NPTE-PTA cheat sheet

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

Capsular patterns: glenohumeral = external rotation > abduction > internal rotation; hip = internal rotation > flexion > abduction > extension; knee = flexion > extension.

Convex-concave rule: a convex surface moving on a concave surface glides opposite the osteokinematic motion; a concave surface moving on a convex surface glides in the same direction.

Close-packed position is maximal joint congruency with maximal capsular tension, allowing minimal accessory motion; loose-packed position has least congruency and is used for joint mobilization.

Tissue healing timeline: inflammatory phase days 0-5, proliferative/fibroplastic phase roughly day 5 to 3-6 weeks, remodeling/maturation phase up to 12 months or more.

Approximate normal AROM: shoulder flexion 180°, abduction 180°, external rotation 90°, internal rotation 70°; elbow flexion 150°; hip flexion 120°; knee flexion 135°; ankle dorsiflexion 20°.

Key dermatomes: C5 lateral arm, C6 thumb, C7 middle finger, C8 little finger, T4 nipple line, T10 umbilicus, L4 medial malleolus, L5 dorsum of foot, S1 lateral foot.

Lachman test at approximately 20-30° knee flexion is the most sensitive clinical test for anterior cruciate ligament integrity; the ACL resists anterior tibial translation and tibial internal rotation.

Osteoporotic bone responds to progressive weight-bearing and resistance loading; spinal flexion combined with rotation and high-impact loading increase vertebral compression fracture risk in severe disease.

Upper motor neuron lesion signs: hyperreflexia, spasticity, clonus, positive Babinski sign, minimal atrophy; lower motor neuron signs: flaccidity, atrophy, fasciculations, hyporeflexia, areflexia.

Modified Ashworth Scale grades resistance to passive movement: 0 = no increase in tone, 1 = slight catch, 1+ = catch then minimal resistance through less than half of ROM, 2 = marked increase through most of ROM, 3 = considerable, 4 = rigid.

Brunnstrom recovery stages: 1 flaccidity, 2 synergy emerging, 3 voluntary synergy movement, 4 movement deviating from synergy, 5 synergy no longer dominant, 6 near-normal coordination, 7 normal.

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.

Glasgow Coma Scale: eye 1-4, verbal 1-5, motor 1-6; total 3-15, with 8 or less indicating severe brain injury and need for airway protection.

ASIA impairment scale: A = no sacral sparing, B = sensory but no motor sparing below level, C = motor preserved with more than half of key muscles below level graded less than 3, D = at least half graded 3 or more, E = normal.

Decorticate posturing shows upper extremity flexion with lower extremity extension (lesion above red nucleus); decerebrate posturing shows extension and internal rotation of all extremities (worse prognosis).

Cranial nerve V controls jaw clenching and facial sensation (test masseter and three sensory divisions); cranial nerve VII controls ipsilateral facial expression, with a lesion causing ipsilateral lower or whole-face weakness.

Neuroplasticity is driven by repetitive, task-specific, salient practice; constraint-induced movement therapy restricts the less-affected upper extremity to force use of the involved limb.

Cardiac output = heart rate × stroke volume; stroke volume = end-diastolic volume − end-systolic volume; resting cardiac output is approximately 5 L/min.

Blood pressure = cardiac output × total peripheral resistance; normal adult values are systolic below 120 mmHg and diastolic below 80 mmHg.

MET values: 1 MET ≈ 3.5 mL O2/kg/min; 2-3 METs = slow walking, 4 METs = climbing one flight of stairs or heavy housework, 10 METs = running.

Orthostatic hypotension is a fall of at least 20 mmHg systolic or 10 mmHg diastolic within minutes of moving from supine to sitting or standing.

Obstructive disease shows FEV1/FVC below 0.70 with increased residual volume and air trapping; restrictive disease shows reduced vital capacity with a preserved or elevated FEV1/FVC ratio.

Typical lung volumes: tidal volume ~500 mL, inspiratory reserve ~3000 mL, expiratory reserve ~1100 mL, residual volume ~1200 mL.

Borg 6-20 RPE: 11-13 corresponds to fairly light to somewhat hard and is the usual target range for moderate-intensity aerobic training; maximal heart rate estimated as 220 − age.

Stop exercise for chest pain, ST segment changes, a drop in systolic pressure greater than 10 mmHg with increasing workload, severe dyspnea, dizziness, pallor, or confusion.

Pursed-lip and diaphragmatic breathing reduce dyspnea and air trapping in COPD; a huff (forced expiration with open glottis) helps mobilize secretions.

Pressure injury staging: 1 = intact skin with nonblanchable erythema, 2 = partial-thickness loss with exposed dermis, 3 = full-thickness loss to subcutaneous fat, 4 = full-thickness loss to fascia, muscle, tendon, or bone.

Wound healing sequence: hemostasis, inflammation (roughly days 1-5), proliferation with granulation and epithelialization (days 5-21), and maturation with type III collagen replaced by type I (weeks to months).

Superficial partial-thickness burn: painful, blistered, moist, blanches with pressure; full-thickness burn: dry, leathery, white or charred, insensate, and usually requiring grafting.

Rule of nines in adults: each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, head 9%, perineum 1%.

Arterial ulcer: punched-out, well demarcated, pale, painful, often on toes or lateral malleolus with low ankle-brachial index; venous ulcer: irregular, shallow, near the medial malleolus with edema and hemosiderin staining.

Ankle-brachial index below 0.90 suggests peripheral arterial disease; above 1.3 suggests noncompressible calcified vessels and requires further vascular testing.

Stable, dry eschar on heels or ischemic limbs is not debrided until vascular status is evaluated; wet or infected eschar requires debridement.

Scar management after wound closure uses silicone gel or sheeting, pressure garments worn approximately 23 hours per day, and massage to improve pliability.

An unstageable pressure injury is full-thickness loss obscured by slough or eschar, so depth cannot be confirmed until the covering is removed or autolytically dissolved.

Diabetes diagnostic thresholds: fasting plasma glucose 126 mg/dL or higher, HbA1c 6.5% or higher, or 2-hour oral glucose tolerance test 200 mg/dL or higher.

Exercise is deferred when blood glucose exceeds 250 mg/dL with ketones, or when hypoglycemia is likely; patients should check glucose before, during, and after activity and carry fast-acting carbohydrate.

Peripheral neuropathy screening uses the 10-g monofilament and vibration (128 Hz tuning fork); patients need daily foot inspection, well-fitting shoes, and no barefoot walking.

Cancer rehabilitation precautions: hold exercise when platelets are below 20,000/µL or hemoglobin is below 8 g/dL; avoid resistance training to irradiated or lytic bone.

DEXA T-score of -2.5 or lower defines osteoporosis, -1.0 to -2.5 defines osteopenia, and each standard deviation drop roughly doubles fracture risk.

Lymphedema is managed with complete decongestive therapy: manual lymphatic drainage, multilayer short-stretch compression, remedial exercise, and skin care, followed by a lifelong maintenance phase.

Fibromyalgia and chronic pain respond best to graded aerobic exercise, education, and pacing; central sensitization means pain is not a reliable guide to tissue damage.

Corticosteroids impair collagen synthesis and raise blood glucose; NSAIDs may delay bone healing; anticoagulants and thrombocytopenia contraindicate deep massage and vigorous joint mobilization.

Residual limb wrapping uses figure-eight turns progressing distal to proximal with greater pressure distally, rewrapped several times daily to shape the limb and control edema.