Paediatrics

For Professional Exam

Made by –
Md. Nurul Amin Sakib
2nd Year BSc. in Occupational Therapy
Batch - 24
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Question Analysis ???

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Paediatric – I

Q-1 : Define Primitive Reflex

Primitive reflexes are involuntary motor responses originating in the brainstem
present after birth in early child development that facilitate survival.
Q-2 : Short Note on ATNR Reflex
Asymmetrical Tonic Neck Reflex
Appears : Birth
Disappears : 4-6 months
Position : - Supine
- Head in midline
- Arms & legs relaxed
Stimulus : Passive or Active rotation of the neck
Response :
❖ Right –
Extensor tone right arm, extension of elbow & maybe the leg & knee,
flexor tone left arm, flexion of elbow & maybe the leg & knee.
❖ Left –
Extensor tone left arm, extension of elbow & maybe the leg & knee,
flexor tone right arm, flexion of elbow & maybe the leg & knee.
Q-3 : Short Note on STNR Reflex
Symmetrical Tonic Neck Reflex
Appears : 4-6 months
Disappears : 8-12 months
Position : Suspended in prone
Stimulus : - Head extended
- Head flexed

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Response : All fours position –

❖ Elbows extend, Hip & Knees flex
❖ Elbows flex, Hip & Knees extend
Q-4 : Short Note on Moro Reflex
Moro Reflex
Appears : Birth
Disappears : 5-6 months
Position : - Hold in supine
- Head in midline
- Hands empty
- Arms on chest
- Relaxed
Stimulus : Head drop a few cm. in relation to trunk
Response :
❖ Phase – I
Extension of elbows & abduction of the arms, hands open.
❖ Phase – II
Arms flex & adduct toward midline, hands fisted.
Q-5 : Short Note on Landau Reflex
Landau Reflex
Appears : 2 - 4 months (peak response at 5-6 months)
Disappears : 1 - 2.5 years
Position :
Hold child in prone or horizontal suspension by placing hands between child's
nipple line & navel.
Procedure : Prone position in space
Response :
• Child's head will right to vertical (active head & neck extension)
• Spine will extend

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• Scapulae will adduct

• Arms will extend & abduct
• Elbows may flex or extend, forearm pronate
• Hips may partially extend
Q-6 : Define Postural reaction
Postural reactions are complex motor responses that provide autonomic control
of posture, balance & coordination.
Q-7 : Write & describe 3 postural reactions
Postural Reactions –
❖ Righting reaction
o Responsible for the development of postural control
o Ability to change positions
o Appears around 6 months of age & persists through life
o Maintain normal postural relationship of the head, trunk & limbs
during activities
❖ Protective reaction
o Appear at 6-9 months & persist
o Automatic reaction against falling
o Using extension of upper & lower limbs
o Present forward, sideways & backwards
❖ Equilibrium reaction
o Postural adjustments of the whole body to maintain balance
o Present in all positions at about 18 months
o Appears approximately 6 months of age & mature around the
age of 4 years
o Perfected between 5-7 years of age
o See equilibrium reactions in prone, supine, sitting, standing etc.
Q-8 : Define Good posture, Bad posture & Stable posture
❖ Good Posture
Good posture is the proper alignment of the body when
standing or sitting.
❖ Bad Posture
Bad posture is a body position that is asymmetrical or non-neutral.
❖ Stable Posture
Stable posture is the ability to control the body position in space for the
purpose of movement & balance.

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Q-9 : Define Postural management

Postural management is the management of posture in sitting, lying, standing &
walking, including using mobility devices.
Q-10 : What can be done for Postural management ?
• Analyse presenting problems
• Maintain segmental alignment
• Secure the pelvis
• Offload forces
• Facilitate changes in position –
o Use gravity to work positively
o Counter asymmetry
Q-11 : Define Sensory Integration
The term sensory integration refers to the processing, integration & organization
of sensory information from the body & the environment.
Q-12 : Write the name of internal senses & external senses
Name of internal senses
➢ Proprioception
o Raise your hand
o Raise your left leg
o Hands on head
➢ Vestibular
o Playing basket ball
o Running through a forest
o Work during walking
Name of external senses
➢ Vision
o Looking at the white board
o Playing video games
o Watching movie
➢ Auditory
o Listening lecture
o Listening music
o Hearing Azan

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➢ Olfactory
o Taking smell of rose
o Taking smell of perfume
o Taking smell of a mango
➢ Gustatory
o Taste some sweets
o Taste a sour mango
o Taste a lemon
➢ Tactile
o Pressure of any objects
o Touch a glass
o Mobile vibration
Q-13 : Define Sensory processing
Sensory processing is the process that organizes & distinguishes sensation from
one's own body & the environment.
Q-14 : Mention 7 Calming stimuli
Calming Stimuli
✓ Sucking small lollies
✓ Soft, soothing music
✓ Swinging
✓ Vibration
✓ Deep pressure, firm hugs, massage
✓ Soft, low lighting
✓ Squeezing or pushing resistance materials
✓ Carrying heavy objects
Q-15 : Mention 7 Alerting stimuli
Alerting Stimuli
✓ Hot/Cold drinks, cool water
✓ Semi-frozen fruit
✓ Strong flavors or smells
✓ Sucking
✓ Running, Jumping
✓ Bouncing on an exercise ball
✓ Loud, fast music
✓ Bright lighting
✓ Active movement

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Q-16 : Write general motor problem affecting hand skills

▪ Inadequate isolation of movements
▪ Poorly graded movements
▪ Poor timing of movements
▪ Disorder in bilateral integration of movements
▪ Limitations in trunk movement & control
Q-17 : Write general guidelines for intervention of motor problem affecting
the hand skills
▪ Positioning of the child
▪ Inhibition or facilitation of tone
▪ Activities to improve postural control
▪ Activities emphasizing isolated arm & hand movements

▪ Reach, grasp, carry, release activities

▪ In hand manipulation activities
▪ Isolated finger movements activities
▪ Bilateral activities
Q-18 : Write the principles of general developmental consideration
✓ Mass to specific
✓ Gross to fine
✓ Proximal to distal
Q-19 : Write the pattern of hand skills development
The pattern of hand skills development
❖ Basic
o Reach
o Grasp
o Carry
o Release
❖ Complex
o In hand manipulation
o Bilateral hand use
Q-20 : Define visual perception
Visual perception is the ability to perceive our surroundings through the light
that enters our eyes.

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Q-21 : Write the name of different visual perceptual component

Visual perceptual component
✓ Visual scanning
✓ Visual motor integration
✓ Visual memory
✓ Visual sequental memory
✓ Visual spatial relations
✓ Visual figure ground
✓ Visual form consistency
✓ Visual closure
Q-22 : Define Play
Any spontaneous or organized activity that provides enjoyment, entertainment,
amusement or diversion.
Q-23 : What play performance will expect for 6-12 months old child ?
Play performance will expect for 6-12 months old child
• Still exploratory & social
• Starting fine motor manipulation
• Greater postural control & spontaneous locomotion
• By 10 month crawling
• By 12 month walking with hands held
Q-24 : What play performance will expect for 12-18 months old child ?
Play performance will expect for 12-18 months old child
• Simple pretend games, more social play
• Walking well, some running
• Can pick up a toy from floor without falling
• Shares toys with parents
• Uses 2 hands in play
Q-25 : Mention the child sitting, standing & walking age according to the
milestone of development
❖ Sitting
5-6 month : Sit with arm support
7-9 month : Sit without arm support

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❖ Standing
10 month : Stands while holding on to furniture
13 month : Stands alone momentarily
❖ Walking
12-14 month : Walking
Q-26 : Define tongue thrust & jaw thrust
Tongue Thrust
In hypertonicity tongue movement are forceful & often maintained in extended
position. This rhythmic in & out movement of tongue is called tongue thrust.
Jaw Thrust
Jaw thrust may be observed in with tongue thrust, it is forceful downward
movement of the lower jaw.
Q-27 : Write principals of treatment for feeding & oral motor control
The principals of treatment for feeding & oral motor control
➢ Proper alignment of head & body
➢ Provide proximal stability
➢ Alteration of facial muscle tone
➢ Facilitate appropriate movement pattern
➢ Desensitize oral area by using child hand
➢ Some feeding positions are –
o Infant sideways on feeders lap
o Face to face on caregivers thigh
o Use corner chair or high chair or foam filled seat or any adjustable
seat.
Q-28 : A child has drooling difficulties, write what treatment strategies
would you follow ?
If a child has drooling difficulties, I would follow some drooling management :
Drooling Management
i. Non invasive modalities
a) Eating & drinking skills
b) Oral motor facilitation
o Brushing
o Icing
o Vibration

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o Manipulation – Line tapping, putting

o Oral motor sensory exercise
ii. Invasive modalities
a) Surgery
b) Radiotherapy
iii. Facial massage
iv. Wiping techniques
v. Position maintains
vi. Lip closing techniques
Q-29 : Define Postural Control
Postural control refers to the ability of the body to maintain a stable and
balanced position during movement.
Q-30 : Write why as an occupational therapist need to know the reflex?
Occupational therapists need to understand reflexes because they play a crucial
role in motor development and functional abilities.
➢ Motor Development
Reflexes are crucial for how we develop movement skills.
➢ Nervous System Check
They help therapists see how well the nervous system is working.
➢ Diagnosing Issues
Reflex assessments help identify specific challenges someone may be
facing.
➢ Sensory-Motor Skills
Reflexes are linked to how well we sense and move, impacting daily
activities.
➢ Early Intervention
Recognizing abnormal reflex patterns early on enables therapists to
intervention and address potential developmental issues before they
become more challenging to overcome.
Q-31 : OT intervention for tongue thrust & jaw thrust
OT intervention for tongue thrust
➢ Oral Motor Exercises
Target exercises to strengthen tongue muscles and improve coordination.
➢ Sensory Input
Provide various textures and tastes for oral stimulation to control of
tongue movements.

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➢ Oral Awareness Activities

Incorporate activities that enhance the child's awareness of their tongue
position, such as tongue-jaw dissociation exercises.
➢ Behavioral Techniques
To promote correct tongue posture during activities like chewing,
swallowing, and speaking.
➢ Speech Therapy Collaboration
Work closely with a speech-language pathologist to address specific
speech-related concerns and ensure a comprehensive approach.
OT Intervention for jaw thrust
➢ Oral-Motor Exercises
Focus on exercises to strengthen and stabilize the jaw muscles. Include
activities like jaw-opening and closing exercises.
➢ Joint Compression Activities
Incorporate activities that provide proprioceptive input to the jaw joint,
promoting stability.
➢ Chewy Tools
Use chewy tubes or other oral-motor tools to encourage appropriate jaw
movements.
➢ Posture and Alignment
Proper alignment can impact jaw function. Provide exercises to promote
head and neck stability.
➢ Functional Activities
Integrate jaw exercises into daily activities like eating and speaking to
promote carryover into functional tasks.

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Paediatric – II

Q-1 : What type of schools do OTs work in?

❖ Inclusive education
• School for students with & without disabilities. In a class, there
will be a mixture of students.
❖ Special school
• School only for students with disabilities
Q-2 : Write OT role at school
• Facilitate student to engage & participate in school life
• Educate staff
• Ensuring client's social & psychosocial welfare
• Provide equipment & environmental modifications
• Inclusion & participation is crucial

Q-3 : Define ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental
disorder characterized by persistent patterns of inattention, hyperactivity, and
impulsivity that significantly impact daily functioning and development.
Q-4 : Write 7 school tips for children with ADHD
• Predictability (Can help child understand expectations)
• Structure (To help break day into achievable steps)
• Shorter work periods (Frequent breaks help)
• Small student-teacher ratio
• Individualized instruction
• Motivating & interesting curriculum
• Use of positive reinforcement
• Good mix of physical / movement opportunities

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Q-5 : Write 7 home tips for children with ADHD

• Make a schedule
• Make simple house rules
• Make sure your direction & understood
• Reward good behavior
• Make sure your child is supervised all the time
• Focus on effort, not grades
• Talk with your child's teacher
• Set a homework routine
• Watch your child around his or her friends

Q-6 : Define Autism

Autism is a brain developmental disorder that is characterized by challenges in
social communication, repetitive behaviors and restricted interests.
Q-7 : Explain some symptoms you may observed to an Autism children
Impairment in Social Interaction

• Lack of appropriate eye gaze

• Lack of warm, joyful expressions
• Lack of sharing interest or enjoyment
• Lack of response to name

Impairment in Communication

• Lack of showing gestures

• Lack of coordination of nonverbal communication
Repetitive Behaviors & Restricted Interests

• Repetitive movements with objects

• Repetitive movements or posturing of body, arms, hands, or fingers

Play
• Children with autism do not know how to play
• They may play with toys in a repetitive manner
• Don’t understanding of what the toys represent

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Cognition
• About 75% of children with autism are functionally mentally retarded.
Sensory motor symptoms
• Walking on their toes
• Flapping their hands up & down
• Flicking their fingers
• Bitting their arms
• Running in circles
• Spinning themselves around
• Pacing up & down
• Avoid certain textures of clothing or food
Q-8 : Write OT Management for children with autism
❖ Sensory integration therapy
The therapy involves deep pressure, brushing, massage, vibration &
the use of play.
❖ Behavioral therapy
Behavioral therapy focuses on the child's actions, the parents are also
required to learn different methods of coping with their children.
❖ Music therapy
It is helpful in relieving anxiety, depression & has benefits in
relaxing the body.
❖ Hand therapy
Occupational therapists use different hand activities & play to
improve hand skills.
❖ Daily life therapy
Daily life therapy is the most important treatment in improving activities
of daily living skills for autism.
❖ Group therapy
This technique needs to be appropriate to the developmental
level of the child.
❖ Social skills training
This technique is used to teach children & adults with autism how to
interact socially.
❖ Prognosis of Autism
Although there is no cure for Autism, appropriate early intervention may
improve social development.

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Q-9 : Define Intellectual Disability

Intellectual disability refers to a condition characterized by limitations in
intellectual functioning and adaptive behavior.
Q-10 : Write down the classification of Intellectual Disability
Basically 4 types of Intellectual Disability :
1. Mild
• IQ Range - 55 to 69
• Requiring intermittent support
• Ability to learn academic skills at 3 to 7 grade level
• Achievement of social & vocational skills
2. Moderate
• IQ Range - 40 to 54
• Requiring limited support
• Perform daily routine function
• May be able to do semiskilled jobs
3. Severe
• IQ Range - 25 to 39
• Requiring extensive support
• Learn to communicate & trained for basic health habits
• Require supervision to complete the tasks
4. Profound
• IQ Range - 20 to 25
• Requiring pervasive support
• Need caregiver assistance for survival purpose
Q-11 : Define Cerebral Palsy
Cerebral palsy is a group of permanent movement disorders that appear in early
childhood, affecting posture and motor skills.
Q-12 : Write the classification of Cerebral Palsy according to muscle tone
Classification of Cerebral Palsy:
1. Athetoid
Characterized by alternating, writing or rotary movements
2. Ataxic
Characterized by uncoordinated movements
3. Floppy (Markedly low tone)

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4. Spastic (High muscle tone)

• Spastic Hemiplegia
• Spastic Diplegia
• Spastic Monoplegia
• Spastic Triplegia
• Spastic Quadriplegia
Q-13 : Describe OT Management for children with Cerebral Palsy
Assessment
• Birth history
• Primitive reflexes & reactions
• Age appropriate developmental milestone
• Performance components
• Play activity
• Daily functional skills
Intervention
• Be considerate of the child's age
• Be alert for signs of sensory overload
• Teach carers correct manual handling techniques
Treatment
• For Normalize of tone
• Improve muscle strength
• To ensure normal development
• To improve sensation
• To improve neck control
• Functional gross motor
• To improve sitting balance
• To improve standing balance
• Gait education
• Improve play activity
• Improve schooling activity
• Improve communication
• To correct posture
• To prevent or correct deformity
• Improve participation in ADL activities

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Q-14 : Define Down Syndrome

Down syndrome is the most common of the chromosomal disorder and a
leading cause of mental retardation.
Q-15 : Write the features of Down Syndrome child
i. General
• Short stature
• Mental retardation
• Babies with down syndrome are usually small & very floppy
• Reduce life expectancy of 40%
ii. Face
• Mongoloid slant
• Flat facial profile
• Flat nasal bridge
• The mouth tend to be hang open
• The tongue is usually enlarge
• The ears are small & rounded
• A broad & short neck
• Flat occiput
iii. Hand & Feet
• Short & broad hand and feet
• A single crease across the centre of the palm's of the hand
• A wide gap between 1st & 2nd toes
• The little finger may short & incurving
iv. Joint instability
v. Head
• Microcephaly
vi. Thorax
• Short sternum
• Congenital heart defect 66%
• Ventricular septal defect 15%
Q-16 : Define Muscular Dystrophy
Muscular dystrophy is a group of genetic disorders characterized by progressive
weakness and degeneration of muscle tissue.

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Q-17 : Write the types of Muscular Dystrophy

Types of Muscular Dystrophy
• Duchenne Muscular Dystrophy (pseudo hypertrophic)
• Limb girdle Muscular Dystrophy
• Faciascapulohumeral Muscular Dystrophy
• Congenital Muscular Dystrophy (CMD)
Q-18 : Write the OT Role / Management for Muscular Dystrophy child
Occupational therapist assess the child, fined out problems then set
up treatment plan.
• Provide orthopedic devices (e,g splints or braces)
• Adaptive equipment & activity can -
✓ Increase mobility
✓ Minimize contracture
✓ Delay spinal curvatures
✓ Maximize in daily activities
✓ Possible role functioning
• AROM & PROM exercise in a gentle manner than maintaining body
function
• Encourage continuing study at home if schooling is not possible
• Maintaining the child's independent mobility for as long as is a major
goal
• Should be prepare to work with these issues of death & dying
Q-19 : Write the basic method Ponseti technique
Basic method Ponseti technique:
• Assess severity & score
• Manipulate foot position
• Cast 5-7 days
• Soak off cast
• Repeat -
✓ Manipulate
✓ Cast 5-7 days
✓ Soak off cast

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Q-20 : Write advantage & disadvantage of Ponseti technique

Advantages of Ponseti techniques:
• Provide best correction of clubfoot deformity
• Avoid complication of surgery
• Is less costly than surgery
• Successful treatment with Ponseti often results in better foot
function and mobility
• The technique can reduce the need for extensive surgical procedures
Disadvantages of Ponseti techniques:
• Long duration of treatment
✓ Casting 6 weeks
✓ Splinting 5-6 years
• Ongoing, regular patients visit
• Require detailed knowledge of anatomy & techniques
• In some severe or complex cases, surgical intervention may be necessary
instead of the Ponseti method

Q-21 : Explain different treatment options of upper limb management for

children with CP
Different treatment options of upper limb management:
• Stretching (ie, paasive vs active ranging)
• Botulinium toxin A
• Splinting
• Conductive education
• NDT
• Constraint therapy
• Surgery
Stretching
• Once off stretches not effective
• Active stretches better then passive
• Passive stretches can be important for maintenance

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Botulinium toxin A
• Neurotoxin
• Hypertonicity often managed with medications to decrease tonicity
• Has been used on lower & upper limbs
• Physical & Occupational therapy intervention
Splinting
• Hard & soft splints
• Varied evidence & academic debate
• Just splints not effective
• Varied effectiveness if combined with therapy in ADLs
Conductive education
• Combination between education & treatment for children with motor
disorder
• To help children learn themselves how to overcome movement problems
• Goals surrounding daily living skills
NDT
• Neurodevelopmental approach
• Bobath or NDT treatment approaches
• Focused on semi-sensory components
• Handling techniques to facilitate more normal patterns
• Positioning techniques to facilitate development
Constraint therapy
• Improve upper limb function
• Taub's monkey experiments
• Early Intervention more effective
• Child motivation is a big factor
Surgery
• Surgery is sometimes required if contractures or bone deformities are
severe enough
• Muscle & tendon lengthening by surgery
• Must be followed by intensive rehabilitation

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Q-22 : Define Spina Bifida

Spina bifida is a congenital condition characterized by the incomplete closure of
the neural tube during early fetal development.
Q-23 : Write the classification of Spina Bifida with functional problem
Classification of Spina Bifida:
1. Spina bifida occulta
2. Spina bifida cystica
✓ Spina bifida with meningocele
✓ Spina bifida with myelomeningocele
Functional problem
• Some neuromuscular impairment may occur
• Mild gait defects
• Bowel or bladder problems
• Meningitis & hydrocephalus
• Sensory motor disturbance
• Hip, spinal or foot deformities
• Bowel & bladder incontinence
• Arnold-Chiari syndrome
• Paralysis
Q-24 : Explain 3 types of clinical observation are reported for diagnosis of
congenital dislocation
1. Ortolani test
• Flexion of knee & hip
• Alternate adduction & pressing of femur downward
• Abduction & lifting of femur
• Click is heard when this happened
2. Galeazzi sign
• Putting the infant in supine position
• Knee flexed to 90 degree
• One knee will be observed to be lower than the other
3. Barlow test
• Adduction of leg
• Pressure on medial side of thigh
• Femur clicking out of acetabulum

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Q-25 : Write management of children with Down Syndrome

Medical management
There is no specific treatment but surgery can offer considerable
cosmetic improvement
Problem list
• Usually the baby is floppy or hypotonic
• Delayed normal development
• To prevent or correct deformity
• Problem in normal gait pattern
• Muscle spasm
• Impaired sensation
• Speech problem
• Hearing & visual problem
• Poor sitting or standing balance
• Poor balance & coordination
• Poor neck & pelvic control
• Impairment of function activity
Treatment
• For normalize low tone
• Improve muscle strength
• To ensure normal development
• To correct posture
• To prevent or correct deformity
• To improve sensation
• To improve neck control
• Functional gross motor
• To improve sitting balance
• To improve standing balance
• Gait education
• Improve play activity
• Improve schooling activity
• Improve communication
• Improve participation in ADL activities

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Q-26 : Define Erb’s Palsy

Erb's Palsy is a condition caused by injury to the brachial plexus, a network of
nerves near the neck, during childbirth.
Q-27 : Mention functional problem of Erb’s Palsy
• Decreased bilateral hand activities (eg, grasp, reach etc.)
• Decreased range of motion
• Difficulty to perform ADL (eg, dressing, eating etc)
• Problem occur to perform productivity like writing also
affecting in leisure
Q-28 : Write OT Management for Erb’s Palsy
• Positioning
• Sensory stimulation
• Guided movement
• Graded movement
• Splinting (abductor splint)
• Introduced with ADL
Q-29 : Define Behavior
Behavior refers to the actions, reactions, or conduct of an individual, organism,
or system in response to stimuli or environmental factors.
Q-30 : Mention the types of behavior
Types of behavior:
1. Uncharacteristic behavior
2. Inappropriate behavior
3. Challenging behavior
Q-31 : Explain behavioral management techniques
▪ Gaining rapport with the child and parents.
▪ Conducting a sound development and psychosocial assessment
▪ Forming a counselling relationship
▪ Giving feedback and psycho-education to the parents
▪ Setting goals with the family…what are their current aims and
expectations
▪ Cognitive elements

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▪ Other forms of therapy eg family issues/therapy, parental mental health,

psychodynamic principles, medication
▪ Child self management principles - teach child anger management, social
skills, coping strategies. Also be positive and focus on the positives eg;
child's strengths and utilize these. Other symptoms - consider the
attachment with each parent, other comorbid conditions etc.
▪ What else has been tried? Success and failures give us good information
▪ School involvement essential
▪ Star charts, best if has a goal, and if the 'stars' are meaningful Whatever
behavior management strategy you consider needs to be planned carefully
as if used at the wrong time or in the wrong way can lead to abusive
application.
Q-32 : Write 2 potential functional problems due to Erb’s Palsy & describe
an example OT intervention for each functional problem
2 potential functional problems
Decrease ROM
Intervention: Design a structured program of passive & active ROM
exercises targeting the shoulder, elbow & wrist joints.
The occupational therapist guides the individual through gentle stretching
& movement exercises, gradually working towards improved flexibility
& joint mobility.
Decreased bilateral hand activities
Intervention: Bilateral integration activities, plan activities that
encourage coordination between the affected & unaffected limbs.
Engage the bilateral tasks such as catching & throwing a ball with both
hands, playing bilateral tabletop games or using both hands in manipulate
object in functional tasks.
Q-33 : Write goals of handling the children with Cerebral Palsy
Goals of handling:
• To establish & encourage interaction and bonding between the mother &
her baby.
• To improve visual & auditory responses and to provide tactile &
proprioceptive inputs.
• To normalize sensori-motor experiences.
• To increase the quality of normal, spontaneous patterns of movement.

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• To promote the orientation of the baby towards the midline.

• To encourage the baby to touch, explore & discover his body and his
environment with his hands.
Q-34 : Short Note – Arthrogryposis
Arthrogryposis
• Condition that affects the nerves and muscles surrounding a joint
• Characterized by multiple joint contractures (shortened muscles) that are
present at birth
• Commonly affects hands, wrists, elbows, shoulders, hips, feet, knees,
back and jaws
• Muscle weakness often present
• In most cases not genetic
• Mainly affects males
• 1 in 17000 births in Australia
• Fatigue is a major issue
• Difficulty with -
✓ Walking
✓ Running
✓ Negotiating steps
✓ Balance
✓ Protective reactions
Treatment :
• To improve muscle strength and range of motion; as well as increasing
posture, transfers, gait balance and co-ordination
• Splinting and serial casting
• Surgery-adjust joint position; tendon transfer
• Occupational therapy - ADL training, adaptive equipment for ADLs,
equipment prescription
Q-35 : Mention how handling the child with ATNR?
• Keep the head in midline using a U-pillow.
• Use a corner seat, position the child using padding on one side to keep the
head in the midline.
• Encourage the child to touch his face with the opposite hand and to suck
on the fingers of the opposite hand.

Md. Nurul Amin Sakib 2nd Year BSc. in Occupational Therapy

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• Advice the mother to carry the child in the crook of her arm with both
shoulders protracted and arms forward.
• If the child has a ATNR or STNR to the right, then mother should carry
the child in her right arm.
Q-36 : Describe Trendelenburg sign
Older children with CDH test is Trendelenburg sign –
Dropping of hip to opposite side of dislocation & shifting of trunk towards
dislocated hip. When child is asked to stand on foot of affected side.
Q-37 : Write the pathological anatomy of Clubfoot
Pathological anatomy of Clubfoot :
• Adduction of the Forefoot
• Inverted Hindfoot
• Ankle Equinus
• Plantar-Medial displacement of the navicular on the head of the Talus
Q-38 : Write the causes of Juvenile Rheumatoid Arthritis (JRA)
Causes of JRA :
• Exact cause is unknown
• Factors that are believed to cause this condition are genetic cause,
histocompatability antigens
• Viruses
• Antigen antibody Immune complexes
• Emotional trauma

Md. Nurul Amin Sakib 2nd Year BSc. in Occupational Therapy