100+ Free ABPMR Pediatric Rehab Practice Questions

Cerebral Palsy & Spasticity Management

GMFCS levels I-V (I — walks without limitation; V — transported in manual wheelchair), MACS for upper-limb function, CFCS for communication, topographic classification (spastic diplegia/hemiplegia/quadriplegia, dyskinetic, ataxic, mixed), AACPDM hip surveillance (annual radiographs for GMFCS III-V; Reimers migration percentage >30% concerning, >50% needs reconstruction), oral baclofen/tizanidine/diazepam, botulinum toxin (onabotulinumtoxinA; max ~16 units/kg or 600 units), intrathecal baclofen, selective dorsal rhizotomy (SDR — best for GMFCS II-III spastic diplegia 4-8 yo), single-event multilevel surgery (SEMLS).

Neuromuscular Disorders (DMD, SMA)

Duchenne MD (X-linked Xp21 dystrophin deletion; Gower sign; calf pseudohypertrophy; loss of ambulation ~10-13 yo without steroids; corticosteroids — prednisone 0.75 mg/kg/day or deflazacort 0.9 mg/kg/day delay LOA 2-3 years; exon-skipping eteplirsen/golodirsen/casimersen/viltolarsen; gene therapy delandistrogene moxeparvovec — Elevidys AAV9 for ages 4+; nonsense-mutation ataluren). SMA (SMN1 5q13 homozygous deletion; types I-IV by age and milestones; nusinersen ASO intrathecal; onasemnogene abeparvovec — Zolgensma AAV9 IV for <2 yo; risdiplam oral). NIV/cough assist, scoliosis surveillance, cardiac surveillance.

Spina Bifida & Myelomeningocele

Neurologic level dictates ambulation prognosis: thoracic — wheelchair; L1-L2 household ambulation with KAFO/RGO; L3 community with KAFO; L4-L5 community with AFO; sacral — community ambulator without bracing. Chiari II malformation (almost universal in MMC), hydrocephalus and VP shunt malfunction (lethargy, headache, vomiting; emergent CT/shunt series), neurogenic bladder (CIC, anticholinergics — oxybutynin/tolterodine, mirabegron, augmentation cystoplasty), neurogenic bowel program, latex allergy precautions (10-70% prevalence), tethered cord syndrome (declining function, scoliosis, pain), MOMS trial (in-utero repair before 26 weeks reduces hindbrain herniation and shunting).

Pediatric Traumatic Brain Injury

Pediatric GCS modifications (verbal scoring adjusted for age), abusive head trauma (subdural hematoma + retinal hemorrhages + posterior rib fractures — mandatory reporting in all states), Rancho Pediatric Levels of Cognitive Functioning, Pediatric Cerebral Performance Category (PCPC), school re-entry (IEP/504 reactivation, gradual return), CISG 2022 graded return-to-school THEN return-to-play (Step 1 daily activities → Step 6 normal activity), agitation cautions (avoid benzodiazepines and typical antipsychotics; use environmental modifications first).

Equipment, Orthotics & Wheelchair Seating

Pediatric AFOs (solid AFO, hinged for stance dorsiflexion control, ground-reaction AFO for crouch gait, dynamic AFO), KAFO and reciprocating gait orthosis (RGO) for L2 spina bifida community ambulation, supramalleolar orthosis (SMO) for hypotonia/pronation, Milwaukee CTLSO and Boston TLSO for adolescent idiopathic scoliosis (Cobb 25-45° still growing per SRS), TLSO for paralytic scoliosis, manual vs power wheelchairs (power mobility appropriate as early as 18-24 months for severe disability), tilt-in-space, custom contoured seating, pressure mapping, gait trainers (Pacer/Rifton).

Pediatric Spinal Cord Injury

SCIWORA (Spinal Cord Injury Without Radiographic Abnormality — children <8 due to disproportionate head size, ligamentous laxity, horizontal facet joints; cervical predominance), pediatric ASIA examination modifications, autonomic dysreflexia >T6 (sit upright, find noxious stimulus — bladder distension #1), neurogenic bladder management (transition to CIC by age 5-6), thermoregulation impairment, pediatric pressure injury risk, growth-rod surgery for early-onset scoliosis (MAGEC/VEPTR), structured transition to adult SCI care.

Pediatric Stroke & Brachial Plexopathy

Perinatal arterial ischemic stroke (early hand preference <12 months is abnormal — red flag for hemiparetic CP), childhood arterial ischemic stroke etiologies (cardiac, arteriopathy, sickle cell, prothrombotic), sickle cell stroke prevention (chronic transfusion, hydroxyurea, transcranial Doppler screening — TCD velocity ≥200 cm/s), constraint-induced movement therapy (CIMT) and bimanual training, obstetric brachial plexopathy (Erb C5-C6 — waiter's tip; Klumpke C8-T1 — claw hand + Horner if T1 root involved), microsurgical repair if no biceps recovery by 3-6 months.

Limb Deficiency & Pediatric Prosthetics

Congenital deficiencies (longitudinal — fibular hemimelia is most common LE longitudinal; transverse) vs acquired pediatric amputation (trauma, sarcoma — osteosarcoma rotationplasty), prosthetic prescription tied to developmental milestones (passive UE prosthesis when sitting balance ~6 months; body-powered ~18 months; myoelectric typically 2-3+ years; LE prosthesis when pulling to stand 9-12 months), socket and prosthesis replacement frequency (socket every 12-18 months, full prosthesis q1-2 years through growth), bony overgrowth in acquired transverse LE amputation (revision surgery; rare in congenital).

Autism & Developmental Disabilities

DSM-5 ASD (persistent deficits in social communication AND restricted/repetitive behaviors with onset in early developmental period), M-CHAT-R/F screening at 18 and 24 months (AAP recommendation), ADOS-2 diagnostic, applied behavior analysis (ABA), Down syndrome (atlantoaxial instability — flexion/extension cervical X-rays before contact sports/Special Olympics; symptoms: gait change, neck pain, weakness, hyperreflexia), intellectual disability (DSM-5 — deficits in intellectual AND adaptive functioning), Fragile X (FMR1 CGG repeat — most common inherited ID), Rett syndrome (MECP2; girls; regression with hand-wringing stereotypies).

School-Based Therapy, IEP/504 & Transitions

IDEA 2004 Part C — Early Intervention birth to 3 years (Individualized Family Service Plan — IFSP); IDEA Part B ages 3-21 — Individualized Education Program (IEP) under 13 disability categories; Section 504 of Rehabilitation Act — accommodations for any student with a substantial limitation, broader eligibility than IDEA; FAPE (Free Appropriate Public Education); LRE (Least Restrictive Environment); transition planning required by IEP at age 16 (Individualized Transition Plan — ITP); ADA Title III; Got Transition Six Core Elements for transition from pediatric to adult medical care (typically initiated age 12-14).

Behavioral, Cognitive & Psychosocial

ADHD (DSM-5 — symptoms in two settings before age 12; stimulants methylphenidate/amphetamines, atomoxetine, alpha-2 agonists guanfacine/clonidine), depression and anxiety in chronic pediatric conditions (CDI, SCARED screens), family-centered care, sibling and parental adjustment, sleep disorders in CP/DMD/SMA (OSA, sleep-onset latency, restless sleep), pain assessment by age (FLACC for nonverbal/preverbal 2 mo-7 yr, FACES for 4-12, Numeric Rating Scale for adolescents), nonpharmacologic pain (CBT, distraction, hypnosis, parental coaching).

Gait & Motor Analysis

Normal gait development (independent walking 12-15 months, mature reciprocal arm swing by age 3, adult pattern by 7), instrumented 3D gait analysis (motion capture, surface/fine-wire EMG, kinetics with force plates) used for surgical planning in CP, Edinburgh Visual Gait Score (EVGS), Observational Gait Scale (OGS), common CP gait patterns (true equinus, jump knee, apparent equinus, crouch gait), Duchenne lordotic gait with toe-walking, standardized motor measures — GMFM-66 (CP), PEDI-CAT, BOT-2 motor proficiency, Bayley-4, AIMS for infants.