ABPTS PWCS cheat sheet

Gross motor milestones: head control ~3-4 months, independent sitting ~6-8 months, pulling to stand ~9 months, independent walking ~12-15 months.

Fine motor sequence: palmar grasp ~5 months, raking ~7 months, pincer grasp ~9-10 months, voluntary release ~12 months.

Primitive reflexes integrate on a schedule: Moro ~4-6 months, ATNR ~6 months, STNR ~9-12 months; persistence beyond these windows signals atypical development.

Prematurity correction: chronological age minus weeks born early, applied until 24 months corrected age for motor and cognitive milestone comparison.

Cerebral palsy classification by tone and topography (spastic, dyskinetic, ataxic; diplegia, hemiplegia, quadriplegia); GMFCS levels I-V describe ambulation prognosis.

Spina bifida: level of lesion predicts function; thoracic lesions typically non-ambulatory, sacral lesions typically community ambulatory; monitor for shunt malfunction and latex allergy.

Down syndrome features include hypotonia, ligamentous laxity, atlantoaxial instability, and increased risk of congenital heart defects; screen for cervical instability before contact activity.

Duchenne muscular dystrophy: X-linked dystrophin deficiency; Gowers sign, calf pseudohypertrophy, proximal weakness; ambulation loss typically in early second decade.

Reliability = consistency of measurement; validity = accuracy in measuring the intended construct; sensitivity detects true positives, specificity detects true negatives.

Standard scores have mean 100 and SD 15; scaled scores mean 10 SD 3; T-scores mean 50 SD 10; z-scores mean 0 SD 1.

Age-equivalent scores do not permit comparison across domains and should not be used to quantify developmental change.

Range of motion, manual muscle testing, and goniometry are impairment-level measures; functional mobility tools (e.g., GMFM, PEDI) are activity-level measures.

Muscle tone grading uses the Modified Ashworth Scale (0-4); deep tendon reflexes graded 0-4+ with 2+ as normal.

Pediatric strength testing: MMT is unreliable below ~5 years; use functional observation or hand-held dynamometry with standardized positioning.

Red flags requiring referral: loss of previously acquired skills, asymmetric movement, persistent primitive reflexes, and head circumference crossing percentile lines.

Motor learning principles: practice specificity, variable practice, blocked-to-random progression, and external focus of attention enhance skill acquisition.

Neuroplasticity drivers: task-specific repetition, intensity, salience, and active engagement; constraint-induced movement therapy restricts the less-affected limb in hemiparesis.

Torticollis intervention: passive stretching of the sternocleidomastoid, positioning, and environmental setup to promote rotation toward the restricted side.

Gait training in pediatrics uses partial body-weight support and treadmill systems; dosage is a key determinant of outcomes.

Outcome measures should match the ICF domain targeted: body function (ROM, strength), activity (GMFM, PEDI), participation (PEM-CY).

Orthotic goals: maintain alignment, prevent deformity, and improve function; serial casting is used for progressive contracture or tone management.

Goal attainment scaling quantifies individualized goals with a five-point scale from -2 (less than expected) to +2 (much greater than expected).

Autonomy, beneficence, nonmaleficence, justice, and veracity are core ethical principles guiding pediatric physical therapy decisions.

Informed consent for minors requires parent or guardian permission plus, where developmentally appropriate, child assent.

Mandated reporting: suspected child abuse or neglect must be reported to designated authorities regardless of confidentiality concerns.

Scope of practice is defined by state practice acts; direct access rules and supervision requirements for assistants vary by jurisdiction.

Documentation must be timely, objective, and defensible; it is a legal record and may be subpoenaed.

Conflict of interest and gifts from vendors should follow institutional policy and professional association guidance.

Confidentiality under HIPAA permits disclosure for treatment, payment, and operations; minimum necessary standard applies.

Evidence hierarchy from strongest to weakest: systematic reviews/meta-analyses, randomized controlled trials, cohort studies, case-control, case series, expert opinion.

EBP triad: best available evidence, clinical expertise, and patient/family values and preferences.

PICO formats a clinical question: Population, Intervention, Comparison, Outcome.

Intention-to-treat analysis preserves randomization; per-protocol analysis can introduce bias.

p-value is the probability of observing results at least as extreme assuming the null hypothesis is true; it is not the probability the null is true.

Confidence intervals convey precision; a 95% CI excluding the null value corresponds to p < 0.05 in a two-sided test.

Quality improvement uses PDSA cycles (Plan-Do-Study-Act) and measures structure, process, and outcome.

Family-centered care places the family as the decision-making unit; goals are co-created with caregivers.

Teach-back confirms comprehension by asking the learner to explain or demonstrate the content in their own words.

Health literacy strategies: plain language, chunking, limiting to 3-5 key points, and using visuals.

Interprofessional collaboration requires role clarity, shared goals, and closed-loop communication.

IEP and 504 plans: IEP provides specialized instruction under IDEA; 504 provides accommodations under Section 504 of the Rehabilitation Act.

Interpreters should be trained medical interpreters, not family members, to maintain accuracy and confidentiality.

Consultation models include direct service, monitoring, and collaborative coaching; coaching builds caregiver capacity for carryover.

Gross motor milestones: head control ~3-4 months, sitting ~6-8 months, pulling to stand ~9 months, walking ~12-15 months.

Fine motor: palmar grasp ~5 months, pincer grasp ~9-10 months, voluntary release ~12 months.

Primitive reflexes integrate: Moro ~4-6 months, ATNR ~6 months, STNR ~9-12 months.

Prematurity corrected age = chronological age minus weeks early, until 24 months corrected.

GMFCS I-V describes ambulation prognosis in cerebral palsy; level I ambulates independently, level V is transported.

Duchenne muscular dystrophy: X-linked dystrophin deficiency with Gowers sign and calf pseudohypertrophy.

Down syndrome risks include hypotonia, atlantoaxial instability, and congenital heart defects.

Spina bifida lesion level predicts ambulation: thoracic lesions typically non-ambulatory, sacral typically ambulatory.

Sensitivity detects true positives; specificity detects true negatives; reliability is consistency, validity is accuracy.

Standard scores mean 100 SD 15; scaled mean 10 SD 3; T-score mean 50 SD 10; z-score mean 0 SD 1.

Age-equivalent scores should not be used to compare across developmental domains.

Modified Ashworth Scale grades spasticity 0-4; deep tendon reflexes graded 0-4+ with 2+ normal.

MMT is unreliable below ~5 years; use functional observation or hand-held dynamometry.

Red flags: loss of acquired skills, asymmetric movement, persistent primitive reflexes, head circumference crossing percentiles.

GMFM and PEDI measure activity-level function; goniometry and MMT measure impairment-level body function.

Motor learning: variable practice, task specificity, and external focus of attention improve skill retention.

Constraint-induced movement therapy restricts the less-affected limb to drive use of the hemiparetic limb.

Torticollis: passive SCM stretching plus positioning to promote rotation toward the restricted side.

Goal attainment scaling uses a five-point scale from -2 to +2 around the expected outcome.

Outcome measures should match the ICF domain: body function, activity, or participation.

Orthoses maintain alignment, prevent deformity, and improve function; serial casting addresses contracture.

Dosage (repetitions, intensity, frequency) is a primary determinant of pediatric motor outcomes.

Core ethical principles: autonomy, beneficence, nonmaleficence, justice, and veracity.

Informed consent for minors requires guardian permission plus developmentally appropriate child assent.

Suspected child abuse or neglect must be reported to designated authorities regardless of confidentiality.

State practice acts define scope of practice, direct access, and supervision of assistants.

HIPAA permits disclosure for treatment, payment, and operations under the minimum necessary standard.

Documentation is a legal record; entries must be timely, objective, and defensible.

Gifts and conflicts of interest with vendors follow institutional policy and professional association guidance.

Evidence hierarchy: systematic reviews/meta-analyses, RCTs, cohort, case-control, case series, expert opinion.

EBP triad: best evidence, clinical expertise, and patient/family values and preferences.

PICO = Population, Intervention, Comparison, Outcome.

Intention-to-treat analysis preserves randomization; per-protocol analysis can introduce bias.

A p-value is the probability of results at least as extreme assuming the null hypothesis is true.

A 95% CI excluding the null corresponds to p < 0.05 in a two-sided test.

PDSA cycles (Plan-Do-Study-Act) drive quality improvement; measures are structure, process, and outcome.

Family-centered care makes the family the decision-making unit with co-created goals.

Teach-back confirms comprehension by having the learner explain or demonstrate in their own words.

Health literacy: plain language, chunking to 3-5 key points, and visual supports.

IDEA governs IEP specialized instruction; Section 504 provides accommodations.

Use trained medical interpreters rather than family members for accuracy and confidentiality.

Closed-loop communication and role clarity support interprofessional collaboration.

Coaching models build caregiver capacity and carryover compared with direct service alone.

Head control ~3-4 months, independent sitting ~6-8 months, walking ~12-15 months.

Pincer grasp emerges ~9-10 months; voluntary release ~12 months.

Moro integrates by ~4-6 months; ATNR by ~6 months; STNR by ~9-12 months.

Corrected age for prematurity applies until 24 months corrected.

GMFCS levels I-V stratify ambulation in cerebral palsy.

Duchenne muscular dystrophy is X-linked with Gowers sign and calf pseudohypertrophy.

Down syndrome: hypotonia, atlantoaxial instability, congenital heart defects.

Spina bifida: lesion level predicts ambulation potential.

Sensitivity = true positive rate; specificity = true negative rate.

Standard score mean 100 SD 15; T-score mean 50 SD 10.

Age-equivalent scores do not allow cross-domain comparison.

Modified Ashworth Scale grades spasticity 0-4.

MMT unreliable below ~5 years of age.

Red flags include loss of acquired skills and asymmetric movement.

GMFM and PEDI assess activity-level function.

Variable practice and external focus enhance motor learning.

CIMT restricts the less-affected limb in hemiparesis.

Torticollis treatment combines SCM stretching and positioning.

Goal attainment scaling ranges from -2 to +2.

Match outcome measures to the ICF domain targeted.

Orthoses maintain alignment and prevent deformity.

Dosage drives pediatric motor outcomes.

Ethical principles: autonomy, beneficence, nonmaleficence, justice, veracity.

Minors require guardian consent plus child assent when appropriate.

Mandated reporting overrides confidentiality for suspected abuse.

State practice acts define scope and supervision rules.

HIPAA permits treatment, payment, and operations disclosures.

Documentation is a legal record requiring objectivity and timeliness.

Vendor gifts follow institutional and association policy.

RCTs rank above cohort and case-control studies in the evidence hierarchy.

EBP integrates evidence, expertise, and patient values.

PICO structures clinical questions.

Intention-to-treat preserves randomization.

p-value assumes the null hypothesis is true.

95% CI excluding the null implies p < 0.05.

PDSA cycles structure quality improvement.

Family-centered care makes families the decision-making unit.

Teach-back verifies comprehension through learner explanation.

Plain language and chunking improve health literacy.

IDEA governs IEPs; Section 504 governs accommodations.

Use trained medical interpreters, not family members.

Closed-loop communication supports interprofessional teams.

Coaching builds caregiver capacity and carryover.

Walking typically emerges between 12 and 15 months of age.

Pincer grasp typically emerges around 9-10 months.

Moro reflex integrates by approximately 4-6 months.

Corrected age applies until 24 months for premature infants.

GMFCS level V indicates transport rather than independent ambulation.

Duchenne muscular dystrophy shows Gowers sign and calf pseudohypertrophy.

Atlantoaxial instability warrants screening in Down syndrome.

Sacral spina bifida lesions are typically community ambulatory.

Specificity reflects the true negative rate of a test.

T-scores have a mean of 50 and SD of 10.

Age-equivalent scores are not valid for cross-domain comparison.

Modified Ashworth Scale scores range from 0 to 4.

Deep tendon reflexes grade 2+ as normal.

Hand-held dynamometry offers standardized pediatric strength testing.

Loss of acquired skills is a red flag for referral.

Task-specific repetition drives neuroplasticity in pediatric intervention.

CIMT restricts the less-affected limb to promote hemiparetic use.

Passive SCM stretching addresses congenital muscular torticollis.

Goal attainment scaling ranges from -2 to +2.

PEM-CY captures participation-level outcomes.

Serial casting addresses progressive contracture.

Intensity and frequency of practice determine motor outcomes.

Nonmaleficence means avoiding harm in clinical decisions.

Guardian consent plus child assent supports pediatric informed consent.

Mandated reporting applies regardless of confidentiality.

Direct access rules derive from state practice acts.

Minimum necessary standard limits HIPAA disclosures.

Clinical documentation may be subpoenaed as a legal record.

Conflict-of-interest policies govern vendor relationships.

Meta-analyses rank at the top of the evidence hierarchy.

EBP requires integrating patient values with evidence.

PICO includes Population, Intervention, Comparison, Outcome.

Per-protocol analysis can introduce selection bias.

p-value does not equal the probability the null is true.

Confidence intervals convey estimate precision.

PDSA stands for Plan-Do-Study-Act.

Family-centered care co-creates goals with caregivers.

Teach-back asks learners to explain content in their own words.

Limiting teaching to 3-5 key points aids retention.

IEPs provide specialized instruction under IDEA.

Section 504 provides accommodations for disability.

Trained medical interpreters preserve accuracy and confidentiality.

Coaching models build caregiver capacity for carryover.

Independent sitting typically emerges between 6 and 8 months.

Voluntary release typically emerges around 12 months.

ATNR integrates by approximately 6 months of age.

Corrected age subtracts weeks of prematurity from chronological age.

GMFCS level I indicates independent ambulation without limitations.

Duchenne muscular dystrophy results from dystrophin deficiency.

Hypotonia is a hallmark feature of Down syndrome.

Thoracic-level spina bifida typically results in non-ambulation.

Sensitivity reflects a test's true positive rate.

Standard scores have a mean of 100 and SD of 15.

Modified Ashworth Scale grades resistance to passive movement.

MMT is unreliable in children under about 5 years.

Goniometry measures impairment-level range of motion.

Asymmetric movement patterns warrant further evaluation.

Head circumference crossing percentile lines is a red flag.

External focus of attention improves motor skill learning.

Torticollis positioning promotes rotation toward the restricted side.

Goal attainment scaling scores range from -2 to +2.

GMFM measures activity-level gross motor function.

Orthoses maintain alignment and prevent deformity.

Partial body-weight support treadmill training supports gait acquisition.

Dosage includes repetitions, intensity, and frequency.

Justice concerns fair distribution of services and resources.

Child assent accompanies guardian consent when developmentally appropriate.

Suspected neglect must be reported to designated authorities.

Supervision requirements for assistants vary by state practice act.

HIPAA applies the minimum necessary standard to disclosures.

Objective, timely documentation supports legal defensibility.

Institutional policy governs vendor gifts and conflicts.

Systematic reviews rank highest in the evidence hierarchy.

Clinical expertise is one element of the EBP triad.

PICO outcome defines the measured result of interest.

Intention-to-treat analysis preserves randomization benefits.

A p-value assumes the null hypothesis is true.

A 95% CI excluding the null implies statistical significance.

PDSA cycles test small changes iteratively.

Family-centered care treats the family as the decision-making unit.

Teach-back verifies understanding through learner demonstration.

Plain language and visuals support health literacy.

IDEA governs IEP specialized instruction and services.

Section 504 provides accommodations, not specialized instruction.

Trained medical interpreters maintain accuracy and confidentiality.

Closed-loop communication confirms message receipt in teams.

Head control typically emerges by 3-4 months of age.

Pulling to stand typically emerges around 9 months.

STNR integrates by approximately 9-12 months.

Corrected age is used until 24 months corrected for prematurity.

GMFCS levels stratify ambulation prognosis in cerebral palsy.

Gowers sign suggests proximal weakness such as Duchenne dystrophy.

Atlantoaxial instability requires screening in Down syndrome.

Lesion level predicts ambulation in spina bifida.

Specificity reflects a test's true negative rate.

Scaled scores have a mean of 10 and SD of 3.

Age-equivalent scores should not quantify developmental change.

Deep tendon reflexes are graded 0 to 4+ with 2+ normal.

PEDI measures activity-level functional performance.

Hand-held dynamometry standardizes pediatric strength measurement.

Persistent primitive reflexes beyond expected windows are a red flag.

Variable practice improves retention compared with blocked practice.

CIMT restricts the less-affected limb in hemiparetic children.

Passive SCM stretching addresses congenital muscular torticollis.

Goal attainment scaling ranges from -2 to +2 around expectation.

Match outcome measures to the targeted ICF domain.

Serial casting addresses progressive contracture or tone.

Repetition and intensity are key dosage variables.

Beneficence means acting for the patient's benefit.

Guardian permission plus child assent supports pediatric consent.

Mandated reporting applies even when confidentiality is claimed.

State practice acts define direct access and supervision.

HIPAA permits treatment, payment, and operations disclosures.

Documentation is a legal record that may be subpoenaed.

Vendor gifts follow institutional and professional policy.

RCTs rank above observational studies in the evidence hierarchy.

Patient values are one element of the EBP triad.

PICO comparison defines the alternative to the intervention.

Per-protocol analysis can introduce selection bias.

p-value is not the probability the null is true.

Confidence intervals convey precision of estimates.

PDSA stands for Plan-Do-Study-Act cycles.

Family-centered care co-creates goals with caregivers.

Teach-back asks learners to explain content in their own words.

Chunking limits teaching to 3-5 key points.

IEPs provide specialized instruction under IDEA.

Section 504 provides accommodations under the Rehabilitation Act.

Trained medical interpreters preserve accuracy and confidentiality.

Coaching models build caregiver capacity for carryover.

Independent sitting typically emerges between 6 and 8 months.

Pincer grasp typically emerges around 9-10 months.

Moro reflex integrates by approximately 4-6 months.

Corrected age applies until 24 months corrected.

GMFCS level V indicates transport rather than ambulation.

Duchenne muscular dystrophy is X-linked dystrophin deficiency.

Hypotonia and ligamentous laxity occur in Down syndrome.

Sacral spina bifida lesions are typically ambulatory.

Sensitivity detects true positives; specificity detects true negatives.

Standard scores mean 100 SD 15; T-scores mean 50 SD 10.

Age-equivalent scores do not permit cross-domain comparison.

Modified Ashworth Scale grades spasticity from 0 to 4.

MMT is unreliable below about 5 years of age.

GMFM and PEDI measure activity-level function.

Loss of acquired skills is a red flag for referral.

Task specificity and repetition drive motor learning.

CIMT restricts the less-affected limb in hemiparesis.

Torticollis treatment combines SCM stretching and positioning.

Goal attainment scaling ranges from -2 to +2.

PEM-CY captures participation-level outcomes.

Orthoses maintain alignment and prevent deformity.

Dosage includes repetitions, intensity, and frequency.

Autonomy, beneficence, nonmaleficence, justice, and veracity guide decisions.

Minors require guardian consent plus developmentally appropriate assent.

Suspected abuse must be reported regardless of confidentiality.

State practice acts define scope and supervision rules.

HIPAA minimum necessary standard limits disclosures.

Documentation is a legal record requiring objectivity.

Conflict-of-interest policies govern vendor gifts.

Systematic reviews and meta-analyses rank highest in evidence hierarchy.

EBP integrates evidence, expertise, and patient values.

PICO structures clinical questions.

Intention-to-treat preserves randomization.

p-value assumes the null hypothesis is true.

95% CI excluding the null implies p < 0.05.

PDSA cycles structure quality improvement.

Family-centered care makes families the decision-making unit.

Teach-back verifies comprehension through learner explanation.

Plain language and chunking improve health literacy.

IDEA governs IEPs; Section 504 governs accommodations.

Use trained medical interpreters, not family members.

Closed-loop communication supports interprofessional teams.

Coaching builds caregiver capacity and carryover.