Physiotherapy Licensing cheat sheet

Muscle fiber types: type I fibers are slow-twitch, oxidative, fatigue-resistant; type II fibers are fast-twitch, glycolytic, fatigue quickly and produce higher force.

Length-tension relationship: active tension is maximal at resting sarcomere length (about 2.0-2.2 micrometers) and declines when the muscle is shortened or overstretched.

Force-velocity relationship: concentric force falls as shortening velocity rises; eccentric contractions can generate greater force than isometric or concentric contractions at the same activation.

Hilton's law: the nerve supplying a joint also supplies the muscles that move the joint and the skin over their distal insertions.

Dermatomes: C5 lateral arm, C6 lateral forearm and thumb, C7 middle finger, C8 little finger, T4 nipple line, T10 umbilicus, L4 medial leg, L5 dorsum of foot, S1 lateral foot.

Myotomes: C5 shoulder abduction, C6 elbow flexion, C7 elbow extension, C8 finger flexion, L2 hip flexion, L3 knee extension, L4 ankle dorsiflexion, L5 great toe extension, S1 ankle plantar flexion.

Upper motor neuron lesions produce spasticity, hyperreflexia, Babinski sign, and clonus; lower motor neuron lesions produce flaccidity, atrophy, fasciculations, and areflexia.

Bone healing phases: inflammatory (days), soft callus (weeks), hard callus (weeks to months), remodeling (months to years); controlled loading during callus phases promotes alignment.

Cardiac output equals heart rate times stroke volume; normal resting output is about 4-8 L/min, and aerobic training increases stroke volume and maximal oxygen uptake.

SOAP note structure: Subjective (history, symptoms), Objective (measurements, tests), Assessment (clinical impression, diagnosis), Plan (interventions, goals, referrals).

Goniometry norms: shoulder flexion 180 degrees, elbow flexion 150 degrees, hip flexion 120 degrees, knee flexion 135 degrees, ankle dorsiflexion 20 degrees, cervical rotation 80 degrees.

Manual muscle testing grades: 0 no contraction, 1 trace, 2 active movement with gravity eliminated, 3 antigravity movement, 4 movement against moderate resistance, 5 normal.

Special tests: anterior drawer and Lachman for ACL, McMurray for meniscal tear, Thompson for Achilles rupture, Phalen and Tinel for carpal tunnel, Spurling for cervical radiculopathy.

Deep tendon reflexes: biceps C5-C6, brachioradialis C5-C6, triceps C7, patellar L3-L4, Achilles S1; grading 0 absent to 4+ clonus.

Sensation testing: light touch with cotton, pinprick with sharp-dull, vibration with 128 Hz tuning fork, proprioception with position matching; compare bilaterally.

Red flags requiring referral: unexplained weight loss, night pain unrelieved by rest, fever, bowel or bladder changes, saddle anesthesia, progressive neurological deficit, history of cancer.

Outcome measures: Berg Balance Scale for balance (score under 45 predicts fall risk), Timed Up and Go over 12 seconds indicates increased fall risk, numeric pain rating scale 0-10.

Vital sign thresholds for exercise caution: systolic over 180 or diastolic over 110 mmHg, resting heart rate over 100 bpm, oxygen saturation below 90 percent.

Strength training parameters: 60-70 percent of 1RM for endurance, 70-85 percent for hypertrophy, 85 percent or more for maximal strength; 2-3 sessions per week per muscle group.

Progressive overload principle: load must increase over time to continue adaptation; specificity means training effects are limited to the trained stimulus.

Aerobic exercise prescription (FITT): frequency 3-5 days per week, intensity 40-85 percent of heart rate reserve, time 20-60 minutes, type large muscle rhythmic activity.

Heart rate reserve method: target heart rate equals resting heart rate plus intensity fraction times (maximal heart rate minus resting heart rate); estimated maximal heart rate is 220 minus age.

RICE for acute soft tissue injury: rest, ice, compression, elevation; ice application 15-20 minutes with skin protection, typically during the first 48-72 hours.

Ultrasound contraindications: over the pregnant uterus, malignant tumors, pacemakers, eyes, growth plates in children, thrombophlebitis, and areas of impaired sensation.

Proprioceptive neuromuscular facilitation hold-relax: isometric contraction of the antagonist pattern for 5-10 seconds, then relaxation and passive stretch into the new range.

Gait training: partial weight bearing, weight bearing as tolerated, and non-weight bearing are prescribed by the physician; assistive device height set at greater trochanter or wrist crease.

Manual therapy grades I-II are small-amplitude oscillations before resistance for pain; grades III-IV are large-amplitude oscillations into resistance for mobility.

Informed consent requires disclosure of nature, risks, benefits, and alternatives, plus voluntary decision-making capacity; it must be documented and can be withdrawn at any time.

Autonomy obligates respect for patient decisions even when the clinician disagrees; beneficence and nonmaleficence require acting for benefit and avoiding harm.

Confidentiality may be breached only with patient consent, legal requirement, or serious imminent risk; minimum necessary information should be shared.

Scope of practice: a therapist must refer to another provider when the patient's needs exceed the therapist's competence, training, or legal authority.

Dual relationships that may impair professional judgment or exploit the patient should be avoided; personal or financial relationships with patients require boundary management.

Documentation standards: record objective findings, interventions, patient response, and changes in status; entries must be timely, accurate, legible, and never altered retroactively without notation.

Delegation to assistive personnel requires that the task be within the assistant's training, that the therapist supervise, and that the therapist retain responsibility for the plan of care.

Fees and billing: charges must reflect services actually delivered; falsifying documentation or billing for undocumented services constitutes fraud.

Fall precautions: bed in lowest position, brakes locked, call light within reach, non-skid footwear, and gait belt use during transfers and ambulation of at-risk patients.

Precautions and contraindications: strict isolation precautions, no weight bearing, spinal precautions, and chest tube precautions must be verified before mobilization.

Orthostatic hypotension: a drop of 20 mmHg systolic or 10 mmHg diastolic on standing; monitor blood pressure and heart rate before and after position changes.

Exercise should be terminated for chest pain, severe dyspnea, dizziness, pallor, diaphoresis, confusion, or a fall in oxygen saturation below 88-90 percent.

Electrical stimulation contraindications: pacemakers, over the heart or carotid sinus, pregnancy, malignancy, areas of impaired sensation, and patients with electronic implants.

Hot pack and modality safety: check skin integrity and sensation, use layers between the agent and skin, and inspect the skin during and after application.

Legal concepts: negligence requires duty, breach, causation, and damages; malpractice is professional negligence; assault is threat and battery is unauthorized touching.

Incident reporting: document the facts of an adverse event objectively in the medical record and file a separate incident report according to facility policy.

Levels of evidence: systematic reviews and meta-analyses of randomized trials rank highest, then randomized controlled trials, cohort studies, case-control studies, case series, and expert opinion.

Sensitivity is the proportion of true positives correctly identified; specificity is the proportion of true negatives correctly identified; high sensitivity supports ruling out disease.

Positive predictive value depends on prevalence; a test with fixed sensitivity and specificity has a higher positive predictive value in a high-prevalence population.

Number needed to treat equals 1 divided by the absolute risk reduction; a smaller number needed to treat indicates greater clinical benefit.

p value is the probability of observing the result or more extreme if the null hypothesis is true; it is not the probability that the null hypothesis is true.

Confidence interval describes the range likely to contain the true effect; a 95 percent interval that excludes the null value corresponds to statistical significance at the 0.05 level.

Intention-to-treat analysis includes all randomized participants in their assigned groups, preserving the benefits of randomization and reducing attrition bias.

Internal validity concerns whether the study measured what it intended; external validity concerns whether results generalize to other populations and settings.

Critical appraisal of a randomized trial addresses randomization, allocation concealment, blinding, completeness of follow-up, and consistency with prior evidence.