, CHAPTER LIST
PART I: Foundations of Pediatric Physical Therapy
Chapter 1: Typical Development
Chapter 2: Pediatric Assessment Tools
Chapter 3: Family-Centered Care
PART II: Examination and Intervention along the Pediatric Continuum of Care
Chapter 4: Physical Therapy in the Neonatal Intensive Care Unit
Chapter 5: Physical Therapy in the Medical Setting (Acute Care, Inpatient and Outpatient Rehabilitation)
Chapter 6: Physical Therapy in the Educational Setting: From Early Intervention to School Age
Chapter 7: Adaptive Equipment
Chapter 8: Orthotics and Prosthetics
PART III: Pediatric Neuromuscular Disorders
Chapter 9: Cerebral Palsy
Chapter 10: Spina Bifida
Chapter 11: Traumatic Brain Injury
Chapter 12: Spinal Cord Injury
Chapter 13: Muscular Dystrophy
Chapter 14: Pain and Regional Pain Disorders
PART IV: Pediatric Musculoskeletal Disorders
Chapter 15: Orthopedic Conditions
Chapter 16: Sports Injuries
Chapter 17: Juvenile Idiopathic Arthritis and Other Rheumatic Disorders
PART V: Pediatric Cardiovascular and Pulmonary Disorders
Chapter 18: Cardiac Conditions
Chapter 19: Pulmonary and Respiratory Conditions
Chapter 20: Fitness and Prevention
PART VI: Other Medical/Surgical Disorders
Chapter 21: Oncologic Disorders
Chapter 22: Burn Injuries
Chapter 23: Autism Spectrum Disorders
Chapter 24: Down Syndrome and Intellectual Disorders
PART VII: Considerations in the Provision of Pediatric Physical Therapy Services
Chapter 25: Transitioning to Adulthood
,Tecklin’s Pediatric Physical Therapy, 6e — Test Bank
Chapter 1: Typical Development
Context: Examines normal motor, sensory, cognitive, and social development from
infancy thchrough adolescence, including developmental milestones and variability in
developmental trajectories.
Core Purpose: Provides the baseline for distinguishing typical vs delayed or atypical
movement—essential for diagnosis, prognosis, and intervention planning.
Question type : Milestone-timing scenarios • Developmental sequence reasoning •
Typical vs delayed clinical vignettes • Primitive reflex integration questions
1) Milestone-timing scenario (gross motor)
A 6-month-old infant is brought for a “development check.” The caregiver reports the
baby rolls both ways, brings feet to mouth, and can sit only if propped with hands
forward. The baby is not yet sitting independently. Which interpretation is MOST
accurate?
A. This pattern is typical; independent sitting commonly consolidates after supported
sitting
B. This is delayed because independent sitting should be present by 6 months
C. This is atypical because rolling both ways should occur after independent sitting
D. This is delayed because feet-to-mouth behavior suggests hypotonia
Answer: A
Very Deep Rationale:
At ~6 months, many infants demonstrate rolling both directions, hands-to-feet
exploration, and prop sitting (often a “tripod” position) before achieving stable, hands-
free sitting. Independent sitting requires maturation of trunk control, anticipatory
postural adjustments, and broader base-of-support strategies—typically emerging over
subsequent weeks/months. The sequence is not “sitting first, rolling later”; rolling can
precede independent sitting. Feet-to-mouth is a normal exploratory pattern reflecting
hip mobility, core engagement attempts, and sensory-motor integration—not a sign of
,hypotonia by itself. The best interpretation is that this profile fits typical variability in the
transition toward independent sitting.
Key words: tripod sitting, trunk control, rolling, typical variability, 6 months
2) Developmental sequence reasoning (postural
control)
Which developmental change BEST explains why infants transition from “en bloc” trunk
movement to more selective segmental rotation during rolling?
A. Emergence of segmental trunk dissociation and improved midline control
B. Extinction of the palmar grasp reflex
C. Increased femoral anteversion during infancy
D. Development of mature reciprocal arm swing
Answer: A
Very Deep Rationale:
Early rolling often occurs as an en bloc pattern (head, trunk, pelvis moving together)
due to limited trunk dissociation and immature anticipatory postural control. As the
nervous system matures, infants develop segmental control—separating upper and
lower trunk movement and using rotation to shift the center of mass efficiently. Midline
orientation (head/eyes/hands to midline) supports organized movement and graded
rotation. Palmar grasp extinction affects hand function, not trunk rotation mechanics.
Femoral anteversion is a skeletal torsional variable, not the primary driver of rolling
strategy. Reciprocal arm swing is a gait-related feature later in development.
Key words: en bloc, trunk dissociation, rotation, midline control
3) Typical vs delayed vignette (fine motor + cognition)
A 10-month-old uses a raking grasp to pick up small cereal pieces and transfers objects
hand-to-hand, but does not show an emerging inferior pincer grasp. The child is pulling
to stand and cruising. Which conclusion is MOST appropriate?
,A. Likely typical variability; pincer refinement may still be emerging at this age
B. Definite fine-motor delay; inferior pincer should be fully mature by 10 months
C. Atypical motor profile; gross motor advancement excludes typical fine-motor lag
D. Suggests abnormal reflex persistence rather than developmental variability
Answer: A
Very Deep Rationale:
At ~10 months, many infants begin transitioning from raking to radial digital grasps,
with the inferior pincer often emerging across late infancy (commonly around 9–12
months) with variability. A child can demonstrate advanced gross motor skills while fine
motor refinement continues—development is not perfectly synchronized across
domains. A “fully mature” pincer (neat pincer) is typically later than early pincer
emergence. There is no evidence here of pathologic reflex persistence; the vignette
describes progressive skill development without red flags (e.g., asymmetry, regression,
loss of skills).
Key words: inferior pincer, raking grasp, variability, domain dissociation
4) Primitive reflex integration (ATNR)
A 5-month-old shows strong head turning to the right with right arm extension and left
arm flexion, repeatedly disrupting midline hand use. Which reflex is MOST implicated,
and why is this concerning at this age?
A. ATNR; persistence interferes with midline orientation and bilateral hand skill
development
B. Moro; persistence prevents trunk flexion needed for sitting
C. TLR; persistence causes obligatory stepping during standing
D. Galant; persistence prevents visual tracking and social engagement
Answer: A
Very Deep Rationale:
The Asymmetric Tonic Neck Reflex (ATNR) produces the “fencer” posture: head turn
→ ipsilateral extension, contralateral flexion. In early infancy, it can facilitate hand regard
and early postural organization; however, persistence beyond the early months can
interfere with midline hand use, bilateral coordination, rolling, and later crawling
patterns because the infant struggles to bring hands together at midline or sustain
,symmetrical postures. Moro is a startle response; while its persistence can affect
regulation and postural control, it does not specifically create the described fencer
pattern. TLR relates to head position influencing extensor/flexor tone globally. Galant is
trunk incurvation with tactile stimulation.
Key words: ATNR, midline, bilateral coordination, reflex persistence
5) Milestone-timing scenario (social-communication)
A 14-month-old walks independently, points to desired objects, and brings toys to show
a caregiver. However, the child rarely responds to name and has minimal shared eye
contact during play. Which interpretation BEST fits typical development principles?
A. Social-communication concerns warrant further screening despite typical gross motor
milestones
B. Typical walking at 14 months rules out significant developmental concerns
C. Lack of name response is typical until at least 24 months
D. Pointing is not expected until after age 2, so the profile is inconsistent
Answer: A
Very Deep Rationale:
Development is multi-domain: strong gross motor progress does not negate possible
concerns in social-communication. Reduced response to name and limited shared eye
gaze can be early red flags requiring screening, even if motor milestones are typical.
Pointing to request and showing objects often emerges in late infancy/early
toddlerhood and is a positive sign of intentional communication, but it does not fully
offset concerns about social reciprocity and joint attention quality. It is incorrect that
name response is not expected until 24 months; typically it emerges much earlier. The
best answer reflects the principle: assess each developmental domain and the quality of
behaviors, not only motor milestones.
Key words: joint attention, response to name, multi-domain, screening
6) Developmental sequence reasoning (standing →
walking)
,Which prerequisite MOST strongly supports the transition from cruising to independent
walking?
A. Ability to shift weight laterally with controlled single-limb support moments
B. Presence of the plantar grasp reflex
C. Persistent wide base with high guard posture without trunk rotation
D. Exclusive reliance on visual input for balance with minimal vestibular contribution
Answer: A
Very Deep Rationale:
Cruising can be performed with continuous upper extremity support and limited need
for dynamic balance. Independent walking requires controlled weight shifting and
brief single-limb support while the center of mass moves forward and laterally.
Developing anticipatory and reactive postural control—integrating vestibular,
somatosensory, and visual inputs—is key. Plantar grasp persistence can interfere with
foot placement. A persistent high guard and wide base may be a transitional strategy,
but it is not a “prerequisite”; rather, it reflects immature balance. Reliance on vision
alone suggests immature sensory integration, not readiness.
Key words: weight shift, single-limb support, cruising, postural control
7) Typical vs delayed vignette (hand dominance)
A caregiver reports that a 9-month-old “always uses the right hand” to reach and
manipulate toys and rarely uses the left hand spontaneously. What is the MOST
appropriate clinical interpretation?
A. Early strong hand preference can be atypical and may warrant screening for
asymmetry
B. Strong hand dominance is expected by 9 months and reflects advanced neuromotor
maturity
C. This is typical if the infant is already crawling
D. Early hand preference is only concerning after age 6 years
Answer: A
Very Deep Rationale:
A pronounced hand preference in infancy can be a red flag because typical
,development involves relatively symmetric exploration and alternating hand use. Early
dominance may reflect underlying asymmetry in tone, strength, range, or sensorimotor
control (e.g., mild hemiparesis). While toddlers later develop clearer handedness, a
strong preference at 9 months—especially with reduced spontaneous use of the other
hand—should trigger careful assessment of bilateral upper extremity function, midline
use, and movement quality. Crawling does not “validate” early preference. Waiting until
school age would miss early intervention windows.
Key words: early hand preference, asymmetry, hemiparesis screening, bilateral use
8) Primitive reflex integration (Moro)
A 5.5-month-old startles easily, throws arms into abduction/extension with crying, and
has difficulty calming after sudden noises. Which functional impact is MOST likely if this
pattern persists?
A. Poor self-regulation and disrupted postural control transitions (e.g., prone ↔ supine)
B. Inability to develop pincer grasp due to thumb adduction
C. Persistent obligatory stepping preventing independent standing
D. Loss of protective extension reactions in sitting
Answer: A
Very Deep Rationale:
A persistent or exaggerated Moro reflex can undermine state regulation, increase
stress reactivity, and interfere with smooth postural transitions because the infant
repeatedly loses organized flexion and midline orientation. This can affect tolerance to
handling, sleep, feeding, and engagement. Pincer grasp problems relate more to fine-
motor development and not specifically to Moro. Obligatory stepping is linked to the
stepping reflex. Protective extension reactions are later-developing postural responses;
persistence of Moro does not directly “remove” them, though overall postural
maturation may be impacted.
Key words: Moro, regulation, startle, transitions, midline
9) Milestone-timing scenario (protective reactions)
, A 8-month-old can sit independently but frequently falls to the side without putting out
a hand to catch themselves. Which explanation BEST fits typical developmental
progression?
A. Lateral protective extension may still be emerging; lack at 8 months can be within
variability
B. Protective extension should be complete in all directions by 5 months
C. Absence of lateral protection is always pathological and indicates cerebral palsy
D. This indicates a primary visual deficit because protection depends entirely on vision
Answer: A
Very Deep Rationale:
Protective extension develops progressively (forward often earlier than lateral/backward)
and shows individual variability. At ~8 months, many infants are refining lateral
protective responses; some may still be inconsistent, especially during rapid
perturbations or when attention is divided. While absent protective reactions can be
concerning if combined with other signs (poor balance, abnormal tone, asymmetry), the
scenario alone can fall within typical variability—hence the best answer emphasizes
developmental sequence and cautious interpretation rather than over-pathologizing.
Protection is not purely visual; it integrates vestibular and somatosensory inputs.
Key words: protective extension, lateral reactions, sitting balance, variability
10) Developmental sequence reasoning (crawling
variation)
Which statement BEST reflects typical developmental trajectories regarding crawling?
A. Crawling can vary widely; some children bypass hands-and-knees crawling and still
develop typical walking
B. Hands-and-knees crawling is mandatory; absence always predicts later coordination
disorder
C. Only children with vestibular dysfunction skip crawling
D. Crawling should appear after independent walking
Answer: A
PART I: Foundations of Pediatric Physical Therapy
Chapter 1: Typical Development
Chapter 2: Pediatric Assessment Tools
Chapter 3: Family-Centered Care
PART II: Examination and Intervention along the Pediatric Continuum of Care
Chapter 4: Physical Therapy in the Neonatal Intensive Care Unit
Chapter 5: Physical Therapy in the Medical Setting (Acute Care, Inpatient and Outpatient Rehabilitation)
Chapter 6: Physical Therapy in the Educational Setting: From Early Intervention to School Age
Chapter 7: Adaptive Equipment
Chapter 8: Orthotics and Prosthetics
PART III: Pediatric Neuromuscular Disorders
Chapter 9: Cerebral Palsy
Chapter 10: Spina Bifida
Chapter 11: Traumatic Brain Injury
Chapter 12: Spinal Cord Injury
Chapter 13: Muscular Dystrophy
Chapter 14: Pain and Regional Pain Disorders
PART IV: Pediatric Musculoskeletal Disorders
Chapter 15: Orthopedic Conditions
Chapter 16: Sports Injuries
Chapter 17: Juvenile Idiopathic Arthritis and Other Rheumatic Disorders
PART V: Pediatric Cardiovascular and Pulmonary Disorders
Chapter 18: Cardiac Conditions
Chapter 19: Pulmonary and Respiratory Conditions
Chapter 20: Fitness and Prevention
PART VI: Other Medical/Surgical Disorders
Chapter 21: Oncologic Disorders
Chapter 22: Burn Injuries
Chapter 23: Autism Spectrum Disorders
Chapter 24: Down Syndrome and Intellectual Disorders
PART VII: Considerations in the Provision of Pediatric Physical Therapy Services
Chapter 25: Transitioning to Adulthood
,Tecklin’s Pediatric Physical Therapy, 6e — Test Bank
Chapter 1: Typical Development
Context: Examines normal motor, sensory, cognitive, and social development from
infancy thchrough adolescence, including developmental milestones and variability in
developmental trajectories.
Core Purpose: Provides the baseline for distinguishing typical vs delayed or atypical
movement—essential for diagnosis, prognosis, and intervention planning.
Question type : Milestone-timing scenarios • Developmental sequence reasoning •
Typical vs delayed clinical vignettes • Primitive reflex integration questions
1) Milestone-timing scenario (gross motor)
A 6-month-old infant is brought for a “development check.” The caregiver reports the
baby rolls both ways, brings feet to mouth, and can sit only if propped with hands
forward. The baby is not yet sitting independently. Which interpretation is MOST
accurate?
A. This pattern is typical; independent sitting commonly consolidates after supported
sitting
B. This is delayed because independent sitting should be present by 6 months
C. This is atypical because rolling both ways should occur after independent sitting
D. This is delayed because feet-to-mouth behavior suggests hypotonia
Answer: A
Very Deep Rationale:
At ~6 months, many infants demonstrate rolling both directions, hands-to-feet
exploration, and prop sitting (often a “tripod” position) before achieving stable, hands-
free sitting. Independent sitting requires maturation of trunk control, anticipatory
postural adjustments, and broader base-of-support strategies—typically emerging over
subsequent weeks/months. The sequence is not “sitting first, rolling later”; rolling can
precede independent sitting. Feet-to-mouth is a normal exploratory pattern reflecting
hip mobility, core engagement attempts, and sensory-motor integration—not a sign of
,hypotonia by itself. The best interpretation is that this profile fits typical variability in the
transition toward independent sitting.
Key words: tripod sitting, trunk control, rolling, typical variability, 6 months
2) Developmental sequence reasoning (postural
control)
Which developmental change BEST explains why infants transition from “en bloc” trunk
movement to more selective segmental rotation during rolling?
A. Emergence of segmental trunk dissociation and improved midline control
B. Extinction of the palmar grasp reflex
C. Increased femoral anteversion during infancy
D. Development of mature reciprocal arm swing
Answer: A
Very Deep Rationale:
Early rolling often occurs as an en bloc pattern (head, trunk, pelvis moving together)
due to limited trunk dissociation and immature anticipatory postural control. As the
nervous system matures, infants develop segmental control—separating upper and
lower trunk movement and using rotation to shift the center of mass efficiently. Midline
orientation (head/eyes/hands to midline) supports organized movement and graded
rotation. Palmar grasp extinction affects hand function, not trunk rotation mechanics.
Femoral anteversion is a skeletal torsional variable, not the primary driver of rolling
strategy. Reciprocal arm swing is a gait-related feature later in development.
Key words: en bloc, trunk dissociation, rotation, midline control
3) Typical vs delayed vignette (fine motor + cognition)
A 10-month-old uses a raking grasp to pick up small cereal pieces and transfers objects
hand-to-hand, but does not show an emerging inferior pincer grasp. The child is pulling
to stand and cruising. Which conclusion is MOST appropriate?
,A. Likely typical variability; pincer refinement may still be emerging at this age
B. Definite fine-motor delay; inferior pincer should be fully mature by 10 months
C. Atypical motor profile; gross motor advancement excludes typical fine-motor lag
D. Suggests abnormal reflex persistence rather than developmental variability
Answer: A
Very Deep Rationale:
At ~10 months, many infants begin transitioning from raking to radial digital grasps,
with the inferior pincer often emerging across late infancy (commonly around 9–12
months) with variability. A child can demonstrate advanced gross motor skills while fine
motor refinement continues—development is not perfectly synchronized across
domains. A “fully mature” pincer (neat pincer) is typically later than early pincer
emergence. There is no evidence here of pathologic reflex persistence; the vignette
describes progressive skill development without red flags (e.g., asymmetry, regression,
loss of skills).
Key words: inferior pincer, raking grasp, variability, domain dissociation
4) Primitive reflex integration (ATNR)
A 5-month-old shows strong head turning to the right with right arm extension and left
arm flexion, repeatedly disrupting midline hand use. Which reflex is MOST implicated,
and why is this concerning at this age?
A. ATNR; persistence interferes with midline orientation and bilateral hand skill
development
B. Moro; persistence prevents trunk flexion needed for sitting
C. TLR; persistence causes obligatory stepping during standing
D. Galant; persistence prevents visual tracking and social engagement
Answer: A
Very Deep Rationale:
The Asymmetric Tonic Neck Reflex (ATNR) produces the “fencer” posture: head turn
→ ipsilateral extension, contralateral flexion. In early infancy, it can facilitate hand regard
and early postural organization; however, persistence beyond the early months can
interfere with midline hand use, bilateral coordination, rolling, and later crawling
patterns because the infant struggles to bring hands together at midline or sustain
,symmetrical postures. Moro is a startle response; while its persistence can affect
regulation and postural control, it does not specifically create the described fencer
pattern. TLR relates to head position influencing extensor/flexor tone globally. Galant is
trunk incurvation with tactile stimulation.
Key words: ATNR, midline, bilateral coordination, reflex persistence
5) Milestone-timing scenario (social-communication)
A 14-month-old walks independently, points to desired objects, and brings toys to show
a caregiver. However, the child rarely responds to name and has minimal shared eye
contact during play. Which interpretation BEST fits typical development principles?
A. Social-communication concerns warrant further screening despite typical gross motor
milestones
B. Typical walking at 14 months rules out significant developmental concerns
C. Lack of name response is typical until at least 24 months
D. Pointing is not expected until after age 2, so the profile is inconsistent
Answer: A
Very Deep Rationale:
Development is multi-domain: strong gross motor progress does not negate possible
concerns in social-communication. Reduced response to name and limited shared eye
gaze can be early red flags requiring screening, even if motor milestones are typical.
Pointing to request and showing objects often emerges in late infancy/early
toddlerhood and is a positive sign of intentional communication, but it does not fully
offset concerns about social reciprocity and joint attention quality. It is incorrect that
name response is not expected until 24 months; typically it emerges much earlier. The
best answer reflects the principle: assess each developmental domain and the quality of
behaviors, not only motor milestones.
Key words: joint attention, response to name, multi-domain, screening
6) Developmental sequence reasoning (standing →
walking)
,Which prerequisite MOST strongly supports the transition from cruising to independent
walking?
A. Ability to shift weight laterally with controlled single-limb support moments
B. Presence of the plantar grasp reflex
C. Persistent wide base with high guard posture without trunk rotation
D. Exclusive reliance on visual input for balance with minimal vestibular contribution
Answer: A
Very Deep Rationale:
Cruising can be performed with continuous upper extremity support and limited need
for dynamic balance. Independent walking requires controlled weight shifting and
brief single-limb support while the center of mass moves forward and laterally.
Developing anticipatory and reactive postural control—integrating vestibular,
somatosensory, and visual inputs—is key. Plantar grasp persistence can interfere with
foot placement. A persistent high guard and wide base may be a transitional strategy,
but it is not a “prerequisite”; rather, it reflects immature balance. Reliance on vision
alone suggests immature sensory integration, not readiness.
Key words: weight shift, single-limb support, cruising, postural control
7) Typical vs delayed vignette (hand dominance)
A caregiver reports that a 9-month-old “always uses the right hand” to reach and
manipulate toys and rarely uses the left hand spontaneously. What is the MOST
appropriate clinical interpretation?
A. Early strong hand preference can be atypical and may warrant screening for
asymmetry
B. Strong hand dominance is expected by 9 months and reflects advanced neuromotor
maturity
C. This is typical if the infant is already crawling
D. Early hand preference is only concerning after age 6 years
Answer: A
Very Deep Rationale:
A pronounced hand preference in infancy can be a red flag because typical
,development involves relatively symmetric exploration and alternating hand use. Early
dominance may reflect underlying asymmetry in tone, strength, range, or sensorimotor
control (e.g., mild hemiparesis). While toddlers later develop clearer handedness, a
strong preference at 9 months—especially with reduced spontaneous use of the other
hand—should trigger careful assessment of bilateral upper extremity function, midline
use, and movement quality. Crawling does not “validate” early preference. Waiting until
school age would miss early intervention windows.
Key words: early hand preference, asymmetry, hemiparesis screening, bilateral use
8) Primitive reflex integration (Moro)
A 5.5-month-old startles easily, throws arms into abduction/extension with crying, and
has difficulty calming after sudden noises. Which functional impact is MOST likely if this
pattern persists?
A. Poor self-regulation and disrupted postural control transitions (e.g., prone ↔ supine)
B. Inability to develop pincer grasp due to thumb adduction
C. Persistent obligatory stepping preventing independent standing
D. Loss of protective extension reactions in sitting
Answer: A
Very Deep Rationale:
A persistent or exaggerated Moro reflex can undermine state regulation, increase
stress reactivity, and interfere with smooth postural transitions because the infant
repeatedly loses organized flexion and midline orientation. This can affect tolerance to
handling, sleep, feeding, and engagement. Pincer grasp problems relate more to fine-
motor development and not specifically to Moro. Obligatory stepping is linked to the
stepping reflex. Protective extension reactions are later-developing postural responses;
persistence of Moro does not directly “remove” them, though overall postural
maturation may be impacted.
Key words: Moro, regulation, startle, transitions, midline
9) Milestone-timing scenario (protective reactions)
, A 8-month-old can sit independently but frequently falls to the side without putting out
a hand to catch themselves. Which explanation BEST fits typical developmental
progression?
A. Lateral protective extension may still be emerging; lack at 8 months can be within
variability
B. Protective extension should be complete in all directions by 5 months
C. Absence of lateral protection is always pathological and indicates cerebral palsy
D. This indicates a primary visual deficit because protection depends entirely on vision
Answer: A
Very Deep Rationale:
Protective extension develops progressively (forward often earlier than lateral/backward)
and shows individual variability. At ~8 months, many infants are refining lateral
protective responses; some may still be inconsistent, especially during rapid
perturbations or when attention is divided. While absent protective reactions can be
concerning if combined with other signs (poor balance, abnormal tone, asymmetry), the
scenario alone can fall within typical variability—hence the best answer emphasizes
developmental sequence and cautious interpretation rather than over-pathologizing.
Protection is not purely visual; it integrates vestibular and somatosensory inputs.
Key words: protective extension, lateral reactions, sitting balance, variability
10) Developmental sequence reasoning (crawling
variation)
Which statement BEST reflects typical developmental trajectories regarding crawling?
A. Crawling can vary widely; some children bypass hands-and-knees crawling and still
develop typical walking
B. Hands-and-knees crawling is mandatory; absence always predicts later coordination
disorder
C. Only children with vestibular dysfunction skip crawling
D. Crawling should appear after independent walking
Answer: A
