NBCOT OTR cheat sheet

Manual muscle testing grades 0-5: 0 = no palpable contraction; 1 = trace contraction without motion; 2 = full range with gravity eliminated; 3 = full range against gravity; 4 = full range against gravity plus some resistance; 5 = normal, holds against maximal resistance.

AROM is produced by the client's own contraction and reflects muscle and tendon integrity; PROM is produced by the examiner and reflects capsular, ligamentous, and soft tissue mobility.

Reliability is consistency of scores (intra-rater, inter-rater, test-retest); validity is whether an instrument measures what it claims (content, construct, criterion-related).

SEM estimates error in a score in the test's own units; MDC is the change exceeding that error needed to claim real change; MCID is the smallest change the client perceives as beneficial.

Modified Ashworth Scale grades spasticity 0-4: 0 = no increase in tone; 1 = slight catch; 1+ = catch then minimal resistance; 2 = marked increase but limb easily moved; 3 = considerable increase; 4 = rigid.

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

MoCA is scored out of 30 and scores below 26 suggest cognitive impairment; MMSE is scored out of 30 with cutoffs adjusted for education, commonly below 24 indicating impairment.

Berg Balance Scale (14 items, 56 points): scores of 45 or below in older adults indicate increased fall risk; Timed Up and Go above roughly 12-13.5 seconds also suggests elevated fall risk.

Cortical sensory testing relies on stereognosis and two-point discrimination to detect parietal lobe dysfunction when primary sensation (light touch, pain, temperature, proprioception) is intact.

Brunnstrom stages after stroke: 1 flaccid, 2 synergy emerging with spasticity, 3 synergies performed voluntarily, 4 movement out of synergy begins, 5 synergies decline with isolated movement, 6 near-normal coordination.

Resting hand splint position: wrist 20-30 degrees extension, MCPs 30-45 degrees flexion, IP joints in slight flexion, thumb abducted, used to prevent deformity in a flaccid or spastic hand.

Posterior-approach THA precautions: no hip flexion past 90 degrees, no adduction across midline, no internal rotation, typically 6-12 weeks; anterior approach instead limits extension and external rotation.

Practice design: massed practice uses long sessions with minimal rest, distributed practice inserts rest intervals; blocked practice supports acquisition while random practice supports retention and transfer.

CIMT candidacy usually requires about 10 degrees of active wrist extension and 10 degrees of finger extension, restraint of the less affected limb for most waking hours, and shaping of functional tasks.

Energy conservation: pace activities, alternate heavy and light tasks, sit for grooming and cooking, use a rolling cart, rest before fatigue; work simplification eliminates unnecessary steps and combines tasks.

Cognitive intervention matching: errorless learning and vanishing cues suit severe memory impairment; spaced retrieval uses expanding recall intervals; external memory aids compensate for persistent deficits.

Dysphagia compensation: chin tuck narrows the airway entrance before the swallow, head turn directs the bolus toward the stronger pharyngeal side, and effortful swallow improves pharyngeal clearance.

Transfer selection: stand-pivot when the client can stand and bear weight without stepping; sliding board when lower extremity weight bearing is restricted; mechanical or two-person lift when the client cannot assist.

Medicare Part A covers inpatient hospital and inpatient rehabilitation facility stays; Part B covers outpatient therapy, which requires a physician-certified plan of care and services that are skilled, reasonable, and necessary.

Jimmo v. Sebelius (2013) clarifies that Medicare covers skilled therapy needed to maintain function or slow decline, not only therapy that produces improvement.

The occupational therapist evaluates, interprets results, establishes goals and the plan of care, and performs reassessments and discharge; the COTA implements the plan under OT supervision and reports progress.

Outpatient timed CPT codes: total timed minutes are divided by 15, with one unit generally requiring at least 8 minutes, and remaining minutes of 8 or more supporting an additional unit.

Medicare requires the plan of care to be certified by the physician and recertified at least every 90 days, stating diagnosis, goals, and the type, frequency, and duration of services.

SOAP documentation: Subjective (client report), Objective (measurable findings), Assessment (clinical interpretation and progress), Plan (next steps); entries must be timely, accurate, and defensible.

AOTA Code of Ethics principles are beneficence, nonmaleficence, autonomy, justice, veracity, fidelity, and prudence; ethical problems are resolved by identifying the issue, gathering facts, weighing options, and acting.

Practitioners obtain informed consent before evaluation and intervention and report suspected abuse, neglect, or exploitation of vulnerable persons to designated state authorities.

NBCOT certification renews every three years with 36 professional development units; evidence hierarchies rank systematic reviews and randomized controlled trials above cohort studies, case series, and expert opinion.