Musculoskeletal
22-29%of exam
ROM + MMTJoint ConditionsPost-Op PrecautionsGait + PostureOrthopedic Tests
Neuromuscular + Nervous
19-25%of exam
Cardiopulmonary
14-19%of exam
Vital SignsExercise ResponseAirway ClearanceCardiac RehabCOPD + CHF
Other Systems
10-22%of exam
IntegumentaryWound StagesMetabolicLymphedemaSystem Interactions
Non-Systems
15-21%of exam
ModalitiesEquipmentSafetyPTA ScopeProfessional Duty
Quick Facts
- Exam
- NPTE-PTA
- Body
- FSBPT
- Items
- 180 (140 scored)
- Time
- 4 hours
- Pass
- Scaled 600/800
- Fees
- $485 + $92
- Provider
- Prometric
- Eligibility
- CAPTE PTA grad
MMT Quick Recall
None Flick Gone Gravity Some Max
3 = antigravity4 = moderate5 = full resistance2 = gravity eliminated
ROM vs MMT
ROM
- Joint motion
- Goniometer
- Degrees measured
- AROM or PROM
MMT
- Muscle strength
- Manual resistance
- 0-5 grade
- Antigravity tested
Motion vs strength
MMT Grades
- 0/5
- No contraction
- 1/5
- Trace flicker only
- 2/5
- Gravity-eliminated full ROM
- 3/5
- Antigravity, no resistance
- 4/5
- Antigravity, moderate resistance
- 5/5
- Antigravity, max resistance
Acute Injury
RICE: Rest Ice Compression Elevation
First 48-72 hoursReduces edemaLimits inflammationAdd NSAIDs if ordered
AROM vs PROM
AROM
- Patient moves
- Tests willing motion
- Strength involved
- Pain limits
PROM
- Clinician moves
- Tests joint integrity
- No muscle effort
- End-feel assessed
Patient vs clinician
Normal AROM
- Shoulder flexion
- 0-180 degrees
- Shoulder abduction
- 0-180 degrees
- Elbow flexion
- 0-150 degrees
- Hip flexion
- 0-120 degrees
- Knee flexion
- 0-135 degrees
- Ankle dorsiflexion
- 0-20 degrees
- Ankle plantarflexion
- 0-50 degrees
Concentric vs Eccentric
Concentric
- Muscle shortens
- Lifts load
- Less force output
- Quad ascending stairs
Eccentric
- Muscle lengthens
- Controls load
- More force output
- Quad descending stairs
Shorten vs lengthen
Normal End-Feels
- Hard
- Bone-to-bone
- Soft
- Tissue approximation
- Firm
- Capsular or muscular
- Empty
- Pain stops motion
- Springy block
- Loose body
- Boggy
- Joint effusion
Open vs Closed Chain
Open chain
- Distal segment free
- Leg extension
- Isolated joint
- Single muscle
Closed chain
- Distal segment fixed
- Squat, lunge
- Multi-joint
- Functional task
Free vs fixed
THA Precautions
- Posterior approach
- No flexion past 90
- Posterior approach
- No adduction past midline
- Posterior approach
- No internal rotation
- Anterior approach
- No extension or ER
- Duration
- 6-12 weeks typical
- Crossing legs
- Always avoid
Gait Quick Facts
- Stance
- 60% of cycle
- Swing
- 40% of cycle
- Double support
- 20% of cycle
- Cadence
- 100-120 steps/min
- Velocity
- 1.2-1.4 m/s
- Trendelenburg
- Weak gluteus medius
- Steppage
- Foot drop pattern
Stroke Side Cue
Left lost language, right rushes risk
Left CVA: aphasiaLeft CVA: cautiousRight CVA: neglectRight CVA: impulsive
Spasticity vs Rigidity
Spasticity
- Velocity dependent
- UMN lesion
- Clasp-knife pattern
- Stroke, SCI
Rigidity
- Velocity independent
- Basal ganglia
- Cogwheel or lead-pipe
- Parkinson disease
Speed-driven vs constant
Tone + Reflexes
- Hypertonia
- UMN lesion sign
- Hypotonia
- LMN or cerebellar
- Spasticity
- Velocity-dependent resistance
- Rigidity
- Velocity-independent resistance
- Clonus
- Rhythmic stretch beats
- Babinski
- Toe extension, UMN
- DTR 2+
- Normal reflex
- DTR 4+
- Hyperactive, clonus
SCI Functional Levels
- C1-C4
- Ventilator dependent
- C5
- Power chair, biceps
- C6
- Tenodesis grasp
- C7
- Independent transfers
- T1-T9
- Wheelchair independent
- T10-L1
- Household ambulation
- L2-S5
- Community ambulation
Stroke Side Profile
- Left CVA
- Right hemiparesis
- Left CVA
- Aphasia, slow cautious
- Right CVA
- Left hemiparesis
- Right CVA
- Neglect, impulsive
- Brunnstrom 1
- Flaccid stage
- Brunnstrom 4
- Movement out synergy
- Brunnstrom 6
- Near normal
Abnormal Vitals Response
- Chest pain begins→Stop, sit, notify(Call PT/RN)
- SBP drops >10→Stop activity(Recheck)
- SBP >200→Stop exercise(Report PT)
- SpO2 <90%→Rest, reassess(Add O2 if ordered)
- HR irregular→Stop, monitor(Document)
- Sudden dyspnea→Position upright(Notify nurse)
Stop Exercise If
- SBP drop
- >10 mmHg with exercise
- SBP rise
- >250 mmHg
- DBP rise
- >115 mmHg
- HR drop
- Below resting
- SpO2
- Below 90%
- RPE
- Borg above 15
- Symptoms
- Chest pain, dizziness
Normal Adult Vitals
- HR rest
- 60-100 bpm
- BP normal
- <120/80 mmHg
- Resp rate
- 12-20 breaths
- SpO2
- >=95% room air
- Temp
- 97-99 F
- MaxHR
- 220 minus age
- Target HR
- 60-80% max
Pressure Injury Stages
- Stage 1
- Nonblanchable erythema
- Stage 2
- Partial dermis loss
- Stage 3
- Full thickness, fat
- Stage 4
- Bone, tendon, muscle
- Unstageable
- Eschar covers wound
- DTI
- Deep tissue injury
Stairs Order
Up with good, down with bad
Good leg leads upBad leg leads downCane with bad legHeaven up, hell down
PT vs PTA Scope
PT
- Initial evaluation
- Develops POC
- Discharge decision
- Sharp debridement
PTA
- Implements POC
- Collects data
- Modifies within POC
- Reports to PT
Evaluate vs implement
Modality Picker
- Acute injury <48h→Cryotherapy(Cold pack)
- Chronic muscle spasm→Moist heat(Hot pack)
- Deep tissue heating→US 1 MHz(Continuous)
- Tissue healing→US pulsed(Nonthermal)
- Acute pain→TENS high(Gate control)
- Muscle reeducation→NMES(Strengthening)
- Wound healing→ES wound(Polarity protocol)
Therapeutic Modalities
- US continuous
- Thermal, deep heat
- US pulsed
- Nonthermal, tissue repair
- US 1 MHz
- Deep, 3-5 cm
- US 3 MHz
- Superficial, 1-2 cm
- TENS
- Pain modulation
- NMES
- Muscle reeducation
- Hot pack
- 8 layers towel
- Cold pack
- 10-20 min max
Isolation Types
Contact Droplet Airborne
Contact: MRSA, gownDroplet: flu, maskAirborne: TB, N95Standard: always
PTA Task Allowed
- Initial evaluation→PT only(Never PTA)
- Develop POC→PT only(Never PTA)
- Sharp debridement→PT only(Outside PTA)
- Spinal manipulation→PT only(Not PTA scope)
- Implement POC→PTA okay(Within plan)
- Collect data→PTA okay(Report PT)
- Modify intensity→PTA okay(Within POC)
- Discharge decision→PT only(PTA reports)
Assistive Devices
- Cane
- Opposite affected side
- Cane height
- Greater trochanter level
- Crutch height
- 2 fingers below axilla
- Walker WBAT
- Most stable choice
- Stairs up
- Good leg first
- Stairs down
- Bad leg first
- Elbow flex
- 20-30 on handgrip
Device Picker
- Min support balance→Single cane(Opposite side)
- Mod support balance→Quad cane(Wider base)
- PWB one limb→Axillary crutches(3-point gait)
- NWB short term→Walker(Most stable)
- Bilateral weakness→Rolling walker(Easier propulsion)
- Long-term LE weak→Forearm crutches(Lofstrand)
Safety + Infection
- Standard
- All patients, all fluids
- Contact
- MRSA, C. diff, gown
- Droplet
- Flu, mask within 6 ft
- Airborne
- TB, N95, negative room
- Gait belt
- Required for transfers
- Fall risk
- Locked brakes always
Common Traps
Evaluate vs implement
PT evaluates ≠ PTA implements POC
MMT 3 vs 4
3 = no resistance ≠ 4 = some resistance
US thermal vs not
Continuous heats ≠ Pulsed does not
Cane side error
Cane opposite side ≠ Not same side
Stairs direction
Good leads up ≠ Bad leads down
Spastic vs rigid
Spastic velocity dependent ≠ Rigid not dependent
Hot pack burn
Use 8 layers ≠ Not direct skin
Posterior THA limit
No flexion past 90 ≠ No adduction past midline
Last Minute
- 1.180 items, 4 hours, scaled 600
- 2.PT evaluates; PTA implements POC
- 3.PTA cannot debride sharp wounds
- 4.MMT 3 = antigravity, no resistance
- 5.Knee normal ROM 0-135 degrees
- 6.Cane opposite affected leg
- 7.Up good leg; down bad leg
- 8.Stop if SBP drops >10 mmHg
- 9.Stop if SpO2 below 90 percent
- 10.1 MHz deep; 3 MHz superficial
- 11.Continuous US heats; pulsed nonthermal
- 12.Hot pack: 8 layers, 15-20 minutes
- 13.Posterior THA: no flexion past 90
- 14.Left CVA aphasia; right CVA neglect
- 15.Contact gown; droplet mask; airborne N95
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