Pediatric Physiotherapy
This domain tests developmental surveillance, primitive reflex knowledge, and condition-specific management in infants and children. Items typically present an age and a behaviour and ask whether it is normal, delayed, or a sign of neurological dysfunction.
Milestone anchors
- 3 months: head control in supported sitting, social smile, hands open more than fisted.
- 6 months: rolls, sits with support, palmar grasp, reaches with both hands.
- 9 months: sits independently, crawls or commando crawls, begins pincer grasp.
- 12 months: pulls to stand, walks with one hand held, mature pincer.
- 15–18 months: walks independently; 2 years: runs and climbs stairs with a rail. Persistent fisting after 3–4 months, strong asymmetry, or no head control by 4–5 months are red flags.
Primitive reflexes and integration
Moro, asymmetrical tonic neck reflex and palmar grasp integrate around 4–6 months; symmetrical tonic neck reflex around 8–12 months; positive support by 2 months. Persistence beyond the expected window suggests central nervous system dysfunction.
Condition-specific essentials
- Cerebral palsy: classified by GMFCS I–V; spastic diplegia is common after prematurity. Strength training is safe and does not increase spasticity; goals should be functional and family-centred.
- Down syndrome: generalised hypotonia; atlantoaxial instability affects a minority (roughly 10–15%), so avoid forced neck hyperflexion and check screening before contact sport.
- Obstetric brachial plexus injury: Erb's palsy (C5–C6) gives the waiter's-tip posture; Klumpke's (C8–T1) gives claw hand and possible Horner's syndrome.
- Congenital muscular torticollis: sternocleidomastoid tightness; early stretching and positioning are most effective in the first months.
- Clubfoot: the Ponseti method uses serial casting, often an Achilles tenotomy, then a foot abduction brace.
Worked example
A 7-month-old does not roll, keeps the hands fisted, cannot sit, and the asymmetrical tonic neck reflex is still strongly present. Reasoning: this reflex should have integrated by 4–6 months, and its persistence with fisting and delayed sitting indicates abnormal tone and postural control rather than simple delay. Refer for developmental and neurological assessment, and begin family-centred positioning and handling advice rather than a strengthening programme.
Traps that cost marks
- Treating a milestone as delayed without checking whether it is a range, not a deadline.
- Missing reflex persistence because the child is otherwise sociable.
- Prescribing resisted exercise as the first response to hypotonia.