NOTCE cheat sheet

Corticospinal tract decussates at the medullary pyramids; lesions above the decussation cause contralateral motor deficits, below cause ipsilateral deficits.

Upper motor neuron signs: hyperreflexia, spasticity, positive Babinski, clonus. Lower motor neuron signs: flaccidity, atrophy, fasciculations, areflexia.

Muscle fiber types: Type I slow-twitch, oxidative, fatigue-resistant (postural endurance); Type II fast-twitch, glycolytic, fatigable (rapid force).

Upper extremity flexor synergy (CVA): scapular retraction/elevation, shoulder abduction/external rotation, elbow flexion, forearm supination.

Lower extremity extensor synergy (CVA): hip extension/adduction/internal rotation, knee extension, ankle plantarflexion/inversion.

Rancho Los Amigos levels: I no response, II generalized, III localized, IV confused/agitated, V confused/inappropriate, VI confused/appropriate, VII automatic/appropriate, VIII purposeful/appropriate.

Decubitus risk factors: immobility, pressure over bony prominences, shear, moisture, malnutrition, sensory loss; staging runs I (nonblanchable erythema) through IV (full-thickness tissue loss).

Spinal cord injury levels: C1-C3 ventilator-dependent; C4 diaphragm; C5 elbow flexion/biceps; C6 wrist extension; C7 elbow extension/triceps; C8-T1 hand intrinsics.

Sensory testing: light touch (A-beta), pinprick (A-delta), temperature (C fibers), proprioception (joint capsule/ligament receptors).

OTPF performance areas: activities of daily living (ADL), instrumental ADL (IADL), rest and sleep, education, work, play, leisure, social participation.

Performance skills categories: motor, process, and social interaction skills; performance patterns are habits, routines, roles, and rituals.

Client factors: values, beliefs, spirituality, body functions, body structures.

Contexts/environments: cultural, personal, physical, social, temporal, virtual.

Activity demands include objects used, space demands, social demands, sequencing, required actions, body functions, and body structures.

Person-Environment-Occupation (PEO) model: optimal performance occurs where the three domains overlap; intervention can target any domain.

Model of Human Occupation (MOHO): volition, habituation, performance capacity, and environment interact to shape occupational engagement.

Canadian Model of Occupational Performance and Engagement (CMOP-E): person (cognitive, affective, physical), environment, and occupation; spirituality at the person's core.

Participation restrictions are distinguished from activity limitations: the former concern involvement in life situations, the latter task execution.

ADL independence: FIM scores 1 (total assist) to 7 (complete independence); a score of 6 means modified independence with a device.

Intervention approaches: establish/restore, modify/adapt, maintain, prevent, and create/promote.

Grading an activity: increase or decrease time, distance, resistance, complexity, number of steps, or amount of assistance.

Handwriting grasp development: palmar supinate (1-1.5 yr), digital pronate (2-3 yr), static tripod (3.5-4 yr), dynamic tripod (4.5-7 yr).

Splinting principles: resting hand splint for positioning in rheumatoid arthritis; functional/tenodesis splint for C6 tetraplegia to enable grasp.

Pressure injury prevention: reposition at least every 2 hours in bed, every 15-30 minutes in a wheelchair; use pressure-relieving surfaces.

Transfer training: stand-pivot for weight-bearing patients; sliding board or mechanical lift for non-weight-bearing patients.

Sensory re-education after peripheral nerve injury: graded texture, vibration, and localization tasks, progressing from protective to discriminative sensation.

Standardized cognitive screens: Mini-Mental State Examination, Montreal Cognitive Assessment, and the Allen Cognitive Level Screen for functional cognition.

Medicare Part B outpatient therapy requires a plan of care certified by a physician and recertification at least every 90 days.

Skilled maintenance therapy is covered when it requires the skills of a therapist to maintain function and prevent decline.

Documentation elements: objective, measurable functional data, skilled rationale, progress toward goals, and plan for next visit.

Informed consent requires capacity, disclosure of risks and benefits, comprehension, and voluntariness.

Ethical principles: autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity.

Scope of practice is defined by state licensure law; supervision requirements for assistants and aides vary by jurisdiction.

HIPAA permits disclosure of protected health information for treatment, payment, and operations; minimum necessary standard applies.

Reimbursement denial risks: missing skilled justification, absent measurable goals, and undocumented progress.

Mandatory reporting of suspected abuse or neglect of vulnerable adults or children overrides confidentiality.

Autonomy: respect the client's right to self-determination and informed choice, including refusal of treatment.

Beneficence: act in the client's best interest; nonmaleficence: avoid causing harm.

Justice: fair and equitable distribution of resources and access to services.

Veracity: truthfulness in all professional communication; fidelity: keep promises and maintain loyalty.

Dual relationships should be avoided when they could impair professional judgment or exploit the client.

Confidentiality exceptions: imminent risk to self or others, suspected abuse or neglect, and court order.

Competence: practice only within the scope of education, training, and licensure; refer when outside that scope.

Informed refusal: document the client's decision, the risks explained, and alternatives offered.

Professional boundaries: avoid accepting gifts that could compromise objectivity and avoid personal relationships with clients.