NBCOT COTA cheat sheet

Screening is a brief check of whether further assessment is warranted; evaluation is a comprehensive, ongoing process producing the occupational profile and the plan of care.

The COTA collects evaluation data through interview, observation, and administration of assessments under OT supervision, then reports findings; the OTR interprets results and writes the plan of care.

Manual muscle test grades: 0 = no palpable contraction, 1 = trace contraction, 2 = full range with gravity eliminated, 3 = full range against gravity, 4 = against gravity plus some resistance, 5 = normal.

Modified Ashworth Scale grades resistance to passive movement from 0 (no increase in tone) to 4 (affected part rigid in flexion or extension); it quantifies spasticity, not strength or ROM.

Sensation testing proceeds from light touch and sharp/dull to proprioception, stereognosis, and two-point discrimination; vision is occluded and findings are compared bilaterally.

Cognitive screens commonly used: MMSE (30 points; 23 or below suggests impairment), MoCA (30 points; below 26 suggests impairment), and the Allen Cognitive Level leather-lacing task (levels 1-6).

ADL and IADL tools: FIM (18 items scored 1-7), Barthel Index (10 items, 0-100), and the Kohlman Evaluation of Living Skills (17 items scored independent or needs assistance).

In most settings OT services require a physician's referral or order; concerns outside the scope of occupational therapy are referred to the appropriate discipline rather than assessed by the COTA.

Intervention approaches are categorized as restore or remediate, modify or compensate, maintain, and prevent; the chosen approach follows from the evaluation findings and the client's goals.

DeLorme progressive resistive exercise: 10 repetitions at 50%, 75%, and 100% of the 10-repetition maximum; the Oxford technique reverses the order from heaviest to lightest.

Random and variable practice conditions produce better carryover than blocked practice; part-task practice suits complex or high-demand tasks, whole-task practice suits simpler ones.

Posterior-approach total hip arthroplasty precautions: no hip flexion beyond 90 degrees, no adduction past midline, no internal rotation, no crossing legs; use a raised toilet seat and abductor pillow.

Joint protection in rheumatoid arthritis: use the largest joint available, spread loads across both hands, avoid sustained tight grips, respect pain, and build up handles on utensils and tools.

Pressure injury prevention: reposition at least every 2 hours in bed and every 15 minutes in a wheelchair; use a 30-degree lateral tilt rather than lying directly on the trochanter.

Mosey's group levels in sequence: parallel, project, egocentric-cooperative, cooperative, and mature; the level chosen matches the members' interaction skills.

Brunnstrom stages of post-stroke motor recovery: 1 flaccidity, 2-3 spasticity and obligatory synergies, 4-5 movement out of synergy, 6-7 near-normal isolated movement.

Graded desensitization after nerve repair progresses from least to most stimulating input (light texture, tapping, vibration, immersion, then functional use) and is stopped if pain increases.

Discharge and transition planning begins at the initial evaluation, when living situation, caregiver support, equipment needs, and environmental barriers are first identified.

Discontinuation criteria include goals met, plateau in progress, client refusal or noncompliance, a change in medical status, and reimbursement or setting limits.

The OTR completes the discharge summary and final assessment; the COTA contributes evaluation and progress data and may carry out the discharge plan of care.

A written home exercise program states the exercise, frequency, repetitions or duration, and precautions, and is confirmed through demonstration and teach-back.

Home safety review covers lighting, throw rugs, stair rails, grab bars, bathroom equipment, bed height, and reachable storage; recommendations are prioritized by fall risk.

Community resources for transition include the Area Agency on Aging, Centers for Independent Living, state vocational rehabilitation agencies, and condition-specific support groups.

Before discharge the client or caregiver must demonstrate safe use of recommended equipment, and the funding source and ordering process for durable medical equipment must be verified.

AOTA Code of Ethics principles: beneficence, nonmaleficence, autonomy, justice, veracity, fidelity, and procedural justice.

COTA services require supervision by an OTR; the type (close, direct, or general) and frequency are set by state practice acts, payer rules, and the practice setting.

Medicare Part A skilled nursing facility: progress reports are completed at least every 10 treatment days, and the physician certifies the plan of care.

Medicare Part B: services must be skilled and medically necessary, and a re-evaluation is required when the client's status changes significantly.

IDEA entitles eligible students to a free appropriate public education and lists occupational therapy as a related service documented in the IEP.

Valid informed consent requires client capacity, voluntariness, and disclosure of the purpose, risks, benefits, alternatives, and right to refuse.

Suspected abuse, neglect, or exploitation of a child or vulnerable adult must be reported to the designated state agency under mandatory reporting laws.

Evidence hierarchy from strongest to weakest: systematic reviews and meta-analyses, randomized controlled trials, cohort and case-control studies, case series, expert opinion.

NBCOT certification is renewed every 3 years by earning 36 professional development units, with one PDU equal to one contact hour of approved learning.