Question 1

Gina is a 14-month-old infant who seemed to be developing normally, but she lately has started to have seizures and is no longer walking.She wrings her hands constantly.Which developmental disorder do these behaviors describe?

Accepted Answer

Rett syndrome is a progressive neurologic disorder that occurs only in girls.It is a genetic disorder with mutation of the X chromosome.The infant or toddler seems to be developing normally until 6-18 months of age, at which time regression in all skills is observed.Microencephaly, seizures, abnormal muscle tone, intellectual disability, loss of purposeful hand use, and stereotypical patterns of behavior (especially hand wringing) emerge.Adolescents with Rett syndrome are generally nonambulatory and do not have functional hand use.

Question 2

Bob, a 5-year-old boy, is unable to dress himself and cannot write his name or count to 10.Bob has a longish face with a high forehead and prominent jaw; he has lax joints and stands with flat feet.Which genetic disorder is suspected?

Accepted Answer

Fragile X syndrome affects boys more often than girls because it is an X-linked genetic disorder.Children present with limited cognitive development, abnormal skull, joints, and feet structures.They exhibit typical structural features, including elongated faces, prominent jaws and foreheads, hypermobile or lax joints, and flat feet.Children with fragile X syndrome may be intellectually delayed and often present with autistic-like behaviors.OT practitioners often work with children with fragile X on sensory processing difficulties, social participation, ADLs, and IADLs.

Question 3

Which disorder is not considered a pulmonary disorder?

Accepted Answer

Pulmonary disorders are conditions that involve the lungs and one's ability to breathe.The most common pulmonary diseases affecting children are asthma and cystic fibrosis.Children with pulmonary diagnoses are referred for OT when they experience problems that interfere with activities of daily living (ADLs), instrumental ADLs (IADLs), sleep and rest, education, play, and social participation.CVA is a neurological condition.

Question 4

What are common signs of arthrogryposis?

Accepted Answer

Arthrogryposis can range from mild to severe, depending on the number of joints involved and the amount of muscle tissue missing.In the classic form of arthrogryposis, all the joints of the extremities are stiff, but the spine is not affected.In addition to contractures, muscles are often thin, weak, or missing.Arm posture in children with arthrogryposis often includes internal rotation, elbow extension with limited flexion, and flexed wrists with ulnar deviation.Contractures in the lower extremities are noted with typical posture including hip abduction and external rotation, knee extension or knee flexion contractures, and foot deformities.Arm and leg muscles are small, with webbed skin covering some or all of the joints.Infants are born with significant contractures that improve with aggressive ROM exercises during infancy.In typical cases, all the joints of the arms and legs are fixed in one position, partly due to muscle imbalance or lack of muscle development during gestation.

Question 5

Karen, the Certified Occupational Therapy Assistant (COTA), is concerned that Tom fell off the balance beam while in OT.He complained of pain, and Karen noticed some swelling and tenderness on his ankle.What is the most likely diagnosis for this injury?

Accepted Answer

A sprain is a traumatic injury to the tendons, muscles, or ligaments around a joint and is characterized by pain, swelling, and discoloration.Sprains can occur when children or adolescents lose their balance and consequently use a protective response that makes the wrist and ankle the most vulnerable joints for injury.Sprains are most frequently seen in the ankles and wrists.Most do not require emergency medical attention or OT intervention.

Question 6

Mira is a 10-year-old with juvenile rheumatoid arthritis (JRA).She has trouble completing her work at school.Which client factors (associated with JRA) may be interfering with her educational work?

Accepted Answer

Children with JRA experience exacerbations and remissions of symptoms.During exacerbations, or flare-ups, symptoms worsen, and the joints become hot and painful; joint damage can occur.During remissions, or pain-free periods, children with JRA may resume typical activities.Joint protection techniques and energy conservation techniques are encouraged at all times so that these strategies become a habit.However, these children may have functional limitations due to contractures and deformities.The OT practitioner helps educate these children on how to protect their joints, compensate for decreased ROM during exacerbations, and complete activities with less stress on the joints (joint protection or energy conservation techniques).Furthermore, the OT practitioner provides these children with stretching and movement activities to maintain the functioning of the joints and prevent contractures.The OT practitioner may prescribe adaptive equipment or technology to help these children engage in everyday activities.

Question 7

What do boys with Duchenne muscular dystrophy (DMD) commonly develop?

Accepted Answer

Boys with Duchenne muscular dystrophy (DMD) commonly develop scoliosis, which is an abnormal curvature of the spine. This occurs because the muscles that support the spine weaken, causing it to become curved. Arthritis, osteoporosis, and seizures are not common symptoms of DMD.

Question 8

What must the OT practitioner never do when a child is having a seizure?

Accepted Answer

If a child has a seizure, the OT practitioner may need to ensure that the child is in a comfortable setting with no dangerous objects nearby.The child can be placed on his or her side on the floor.The OT practitioner should never place an object in the child's mouth during a seizure.

Question 9

Which statement most closely reflects the OT intervention for a child who has a traumatic brain injury (TBI)?

Accepted Answer

Children and adolescents with TBIs are referred for OT because of their inability to function in the areas of occupation (ADLs, IADLs, education, work, play, and social participation; see Box 13-12).The trauma to the brain typically results in motor, cognitive, and emotional changes.Motor deficits may include abnormal muscle tone (changes in the resting state of a muscle typically resulting in increased muscle tone), hemiplegia (involvement of the arm and leg on one side of the body), and quadriplegia (involvement of both arms and legs).As the swelling of the brain begins to heal, some of the deficits may improve.Children and adolescents with TBI may need to relearn motor patterns.They may have musculoskeletal concerns secondary to tone problems and may require orthoses of the extremities to maintain and improve the ROM.OT practitioners work with children and adolescents who have sustained TBIs to help them relearn movements.OT practitioners address cognitive changes such as difficulty with attention and concentration, loss of memory, word-finding problems, and poor abstract thinking and reasoning.These children and adolescents may experience perceptual deficits that include lack of awareness of their surroundings and poor sequencing and timing skills.They may experience emotional changes such as lability (moods ranging from happy to tearful or angry), inappropriateness (e.g., cursing, touching, and disrobing), and personality changes.Children and adolescents with TBI may demonstrate a "flat" affect, showing little or no emotion.Often, aggressiveness, impulsivity, and irritability occur during recovery.

Question 10

Martin is a 10-year-old boy with DCD who has difficulty writing and tying his shoes.He is falling behind in school.He falls and bumps into things frequently and performs poorly in sports.Which statement is true concerning DCD?

Accepted Answer

DCD encompasses a wide range of characteristics, but an essential feature is that the child's motor coordination is markedly below his or her chronologic age and intellectual ability and significantly interferes with ADLs.If intellectual disability is present, the motor difficulties must be in excess of those usually associated with the level of severity of intellectual disability.These children also often exhibit low self-esteem, show frustration, and begin to expect failure.Many professionals suggest that these children will outgrow their coordination deficits, but evidence indicates that children who have DCD continue to have difficulty in adolescence and adulthood.

Question 11

Kendra, a 7-year-old girl, shows some hand flapping behaviors and some difficulty with expressing herself.She speaks slowly and does not seek out her peers.Although Kendra is able to perform her self-help skills and receives good grades in school, the teacher notices that Kendra is "by herself" frequently.Which developmental disorder do these behaviors describe?

Accepted Answer

The most recent Diagnostic and Statistical Manual (Fifth edition; DSM-V) defines autism by the presence of four diagnostic criteria as follows:
1.Persistent deficits in social communication and social interaction across multiple domains.
2.Restricted, repetitive patterns of behavior, interests, or activities.This may include stereotyped motor activities, insistence on sameness, fixed routines and ritualized patterns, highly restricted, fixated interests, and/or altered sensitivity and reactivity to sensory input.
3.Symptoms presenting early in life (apparent by 12-24 months but manifest earlier).
4.Symptoms causing significant impairment in social and/or occupational functioning.

Question 12

Why is it important for a COTA to understand the problems commonly associated with a specific diagnosis?

Accepted Answer

COTAs work with team members to help children and their families.Being knowledgeable about problems commonly associated with diagnoses helps them know what to expect, prepare for data collection and intervention, and provides more feedback to the treatment team.

Question 13

Theodore is a 2-year-old boy who avoids playing with others.He does not ask his mother for help, screams to have his needs met, prefers to sit alone, and flaps his hands in front of his face.He loves to spin the wheels on toy cars and to swing.Which developmental disorder do these behaviors describe?

Accepted Answer

The most recent Diagnostic and Statistical Manual (Fifth edition; DSM-V) defines autism by the presence of four diagnostic criteria as follows:
1.Persistent deficits in social communication and social interaction across multiple domains.
2.Restricted, repetitive patterns of behavior, interests, or activities.This may include stereotyped motor activities, insistence on sameness, fixed routines and ritualized patterns, highly restricted, fixated interests, and/or altered sensitivity and reactivity to sensory input.
3.Symptoms presenting early in life (apparent by 12-24 months but manifest earlier).
4.Symptoms causing significant impairment in social and/or occupational functioning.

Question 14

Carolyn is a 5-year-old with a cardiac disorder.She has trouble playing with her peers at day care.Which client factors (associated with cardiac disorders) may be interfering with her play?

Accepted Answer

Children with congenital heart defects allocate more energy for basic physiologic function leaving less energy available for developmental tasks.A referral of children with cardiac disorders to the pediatric occupational therapy (OT) practitioner is typically based on secondary deficits associated with the child's primary diagnosis.Oral-motor and feeding issues or sensory processing problems may necessitate a referral to a pediatric occupational therapist.

Question 15

Sean injured himself on the stove, resulting in a second-degree burn.Which statement describes the involvement?

Accepted Answer

Second-degree burns are partial-thickness burns and involve the epidermis and portions of the dermis.Although second-degree burns will heal, the process can be painful and scarring may be a result.

Quiz 13: Pediatric Health Conditions