Question 1

Which description is not a purpose of positioning?&#10;A) Improves functioning&#10;B) Eliminates skin breakdown&#10;C) Limits the child's movement&#10;D) Enhances socialization

Accepted Answer

Positioning refers to a child's ability to maintain postural control while participating in daily activities.For example, a therapist may help a child sit in an adapted chair that provides additional support at the trunk so that he or she can write more efficiently and effectively in school.
The principles of positioning children include the following:
.Provide the child with a variety of positioning options throughout the day.
.Consider positions that enhance function in specific activities.
.Avoid positions that restrict the child's ability to move purposefully.
.Provide positions that are comfortable for the child.
.Consider safety when determining optimal positions (e.g., do not leave a child unattended in a positioning device).
.Ensure proper skeletal alignment and body symmetry during positioning of the child.
.Recommend positioning equipment that provides external trunk stability to facilitate movement.

Question 2

What statement most closely describes the principle of neurodevelopmental treatment (NDT)?&#10;A) Through repetition of movement, children develop improved neural pathways to help them move.&#10;B) Repetition of movement improves muscle tone so that the child is able to sustain correct movements.&#10;C) Repetition of movement increases range of motion and muscle strength.&#10;D) Sensory feedback provided by handling techniques motivates the child to move.

Accepted Answer

The following list provides a summary of NDT principles that guide intervention:
.The goal of NDT intervention is to improve overall function in daily tasks by increased active use of the trunk and involved extremities.
.Intervention should be individualized and focused on functional outcomes.
.OT practitioner may attempt to normalize muscle tone before and during functional movement.
.OT practitioner should analyze musculoskeletal limitations interfering with movement and function.
.OT practitioner should facilitate normal movement patterns, including both passive and active movements that are meaningful to children.
.Treatment should emphasize quality of movement (e.g., accuracy, quickness, adaptability, and fluency) and reproducibility of movement.
.Experience is a driving force for children.New activities build on previous sensorimotor experiences (typical and atypical).
.Target postural control and movement by using key points of control.Proximal points of control (e.g., hips, trunk, and pelvis) provide more support to children, while distal points of control (e.g., head, hands, and feet) require children to perform more of the movement.
.Engage children in "typical" movement and repetition using new movement patterns, which develops new neural pathways.
.Children's motivation and active problem solving should be considered when developing therapy goals and treatment activities.

Question 3

Tyrell is an 8-year-old with spastic quadriplegia cerebral palsy who has made great gains in head control and use of his arms and hands while positioned prone on a wedge.The COTA decides to have Tyrell try to use his skills at a more advanced level.Which activity is most likely to integrate his success with prone posture?

A) Self-feeding while seated on a bolster chair.
B) Initiating forward movement while prone on a scooter board.
C) Reading a story while prone on a wedge.
D) Swimming with his classmates at school.

Accepted Answer

The prone position, in which a child is positioned on his or her tummy, facilitates neck and trunk extension and thus helps the child build muscle strength and stability in the neck, upper back, shoulders, arms, and hands.Once a child develops strength, he or she is able to better stabilize and control upper arm movements.Once the child has established stability in prone, he is ready to progress to movement in prone.

Question 4

What does prone position facilitate in infants?&#10;A) Hand strength and neck and trunk extension&#10;B) Elbow extension and neck flexion&#10;C) Trunk flexion, leg strength, and abdominal strength&#10;D) Trunk extension and leg and hand strength

Accepted Answer

The prone position, in which a child is positioned on his or her tummy, facilitates neck and trunk extension and thus helps the child build muscle strength and stability in the neck, upper back, shoulders, arms, and hands.Once a child develops strength, he or she is able to better stabilize and control upper arm movements and muscle control.Prone position leads to higher-level motor skills such as prone-on-elbows, prone-on-extended-elbows, and quadruped positions.

Question 5

Which statement correctly describes positioning?&#10;A) Children should assume a variety of positions.&#10;B) The ideal functional position is sitting.&#10;C) Positioning does not improve social interactions.&#10;D) Only children younger than 1 year sit on the floor.

Accepted Answer

In the case of typically developing children, assuming and maintaining a variety of positions leads to the development of more mature movement and overall motor control.Children naturally gain improved motor planning and coordination as they develop postural control in each new developmental position.

Question 6

The COTA positions her palm on the child's abdomen and back in an effort to help the child move from upright sitting to quadruped.What is the term used for what the practitioner is doing?&#10;A) Handling&#10;B) Intervention&#10;C) Positioning&#10;D) Weight bearing

Accepted Answer

OT practitioners use positioning and handling techniques to help children engage to their fullest extent in daily occupations.In addition, OT practitioners use handling techniques to promote improved motor control during the performance of daily tasks and activities.As such, handling involves continual evaluation of children's responses to the practitioner's input (i.e., cues and touching) as it relates to the desired motor movement.This is a dynamic process and therefore requires the practitioner to be aware of how he or she is influencing children's motor and emotional responses.

Question 7

The Certified Occupational Therapy Assistant (COTA) observes a 6-year-old child with cerebral palsy and high muscle tone using a W-sitting position on the floor at all times.What does this observation suggest about the child?

A) He is developing normally.
B) He is using a compensatory position to establish stability.
C) He is using a position considered normal for an older child.
D) He is using a compensatory position to establish mobility.

Accepted Answer

Children with poor trunk stability may favor a W-sitting position, since the lower extremities are positioned to provide a wide base of support.W-sitting does not require trunk strength or stability and thus makes it easier for children to manipulate objects and play on the floor.However, W-sitting may lead to orthopedic problems, including increased risk of hip dislocation, joint deformities, and the aggravation of muscle tightness.W-sitting does not allow for rotation, weight shifting, or the opportunity to cross midline.Therefore, occupational therapy (OT) practitioners discourage W-sitting by promoting other sitting positions that engage children's postural system and encourage the use of trunk muscles.Alternatives to W-sitting include tailor-sitting; long-sitting; side-sitting; or sitting on the OT practitioner's lap, on a bench, or on a ball.

Question 8

What is the first event that must happen for a child to move?&#10;A) Flexion&#10;B) Extension&#10;C) Rotation&#10;D) Weight shift

Accepted Answer

All movement requires an initial weight shift.The term weight shift refers to the change in the center of mass which allows one to move a body part.

Question 9

Yuki is a 9-year-old with spastic quadriplegia.Yuki's parents would like her to be able to participate in their weekly family game time.What is the most important point to consider when developing a positioning plan for Yuki?

A) Yuki has her head upright.
B) Yuki is able to participate from her wheelchair.
C) Yuki can easily move her wheelchair if she wants to leave the room.
D) Yuki is safely secured with a lap belt.

Accepted Answer

Neck extension below a 45-degree angle is recommended, as this prevents the head movement from triggering hyperextension throughout the body.

Question 10

Arthur is a 4-year-old with Down syndrome who is beginning to work on bilateral midline hand skills.His low muscle tone causes him to fatigue quickly when working against gravity.What is a good positioning choice to help Arthur's fine motor play?

A) Long-sitting on the floor.
B) Placement in a supine stander, reclined 30-40 degrees.
C) Seated in a chair with good support to the trunk.
D) Sitting independently on a bench.

Accepted Answer

One of the first principles of positioning is to assure that children have the capacity to align head, trunk, and pelvis with extremities approaching midline.The ability to maintain proper body alignment is important for developing postural stability and allows children to participate in daily occupations.Symmetrical positioning, with head, neck, trunk, and pelvis aligned, allows children to move their arms and legs efficiently, bring the hands to midline to play with objects, couple the visual system with hand use, and engage the upper and lower body together.

Question 11

What is considered the optimal sitting position for children with cerebral palsy (spastic quadriplegia)?&#10;A) Chair reclined for comfort&#10;B) Hips extended back into chair&#10;C) Knees extended into long-sitting&#10;D) Hips flexed forward

Accepted Answer

The answer of What is considered the optimal sitting position...

Question 12

Which position benefits a child with increased trunk muscle extensor tone while standing in a Freedom stander?&#10;A) Neutrally positioned&#10;B) Slightly tilted backward&#10;C) Slightly tilted forward&#10;D) Tilted back into supine position

Accepted Answer

The answer of Which position benefits a child with increased...

Question 13

Anitra is a 2-year-old with low muscle tone, flat emotions, and frequent lethargy.The COTA who treats her has difficulty gaining Anitra's attention when trying to engage her in movement activities.What handling technique can facilitate increased tone, alertness, and activity level?

A)Slowly rocking with her positioned sideways in an adult-sized rocking chair.
B) Wrapping her with a light flannel blanket.
C) Tickling her feet.
D) Positioning her on the lap and bouncing her up and down.

Accepted Answer

The answer of Anitra is a 2-year-old with low muscle...

Question 14

What are the reactions called that bring the body back to midline position and the head into vertical position (e.g., when an infant is tilted to the side and brings his head back to the middle)?&#10;A) Equilibrium&#10;B) Protective extension&#10;C) Righting&#10;D) Balance

Accepted Answer

The answer of What are the reactions called that bring...

Deck 18: Positioning and Handling: A Neurodevelopmental Approach