Child and Youth Sample Cases

Click here for Child and Youth Answers to Sample Cases.

Case A

A six-month-old baby has been referred to a physical therapist for assessment of a head tilt. The baby had a normal gestation. The mother is a 16-year-old who reports she was unaware of her pregnancy until the 20th week of gestation. The referral from the doctor indicates a concern about the child’s difficulty with lateral head righting and a possible diagnosis of right torticollis.

1.  When completing the physical assessment of the baby, what should the physical therapist expect to find that would confirm the diagnosis of right torticollis? (Select 3)

1 – There is a small palpable lump in the (L) sternocleidomastoid.

2 – Baby has facial and skull symmetry.

3 – Baby’s head is positioned in right lateral neck flexion.

4 – Baby’s head is positioned in left lateral neck flexion.

5 – Baby’s face is rotated to the right.

6 – Baby’s face is rotated to the left.

7 – Baby is able to demonstrate lateral head righting to the left side.

8 – Baby is able to demonstrate lateral head righting to the right side.

 2.  Following the assessment, the physical therapist confirmed the child has a right torticollis. The physical therapist chooses to provide education for the mother about how to position her baby when she is carrying her and placing her in bed. What instructions should the physical therapist give to the mother about positioning? (Select 2)

1 – When playing with your child hold the toys up and to the left.

2 – Place the bed so the interesting side of the room is on the right side.

3 – Place the bed so the interesting side of the room is on the left side.

4 – Alternate the side on which you carry your child.

5 – With your baby lying on her tummy, place toys on the left.

6 – With your baby lying on her tummy, place toys on the right.

7 – Only allow your baby to sleep on the left side.

 3.  When the baby’s mother arrives at the clinic, she states she feels like she doesn’t know what she is doing. When the physical therapist questions her further, the mother gets upset and states she feels all alone in the world and that her own mother has distanced herself from the baby and refuses to help with care. Which individuals or services should the physical therapist contact (with the appropriate consent from the mother) to arrange additional support? (Select 2)

1 – The grandmother, to let her know her daughter feels all alone and ask why she isn’t helping.

2 – The referring doctor, to monitor the mother’s emotional status.

3 – A favourite teacher at school, to ask about child care arrangements that can be made for additional support.

4 – Social services, because it is possible the child isn’t being cared for adequately.

5 – The local infant development program, for assistance with parent education.

6 – The mother’s best friend, to see if she can help with the baby’s care.

 4.  The patient requests a business card to give to a friend of hers who is seeking physical therapy services for her child. The physical therapist completed her Master of Physical Therapy, has taken continuing education in pediatrics and is a member of the Canadian Physiotherapy Association. How should the physical therapist’s credentials be indicated on her business card? (Select 1)

1 – MPT, MCPA

2 – Registered PT, MCPA

3 – MPT, MemCPA

4 – MPT; additional education in pediatric physical therapy

Case B

A school based physical therapist is working with an 11-year-old girl who had a congenital malformation requiring a below-the-knee amputation of her left leg as an infant. The student uses her prosthesis independently and has excellent gross motor skills.

1.  The student’s class is going on a skating field trip. The student does not have a special prosthesis for skating so her classroom teacher asked the physical therapist to “do something special” with the student during that time. How should the physical therapist proceed? (Select 1)

1 – In advance of the field trip, help the student find a pair of skates that fit her everyday prosthesis.

2 – Refer the student to the prosthetist for a recreational prosthesis for skating and write a letter of support for funding from the War Amps.

3 – During the field trip time do a thorough gross motor assessment of the student and then have a cup of hot chocolate together.

4 – Use the field trip time to work with the student on her basketball skills in the school gym.

 2.  Mid-way through the school year, the student’s prosthesis needs revisions due to her growth. She will be without her prosthesis for two weeks and will be using forearm crutches during this time. She does not want to attend school because her classmates nicknamed her ‘hoppy’ last year when she came to school with her crutches. How should the physical therapist proceed? (Select 1)

1 – Call a meeting of the student’s school-based team, including the student and her parents, to develop a disability awareness plan that educates her classmates, and a safety plan that monitors the student’s experiences.

2 – Lecture the student’s classmates for their behaviour towards the student last year. Let them know it is considered bullying and any future name-calling will result in their recesses being revoked.

3 – Support the student in her choice not to attend school. Advocate for an educational assistant to go to her home and help her stay up-to-date in her school work during the two weeks of class she will miss.

4 – Meet with the student’s parents. Acknowledge that the name-calling is likely a symptom of ongoing and systemic problems and give them information to choose a distance education program so their daughter can be schooled at home.

3.  The student and her single mother have recently moved to live with her grandfather due to financial limitations. The student confides in you that last night her grandfather punched the student’s mother in the face, and spanked the student repeatedly with a wooden spoon. How should the physical therapist respond to this information? (Select 2)

1 – Report the suspected abuse of the student to the Ministry of Children and Family Development (MCFD) as soon as the conversation with the student is over.

2 – Report the suspected abuse of the student’s mother to the Ministry of Children and Family Development (MCFD) as soon as the conversation with the student is over.

3 – Accurately document the conversation and actions taken in the student’s physical therapy chart.

4 – Call the student’s mother in for an emergency meeting to see if there are signs of bruising on her face.

5 – Find a private location, ask to see the student’s buttocks and take a picture of any bruising.

6 – Discuss strategies with the student about how not to aggravate her grandfather’s temper.

4.  The student asked the physical therapist to have a look at her stump. The student states it is itchy and driving her crazy. The physical therapist observes what looks like wide-spread folliculitis, which the student has not previously had. What should the physical therapist recognize as actions taken by the student which may have contributed to the development of folliculitis? Indicate True or False.

1 – Recently started shaving her legs.

2 – Washing her stump with anti-bacterial soap.

3 – Drying the prosthetic socket out fully each night.

5.  Six months later, the student is referred for physical therapy treatment because of left lateral knee pain. The student reports she has started running lately. What should the physical therapist include in the initial assessment of the student? (Select 2)

1 – Gait analysis.

2 – Ober’s test of the left lower extremity.

3 – FABER test of the left lower extremity.

4 – Thompson’s test of the left lower extremity.

5 – The MABC-2 (Movement Assessment Battery for Children-2).

6 – Girth measurements of the thigh bilaterally.

Case C

A six-year-old boy sustained a mid-shaft fracture of his left femur. Surgery was performed at 11:00 p.m. The surgeon fixed the fracture with two Nancy nails, and the boy was returned to the unit without complications. He was referred for physical therapy to be taught crutch walking, feather weight bearing. At 10:00 a.m. the next day the physical therapist introduced herself to both the child and mother and explained why she was to see the child. The mother agreed to proceed with treatment.

1. The physical therapist has a high school student shadowing her work for the day. What should the physical therapist do to ensure informed consent from the patient to have the student present during therapy? Indicate True or False.

1 – It is acceptable for the student to be present during the physical therapist’s initial contact with the patient and his parents.

2. The physical therapist has taught the child to walk feather weight-bearing with crutches with supervision. During the walk to the stairwell to practice stair-climbing with the physical therapist, the child puts more than feather weight through his left leg and begins to cry. He states he felt a ‘pop’. What should the physical therapist do immediately? (Select 3)

1 – Use a wheelchair to return the child to his bed.

2 – Explain to the mother what has happened.

3 – Complete a full assessment of the left leg.

4 – Apply a warm compress to the child’s thigh for pain relief.

5 – Ask the child’s nurse to give him more pain medication.

6 – Continue to teach the child how to maneuver the stairs.

7 – Ask the unit clerk to page the orthopaedic surgeon.

3. When teaching the child how to use crutches, the physical therapist noticed he is easily distracted and becomes unsteady. When the child is redirected, he is steady and requires standby supervision only. How should the physical therapist proceed in preparation for the child’s safety upon discharge home? (Select 2)

1 – Ask the parents to carry the child up and down the stairs, as the child is unsafe.

2 – Explain to the child and his parents that he will fall if he doesn’t concentrate when he is walking.

3 – Explain to the parents it is best to keep the child quiet with limited mobilization as he isn’t safe.

4 – Explain the situation to the orthopaedic surgeon and suggest the patient not be discharged yet.

5 – Inform the parents the child will require supervision for several days when walking with the crutches.

6 – Ask the parents if the child has been assessed for attention deficit disorder.

4. The child has been home for three days. The mother contacts the physical therapist stating the child is refusing to walk because of pain and she doesn’t know what to do. Upon discharge, arrangements were made for a wheelchair to be available for the child. How should the physical therapist proceed? (Select 2)

1 – Direct the mother to use the wheelchair for her child.

2 – Ensure the child is getting proper pain medication by asking about the frequency of administration.

3 – Tell the mother she should reread the pamphlet about crutch walking and call back if she has further problems.

4 – Advise the mother to take her son to the local hospital emergency department.

5 – Refer the child to a physical therapy clinic close to his home for assessment and treatment.

Case D

A physical therapist notices when her neighbour’s 14-month-old baby pulls to stand, there is a lack of symmetry in the fat creases about the child’s hips and thigh. The physical therapist asks if there were complications during the birth; the mother responds that everything went very well and the baby had an APGAR of 9/10. The mother mentions that her baby seems a bit slow to walk.

1. The physical therapist is concerned about the child’s development and mentions to the mother she should have the baby re-assessed by her family practitioner. The mother requests the physical therapist, who works in geriatrics, examine her baby. How should the physical therapist respond to the mother? (Select 2)

1 – Suggest she follow up with one of three other physical therapists who specialize in paediatrics.

2 – Ask when the other children in the family started to walk, and remind her not all babies progress at the same rate.

3 – Advise her to voice her concerns with her general practitioner, and help her write them down.

4 – Suggest she ask her own mother when she started to walk, as this could be a genetic developmental issue.

5 – Suggest all new mothers compare their babies too much, and given more time the baby will meet milestones.

2. The child was assessed by an orthopaedic surgeon who determined she had a dislocated left hip. She underwent open tenotomy of her adductors with reduction and in a hip spica. The spica has been removed and she is referred to the paediatric clinic for treatment. The paediatric physical therapist and the orthopaedic surgeon decide the baby can weight bear on the affected side. Today the baby has been accompanied to the physical therapy treatment session by the mother who is very apprehensive and asks to take the child home just after the treatment begins. How should the physical therapist proceed? (Select 1)

1 – Explain to the mother the benefit for the baby to begin weight bearing and see if she agrees to proceed.

2 – Speak with the orthopaedic surgeon to explain the mother is too anxious and treatment should be stopped.

3 – Continue with the treatment, because when the mother sees how happy the baby is, she will be less anxious.

4 – Stop the intervention and ask the mother to leave the treatment area and return when she is ready to proceed.

3. The clinic requires outcome measures be completed to monitor treatment effectiveness and cost. What outcome measures should the physical therapist use eight weeks after the baby has had the hip spica removed? (Select 2)

1 – Timed Up and Go.

2 – Bayley Scales of Infant Development.

3 – Gross Motor Function Measure.

4 – Range of motion/strength of hips and knees.

5 – Gower’s sign.

6 – Ortalani test.