Watch the video version of this Q&A episode on YouTube - https://youtu.be/MW_zSbc8ajw

A physical therapist analyzes the gait of a child with spastic diplegia cerebral palsy in the school setting. Based on this diagnosis, which muscle group is MOST likely to be shortened?

1. Hip adductors
2. Knee extensors
3. Hip abductors
4. Ankle dorsiflexors

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A physical therapist analyzes the gait of a child with spastic diplegia cerebral palsy in the school setting. Based on this diagnosis, which muscle group is MOST likely to be shortened?

1. Hip adductors
2. Knee extensors
3. Hip abductors
4. Ankle dorsiflexors

Let’s take a quick dive into cerebral palsy.

Cerbrebral Palsy
Cerebral palsy is a non-progressive disorder of the central nervous system resulting in impairments in posture and volitional movement. It’s an umbrella term used to describe movement disorders due to brain damage acquired in utero, during birth or infancy. Cerebral palsy is classified by extremity involvement and muscle tone. 
 
Let’s break down this particular type of cerebral palsy. 

Spastic – Motor disturbance characterized by muscle spasms and hypertonia

Diplegia – Limb involvement typically involving the lower legs

Cerebral – Brain injury involving the cerebrum

Palsy – Resultant movement disorder

In summary, spastic diplegia describes an upper motor neuron lesion in the motor cortex of the cerebrum involving the trunk and lower extremities with the upper extremities affected to a lesser degree.

The question is asking, based on the diagnosis, which muscle group is MOST likely to be shortened?

Let’s explore each of the options:

Option 1 - Hip adductors 
During gait the combination of excessive hip flexion, adduction, and internal rotation produces a scissoring pattern. This type of gait deviation results primarily due to the presence of spasticity. 

Common management techniques of spasticity in this population include muscle lengthening or release of the shortened musculature. 

Skeletal muscle relaxants are also used to control spasticity and can be given orally, intrathecally, or through injection at the motor point. 

Option 2 - Knee extensors 
The knee flexors, not the knee extensors, are shortened as a result of the spasticity seen in children with spastic diplegia cerebral palsy.

Option 3 - Hip abductors 
The hip adductors, not the hip abductors, are shortened in children with spastic diplegia cerebral palsy.

Option 4 - Ankle dorsiflexors 
The plantar flexors, not the dorsiflexors, are shortened in children with spastic diplegia cerebral palsy resulting in limited active ankle dorsiflexion. 

Ankle-foot orthoses are commonly used to position the foot in dorsiflexion to facilitate foot clearance during the swing phase of gait or to decrease genu recurvatum.

The correct answer is Option 1

Let’s explore the all student data:
60% of students selected Option 1, Hip adductors, the correct response
17% of students selected Option 2, Knee extensors
8% of students selected Option 3, Hip abductors
15% of students selected Option 4, Ankle dorsiflexors

System Classification
This question is a Neuromuscular and Nervous Systems question which represents approximately 24% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 1 question since the question requires students to possess basic foundational academic knowledge. Remediation of Level 1 questions occurs through academic review of entry-level content using textbooks, review books, Basecamp, and flash cards.

Academic Focus Area
Looking to review related academic content? Check out pages 321, 338-339 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!