Helen Carey
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Hi Marie, thank you for bringing this to our attention. You are correct. We apologize for the confusion. Technically, Mann Whitney U or Chi-squared test could be correct for this question as they are both non-parametric tests (and t-test and pearson correlation are parametric tests). Mann Whitney U is recommended for ordinal-level data that can be ranked (such as attributes that can be ranked: IVH grades, MMT grades), although we don’t know the exact distance between the ranks/values. Chi-square is recommended for nominal or categorical outcomes where you can label an attribute, but they aren’t ranked (lowest level of measurement, such as race, gender).
Regarding use of parametric tests, ratio level data has a natural zero and is the highest level of measurement (time, distance, etc) while interval level data has a designated order and distance between values but not a natural zero (temperature).
Most of our therapy measures are ordinal or interval level. The best example is that the GMFM-88 is an ordinal scale because the exact difference between item scores can’t be determined. However, the GMFM-66 underwent Rasch analysis to determine item difficulty and convert the test to an interval scale: the GMAE software can calculate score changes based on item difficulty because the difference between score values is known. I have often read that many of our pediatric measures (PDMS, Bayley, etc) are “interval-like” and sort of hover between interval and ordinal data. That is why you often see parametric tests used to analyze that data in studies.
Thank you!
HelenHi Marie,
I believe that the text is correct as end-expiratory lung volume would be the reserve of air left in the lungs after expiration. This residual volume is important to keep the lungs inflated (reduce change of collapsing). A greater inspiration (“prolonged slow inspiration”) would increase the inspiratory lung volumes, which would influence functional residual capacity after expiration, which improves lung volume at rest and decreases atelectasis (collapse of a lung, or part of a lung, due to the alveoli losing air). The youtube video below explains the different lung volumes.I hope this helps!
HelenAlso, the PCS exam shouldn’t ask questions where their is distinct variability across states, such as specific components of EI eligibility that vary from state to state. It would seem impossible to have a correct answer.
Hi Kaci,
This is a great discussion topic. I would suspect that in most states, PTs would need to go through the child’s PCP or another specialist involved in the child’s care. For the purpose of exam questions, I would interpret a referral question less literally, such as who the child would benefit from seeing for a consult, and not literally that you would make the referral. The exception would be a question asking directly about the PT’s scope of care and legal requirements. In our practice questions, we are probing to see if you understand clinical characteristics that indicate a specific diagnosis/condition/clinical problem needing further examination by another professional. Being able to determine when a patient’s problem is beyond the scope of a PTs knowledge and competence for care is an important clinical practice competency. We teach it in DPT education, it is a part of the new Competency Based Education framework, and is included in Direct Access legislation in many states (and also practice acts). I hope this helps!
Helen(From the link above): Spinal muscular atrophy (SMA) is a rare genetic disease caused by the deletion or mutation of the survival motor neuron 1 (SMN1) gene. The SMN1 gene produces survival motor neuron (SMN) protein that is critical for normal function of motor neurons.
Patients with SMA have an insufficient amount of SMN protein, which leads to permanent loss of motor neurons. Untreated, SMA Type 1 is the number one genetic cause of infant death.
Yes, I would plan to answer questions related to SMA1 based on typical progression. Current gene therapies change the genetics and allow the infants to produce the appropriate components.
I am not sure if meds will be listed on the exam with their retail/brand name, generic, or chemical name. Hopefully, questions will name the drug more than 1 way.
Best practice would indicate that you should use the least restrictive device possible, since devices add weight and bulk and can unintentionally hinder function (such as AFOs hindering crawling and sitting on the floor, but providing stability in stance). AFOs can sometimes assist with knee hyperextension in stance, depending on the child’s biomechanics and tone.
Yes, the APPT has a fact sheet. That is why we didn’t do one.
Yes, a hinged AFO can have a posterior strap (usually D-ring with velcro) which can adjust the amount of DF allowed. That could be useful if the child crouches instead of posturing into PF.
Hi,
You definitely want to know side effects as we should be able to identify those when present with a child in a session. The study guide groups meds by class, which should help you be able to identify mechanisms and such on an exam.Orthoses are tough and not well covered in any of the major textbooks. You definitely want to know the function of each device, such as motions they block, motions they allow, etc. Posterior leaf spring is flimsy so designed to support foot drop; it won’t hold up to spasticity such as equinus/ankle PF posturing. Hinged and solid AFOs function primarily to block PF posturing, so are best in spastic situations. The hinge allows for ankle DF for functional tasks, such as squatting and descending stairs (plus forward advancement of the tibia during stance phase of gait). Do you have any specific questions?
Great question! The exam is supposed to reflect contemporary practice, so focus on those orthoses that are most common currently in practice. In situations like these, it’s generally good to know how the orthoses might be similar and different, in case a question wants you to identify the most appropriate device for a particular clinical scenario.
