Exam-like questions-Pediatrics

A COTA is working with a group of children in a preschool program. All of the children in the group are able to sit independently on the floor except for one child with cerebral palsy. The child has told the COTA that they want to sit on the floor with their peers and not in their wheelchair during morning circle time. What would the COTA MOST likely recommend for the child to use?

• Hammock seat

• corner floor sitter

• wheelchair insert

• prone stander

Answer explanation

The floor sitter (answer B) may enable the child to play on the floor near their peers. (p.126) A hammock (answer A) would not allow the child to feel as if they are participating in the same manner in view of their desire to sit on the floor with their peers. Introducing an adapted wheelchair insert or a prone stander (answers C and D) ignores the child's desire to sit on the floor with their peers. Wheelchair inserts are often used for positioning a child in a wheelchair to permit increased trunk support and stability, thus allowing for more independent use of the upper extremities. A prone stander allows the child to assume a standing or weight-bearing position, but would not assist with positioning him with his classmates who are sitting on the floor.

A COTA is discharging a 4-year-old child with cerebral palsy from a rehabilitation setting to home. What are the MOST appropriate instructions for the COTA to provide to the family for maintaining correct jaw control while feeding the child from the side?

• Jaw opening and closing are controlled by your index and middle fingers, thumb on child's cheek

• jaw opening and closing are controlled with your index finger and middle fingers, thumb on the larynx for stability

• jaw opening and closing are controlled with the palm of your hand cupping the jaw, your thumb on the cheek

• jaw opening and closing are controlled with your index and middle fingers, thumb on the child's ear for stability

Answer explanation

The correct position of the adult's hand for jaw control when the child is fed from the side is described in answer A. Answers B and D are incorrect because the thumb should be placed on the child's cheek to provide joint stability. Answer C is incorrect because controlling the child's jaw movement with the adult's whole hand provides less control of the child's jaw than the recommended method. Placing the adult's thumb on the child's ear (answer D) is also incorrect because of discomfort for the child, and because thumb placement should be near the fulcrum of jaw movement (at the tempomandibular joint). If the child is fed from the front, the adult's thumb is placed on the chin, with middle finger under the chin to control opening and closing of the jaw. The index finger then rests on the side of the child's face to provide stability. (p.409 f14-6)

An outpatient OTR has administered, scored, and interpreted data from interview, observation, and assessments. What is the FIRST step the OTR and COTA should take in developing recommendations for the child?

• describe and prioritize the problem areas and needs

• document findings using easily understood language

• consider roles and occupations performed and develop plans to improve competence in these areas

• analyze the effects of deficits on developmental tasks and develop plans to achieve age normed levels

Answer explanation

“A child or adolescent is referred to occupational therapy services because he or she has a specific diagnosis . . . or because he or she exhibits a particular functional problem. . . . Although the diagnosis or problem is the reason for therapy services, the occupational therapist always views the child or youth as a person first. Client-centered intervention [answer C] has many implications for how the occupational therapist designs intervention.” (p.1) Describing and prioritizing needs (answer A) and analyzing the impact performance deficits have on developmental tasks (answer D) are part of the evaluation and planning processes, and the therapist considers these factors in relation to the child's roles and occupations in which the child is expected to engage. Summarizing the evaluation results and recommendation in easily understood language (answer B) is a final step in the process, as it the clinician's responsibility to “communicate information clearly, and, more importantly, they need to ensure the clients understand the material conveyed.” (p.354)

What is the BEST approach for the COTA to take to promote playfulness and self-expression in a young child with mild intellectual disability?

• model imagination and use playful facial expressions and vocalizations

• ask the child to demonstrate their favorite things to do during playtime

• offer the availability of toys that are familiar and played with frequently

• provide activities that give a child a means of release of emotional energy

Answer explanation

To facilitate playfulness and self-expression a “therapist should express a playful attitude through speech, body language, and facial expressions [answer A].” (p.492) Asking the child to demonstrate favorite things to do during playtime (answer B) and using familiar toys (answer C) may provide insight into the child's current play, yet these approaches do not help to expand the child's current play behavior to become more playful. Leather tooling (answer D) requires a structure and focus on sequential steps and these generally do not promote imagination, pleasure, and playfulness.

A child demonstrates aggressive and disruptive behavior in school as a result of a low sensory threshold. Which suggestions would be MOST useful to discuss with the teacher regarding an upcoming class bus trip to the zoo?

• review the bus rules with the child and apply consequences consistently

• sit the child at the front of the vehicle and use earmuffs to dampen noise

• have them monitor classmates and report poor behavior

• set the criteria for a successful trip and reward success

Answer explanation

Sitting the child at the front of the bus and using earmuffs to dampen noise (answer B) reduces sensory stimulation present on the bus ride. A child with low sensory threshold over-responds and is “overwhelmed by ordinary sensory input and reacts defensively to it, often with strong anxiety and activation of the sympathetic nervous system.” (p.268) When seated at the front of the bus, the child will experience less jostling by peers, resulting in less tactile and visual stimulation. The earphones will reduce auditory overload. Reviewing the rules, monitoring classmates, and rewarding success (answers A, C, and D) are behavioral management techniques that do not take the child's hypersensitivity into account. (pp.376–377)