NHPC BPT cheat sheet

Brachial plexus roots C5-T1; trunks: upper (C5-C6), middle (C7), lower (C8-T1); divisions occur behind clavicle, cords named by relation to second part of axillary artery.

Rotator cuff muscles SITS: supraspinatus (abduction initiation, suprascapular nerve), infraspinatus (external rotation, suprascapular), teres minor (external rotation, axillary), subscapularis (internal rotation, upper and lower subscapular).

Lumbar plexus: femoral nerve L2-L4 (quadriceps, hip flexors); obturator L2-L4 (adductors); superior gluteal L4-S1 supplies gluteus medius and minimus, whose weakness causes Trendelenburg sign.

Median nerve innervates thenar muscles via recurrent branch (opponens pollicis, abductor pollicis brevis, flexor pollicis brevis); ulnar nerve supplies most intrinsic hand muscles and causes claw hand.

Sciatic nerve L4-S3 divides into tibial and common peroneal; common peroneal winds round fibular neck, so foot drop follows fibular neck injury.

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

Knee ligaments: ACL prevents anterior tibial translation and limits internal rotation; PCL prevents posterior translation; MCL resists valgus; LCL resists varus stress.

Carpal tunnel boundaries: transverse carpal ligament (flexor retinaculum) over carpal arch; contents are flexor digitorum superficialis and profundus tendons, flexor pollicis longus, and median nerve.

Resting membrane potential about -70 mV, set mainly by potassium permeability; threshold about -55 mV; depolarisation opens voltage-gated sodium channels, repolarisation follows potassium efflux.

Cardiac output = heart rate x stroke volume; normal 4-8 L/min. Stroke volume depends on preload, afterload and contractility (Frank-Starling relationship).

Vital capacity = inspiratory reserve volume + tidal volume + expiratory reserve volume; residual volume cannot be exhaled; FEV1/FVC normally about 0.75-0.80.

Oxygen carriage: about 97-98% bound to haemoglobin, 1.5-2% dissolved; right shift of the dissociation curve (raised CO2, acidosis, heat, 2,3-DPG) releases oxygen to tissues.

Muscle contraction: action potential travels via T-tubules, sarcoplasmic reticulum releases calcium, calcium binds troponin C, cross-bridge cycling occurs; relaxation requires calcium reuptake (SERCA).

Muscle fibre types: type I slow oxidative, fatigue-resistant, postural; type IIa fast oxidative-glycolytic; type IIb/IIx fast glycolytic, powerful but fatigable.

Exercise response: heart rate and stroke volume rise, systolic pressure rises while diastolic changes little; peripheral resistance falls in working muscle, so mean arterial pressure rises moderately.

Nerve conduction follows the all-or-none law; strength of stimulus is coded by frequency and recruitment. Conduction velocity increases with myelination and fibre diameter.

Levers: first class (fulcrum between effort and load, e.g. triceps at elbow), second class (load between fulcrum and effort, e.g. calf raise), third class (effort between fulcrum and load, most common in the body).

Moment of force = force x perpendicular distance from axis. Moment arm of a muscle changes with joint angle, so torque output is angle-dependent.

Open kinetic chain: distal segment free, e.g. seated knee extension; closed kinetic chain: distal segment fixed, e.g. squat, producing joint compression and co-contraction.

Concentric contraction shortens muscle and produces force while shortening; isometric produces force without length change; eccentric produces force while lengthening and generates the highest tension.

Gait cycle: stance about 60% and swing about 40% of the cycle; double support occurs twice per cycle and increases in duration with slower walking speed.

Normal joint ranges (approximate): shoulder flexion 180 degrees, elbow flexion 140-150, hip flexion 120, knee flexion 135-140, ankle dorsiflexion 20, plantarflexion 50.

Length-tension relationship: maximum active tension near resting sarcomere length where actin-myosin overlap is optimal; excessive stretch or shortening reduces force.

Axis and plane pairing: sagittal plane with frontal (coronal) axis for flexion-extension; frontal plane with sagittal axis for abduction-adduction; transverse plane with vertical axis for rotation.

Inflammation: rubor, calor, tumor, dolor, functio laesa; acute phase mediated by histamine, bradykinin and prostaglandins with neutrophil predominance; chronic phase shows lymphocytes and macrophages.

Healing by primary intention occurs in clean apposed wounds; secondary intention in open wounds with granulation tissue and greater scarring; bone healing passes through haematoma, soft callus, hard callus and remodelling.

Cell injury: reversible changes include swelling and fatty change; irreversible injury shows membrane damage, mitochondrial failure and nuclear changes (pyknosis, karyolysis, karyorrhexis).

Neoplasia: benign tumours are encapsulated, well differentiated and non-metastatic; malignant tumours show invasion, metastasis, anaplasia and pleomorphism. Grading describes differentiation, staging describes spread.

Thrombosis triad (Virchow): endothelial injury, altered blood flow (stasis or turbulence) and hypercoagulability. Embolus travels and lodges in a distant vessel.

Osteoporosis: reduced bone mineral density with T-score at or below -2.5 on DXA; osteomalacia is defective mineralisation with soft bone; osteomyelitis is usually caused by Staphylococcus aureus.

Rheumatoid arthritis is a chronic autoimmune synovitis with symmetric small-joint involvement and anti-CCP antibodies; osteoarthritis is degenerative cartilage loss with osteophytes and joint space narrowing.

Standard precautions apply to all patients: hand hygiene, gloves, and safe sharps handling. Sterilisation kills spores; disinfection reduces pathogens on inanimate surfaces.

NSAIDs inhibit cyclo-oxygenase, reducing prostaglandin synthesis; adverse effects include gastric ulceration, renal impairment and bronchospasm in aspirin-sensitive asthma. Paracetamol overdose causes hepatic necrosis.

Corticosteroids suppress inflammation via gene transcription effects; long-term use causes osteoporosis, hyperglycaemia, hypertension, Cushingoid features and muscle wasting, so taper on withdrawal.

Muscle relaxants: centrally acting agents such as baclofen (GABA-B agonist) and tizanidine (alpha-2 agonist) reduce spasticity; dantrolene acts peripherally on the sarcoplasmic reticulum.

Local anaesthetics block voltage-gated sodium channels; small unmyelinated pain fibres are blocked before motor fibres. Adrenaline prolongs the block and reduces systemic absorption.

Opioids act on mu receptors; effects include analgesia, sedation, respiratory depression and constipation. Naloxone is the antidote for overdose.

Anticoagulants: heparin acts via antithrombin, warfarin inhibits vitamin K-dependent clotting factors, and low molecular weight heparin is monitored less often; physiotherapists watch for bleeding risk during manual therapy.

Antibiotics: penicillins and cephalosporins inhibit cell wall synthesis; aminoglycosides inhibit the 30S ribosome and are ototoxic and nephrotoxic; vancomycin is used for MRSA.

Drugs used in cardiopulmonary care: beta-blockers reduce heart rate and are used after myocardial infarction; beta-2 agonists bronchodilate; diuretics reduce preload in heart failure.

TENS: conventional high-frequency (around 80-100 Hz, narrow pulse) relieves pain via gate control; low-frequency (around 2-4 Hz) is thought to act via endorphin release. Avoid in pacemaker patients and over the abdomen in pregnancy.

Interferential current uses two medium-frequency alternating currents that cross to produce a low-frequency beat; it penetrates tissue more comfortably than low-frequency current.

Russian current (2500 Hz carrier, 50 Hz bursts) is used for muscle strengthening; faradic-type interrupted direct current stimulates innervated muscle, while denervated muscle needs long-duration pulses.

Ultrasound: continuous mode causes thermal effects (deep heating), pulsed mode is non-thermal. Dose in W/cm2; keep the head moving to avoid periosteal pain and avoid over the heart, eyes, gonads and malignancy.

Shortwave diathermy produces deep heating by high-frequency electromagnetic energy, with capacitive or inductive application; remove all metal and avoid areas with implants, pregnancy and impaired sensation.

Cryotherapy reduces temperature, blood flow and nerve conduction velocity to relieve pain and oedema; contraindications include Raynaud phenomenon and cold hypersensitivity. Heat increases blood flow and tissue extensibility.

Laser (low-level light therapy) uses wavelengths around 600-1000 nm and is applied with goggles; avoid over the thyroid, pregnancy and malignancy. Ultraviolet therapy is used for skin conditions such as psoriasis.

Electrical safety: check skin integrity, avoid current across the heart, use correct electrode contact, and follow contraindications for pacemakers, pregnancy, malignancy and active infection.

Exercise prescription follows FITT: frequency, intensity, time and type. Aerobic training: 3-5 days per week at 40-70% of heart rate reserve for moderate intensity.

Progressive resistance training follows the overload principle: 2-3 sessions per week, 2-4 sets of 8-12 repetitions at 60-80% of one repetition maximum for strength in healthy adults.

Range of motion exercises: passive (therapist moves the limb), active-assisted, active and resisted. Passive range maintains mobility but does not build strength.

Isometric exercise is used early after injury or surgery when joint motion is restricted; it raises blood pressure, so caution is needed in cardiac patients.

Proprioceptive neuromuscular facilitation uses diagonal patterns and techniques such as hold-relax and contract-relax to increase range and facilitate movement.

Balance training progresses from static (feet together, eyes open) to dynamic and reactive tasks; support the patient with a gait belt and reduce base of support gradually.

Goniometry measures joint range; the axis is placed at the joint centre and the stationary arm along the proximal segment. Record active and passive values separately.

Manual muscle testing grades 0-5: 0 no contraction, 1 visible contraction without movement, 2 movement with gravity eliminated, 3 movement against gravity, 4 against gravity with some resistance, 5 normal.

Low back pain: most cases are non-specific and improve within weeks; red flags include cauda equina features (saddle anaesthesia, bladder dysfunction), fever, unexplained weight loss, night pain and progressive neurological deficit.

Osteoarthritis management combines exercise, weight management and education; manual therapy and modalities are adjuncts. Total joint replacement needs early mobilisation and strengthening.

Frozen shoulder (adhesive capsulitis) passes through painful, frozen and thawing phases; treatment is staged, with pain control and gentle range early and stretching later.

Lateral epicondylalgia is an overuse tendinopathy of the wrist extensors at the lateral epicondyle; eccentric loading and grip strengthening are used. Medial epicondylalgia affects the wrist flexors.

Anterior cruciate ligament injury: rehabilitation focuses on quadriceps and hamstring strength, proprioception and return-to-sport criteria; meniscal tears may cause locking, and McMurray test is used.

Fracture healing and rehabilitation: immobilisation causes muscle atrophy and joint stiffness, so early adjacent-joint exercise is used within the surgeon's restrictions.

Posture and ergonomics: neutral spine, load close to the body, and workstation adjustment reduce cumulative spinal load. Manual handling technique is a core preventive skill.

Cervical spine: upper cervical rotation and extension movements stress the vertebral artery, so screen for dizziness and vertebrobasilar symptoms before manipulation.

Stroke: the acute phase needs early mobilisation and positioning; rehabilitation addresses tone, selective movement, balance, transfers and function. Hemiplegia affects the contralateral side.

Upper motor neuron lesion signs: spasticity, hyperreflexia, clonus, Babinski sign and loss of fine dexterity. Lower motor neuron lesion signs: flaccidity, atrophy, fasciculation and areflexia.

Spasticity is velocity-dependent increased resistance to passive movement (modified Ashworth scale). Management includes positioning, stretching, botulinum toxin and intrathecal baclofen.

Bobath approach (neurodevelopmental therapy) uses handling and facilitation to improve postural control and movement quality; task-specific practice and constraint-induced movement therapy are also evidence-based.

Parkinson disease: rigidity, bradykinesia, resting tremor and postural instability; exercise targets amplitude, cueing for gait and balance training to reduce falls.

Guillain-Barre syndrome is an acute ascending demyelinating polyneuropathy; monitor vital capacity and respiratory function, prevent contractures and avoid overexertion early.

Spinal cord injury: level and completeness determine function. T6 and above carries risk of autonomic dysreflexia (severe hypertension, headache, bradycardia) triggered by bladder, bowel or skin stimuli.

Multiple sclerosis: fatigue management, energy conservation, cooling and strengthening are used; avoid overheating because heat worsens symptoms (Uhthoff phenomenon).

Breathing exercises: diaphragmatic breathing, pursed-lip breathing and positioning relieve dyspnoea; pursed-lip breathing slows expiration and prevents airway collapse in COPD.

Airway clearance techniques include postural drainage, percussion, vibration, huffing, active cycle of breathing and positive expiratory pressure devices; avoid head-down positions in raised intracranial pressure and recent haemoptysis.

Cardiac rehabilitation phases: inpatient phase, early outpatient, late outpatient and maintenance. Exercise is prescribed with a warm-up, training phase and cool-down, monitored by heart rate and symptoms.

Six-minute walk test measures functional exercise capacity; record distance, oxygen saturation, heart rate and dyspnoea score (Borg scale) before and after.

Vital signs: normal resting heart rate 60-100 beats/min, respiratory rate 12-20 breaths/min, blood pressure around 120/80 mmHg, oxygen saturation 94-100%. Stop exercise on chest pain, severe dyspnoea or dizziness.

COPD rehabilitation improves dyspnoea and quality of life; smoking cessation, vaccination, pulmonary rehabilitation and home exercise are core components.

Community-based rehabilitation is delivered in homes and primary care, emphasising functional independence, caregiver training and accessibility of services.

Heart failure exercise should be supervised when severe; watch for weight gain, oedema and orthopnoea indicating decompensation.

Informed consent requires the patient to be competent, given adequate information and free from coercion; document consent for assessment and treatment.

Confidentiality: patient information must not be disclosed without consent except when required by law, court order or serious public health risk.

Professional boundaries: avoid dual relationships and never exploit the therapeutic relationship. Report impaired or unsafe colleagues through proper channels.

Scope of practice: treat within your competence and training; refer when the condition exceeds your scope. Continuing professional development maintains competence.

Documentation must be contemporaneous, accurate, dated and signed; records are legal documents and may be subpoenaed.

Duty of care and negligence: a practitioner owes a duty of care, must meet a reasonable standard, and breach causing harm gives rise to liability.

Ethical principles: autonomy, beneficence, non-maleficence and justice guide decisions. Truthfulness and integrity are expected in billing and certification.

Advertising and titles must not mislead; practitioners may not claim cures or use unverified credentials. Follow the registering council's code of conduct and disciplinary procedures.

Study designs: randomised controlled trial is best for treatment effect; cohort and case-control studies examine risk and prognosis; cross-sectional studies measure prevalence; case reports describe single cases.

Randomisation reduces selection bias; blinding (single, double, triple) reduces observer and performance bias. Intention-to-treat analysis preserves randomisation benefits.

Validity: internal validity concerns whether the study answers its question without bias; external validity concerns generalisability. Reliability is reproducibility; validity is accuracy of measurement.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives). Positive predictive value depends on prevalence.

Descriptive statistics: mean and standard deviation for normally distributed data; median and interquartile range for skewed data. Nominal data are summarised as proportions.

Inferential statistics: p value is the probability of the observed result if the null hypothesis is true; 95% confidence interval is the range likely to contain the true effect. Type I error is a false positive, type II a false negative.

Parametric tests (t-test, ANOVA) assume normal distribution; non-parametric alternatives include Mann-Whitney U, Wilcoxon and Kruskal-Wallis. Chi-square tests compare categorical proportions.

Evidence hierarchy: systematic reviews and meta-analyses of randomised trials sit at the top, then randomised trials, cohort studies, case-control studies, case series and expert opinion. Critical appraisal asks about validity, results and applicability.

Measures of central tendency: mean is sensitive to outliers; median is robust; mode is the most frequent value. Standard deviation describes spread around the mean.

Relative risk = incidence in exposed / incidence in unexposed; odds ratio compares odds of exposure in cases and controls and approximates relative risk for rare outcomes.

Absolute risk reduction = control event rate minus treatment event rate; number needed to treat = 1 / absolute risk reduction.

Correlation coefficient r ranges from -1 to +1 and measures linear association; it does not imply causation. r squared is the proportion of variance explained.

Sample size depends on effect size, variability, power (usually 0.80) and significance level (usually 0.05); larger samples narrow confidence intervals.

Normal distribution: about 68% of values lie within one standard deviation of the mean, 95% within two, 99.7% within three.

Survival analysis uses Kaplan-Meier curves and hazard ratios; censoring occurs when follow-up ends before the event.

Screening test interpretation: high sensitivity suits ruling out disease, high specificity suits confirming it; the predictive value changes with prevalence.

Evidence-based practice integrates the best available research evidence, clinical expertise and patient values and preferences; none of the three alone is sufficient.

The five steps: formulate an answerable question, search for evidence, critically appraise it, apply it to the patient, and evaluate the outcome.

PICO framework: Population, Intervention, Comparison, Outcome. A well-built question makes the search precise and reproducible.

Levels of evidence rank study designs; recommendations also consider consistency, directness, effect size and patient preferences, not design alone.

Clinical practice guidelines synthesise evidence and give recommendations; check the date, the developers and whether they used a systematic method such as GRADE.

Outcome measures should be reliable, valid and responsive; examples include the visual analogue scale for pain and the Barthel index for function.

Publication bias occurs when positive studies are more likely to be published, inflating apparent treatment effects; funnel plots detect it in meta-analyses.

Applying evidence: consider whether the study population resembles your patient, whether the intervention is feasible, and whether benefits outweigh harms and costs.

Brachial plexus roots C5-T1; trunks: upper (C5-C6), middle (C7), lower (C8-T1); divisions occur behind clavicle, cords named by relation to second part of axillary artery.

Rotator cuff muscles SITS: supraspinatus (abduction initiation, suprascapular nerve), infraspinatus (external rotation, suprascapular), teres minor (external rotation, axillary), subscapularis (internal rotation, upper and lower subscapular).

Lumbar plexus: femoral nerve L2-L4 (quadriceps, hip flexors); obturator L2-L4 (adductors); superior gluteal L4-S1 supplies gluteus medius and minimus, whose weakness causes Trendelenburg sign.

Median nerve innervates thenar muscles via recurrent branch (opponens pollicis, abductor pollicis brevis, flexor pollicis brevis); ulnar nerve supplies most intrinsic hand muscles and causes claw hand.

Sciatic nerve L4-S3 divides into tibial and common peroneal; common peroneal winds round fibular neck, so foot drop follows fibular neck injury.

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

Knee ligaments: ACL prevents anterior tibial translation and limits internal rotation; PCL prevents posterior translation; MCL resists valgus; LCL resists varus stress.

Carpal tunnel boundaries: transverse carpal ligament (flexor retinaculum) over carpal arch; contents are flexor digitorum superficialis and profundus tendons, flexor pollicis longus, and median nerve.

Resting membrane potential about -70 mV, set mainly by potassium permeability; threshold about -55 mV; depolarisation opens voltage-gated sodium channels, repolarisation follows potassium efflux.

Cardiac output = heart rate x stroke volume; normal 4-8 L/min. Stroke volume depends on preload, afterload and contractility (Frank-Starling relationship).

Vital capacity = inspiratory reserve volume + tidal volume + expiratory reserve volume; residual volume cannot be exhaled; FEV1/FVC normally about 0.75-0.80.

Oxygen carriage: about 97-98% bound to haemoglobin, 1.5-2% dissolved; right shift of the dissociation curve (raised CO2, acidosis, heat, 2,3-DPG) releases oxygen to tissues.

Muscle contraction: action potential travels via T-tubules, sarcoplasmic reticulum releases calcium, calcium binds troponin C, cross-bridge cycling occurs; relaxation requires calcium reuptake (SERCA).

Muscle fibre types: type I slow oxidative, fatigue-resistant, postural; type IIa fast oxidative-glycolytic; type IIb/IIx fast glycolytic, powerful but fatigable.

Exercise response: heart rate and stroke volume rise, systolic pressure rises while diastolic changes little; peripheral resistance falls in working muscle, so mean arterial pressure rises moderately.

Nerve conduction follows the all-or-none law; strength of stimulus is coded by frequency and recruitment. Conduction velocity increases with myelination and fibre diameter.

Levers: first class (fulcrum between effort and load, e.g. triceps at elbow), second class (load between fulcrum and effort, e.g. calf raise), third class (effort between fulcrum and load, most common in the body).

Moment of force = force x perpendicular distance from axis. Moment arm of a muscle changes with joint angle, so torque output is angle-dependent.

Open kinetic chain: distal segment free, e.g. seated knee extension; closed kinetic chain: distal segment fixed, e.g. squat, producing joint compression and co-contraction.

Concentric contraction shortens muscle and produces force while shortening; isometric produces force without length change; eccentric produces force while lengthening and generates the highest tension.

Gait cycle: stance about 60% and swing about 40% of the cycle; double support occurs twice per cycle and increases in duration with slower walking speed.

Normal joint ranges (approximate): shoulder flexion 180 degrees, elbow flexion 140-150, hip flexion 120, knee flexion 135-140, ankle dorsiflexion 20, plantarflexion 50.

Length-tension relationship: maximum active tension near resting sarcomere length where actin-myosin overlap is optimal; excessive stretch or shortening reduces force.

Axis and plane pairing: sagittal plane with frontal (coronal) axis for flexion-extension; frontal plane with sagittal axis for abduction-adduction; transverse plane with vertical axis for rotation.

Inflammation: rubor, calor, tumor, dolor, functio laesa; acute phase mediated by histamine, bradykinin and prostaglandins with neutrophil predominance; chronic phase shows lymphocytes and macrophages.

Healing by primary intention occurs in clean apposed wounds; secondary intention in open wounds with granulation tissue and greater scarring; bone healing passes through haematoma, soft callus, hard callus and remodelling.

Cell injury: reversible changes include swelling and fatty change; irreversible injury shows membrane damage, mitochondrial failure and nuclear changes (pyknosis, karyolysis, karyorrhexis).

Neoplasia: benign tumours are encapsulated, well differentiated and non-metastatic; malignant tumours show invasion, metastasis, anaplasia and pleomorphism. Grading describes differentiation, staging describes spread.

Thrombosis triad (Virchow): endothelial injury, altered blood flow (stasis or turbulence) and hypercoagulability. Embolus travels and lodges in a distant vessel.

Osteoporosis: reduced bone mineral density with T-score at or below -2.5 on DXA; osteomalacia is defective mineralisation with soft bone; osteomyelitis is usually caused by Staphylococcus aureus.

Rheumatoid arthritis is a chronic autoimmune synovitis with symmetric small-joint involvement and anti-CCP antibodies; osteoarthritis is degenerative cartilage loss with osteophytes and joint space narrowing.

Standard precautions apply to all patients: hand hygiene, gloves, and safe sharps handling. Sterilisation kills spores; disinfection reduces pathogens on inanimate surfaces.

NSAIDs inhibit cyclo-oxygenase, reducing prostaglandin synthesis; adverse effects include gastric ulceration, renal impairment and bronchospasm in aspirin-sensitive asthma. Paracetamol overdose causes hepatic necrosis.

Corticosteroids suppress inflammation via gene transcription effects; long-term use causes osteoporosis, hyperglycaemia, hypertension, Cushingoid features and muscle wasting, so taper on withdrawal.

Muscle relaxants: centrally acting agents such as baclofen (GABA-B agonist) and tizanidine (alpha-2 agonist) reduce spasticity; dantrolene acts peripherally on the sarcoplasmic reticulum.

Local anaesthetics block voltage-gated sodium channels; small unmyelinated pain fibres are blocked before motor fibres. Adrenaline prolongs the block and reduces systemic absorption.

Opioids act on mu receptors; effects include analgesia, sedation, respiratory depression and constipation. Naloxone is the antidote for overdose.

Anticoagulants: heparin acts via antithrombin, warfarin inhibits vitamin K-dependent clotting factors, and low molecular weight heparin is monitored less often; physiotherapists watch for bleeding risk during manual therapy.

Antibiotics: penicillins and cephalosporins inhibit cell wall synthesis; aminoglycosides inhibit the 30S ribosome and are ototoxic and nephrotoxic; vancomycin is used for MRSA.

Drugs used in cardiopulmonary care: beta-blockers reduce heart rate and are used after myocardial infarction; beta-2 agonists bronchodilate; diuretics reduce preload in heart failure.

TENS: conventional high-frequency (around 80-100 Hz, narrow pulse) relieves pain via gate control; low-frequency (around 2-4 Hz) is thought to act via endorphin release. Avoid in pacemaker patients and over the abdomen in pregnancy.

Interferential current uses two medium-frequency alternating currents that cross to produce a low-frequency beat; it penetrates tissue more comfortably than low-frequency current.

Russian current (2500 Hz carrier, 50 Hz bursts) is used for muscle strengthening; faradic-type interrupted direct current stimulates innervated muscle, while denervated muscle needs long-duration pulses.

Ultrasound: continuous mode causes thermal effects (deep heating), pulsed mode is non-thermal. Dose in W/cm2; keep the head moving to avoid periosteal pain and avoid over the heart, eyes, gonads and malignancy.

Shortwave diathermy produces deep heating by high-frequency electromagnetic energy, with capacitive or inductive application; remove all metal and avoid areas with implants, pregnancy and impaired sensation.

Cryotherapy reduces temperature, blood flow and nerve conduction velocity to relieve pain and oedema; contraindications include Raynaud phenomenon and cold hypersensitivity. Heat increases blood flow and tissue extensibility.

Laser (low-level light therapy) uses wavelengths around 600-1000 nm and is applied with goggles; avoid over the thyroid, pregnancy and malignancy. Ultraviolet therapy is used for skin conditions such as psoriasis.

Electrical safety: check skin integrity, avoid current across the heart, use correct electrode contact, and follow contraindications for pacemakers, pregnancy, malignancy and active infection.

Exercise prescription follows FITT: frequency, intensity, time and type. Aerobic training: 3-5 days per week at 40-70% of heart rate reserve for moderate intensity.

Progressive resistance training follows the overload principle: 2-3 sessions per week, 2-4 sets of 8-12 repetitions at 60-80% of one repetition maximum for strength in healthy adults.

Range of motion exercises: passive (therapist moves the limb), active-assisted, active and resisted. Passive range maintains mobility but does not build strength.

Isometric exercise is used early after injury or surgery when joint motion is restricted; it raises blood pressure, so caution is needed in cardiac patients.

Proprioceptive neuromuscular facilitation uses diagonal patterns and techniques such as hold-relax and contract-relax to increase range and facilitate movement.

Balance training progresses from static (feet together, eyes open) to dynamic and reactive tasks; support the patient with a gait belt and reduce base of support gradually.

Goniometry measures joint range; the axis is placed at the joint centre and the stationary arm along the proximal segment. Record active and passive values separately.

Manual muscle testing grades 0-5: 0 no contraction, 1 visible contraction without movement, 2 movement with gravity eliminated, 3 movement against gravity, 4 against gravity with some resistance, 5 normal.

Low back pain: most cases are non-specific and improve within weeks; red flags include cauda equina features (saddle anaesthesia, bladder dysfunction), fever, unexplained weight loss, night pain and progressive neurological deficit.

Osteoarthritis management combines exercise, weight management and education; manual therapy and modalities are adjuncts. Total joint replacement needs early mobilisation and strengthening.

Frozen shoulder (adhesive capsulitis) passes through painful, frozen and thawing phases; treatment is staged, with pain control and gentle range early and stretching later.

Lateral epicondylalgia is an overuse tendinopathy of the wrist extensors at the lateral epicondyle; eccentric loading and grip strengthening are used. Medial epicondylalgia affects the wrist flexors.

Anterior cruciate ligament injury: rehabilitation focuses on quadriceps and hamstring strength, proprioception and return-to-sport criteria; meniscal tears may cause locking, and McMurray test is used.

Fracture healing and rehabilitation: immobilisation causes muscle atrophy and joint stiffness, so early adjacent-joint exercise is used within the surgeon's restrictions.

Posture and ergonomics: neutral spine, load close to the body, and workstation adjustment reduce cumulative spinal load. Manual handling technique is a core preventive skill.

Cervical spine: upper cervical rotation and extension movements stress the vertebral artery, so screen for dizziness and vertebrobasilar symptoms before manipulation.

Stroke: the acute phase needs early mobilisation and positioning; rehabilitation addresses tone, selective movement, balance, transfers and function. Hemiplegia affects the contralateral side.

Upper motor neuron lesion signs: spasticity, hyperreflexia, clonus, Babinski sign and loss of fine dexterity. Lower motor neuron lesion signs: flaccidity, atrophy, fasciculation and areflexia.

Spasticity is velocity-dependent increased resistance to passive movement (modified Ashworth scale). Management includes positioning, stretching, botulinum toxin and intrathecal baclofen.

Bobath approach (neurodevelopmental therapy) uses handling and facilitation to improve postural control and movement quality; task-specific practice and constraint-induced movement therapy are also evidence-based.

Parkinson disease: rigidity, bradykinesia, resting tremor and postural instability; exercise targets amplitude, cueing for gait and balance training to reduce falls.

Guillain-Barre syndrome is an acute ascending demyelinating polyneuropathy; monitor vital capacity and respiratory function, prevent contractures and avoid overexertion early.

Spinal cord injury: level and completeness determine function. T6 and above carries risk of autonomic dysreflexia (severe hypertension, headache, bradycardia) triggered by bladder, bowel or skin stimuli.

Multiple sclerosis: fatigue management, energy conservation, cooling and strengthening are used; avoid overheating because heat worsens symptoms (Uhthoff phenomenon).

Breathing exercises: diaphragmatic breathing, pursed-lip breathing and positioning relieve dyspnoea; pursed-lip breathing slows expiration and prevents airway collapse in COPD.

Airway clearance techniques include postural drainage, percussion, vibration, huffing, active cycle of breathing and positive expiratory pressure devices; avoid head-down positions in raised intracranial pressure and recent haemoptysis.

Cardiac rehabilitation phases: inpatient phase, early outpatient, late outpatient and maintenance. Exercise is prescribed with a warm-up, training phase and cool-down, monitored by heart rate and symptoms.

Six-minute walk test measures functional exercise capacity; record distance, oxygen saturation, heart rate and dyspnoea score (Borg scale) before and after.

Vital signs: normal resting heart rate 60-100 beats/min, respiratory rate 12-20 breaths/min, blood pressure around 120/80 mmHg, oxygen saturation 94-100%. Stop exercise on chest pain, severe dyspnoea or dizziness.

COPD rehabilitation improves dyspnoea and quality of life; smoking cessation, vaccination, pulmonary rehabilitation and home exercise are core components.

Community-based rehabilitation is delivered in homes and primary care, emphasising functional independence, caregiver training and accessibility of services.

Heart failure exercise should be supervised when severe; watch for weight gain, oedema and orthopnoea indicating decompensation.

Informed consent requires the patient to be competent, given adequate information and free from coercion; document consent for assessment and treatment.

Confidentiality: patient information must not be disclosed without consent except when required by law, court order or serious public health risk.

Professional boundaries: avoid dual relationships and never exploit the therapeutic relationship. Report impaired or unsafe colleagues through proper channels.

Scope of practice: treat within your competence and training; refer when the condition exceeds your scope. Continuing professional development maintains competence.

Documentation must be contemporaneous, accurate, dated and signed; records are legal documents and may be subpoenaed.

Duty of care and negligence: a practitioner owes a duty of care, must meet a reasonable standard, and breach causing harm gives rise to liability.

Ethical principles: autonomy, beneficence, non-maleficence and justice guide decisions. Truthfulness and integrity are expected in billing and certification.

Advertising and titles must not mislead; practitioners may not claim cures or use unverified credentials. Follow the registering council's code of conduct and disciplinary procedures.

Study designs: randomised controlled trial is best for treatment effect; cohort and case-control studies examine risk and prognosis; cross-sectional studies measure prevalence; case reports describe single cases.

Randomisation reduces selection bias; blinding (single, double, triple) reduces observer and performance bias. Intention-to-treat analysis preserves randomisation benefits.

Validity: internal validity concerns whether the study answers its question without bias; external validity concerns generalisability. Reliability is reproducibility; validity is accuracy of measurement.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives). Positive predictive value depends on prevalence.

Descriptive statistics: mean and standard deviation for normally distributed data; median and interquartile range for skewed data. Nominal data are summarised as proportions.

Inferential statistics: p value is the probability of the observed result if the null hypothesis is true; 95% confidence interval is the range likely to contain the true effect. Type I error is a false positive, type II a false negative.

Parametric tests (t-test, ANOVA) assume normal distribution; non-parametric alternatives include Mann-Whitney U, Wilcoxon and Kruskal-Wallis. Chi-square tests compare categorical proportions.

Evidence hierarchy: systematic reviews and meta-analyses of randomised trials sit at the top, then randomised trials, cohort studies, case-control studies, case series and expert opinion. Critical appraisal asks about validity, results and applicability.

Measures of central tendency: mean is sensitive to outliers; median is robust; mode is the most frequent value. Standard deviation describes spread around the mean.

Relative risk = incidence in exposed / incidence in unexposed; odds ratio compares odds of exposure in cases and controls and approximates relative risk for rare outcomes.

Absolute risk reduction = control event rate minus treatment event rate; number needed to treat = 1 / absolute risk reduction.

Correlation coefficient r ranges from -1 to +1 and measures linear association; it does not imply causation. r squared is the proportion of variance explained.

Sample size depends on effect size, variability, power (usually 0.80) and significance level (usually 0.05); larger samples narrow confidence intervals.

Normal distribution: about 68% of values lie within one standard deviation of the mean, 95% within two, 99.7% within three.

Survival analysis uses Kaplan-Meier curves and hazard ratios; censoring occurs when follow-up ends before the event.

Screening test interpretation: high sensitivity suits ruling out disease, high specificity suits confirming it; the predictive value changes with prevalence.

Evidence-based practice integrates the best available research evidence, clinical expertise and patient values and preferences; none of the three alone is sufficient.

The five steps: formulate an answerable question, search for evidence, critically appraise it, apply it to the patient, and evaluate the outcome.

PICO framework: Population, Intervention, Comparison, Outcome. A well-built question makes the search precise and reproducible.

Levels of evidence rank study designs; recommendations also consider consistency, directness, effect size and patient preferences, not design alone.

Clinical practice guidelines synthesise evidence and give recommendations; check the date, the developers and whether they used a systematic method such as GRADE.

Outcome measures should be reliable, valid and responsive; examples include the visual analogue scale for pain and the Barthel index for function.

Publication bias occurs when positive studies are more likely to be published, inflating apparent treatment effects; funnel plots detect it in meta-analyses.

Applying evidence: consider whether the study population resembles your patient, whether the intervention is feasible, and whether benefits outweigh harms and costs.