulling the objects in with the fingers and resting the objects against the thumb, which is flexed into the palm. Which of the following treatments would be MOST APPROPRIATE for this client? A) Facilitation of an ulnar‒palmar grasp. B) Finger-to-palm translation skills. C) A neoprene thumb splint for home activities. D) Palm-to-finger translation skills.
A neoprene thumb splint for home activities.
A 15-month-old child with myelomeningocele demonstrates decreased UE strength, inability to sit independently, and has poor hand manipulation skills. Which of the following treatment plans is MOST APPROPRIATE? A) Completion of manual muscle testing in a supported sitting position. B) Activities in a side-sitting position. C) Theraband exercises in multiple positions. D) Scissors use and cutting practice.
Activities in a side-sitting position.
A 15-month-old child with myelomeningocele demonstrates decreased UE strength, cannot sit independently, and has poor hand manipulation skills. What is the MOST APPROPRIATE intervention for this client? A) Completion of an MMT in supported sitting. B) Activities in side sitting. C) Theraband exercises. D) Scissors use and cutting practice.
Activities in side sitting.
A young adult with a TBI has dysphagia, but has now advanced to oral feeding. The FIRST food and drink taken orally should include: A) Soft canned fruit and fruit nectar. B) Plain yogurt and ice chips. C) Applesauce and fruit nectar thickened with banana. D) Scrambled eggs and fruit nectar thickened with banana.
Applesauce and fruit nectar thickened with banana.
A child uses wrist extension every time an object is released. Which of the following activities is MOST LIKELY to encourage wrist extension during release of an object? A) Ask the child to place objects into a container located just lateral of midline and at arm's length. B) Ask the child to place objects into a container located at midline and close to the body. C) Ask the child to move small objects from palm to finger before releasing. D) Ask the child to transfer objects from hand to hand using stabilization with release.
Ask the child to place objects into a container located just lateral of midline and at arm's length.
An 11-year-old child with a diagnosed seizure disorder is currently being managed with medications. Which of the following safety precautions would be MOST IMPORTANT to consider in this client's intervention plan? A) Awareness of emergency procedures for seizures, environmental monitoring, and dietary restrictions. B) Medication monitoring. C) Environmental monitoring and CPR. D) Dietary restrictions.
Awareness of emergency procedures for seizures, environmental monitoring, and dietary restrictions.
A 31-week-gestational-age infant has difficulty with nippling skills. The infant has a nasogastric tube, receives oxygen via a nasal cannula, and has increased respiratory rate at rest. Which of the following treatments is BEST? A) Delay treatment until the infant reaches 34 weeks' gestational age. B) Begin addressing non-nutritive sucking techniques. C) Provide stimulation to increase the infant's state of alertness. D) Begin working on nutritive sucking with a soft, fast-flow nipple to help decrease effort.
Begin addressing non-nutritive sucking techniques.
A 31-week-gestational-age infant is referred to occupational therapy to address his nippling skills. The infant currently has a nasogastric tube, receives oxygen via a nasal cannula, and is noted to have an increased respiratory rate at rest. Which approach to treatment would be MOST APPROPRIATE? A) Hold off starting treatment until the infant is at 34 weeks' gestation. B) Begin working on addressing non-nutritive sucking techniques. C) Provide stimulation to increase the infant's state of alertness. D) Begin working on nutritive sucking with a soft, fast-flow nipple to help decrease the effort.
Begin working on addressing non-nutritive sucking techniques.
Which of the following performance areas are often affected in sensory integrative dysfunctions? A) Social and perceptual. B) Cognitive and behavioral. C) Behavioral, social, academic, and motor coordination. D) Motor coordination and academic.
Behavioral, social, academic, and motor coordination.
A child with spastic hemiplegia lacks 20 degrees of passive elbow extension on the right because of tone. Which of the following activities performed by the child would BEST reduce the tone? A) Use both hands to push a weighted child's toy grocery cart. B) Complete a large floor puzzle in a four-point position. C) Pick up a weighted ball to drop down a ramp toward bowling pins. D) Build a four-piece shape puzzle in a right-side sitting position.
Build a four-piece shape puzzle in a right-side sitting position.
A three-year-old client with spastic hemiplegia demonstrates a tendency to hold the right UE in a flexor synergy pattern when completing activities with the left UE. The arm does relax down to 90-degree elbow extension with the wrist in 40-degree flexion at rest. The client demonstrates ‒20 degrees of passive elbow extension because of tone. Which activity will BEST help to reduce the tone in the right UE? A) Using both hands to push a weighted child's toy grocery cart. B) Completing a large floor puzzle in four-point position. C) Picking up a weighted ball to drop down a ramp toward bowling pins. D) Building a four-piece shape puzzle in right-side sitting position.
Building a four-piece shape puzzle in right-side sitting position.
A 12-month-old infant with right hemiplegia has decreased grasping skills. During right-hand use, the child grasps objects by pulling in with the fingers and resting the object against the thumb, which is flexed into the palm. Which of the following interventions is MOST APPROPRIATE? A) Facilitate an ulnar‒palmar grasp. B) Practice finger-to-palm translation skills. C) Provide a neoprene thumb splint for home activities. D) Practice palm-to-finger translation skills.
Provide a neoprene thumb splint for home activities.
A 15-year-old child was admitted to a rehabilitation unit three months prior due to a closed head injury. Upon admission, the child demonstrated decreased cognition, significant left UE flexor synergy patterning, and poor static and dynamic sitting balance, and required maximum to total assist for all ADL skills. During the reevaluation, the therapist notes that the client is now able to sit on the edge of the bed independently, follow three-step commands consistently, and perform ADLs with moderate to maximal assist. Despite significant focus on improving left UE tone and strength, the child continues to exhibit significant flexor synergy patterning, and progress with therapy has slowed significantly in the past weeks. The child will be discharged home within two weeks and will be following up in a day treatment program. Which action from the occupational therapist would be MOST appropriate? A) Continue with a heavy focus on normalizing the client's tone and strength to maximize progress. B) Change the treatment focus to incorporate more teaching of compensatory ADL techniques. C) Discharge the client from OT, as the decrease in progress indicates that her maximum potential has been reached. D) Change the OT focus to address more activities to prepare the client for returning to the school environment.
Change the treatment focus to incorporate more teaching of compensatory ADL techniques.
An OT is asked to give an in-service program on handwriting to teachers of kindergarten through second grade, and believes that activities based on the biomechanical model of practice would be the easiest to carry out in the classroom. Which of the following strategies SHOULD be included? A) Check desk height and students' ability to touch feet to the floor, provide a variety of pencil grips for the teachers to try with the students, and tape strips on the desk to show proper position of the paper while writing. B) Do warm-up activities before writing, provide opportunities for strengthening using items such as clay, and have the children change writing positions frequently to assess which is best for each child. C) Explore the current method of instruction for handwriting and analyze the components, provide suggestions for enhancing each phase, and possibly change the order in which the letters are introduced. D) Offer a variety of writing instruments, provide a variety of paper types with different colored lines, and suggest a station where the children draw the letters in sand or rice on a cookie sheet before writing on paper.
Check desk height and students' ability to touch feet to the floor, provide a variety of pencil grips for the teachers to try with the students, and tape strips on the desk to show proper position of the paper while writing.
A therapist is asked to give an in-service program on handwriting to teachers of kindergarten through second grade. The in-service focus is on the biomechanical model of practice. Which strategies would be MOST IMPORTANT to include in the suggestions to the teachers? A) Check desk height to ensure the students' feet touch the floor, provide a variety of pencil grips, and place tape strips on the desk to show proper position of the paper while writing. B) Do warm-up activities before writing, provide opportunities for strengthening such as playing with clay, and change writing positions frequently to assess which is best. C) Explore the current method of instruction for handwriting and analyze the components: cognitive phase, associative phase, and autonomous phase. Provide suggestions for enhancing each phase and possibly change the order that the letters are introduced. D) Offer a variety of writing instruments, such as crayons, markers, and pencils, as well as a variety of paper with different color lines. Suggest a station where the children draw the letters in sand or rice on a cookie sheet before writing on paper.
Check desk height to ensure the students' feet touch the floor, provide a variety of pencil grips, and place tape strips on the desk to show proper position of the paper while writing.
An appropriate method for teaching a child to tie shoes is backward chaining. Which of the following activities BEST describes backward chaining? A) Have the child start with shoe tying and present activities that are a step easier, such as stringing, lacing, and so on until you find the level where the child is successful. Start the intervention at that level, then move forward until the goal of shoe tying is achieved B) Give verbal cues for each step while untying the shoe to make sure the child understands how each step was accomplished. C) Teach the child to untie the shoe before learning to tie the shoe. D) Complete all but the last step and let the child complete the last step. When the child is successful, let the child complete the last two steps, and so on, until the child can tie the shoes independently.
Complete all but the last step and let the child complete the last step. When the child is successful, let the child complete the last two steps, and so on, until the child can tie the shoes independently.
An appropriate method for teaching a child to tie shoes is backward chaining. Which of the following activities BEST describes backward chaining? A) Start with shoe tying and then present easier activities such as stringing, until the child can successfully complete a task. B) Provide verbal cues for each shoe-tying step while untying the shoe, to make sure the child understands how each step was accomplished. C) Teach the child to untie the shoe before learning to tie the shoe. D) Complete all shoe tying steps except the last step, and let the child complete that step. When the child is successful, the child then completes the last two steps, and so on, until tying occurs independently.
Complete all shoe tying steps except the last step, and let the child complete that step. When the child is successful, the child then completes the last two steps, and so on, until tying occurs independently.
An OT is treating a nine-month-old infant with a history of failure to thrive. The evaluation showed poor overall strength and endurance, which are being addressed through developmental positioning, oral motor exercises, and home program activities with the family. After six weeks, minimal progress is noted. Which of the following actions is MOST APPROPRIATE? A) Continue to work with the child for an additional six weeks. B) Discharge the child because of lack of progress. C) Consult with a dietitian/nutritionist to monitor caloric intake. D) Change the focus of therapy to fine motor skills.
Consult with a dietitian/nutritionist to monitor caloric intake.
A therapist is working with a nine-month-old child with a history of failure to thrive. The evaluation showed poor overall strength and endurance. A therapist addresses these issues through developmental positioning, oral motor exercises, and home program activities with the family. After six weeks, there is minimal progress. Which action would be MOST APPROPRIATE for the occupational therapist to perform? A) Continue with therapy for an additional six weeks. B) Discharge the child because of lack of progress. C) Consult with a dietitian/nutritionist to monitor the child's caloric intake. D) Change the focus of therapy to fine motor skills.
Consult with a dietitian/nutritionist to monitor the child's caloric intake.
A child has decreased cognition, a pattern of left upper extremity flexor synergy, and decreased static and dynamic sitting balance, and requires maximum to total assist for all ADL skills. Which of the following goals should be addressed INITIALLY? A) Improving cognitive skills. B) Teaching compensation techniques for ADL skills. C) Decreasing/normalizing tone and overall strengthening. D) Teaching nondominant hand writing skills.
Decreasing/normalizing tone and overall strengthening.
A therapist is working with a 15-year-old, left-hand-dominant client who was recently admitted to the acute rehabilitation unit. The child demonstrates decreased cognition, left UE flexor synergy patterning, and decreased static and dynamic sitting balance, and requires maximum to total assist for all ADL skills. What should the INITIAL OT treatment goals address? A) Cognitive skills. B) Teaching compensation techniques for ADL skills. C) Decreasing/normalizing tone and overall strengthening. D) Teaching right-hand writing skills.
Decreasing/normalizing tone and overall strengthening.
During an early intervention arena assessment, a teacher determines that there are fine motor delays in a two-year-old student. What is the FIRST thing that an OT should do with this information? A) Determine educationally relevant long- and short-term goals. B) Perform a standardized fine motor assessment. C) Begin working on fine motor skills. D) Give the parents a home program.
Determine educationally relevant long- and short-term goals.
During arena assessment in an early intervention setting, a teacher identifies fine motor delays in a student. Which of the following actions are MOST APPROPRIATE initially? A) Determine educationally relevant long- and short-term goals. B) Perform a standardized fine motor assessment. C) Begin working on fine motor skills. D) Give the parents a home program.
Determine educationally relevant long- and short-term goals.
A therapist is playing a game that involves having the child hold several playing pieces in one hand and drop them one at a time into a specific spot. What is the MOST APPROPRIATE grasp pattern that the therapist is addressing and for what purpose? A) Power grasp; it works on radial‒ulnar dissociation. B) Neat pincer; it works on fine grasp and release with the thumb and index finger. C) Lateral pinch; it works on encouraging wrist stability and use of intrinsic muscles. D) Power grasp; it works on strengthening finger abductors needed for release of objects.
Power grasp; it works on radial‒ulnar dissociation.
A high school student with a traumatic brain injury is returning to school. Which of the following activities is MOST IMPORTANT to identify the least restrictive environment for the student? A) Determine the extent to which the student can participate in the general education setting and which supports are necessary. B) Complete a visual perceptual evaluation to determine if the student can perform written work or if assistive technology is needed. C) Assess strength and range of motion. D) Determine whether the building is accessible.
Determine the extent to which the student can participate in the general education setting and which supports are necessary.
A high school student with a traumatic brain injury is returning to school. An OT is part of the multidisciplinary team working to get the student in the most appropriate, least restrictive environment. What should the OT's PRIMARY focus be? A) Determining the extent to which the student can participate in the general education setting and which supports are necessary. B) Completing a visual perceptual evaluation to determine if the student can perform written work or if assistive technology is needed. C) Assessing strength and range of motion. D) Determining whether the building is accessible.
Determining the extent to which the student can participate in the general education setting and which supports are necessary.
When considering play and recreational activities for a child with JRA, which management would be MOST IMPORTANT for the therapist to consider? A) Energy conservation and work simplification instructions. B) Handling and positioning techniques to prevent fractures. C) Wearing and use of protective arm and leg guards and orthoses. D) Medical management on the use of therapeutic drugs.
Energy conservation and work simplification instructions.
An OT is asked to conduct an initial evaluation on a child. The clinic uses a standardized test with which the OT is not familiar. Which of the following actions is MOST APPROPRIATE? A) Apologize to the family and reschedule the evaluation after the test is learned. B) Evaluate the child using nonstandardized methods. C) Administer the test, reading the manual during the evaluation. D) Request that the clinic purchase a test that is familiar to the OT.
Evaluate the child using nonstandardized methods.
An 18-month-old child with spastic cerebral palsy is referred to OT for treatment. The child cannot sit independently and is having problems reaching. The parents' goal is for their child to walk. What is the MOST APPROPRIATE approach for this client? A) Explain to the family that you will find them a physical therapist. B) Explain to the family that you need to send a note to the doctor stating that treatment was refused. C) Explain to the family which OT goals could be attained through improved trunk control. D) Explain to the family that you will work on ambulation, as that is their goal.
Explain to the family which OT goals could be attained through improved trunk control.
A therapist is working with a five-year-old child who has leukemia and is undergoing chemotherapy. The client was developing normally before the diagnosis. An OT evaluation reveals that the client is weak and dependent in ADLs. The mother feels useful when she is able to help her daughter with bathing, dressing, and grooming. What is the MOST APPROPRIATE approach to take? A) Tell the mother that the child needs to do her own bathing, dressing, and grooming. B) Discuss with the social worker that the mother is interfering with treatment. C) Discontinue therapy because the child had typical skills before her diagnosis and treatment, and they should return. D) Focus the OT treatment on strengthening, and allow the mother to continue her caregiving role.
Focus the OT treatment on strengthening, and allow the mother to continue her caregiving role.
A child with leukemia is undergoing chemotherapy. Prior to the diagnosis, the child was developing normally. Currently, the child is weak and dependent on the parents for activities of daily living. Which of the following actions is MOST APPROPRIATE? A) Inform the parents that they should allow the child to perform own bathing, dressing, and grooming. B) Discuss with the social worker that the parents are interfering with treatment. C) Discontinue therapy because the child had normal development before the diagnosis and the skills should return. D) Focus treatment on strengthening, and allow the parents to continue in caregiving roles.
Focus treatment on strengthening, and allow the parents to continue in caregiving roles.
A child with sensory integrative disorder is receiving occupational therapy. Treatment has included proprioceptive and vestibular input to work on modulating sensory input. The OT has planned an obstacle course today, but upon entering the room the child sees a swing and begins talking about how it would make a great pirate ship. Which of the following approaches would be BEST for this treatment session? A) Have the child complete the obstacle course as planned, as this activity provides the most appropriate input. B) Follow the child's lead and allow the child to sit in the swing while providing the right amount of input. C) Follow the child's lead and set up the treatment so that the child is required to activate the swing. D) Have the child complete the obstacle course, allowing for 10 minutes of swing time when the task is completed.
Follow the child's lead and set up the treatment so that the child is required to activate the swing.
A 10-year-old child with a sensory integrative disorder is coming to occupational therapy for treatment. The therapist has been using proprioceptive and vestibular input to help work on modulating sensory input. In today's session, the therapist plans to complete an obstacle course with the client. Upon entering the room, however, the client sees a swing and begins talking about how it would make a great pirate ship. Which approach would be MOST APPROPRIATE for this treatment session? A) Have the client complete the obstacle course as planned to provide the most appropriate input. B) Follow the client's lead and have her sit in the swing while you push the client to provide the right amount of input. C) Follow the client's lead and set it up so that the client has to activate the swing herself. D) Complete the obstacle course and tell the client that she can swing for 10 straight minutes if she does the obstacle course well.
Follow the client's lead and set it up so that the client has to activate the swing herself.
A 16-year-old with cerebral palsy has average cognitive skills but significant motor impairments. The OT has been working on increasing the speed of written work, but the goal is not met. The student expresses a desire to go to community college. Which of the following actions is MOST APPROPRIATE? A) Tell the student and team that the child's goal is not realistic. B) Work harder on handwriting during the upcoming school year. C) Discontinue services because the student has not met the goal for high school. D) Investigate assistive technology or alternative modifications that the college may offer.
Investigate assistive technology or alternative modifications that the college may offer.
A school OT is working on independence in ADLs with a four-year-old child with autism. When working with the client in a one-on-one setting, the client can perform all of these steps: removing his backpack, getting out his folder, and hanging his backpack. He can also unzip his coat and hang it on the hook in the treatment room. When taken near his locker, he is overwhelmed by the other students near him and cannot perform the activities without verbal cuing at every step. Which action would be MOST APPROPRIATE for the occupational therapist to perform next? A) Bring another student into the treatment room with the client so he can practice with a friend. B) Give the client a picture schedule to be taped in his locker that sequences the steps. C) Arrange for an adult to help the client when he arrives, because the OT cannot be there every day. D) Let the client hang his coat and backpack in the treatment room.
Give the client a picture schedule to be taped in his locker that sequences the steps.
A five-year-old child with muscular dystrophy comes up to standing from kneeling by using his arms to crawl up the thighs. Which term best describes this maneuver? A) Primitive reflex. B) Gower's sign. C) Hypertonia. D) Exaggerated reflex.
Gower's sign.
The OT in a developmental education setting for severely physically and cognitively impaired students is training a young adult to use a spoon to feed herself. The MOST APPROPRIATE technique to help the student learn this skill is: A) Verbal prompting. B) Observing herself in a mirror while the therapist performs the task. C) Hand-over-hand technique combined with backward chaining. D) Observing herself in a mirror while she uses the spoon.
Hand-over-hand technique combined with backward chaining.
A nine-year-old student with developmental delays and low trunk tone is having difficulty with self-feeding in the school cafeteria. The student uses a wheelchair for distances but can ambulate with a walker within the classroom. She loves to socialize and sits with her classmates at lunch. During observation, the therapist notes that the client is able to feed herself with one hand while maintaining her balance with the other hand. She can feed herself a sandwich, but could not open the bag of chips, nor could she stabilize the yogurt container while scooping with a spoon. Which recommendation would be MOST IMPORTANT for this child? A) Ask the child's parents to modify what they send in for her lunch so she can be independent, sending only things that require finger feeding. B) Assign the child a peer helper to open her food when needed. C) Have the child sit in her wheelchair at the end of the table so she is properly positioned with adequate trunk and foot supports so she can use both hands. D) Provide the child with adaptive equipment, such as a nonskid bowl, so she can scoop foods without having to stabilize them with her other hand.
Have the child sit in her wheelchair at the end of the table so she is properly positioned with adequate trunk and foot supports so she can use both hands.
A student with developmental delays and low trunk tone is having difficulty with self-feeding. Observation reveals the student sits at a table and uses one hand to eat while the other hand maintains balance. The child ate a sandwich, but could not open a bag of chips or stabilize a yogurt container to scoop with the spoon. Which of the following recommendations is BEST? A) Ask the parents to modify the student's lunch so the student can be independent. B) Assign the student a peer helper to open food when needed. C) Have the student sit in a wheelchair for adequate trunk and foot support, which will allow use of both hands. D) Provide adaptive equipment, such as a nonskid bowl, so the students does not need both hands to scoop food.
Have the student sit in a wheelchair for adequate trunk and foot support, which will allow use of both hands.
A seven-year-old child with a history of autism is being treated by an occupational therapist. The therapist notes that the child has difficulty with processing proprioceptive input, and this is interfering with his ability to control fine motor skills, play safely on the playground, and remain in line without hitting or bumping into the other children. The therapist will treat the client with a sensory integrative approach but wants to develop some compensatory skills to help the client immediately with some of the issues. Which compensatory skill would be BEST to teach this client? A) Having the client use a weighted pencil in class. B) Having the client complete fine motor skills in the classroom during recess. C) Having the client help carry equipment to set up the treatment area. D) Having the child help straighten up the classroom before lunch.
Having the client use a weighted pencil in class.
A student has poor posture while writing, an awkward pencil grip, and poor letter formation. The OT is consulting with the teacher. Which of the following activities is MOST IMPORTANT to review? A) Why the student cannot write as well as the other students in the class. B) Why the teacher should use an alternative handwriting curriculum. C) How to position the student to improve posture while writing. D) Services provided to the student during individual OT sessions.
How to position the student to improve posture while writing.
An OT wants to improve left hand control for a student with a diagnosis of right spastic hemiplegia. The child is placed in a side-sitting position on the left side, to allow weight bearing through the left upper extremity. Which of the following rationales BEST explains the purpose this position? A) Encourages use of the right hand. B) Shortens trunk muscles on the left for symmetry when sitting. C) Provides full range of motion. D) Improves stability of the scapulohumeral area.
Improves stability of the scapulohumeral area.
A child is observed using the writing hand to turn a pencil and erase. Which of the following skills is the child demonstrating? A) Tool use. B) Grasp and release. C) Bilateral coordination. D) In-hand manipulation.
In-hand manipulation.
An 11-year-old child with arthrogyposis who has successfully received treatment in the past is referred for an evaluation. During the evaluation, the therapist finds that the child demonstrates bilateral elbow contractures and limited finger movement. The client requires moderate to minimal assistance with various grooming skills, and moderate assistance with donning pants and doffing a shirt. Donning a shirt and doffing pants are performed independently. The client and the client's mother state that their goal for treatment is for the client to improve UE strength enough to be able to join an adaptive bowling league. Which treatment focus would be MOST APPROPRIATE for this child? A) Splinting the client's hands to improve his ability to hold his toothbrush. B) Increasing the client's independence in dressing skills. C) Incorporating shoulder strengthening activities through a home exercise program. D) Decreasing the client's elbow contractures.
Incorporating shoulder strengthening activities through a home exercise program.
A therapist is at an IEP for a 16-year-old female with cerebral palsy. The client has average cognitive skills but significant motor impairments. Despite working hard on the goal of increasing the speed of written work so the client can keep pace with peers, the goal was not met. The client expresses that she would like to go on to the community college, but she does not really know which course of study to pursue. The OT does not believe that the client will be able to keep pace with the written demands of community college, irrespective of the specific classes taken. What is the MOST APPROPRIATE role for the OT at the IEP? A) Tell the client that her goal is not realistic. B) Take the client's concerns seriously and work harder on her handwriting during the upcoming school year. C) Discontinue services because the client has not met the goal for high school. D) Investigate assistive technology or alternative modifications that the college may offer.
Investigate assistive technology or alternative modifications that the college may offer.
A child with cerebral palsy demonstrates increased use of the extensor musculature when attempting movements against gravity. When moving into flexion, the child has very poor control of the neck and trunk musculature, with complete head lag noted in the pull to sit. Which of the following activities will BEST facilitate antigravity flexion? A) Participating in pull-to-sit activities from a supine position on the mat or a wedge. B) Practicing in prone extension activities on a therapy ball. C) Practicing in prone extension activities on the mat. D) Moving from a sitting position to a supine position on a therapy ball or wedge.
Moving from a sitting position to a supine position on a therapy ball or wedge.
A 16-month-old child with cerebral palsy demonstrates increased use of extensor musculature when attempting movement against gravity. The child is noted to have very poor antigravity movements of the neck and trunk musculature when moving into flexion, with complete head lag noted in the pull to sit. Which activity is MOST APPROPRIATE for the OT to incorporate into the treatment sessions to facilitate antigravity flexion? A) Pull-to-sit activities from supine position on the mat. B) Prone extension activities on a therapy ball. C) Prone extension activities on the mat. D) Moving from sitting to supine position on a therapy ball or wedge.
Moving from sitting to supine position on a therapy ball or wedge.
A three-year-old child is referred for an evaluation due to lack of expected development. Which of the following tasks will BEST evaluate upper extremity strength? A) Ask the parents how much the child can lift. B) Observe the child during structured play activities. C) Perform a manual muscle test. D) Assess the child's muscle tone.
Observe the child during structured play activities.
An 18-month-old child with spastic cerebral palsy cannot sit independently and is having problems with reaching. The parents' goal is for their child to walk. Which of the following explanations SHOULD be provided to the family? A) physical therapist referral is needed. B) The doctor will need to be informed that treatment was refused. C) Occupational therapy goals can be obtained through improved trunk control. D) Treatment will work on ambulation since this is the parents' goal.
Occupational therapy goals can be obtained through improved trunk control.
An OT observes a nurse feeding a child, with the child positioned in neck hyperextension with poor trunk support. Which of the following responses by the OT is MOST APPROPRIATE? A) Say nothing since the nurse is a professional. B) Tell the nurse that the child's position is inappropriate, as the child may aspirate. C) Inform the nurse that feeding is better performed by the treating OT. D) Offer to show the nurse a safer way to position the child.
Offer to show the nurse a safer way to position the child.
An 11-year-old client presents to occupational therapy with spastic diplegic cerebral palsy. Which of the following categories of information from the International Classification of Functioning, Disability, and Health BEST provides the occupational therapist with the context in which the client's occupational roles occur? A) Activities. B) Body functions and structure. C) Participation. D) Personal and environmental factors.
Personal and environmental factors.
A 12-month-old child has good head and neck control when relaxed, but frequently pushes into extension because of increased extensor tone. The parents report that tone makes it difficult to dress the child. Which of the following suggestions is MOST APPROPRIATE? A) Provide full support by lying the child on the changing table. B) Hold the child in a standing position. C) Put the child in a side-sitting position. D) Place the child on a lap in supported sitting.
Place the child on a lap in supported sitting.
Parents of a 12-month-old child are having difficulty with dressing the child because of her increased extensor tone. The child demonstrates good head and neck control when not pushing into extensor posturing. Which suggestion would be MOST APPROPRIATE to make to the parents? A) Place the child in supine position on the changing table. B) Hold the child in supported standing position. C) Put the child in side-sitting position. D) Place the child on the parent's lap in supported sitting position.
Place the child on the parent's lap in supported sitting position.
A therapist is working with an eight-year-old child who demonstrates wrist flexion every time she releases an object. Which action would be BEST to encourage increased wrist extension with object release? A) Place the container just lateral of midline and at almost arm's length from the child. B) Place the container at midline and close to the body. C) Use small objects and have the client translate them from palm to finger before releasing. D) Have the client work on transferring objects hand to hand so she can use stabilization with release.
Place the container just lateral of midline and at almost arm's length from the child.
A 10-month-old infant is receiving occupational therapy services to address feeding difficulties. The client has difficulty moving the food from the front to the back of the mouth for swallowing. Which action would be MOST HELPFUL to improve the ability to move the food posteriorly for swallowing? A) Elevate the client's chin slightly so that gravity will help pull the food back. B) Use a spoon with a small bowl so that the food is easier to get off the spoon. C) Place the spoon to the posterior portion of the mouth. D) Place the spoon to alternate sides of the mouth.
Place the spoon to alternate sides of the mouth.
A therapist is evaluating a preschool-aged child with sensory processing difficulties. The therapist discovers that the child reacts negatively to light touch, has poor proprioceptive awareness, and has difficulty grading movements. The child frequently has trouble during free play time and pushes other children or screams when they approach him. The teacher describes his play as "roughhousing" with very little imaginative play. Which suggestions would be MOST APPROPRIATE for the teacher? A) Have the child play at a table filled with cotton and feathers so he can get used to light touch. B) Provide proprioceptive input, such as jumping or wheelbarrow walking, just before free play. C) Explain to the child how to play with the toys so he will have a better idea how to do it. D) Spin the child on a swing before play to help organize him.
Provide proprioceptive input, such as jumping or wheelbarrow walking, just before free play.
The parents of a child who has athetoid cerebral palsy have a goal of improving the child's self-feeding. Which of the following techniques will BEST facilitate hand-to-mouth skills? A) Practice using utensils with built-up handles. B) Hold the utensil in the child's hand with hand over hand. C) Provide shoulder depression, protraction and humeral support. D) Use a mobile arm support during feeding techniques.
Provide shoulder depression, protraction and humeral support.
A preschool-aged child has sensory processing difficulties, which include negative reaction to light touch, poor proprioceptive awareness, and difficulty grading movements. During free play time, the child frequently pushes other children or screams when approached. The teacher describes the student's play as "roughhousing" with very little imaginative play. Which of the following suggestions is MOST IMPORTANT regarding free time play? A) Have the child play at a table filled with cotton and feathers to develop tolerance to light touch. B) Provide the child with proprioceptive input, such as jumping, just before free play time to improve personal space awareness. C) Explain to the child how to play with the toys to decrease the child's frustrating with using toys. D) Spin the child on a swing before play to improve tolerance to light touch and other children being close by.
Provide the child with proprioceptive input, such as jumping, just before free play time to improve personal space awareness.
A therapist is working with a two-year-old child with a history of athetoid cerebral palsy. The parents' goal is for the child to be able to self-feed. Which technique would be BEST to develop hand-to-mouth skills? A) Practicing with utensils with built-up handles. B) Using a hand over hand to hold the utensil in the child's hand. C) Providing shoulder depression and protraction and humeral support. D) Using a mobile arm support during feeding techniques.
Providing shoulder depression and protraction and humeral support.
An OT is evaluating hand skills in a child. While the child is holding a 1-inch cube, the child demonstrates an ulnar grasp pattern. Which of the following grasps should emerge NEXT? A) Radial. B) Hook. C) Pincer. D) Tripod.
Radial.
A six-year-old child with no clear diagnosis is referred for evaluation and treatment at an outpatient clinic. The parents report that the child has difficulty holding and manipulating objects. The OT evaluation indicates normal tone and strength but fine motor skills that are at the level of a four-year-old. What is the MOST APPROPRIATE intervention for this client? A) Refer the child back to the doctor for diagnosis. B) Treat the child for fine motor skill difficulties. C) Refer the child to an early intervention program. D) Refer the child to a school-based program.
Refer the child to a school-based program.
An OT in a school setting completes an initial evaluation of a student after receiving a prescription from the parent. The student is keeping up educationally, but has increased tone and decreased strength in the right upper extremity. Which of the following actions is MOST APPROPRIATE by the OT? A) Begin treatment this week since a prescription has been received. B) Refer the parent to a medical-based clinic since the child is functional in the educational setting. C) Begin treatment this week since any OT can treat tone and strength issues. D) Recommend no additional treatment, as the child is functional in the educational setting.
Refer the parent to a medical-based clinic since the child is functional in the educational setting.
A six-year-old child is referred to an outpatient pediatric vision clinic for a visual perceptual evaluation with complaints and symptoms of headache and strabismus. Upon further evaluation, the parents noted that the child has recently displayed cognitive changes and irritability. Which action would be MOST IMPORTANT for the therapist to undertake? A) Administer the Developmental Test of Visual Perception (DTVP-II). B) Administer the Stanford-Binet Intelligence Scale. C) Report the recent cognitive changes and irritability to the child's pediatrician for further medical assessment. D) Contact the classroom teacher to assess the child's performance in school.
Report the recent cognitive changes and irritability to the child's pediatrician for further medical assessment.
A school occupational therapist has evaluated a second-grade student. The results show that the client has poor posture while writing, an awkward pencil grip, and poor letter formation. The therapist is written into the IEP on a direct and consultative basis. Which action would be MOST IMPORTANT during the consultation with the teacher? A) Reviewing why the student cannot write as well as the other students in the class. B) Reviewing why the teacher should use an alternative handwriting curriculum. C) Reviewing how to position the student to improve his posture while writing. D) Reviewing what the OT does with the client in the individual sessions.
Reviewing how to position the student to improve his posture while writing.
A child's parents report that the child is very slow in getting dressed (especially if buttoning is involved), is easily frustrated with fine motor tasks, and has difficulty keeping food on the spoon when bringing it to mouth. However, the child has normal tone, range, and strength. Which of the following treatment approaches is MOST APPROPRIATE? A) Sensory integrative approach for tactile discrimination and perception problems. B) Biomechanical approach to work on coordination and grip strength. C) Neurophysiological approach using proprioceptive neuromuscular feedback patterns to improve crossing midline. D) Cognitive perceptual approach to teach environment adaptation and compensatory techniques.
Sensory integrative approach for tactile discrimination and perception problems.
A six-year-old child was referred to OT for an evaluation. During the evaluation, the therapist finds that the client's tone, range, and strength are age appropriate. The client demonstrates difficulty buttoning, especially when not looking at the buttons, and she frequently repositions the pencil in her hand during fine motor tasks. The parents reported that the child is very slow in getting dressed, especially if buttoning is involved; she also gets easily frustrated with fine motor tasks and has difficulty keeping food on the spoon when bringing it to her mouth. What is the MOST APPROPRIATE intervention for this child? A) Sensory integrative approach for tactile discrimination and perception problems. B) Biomechanical approach to work on coordination and grip strength. C) Neurophysiological approach using PNF patterns to improve crossing midline. D) Cognitive perceptual approach to adapt the child's environment and help her learn compensatory techniques.
Sensory integrative approach for tactile discrimination and perception problems.
A child is having trouble learning to button a shirt. The child can get the button to the buttonhole, but then has trouble pushing the button through the hole. Which of the following activities is MOST LIKELY to facilitate buttoning skills? A) Holding a pan and pretending to stir inside it with a spoon. B) Separating playing cards. C) Pinching clay. D) Moving pennies from the palm to the fingers.
Separating playing cards.
A five-year-old client is having trouble learning to button his shirt. The client gets the button to the button hole but then has trouble pushing the button through the hole. Which treatment will be BEST to improve the client's buttoning skills? A) Holding a pan and pretending to stir inside it with a spoon. B) Separating playing cards. C) Pinching clay. D) Moving pennies from the palm to the fingers.
Separating playing cards.
An 18-month-old infant with myelomeningocele can maintain grasp on an object but does not reach for objects. The infant does not transfer objects from hand to hand and sits in a slouched position with one hand propped at all times. Which position is MOST APPROPRIATE for the OT to work on for developing midline play and midline crossing? A) Side-lying. B) Supine. C) Supported upright sitting. D) Supported reclined sitting.
Side-lying.
An infant with myelomeningocele can maintain grasp on an object but does not reach for objects or transfer objects from hand to hand. The child sits in a slouched position with one hand propped at all times. Which of the following positions is MOST APPROPRIATE to develop midline play and midline crossing? A) Side-lying. B) Supine. C) Supported upright sitting. D) Supported reclined sitting.
Side-lying.
Which of the following skills will be MOST DIFFICULT for a child with visual perceptual deficits? A) Tool use. B) Proprioception. C) Spatial perception. D) Visual tracking.
Spatial perception.
A child was in a motor vehicle accident (MVA) and sustained multiple fractures and a closed head injury. The child is in the pediatric intensive care unit (PICU) and the parents are at the bedside. Which of the following actions are MOST APPROPRIATE initially? A) Reposition the child to improve comfort. B) Provide splints to prevent contractures. C) Speak to the parents about the role of occupational therapy. D) Develop a comprehensive treatment plan.
Speak to the parents about the role of occupational therapy.
A client refuses to wear any clothing that has tags. Which sensory modulation problem is consistent with this behavior? A) Hypersensitivity. B) Sensation-seeking behavior. C) Tactile defensiveness. D) Tactile insecurity.
Tactile defensiveness
A child with hypotonia demonstrates decreased strength through the abdominal muscles. The child is working in a four-point position to increase upper extremity strength and overall trunk control. Which of the following techniques BEST recruits the abdominal muscles? A) Tap the abdominal muscles throughout the activity. B) Tap the abdominal muscles intermittently during the activity. C) Sit the child in a four-point position with a bolster supporting the abdomen. D) Have the child rock slowly forward and back while in four-point position.
Tap the abdominal muscles intermittently during the activity.
A six-year-old client with hypotonia demonstrates decreased strength of the abdominal muscles. The therapist uses a four-point position to increase UE strength and overall trunk control. Which technique would be MOST APPROPRIATE to facilitate recruitment of the abdominal muscles? A) Tapping the abdominal muscles throughout the activity. B) Tapping the abdominal muscles intermittently during the activity. C) Using a bolster to support the abdomen while in a four-point position. D) Having the child complete slow forward-and-back rocking while in four-point position.
Tapping the abdominal muscles intermittently during the activity.
A new child in the neonatal intensive care unit (NICU), who was born at 33 weeks' gestation, has been referred to occupational therapy services. After meeting the family and evaluating the child, what should the INITIAL treatment address? A) Teaching the parents how to position the child in ways to support extension. B) Teaching the parents how to provide tactile and vestibular input to help increase the infant's alertness. C) Teaching the parents how to position the infant in ways to support flexion. D) Teaching the parents how to encourage the infant to reach for faces and toys.
Teaching the parents how to position the infant in ways to support flexion.
A school therapist is writing a goal for a kindergartener with mild cerebral palsy. The client has decreased fine motor skills as a result of increased tone but is independent with most ADLs. Which goal would be MOST APPROPRIATE for the IEP? A) The student will display age-appropriate fine motor skills, per the Battelle Developmental Inventory. B) The student will demonstrate decreased tone following weight-bearing activities. C) The student will use scissors to cut a 6-inch line. D) The student will be independent on all playground equipment available in the school setting.
The student will use scissors to cut a 6-inch line.
An OT is writing a goal for a child with mild cerebral palsy. The student has decreased fine motor skills as a result of increased tone, but is independent with most ADLs. Which of the following goals is MOST APPROPRIATE for the IEP? A) The student will display age-appropriate fine motor skills, per the Battelle Developmental Inventory. B) The student will demonstrate decreased tone following weight-bearing activities. C) The student will use scissors to cut a 6-inch line. D) The student will be independent on all playground equipment available in the school setting.
The student will use scissors to cut a 6-inch line.
A five-year-old student with a diagnosis of right spastic hemiplegia is coming to therapy for decreased left hand control. The therapist places the child in side sitting position to her left side so she has to bear weight on her left upper extremity. What is the MOST LIKELY purpose of using this position with this child? A) This position will encourage the use of the right hand. B) This position will shorten the trunk muscles on the left side and improves symmetry in sitting. C) This position will work to improve shoulder range of motion. D) This position will improve stability in the scapula‒humeral area.
This position will improve stability in the scapula‒humeral area.
A 25-month-old client sustained a mild brachial plexus injury of the right UE. When using the right hand in therapy, the child demonstrates a standard pincer and spherical grasp, can inconsistently release small objects into small mouth containers, and can inconsistently stack six blocks. When observed during free play, the client consistently reaches for and manipulates objects with the left hand using the right UE as a gross assist, primarily holding objects between the body and the right UE. Which of the following treatments would be MOST APPROPRIATE next? A) Facilitate use of the right hand to hold paper during cutting with the left hand. B) Facilitate use of a pronated digital grasp to hold a crayon in the right hand. C) Use a splint or cast to restrain the left UE. D) Instruct the parents on tactile cues and verbal input to encourage increased use of the right UE.
Use a splint or cast to restrain the left UE.
A 25-month-old child sustained a mild brachial plexus injury of the right upper extremity. During right-hand use, the child demonstrates standard pincer and spherical grasp, can inconsistently release small objects into small mouth containers, and can inconsistently stack six blocks. During free play, the child consistently reaches for and manipulates objects with the left hand while the right upper extremity is used as a gross assist, primarily holding objects close to the body. Which of the following treatments is BEST? A) Facilitate use of the right hand to hold paper during cutting with the left hand. B) Facilitate use of a pronated digital grasp to hold a crayon in the right hand. C) Use a splint or cast to restrain the left upper extremity. D) Instruct the parents on tactile cues and verbal input to encourage increased use of the right upper extremity.
Use a splint or cast to restrain the left upper extremity.
A child with autism has difficulty with processing proprioceptive input. This problem interferes with the child's ability to control fine motor skills, play safely on the playground, and remain in line without hitting or bumping into other children. Which of the following activities BEST describes a compensatory technique the child could perform? A) Use a weighted pencil in class. B) Complete fine motor skills in the classroom during recess. C) Help carry equipment to set up the treatment area. D) Help straighten up the classroom before lunch.
Use a weighted pencil in class.
A student is observed to have consistent slouching when standing or sitting, rests the head on the desk after a few minutes of being seated, has difficulty kicking a ball, and has difficulty with jumping jacks in gym. Which of the following sensory processing skills MOST LIKELY need to be addressed? A) Sensory registration problems. B) Tactile defensiveness. C) Gravitational insecurity. D) Vestibular‒proprioception problems.
Vestibular‒proprioception problems.
The teacher of an eight-year-old student approaches the OT for guidance. The teacher states that the student consistently slouches when standing or sitting, and that within a few minutes of sitting at the desk, the student is resting her head on the desk. The teacher also reports that the student is having difficulty kicking a ball and doing activities such as jumping jacks in gym. What is the MOST IMPORTANT sensory processing deficit to address in the intervention for this child? A) Sensory registration problems. B) Tactile defensiveness. C) Gravitational insecurity. D) Vestibular‒proprioception problems.
Vestibular‒proprioception problems.
An OT is doing a consultation for a two-year-old child with osteogenesis imperfecta. Which instructions would be MOST ESSENTIAL for the OT to give to the caregivers? A) Energy conservation and work simplification instructions. B) Proper positioning when lying in bed. C) Wearing and use of protective arm and leg guards and orthoses. D) Care and precautions of the surgical inserted metal rods.
Wearing and use of protective arm and leg guards and orthoses.
An eight-year-old child was recently diagnosed with ADHD. The pediatrician has prescribed stimulant pharmacotherapy and behavioral interventions. What are common side effects of these medications with which the therapist be familiar? A) Increased jittery behavior. B) Sleepy or drowsiness, and increased appetite. C) Weight loss, loss of appetite, interrupted sleep patterns, and slow growth. D) Weight gain and aggressive behavior.
Weight loss, loss of appetite, interrupted sleep patterns, and slow growth
A therapist is working with a 10-month-old infant with delayed developmental skills because of severe hypotonia. The infant has progressed from lying in prone position with the trunk, head, and extremities all in direct contact with the surface, to being able to maintain static prone on elbows and prone on extended hands positions for a few seconds. What is the NEXT skill the OT should facilitate through handling and facilitation techniques? A) Transitioning into four-point position. B) Weight shifting in prone on elbows position. C) Weight shifting in prone on extended hands position. D) Transitioning into sitting.
Weight shifting in prone on elbows position.
An infant has delayed developmental skills as a result of severe hypotonia. The child is currently able to maintain a static prone on elbows position, and can push into prone on extended hands position for a few seconds. Which of the following activities will BEST facilitate continued development? A) Transitioning into a four-point position. B) Weight shifting into a prone on elbows position. C) Weight shifting into a prone on extended hands position. D) Transitioning into a sitting position.
Weight shifting into a prone on elbows position.
A therapist is working with a seven-month-old infant who is developmentally delayed. The client has decreased head control, increased tone throughout, and poor proximal stability. The client dislikes the primary treatment position of prone on elbows and tolerates it only briefly before crying. What is the BEST advice that should be given to the parents regarding prone on elbow positioning? A) Work in this position at home for short periods several times a day. B) Avoid the position at home and let the therapist use the position in therapy. C) Carry the infant in a front carrier, because it will provide the same input. D) Use the position for up to a half-hour once a week until the infant tolerates it.
Work in this position at home for short periods several times a day.
A child with developmentally delays has decreased head control, poor proximal stability, and increased tone throughout the body. During treatment in a prone on elbows position, the infant cries after a short duration of time. Which of the following recommendation is BEST to give the parents? A) Work on the prone on elbows position at home for short periods, several times a day, to increase infant tolerance. B) Avoid the prone on elbows position at home so the infant will not grow to dislike the parents. C) Carry the infant in a front carrier, because the carrier will provide the same input to the infant. D) Put the infant in the prone on elbows position for up to 30 minutes, once a week, until the child tolerates it.
Work on the prone on elbows position at home for short periods, several times a day, to increase infant tolerance.
