Ch.26 – Case Study Congenital Muscular – Test Bank + Answers

Chapter 26. Case Study: Congenital Muscular Torticollis

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Torticollis is characterized by:
   1. ipsilateral cervical lateral flexion and contralateral cervical rotation.
   2. ipsilateral cervical lateral flexion and ipsilateral cervical rotation.
   3. contralateral cervical lateral flexion and contralateral cervical rotation.
   4. contralateral cervical lateral flexion and ipsilateral cervical rotation.
2. Common co-occurring conditions with congenital muscular torticollis include all of the follow except:
   1. developmental dysplasia of the hip.
   2. perinatal brachial plexus palsy.
   3. visual impairment.
   4. foot deformities.
   5. craniofacial asymmetry.
3. The ideal age window to begin physical therapy intervention for congenital muscular torticollis is:
   1. between 12 and 18 months of age.
   2. between 9 and 12 months of age.
   3. between 6 and 12 months of age.
   4. between 1 and 6 months of age.
4. To assess pain in infants with CMT, an appropriate measure to select would be the:
   1. FACES pain scale.
   2. visual analog scale.
   3. FLACC scale.
   4. CRIES scale.
5. A child presents to physical therapy with an Argenta’s Clinical Classification of Plagiocephaly Type II. The therapist interprets this to mean:
   1. the child has posterior flattening of the cranium with anterior shift of the ipsilateral ear.
   2. the child has posterior flattening of the cranium, anterior shift of the ipsilateral ear, and ipsilateral frontal bossing.
   3. the child has posterior flattening of the cranium, anterior shift of the ipsilateral ear, ipsilateral frontal bossing, and facial asymmetry.
   4. the child has posterior flattening of the cranium, anterior shift of the ipsilateral ear, ipsilateral frontal bossing, facial asymmetry, and temporal bossing.
6. A cranial remodeling orthosis is typically worn _________ hours per day.
   1. 8
   2. 12
   3. 18
   4. 23
7. Each of the following medical conditions should be screened to differentially diagnose CMT in infants except:
   1. reflux.
   2. congenital scoliosis.
   3. ear infections.
   4. cardiopulmonary conditions.
   5. visual impairment.
8. A 6-month-old child was referred to physical therapy for right torticollis. The most effective method to stretch the muscle is by positioning the head and neck into:
   1. left side-bending and left rotation.
   2. right side-bending and left rotation.
   3. right side-bending and right rotation.
   4. left side-bending and right rotation.
9. A 4-month-old infant diagnosed with CMT is referred for a physical therapy evaluation. Her mother first noticed the head preference at 1 month of age. A physical therapy student questions his supervising physical therapist about the timing of the infant’s referral. What is the most appropriate response?
   1. Yes, 4 months is appropriate.
   2. No, the infant should have been referred at 3 months.
   3. No, the physician should have instructed the parent in a stretching program and referred to physical therapy at 2 months if the head preference persisted.
   4. No, the infant should have been referred at 1 month when the head preference was first noticed.
10. A 5-month-old infant diagnosed with CMT is referred for a physical therapy evaluation. He exhibits a 20° right head tilt, cervical lateral flexion passive range of motion (PROM) right 55° and left 50°, and cervical rotation PROM right 110° and left 105°. His father states that he demonstrated no head preference until 3 weeks ago when he started to consistently tilt his head toward the right. This is confirmed by pictures of the infant on the father’s phone. Consulting Figure 1 of the 2018 CMT CPG, what is the most appropriate course of action?
    1. Refer the infant to his pediatrician for further diagnostic testing.
    2. Initiate physical therapy intervention.
    3. Refer the infant to his pediatrician for further diagnostic testing and initiate physical therapy intervention.
    4. No intervention or further referral is indicated.
11. A 3-month-old infant diagnosed with CMT is referred for an evaluation. She exhibits a 20° right head tilt, cervical lateral flexion passive range of motion (PROM) right 55° and left 40°, and cervical rotation PROM right 95° and left 110°. Her parents state that she has tended to look toward the left and tilt her head toward the right since birth. This is confirmed by pictures of the infant on their phone. What is the most appropriate course of action?
    1. Refer the infant to her pediatrician for further diagnostic testing.
    2. Initiate physical therapy intervention.
    3. Refer the infant to her pediatrician for further diagnostic testing and initiate physical therapy intervention.
    4. No intervention or further referral is indicated.
12. A 4-month-old infant diagnosed with CMT is referred for a physical therapy evaluation. He exhibits a 15° left head tilt, cervical lateral flexion passive range of motion (PROM) right 45° and left 55°, cervical rotation PROM right 100° and left 100°, and poor visual tracking. What is the most appropriate course of action?
    1. Refer the infant to his pediatrician for further diagnostic testing.
    2. Initiate physical therapy intervention.
    3. Refer the infant to his pediatrician for further diagnostic testing and initiate physical therapy intervention.
    4. No intervention or further referral is indicated.
13. A 5-month-old infant diagnosed with CMT is referred for a physical therapy evaluation. His mother asks how long her son will require physical therapy intervention. What is the most appropriate response?
    1. 1 to 3 months.
    2. 5 to 7 months.
    3. 9 to 11 months.
    4. 13 to 15 months.
14. A 2-month-old infant diagnosed with left CMT is referred for a physical therapy evaluation. Parents are concerned because she has a flat spot on the back, right side of her head, and her ears are not symmetrical. To address this concern, parents are instructed in positioning to encourage left cervical rotation. What is the most appropriate course of action?
    1. Monitor head shape until 4 to 6 months of age, then refer for cranial helmet assessment if indicated.
    2. Monitor head shape until 12 months of age, then refer for cranial helmet assessment if indicated.
    3. Refer immediately for cranial helmet assessment.
15. A 7-month-old infant with left CMT is receiving physical therapy intervention. What is the most appropriate intervention?
    1. Stretching into right cervical lateral flexion and left rotation
    2. Environmental adaptations to promote left cervical lateral flexion and left rotation
    3. Soft tissue massage to left sternocleidomastoid
    4. Kinesiotape to right sternocleidomastoid
16. A 9-month-old infant with right CMT is reassessed following 6 months of weekly physical therapy intervention. He has made minimal progress since his last reassessment 3 months ago. He demonstrates cervical lateral flexion PROM right 60° and left 40°, cervical rotation PROM right 85° and left 105°, MFS score 5/5 on the right and 3/5 on the left, an age equivalent of 9 months on the Alberta Infant Motor Scale, and a right head tilt of 15° in all positions. What is the most appropriate course of action?
17. Discontinue the infant from direct physical therapy and reassess in 3 to 6 months.
18. Continue with weekly physical therapy for 3 months, then reassess.
19. Discharge from physical therapy episode of care.
20. Refer the infant to an orthopedic surgeon for further diagnostic testing.
21. A 9-month-old infant with left CMT is reassessed following 6 months of weekly physical therapy intervention. The infant demonstrates cervical lateral flexion PROM left 50° and right 45°, cervical rotation PROM left 100° and right 105°, MFS score 5/5 on the left and 4/5 on the right, an age equivalent of 9 months on the Alberta Infant Motor Scale, and no head tilt in all positions. What is the most appropriate course of action?
    1. Discontinue the infant from direct physical therapy and reassess in 3 to 6 months.
    2. Continue with weekly physical therapy for 3 months, then reassess.
    3. Discharge from physical therapy episode of care.
    4. Refer the infant to an orthopedic surgeon for further diagnostic testing.

True or False

Indicate whether the statement is true or false.

1. Stretching for infants with torticollis should be aggressive and should be continued even if the infant resists the stretch or holds their breath.
2. The optimal dosage for CMT stretching is 15 repetitions per day with a 10- to 20-second hold.

Chapter 26