National Physical Therapy Examination (NPTE) Practice Exam

What is the most appropriate recommendation for managing scoliosis in a 4-year-old with L1 myelomeningocele and a 25° curve?

1. Continue to monitor with no intervention

2. Begin a home program of stretching exercises

3. Refer to an orthopedic surgeon for spinal fusion

4. Fit with a thoracolumbosacral orthosis

The correct answer is: Fit with a thoracolumbosacral orthosis

The most appropriate recommendation for managing scoliosis in a 4-year-old with L1 myelomeningocele and a 25° curve is to fit with a thoracolumbosacral orthosis (TLSO). This choice is supported by the fact that children with myelomeningocele are at increased risk for scoliosis due to the neurological deficits associated with their condition. A curve of 25° is significant enough to warrant intervention to prevent progression, especially in a growing child where untreated scoliosis could lead to worsening deformity and associated complications later on. The use of a TLSO can help in stabilizing the spine and managing the curvature as the child grows. It can also facilitate corrective alignment, which is crucial for maintaining functional mobility and postural stability for the child. Early intervention with a brace is often recommended in cases of scoliosis combined with myelomeningocele to minimize the risk of further deformity and to support overall alignment. Monitoring without intervention may not be sufficient given the existing curvature; scoliosis can worsen over time, particularly in children with underlying muscular or neurological issues. A home stretching program primarily addresses muscle tightness rather than the structural element of the curve itself, making it less suitable as a standalone approach. Referral