ABPTS NCS cheat sheet

Upper motor neuron signs: hyperreflexia, spasticity, Babinski sign, clonus, and loss of dexterity; lower motor neuron signs: fasciculations, atrophy, hypotonia, and areflexia.

UMN lesions affect a region or limb pattern; LMN lesions map to a single root or peripheral nerve territory.

Cerebellar signs: dysmetria, intention tremor, ataxia, dysdiadochokinesia, and gait wide-based; strength is preserved.

Basal ganglia signs: resting tremor, rigidity, bradykinesia, and postural instability (Parkinsonism); dopamine-responsive.

Sensory ataxia worsens with eyes closed (positive Romberg) and with reduced position sense; cerebellar ataxia does not.

Brown-Séquard syndrome: ipsilateral motor and proprioceptive loss with contralateral pain and temperature loss below the lesion.

Central cord syndrome: greater arm than leg weakness, often after hyperextension in a stenotic cervical spine.

Radiculopathy follows a dermatomal/myotomal pattern with positive neurodynamic tests; myelopathy adds UMN signs and bowel/bladder change.

Red flags mandating referral: saddle anesthesia, new bowel/bladder dysfunction, progressive bilateral weakness, or fever with spinal pain.

Mental status: arousal, orientation, attention, memory, and executive function; the Mini-Mental State Examination scores 0-30 with 24 or below suggesting impairment.

Cranial nerve screen covers I-XII; note pupillary light reflex (II, III), extraocular movements (III, IV, VI), and facial symmetry (VII).

Manual muscle testing grades 0-5; 3/5 indicates antigravity movement through full range without added resistance.

Deep tendon reflexes graded 0-4+; 2+ is normal, 3+ is brisk, and 4+ includes clonus.

Sensation tested by light touch, pinprick, vibration (128 Hz), and proprioception; compare dermatomes bilaterally.

Coordination: finger-to-nose, heel-to-shin, rapid alternating movements, and tandem stance; note intention tremor.

Balance outcome measures: Berg Balance Scale (0-56; below 45 predicts fall risk) and Timed Up and Go (over 12 seconds indicates increased fall risk).

Gait speed below 0.8 m/s indicates limited community ambulation; 1.0 m/s or more supports community ambulation.

Stroke recovery is fastest in the first 3-6 months; motor recovery plateau often occurs by 6-12 months but varies by lesion.

Prognostic indicators after stroke: initial motor severity, sitting balance by 2-4 weeks, age, and presence of hemispatial neglect.

Task-specific, high-repetition practice drives neuroplasticity; intensity and salience are key dosing variables.

Constraint-induced movement therapy requires some active wrist and finger extension and is contraindicated with severe neglect or poor cognition.

Locomotor training with body-weight support and treadmill is indicated when overground gait is unsafe or low endurance.

Prognosis after spinal cord injury depends on level and completeness (ASIA Impairment Scale A-E); AIS A has poorest ambulation prognosis.

Goal setting uses SMART criteria and patient-centered priorities; prognosis informs realistic timeframes for goal attainment.

Discharge planning addresses home environment, caregiver training, durable medical equipment, and community reintegration needs.

Spasticity management: sustained stretch, positioning, and serial casting; botulinum toxin or intrathecal baclofen for focal or generalized tone.

Neurodevelopmental treatment and proprioceptive neuromuscular facilitation emphasize handling, facilitation, and movement quality.

Functional electrical stimulation can assist dorsiflexion for foot drop and upper extremity reach in selected patients.

Vestibular rehabilitation: habituation for positional vertigo, adaptation for gaze stability, and substitution for bilateral loss.

Gait training for Parkinson disease: external cues (auditory, visual) and large-amplitude stepping reduce freezing.

Pressure injury prevention in immobility: reposition at least every 2 hours and inspect skin at high-risk sites.

Respiratory management in neuromuscular disease: incentive spirometry, assisted cough, and monitoring vital capacity trends.

Dual-task training and balance perturbation training reduce fall risk in chronic neurologic populations.

Motor development proceeds cephalocaudal and proximodistal; head control precedes rolling, sitting, crawling, and walking.

Typical milestones: independent sitting by 6-8 months, cruising by 9-12 months, and independent walking by 12-15 months.

Primitive reflexes (Moro, ATNR, palmar grasp) integrate in the first 4-6 months; persistence suggests neurologic concern.

Postural control requires somatosensory, visual, and vestibular inputs integrated with anticipatory and reactive adjustments.

Aging reduces reaction time, strength, and sensory acuity, increasing fall risk and slowing gait speed.

Gait cycle: stance is about 60% and swing about 40% of the cycle; double support increases with age and pathology.

Functional mobility training should match the patient's environment and task demands, not just clinic performance.

Pediatric tone and reflex assessment guides positioning and equipment prescription for cerebral palsy and similar conditions.

Anticoagulants (warfarin, heparin, DOACs) increase bleeding risk; monitor for bruising and avoid aggressive manual therapy over vascular structures.

Corticosteroids cause muscle weakness, osteoporosis, and impaired wound healing with prolonged use.

Antispasticity agents: baclofen (intrathecal or oral), tizanidine, and diazepam; monitor sedation and weakness.

Levodopa with carbidopa is the mainstay of Parkinson disease; dyskinesias and on-off fluctuations emerge with long-term use.

Antiepileptics (phenytoin, carbamazepine) can cause ataxia and sedation; monitor balance and gait changes.

Post-surgical precautions: spinal fusion restricts flexion and rotation; craniotomy avoids Valsalva and straining initially.

Autonomic dysreflexia in T6 or higher SCI: sudden hypertension, headache, and bradycardia; sit upright and identify the trigger.

Deep vein thrombosis risk after stroke or SCI: monitor for unilateral swelling and pain; early mobilization and prophylaxis reduce risk.

Fall prevention education includes home hazard removal, adequate lighting, and appropriate footwear.

Physical activity guidelines for adults: at least 150 minutes of moderate activity weekly plus strength training twice weekly.

Stroke risk reduction targets blood pressure, smoking cessation, diabetes control, and physical activity.

Teach-back confirms comprehension; ask the patient to explain the plan in their own words.

Health literacy affects adherence; use plain language, visual aids, and limit information per session.

Caregiver education should cover safe transfers, assistive device use, and emergency warning signs.

Secondary prevention after stroke includes antiplatelet or anticoagulant therapy and control of vascular risk factors.

Screen for depression and social isolation in neurologic populations; refer when indicated.

Autonomy requires informed consent and respecting patient choices; beneficence and nonmaleficence guide intervention selection.

Scope of practice: refer to other providers when findings exceed PT expertise or when red flags appear.

Documentation should be objective, timely, and include skilled interventions, patient response, and progress toward goals.

Interprofessional collaboration improves outcomes in stroke, SCI, and neurodegenerative care through shared goal setting.

Confidentiality is governed by HIPAA; disclose protected health information only as permitted.

Conflict of interest: disclose financial or personal interests that could influence clinical decisions.

Advocacy includes addressing access barriers, equipment funding, and environmental modifications for patients.

Supervision of support personnel follows state practice acts and requires delegation within the PT's competence.

Evidence hierarchy: systematic reviews and randomized controlled trials rank above cohort studies, case series, and expert opinion.

Sensitivity is the ability to detect disease when present; specificity is the ability to rule out disease when absent.

Positive predictive value depends on prevalence; likelihood ratios are less affected by prevalence.

Number needed to treat equals 1 divided by the absolute risk reduction.

Minimal clinically important difference is the smallest change patients perceive as beneficial; it differs from statistical significance.

Internal validity threats include selection bias, attrition, and lack of blinding; randomization reduces selection bias.

Quality improvement uses Plan-Do-Study-Act cycles and measures structure, process, and outcomes.

Outcome measures should be reliable, valid, and responsive for the population and setting used.

Motor development proceeds cephalocaudal and proximodistal; head control precedes rolling, sitting, crawling, and walking.

Typical milestones: independent sitting by 6-8 months, cruising by 9-12 months, and independent walking by 12-15 months.

Primitive reflexes (Moro, ATNR, palmar grasp) integrate in the first 4-6 months; persistence suggests neurologic concern.

Postural control requires somatosensory, visual, and vestibular inputs integrated with anticipatory and reactive adjustments.

Aging reduces reaction time, strength, and sensory acuity, increasing fall risk and slowing gait speed.

Gait cycle: stance is about 60% and swing about 40% of the cycle; double support increases with age and pathology.

Functional mobility training should match the patient's environment and task demands, not just clinic performance.

Pediatric tone and reflex assessment guides positioning and equipment prescription for cerebral palsy and similar conditions.