NBCOT Exam Prep Domain 1 and 2

Modified Ashworth Scale (MAS)

• 0 = No increase in tone

• 1 = Slight increase

• 1+ = Slight increase through <50% of ROM

• 2 = Increased tone through most ROM, moves easily

• 3 = Considerable increase, passive movement difficult

• 4 = Rigid

⭐ Higher score = more spasticity.

INR (International Normalized Ratio)

Measures blood clotting (used with Warfarin).

• Normal: ~0.8–1.2

• Therapeutic: 2.0–3.0

• Mechanical heart valve: 2.5–3.5

• >4–5: Increased bleeding risk

⭐ High INR = bleeding precautions.

t-score

average=40-60, 40 is below average

Alzheimer's Disease Stages

Early: Memory loss, mild forgetfulness, independent with some cues.

Middle: Confusion, impaired ADLs, wandering, supervision needed.

Late: Severe cognitive decline, dependent for ADLs, limited communication.

⭐ OT focus shifts from remediation → caregiver support and safety.

Pattern Memory Hook”

• 1–2 = basically normal aging

• 3–4 = noticeable + early Alzheimer’s

• 5 = ADLs start needing help

• 6–7 = full dependence + late stage

Premotor Cortex Preservation vs Ideational Apraxia

Premotor cortex preserved:
Can still plan and perform learned movement.

Ideational apraxia:
Cannot correctly sequence or use objects despite adequate strength.

Example:
Uses a toothbrush to comb hair.

⭐ Think: "Lost the idea of the task."

Axonotmesis

Peripheral nerve injury.

• Axon damaged

• Connective tissue intact

Recovery:
✔ Possible because axon can regenerate.

Severity:
Neuropraxia < Axonotmesis < Neurotmesis.

Volar Wrist Orthosis

Purpose:
Maintains wrist in functional/slight extension.

Used for:

• Carpal tunnel syndrome

• Wrist pain

• Tendinitis

• Mild wrist instability

⭐ Keeps wrist neutral to slight extension.

Trigger Finger Orthosis

Use:
Static immobilization orthosis

Purpose:
Keeps tendon from catching during flexion.

Goal:
Reduce inflammation and allow healing.

Fetal Alcohol Syndrome (FAS)

Features:

• Growth delay

• Intellectual disability

• Attention deficits

• Poor executive function

• Characteristic facial features

OT focus:

• Sensory regulation

• Self-care

• School participation

• Executive function

Central Field Impairment

Loss of central vision.

Common cause:
Macular degeneration.

Difficulty:

• Reading

• Recognizing faces

• Fine detail

Peripheral vision usually remains intact.

Allen Cognitive Levels (Ultra-Simplified)

Level 1: Total assist

Level 2: Large movements only

Level 3: Manual actions; needs step-by-step cues

Level 4: Can perform familiar routines

Level 5: Learns by trial and error; needs help with new/complex tasks

Level 6: Independent problem solving

⭐ Memory trick:
1 = Total care → 6 = Independent

Functional Independence Measure (FIM)

7 = Complete independence

6 = Modified independence (device/time)

5 = Supervision/setup

4 = Minimal assist (≥75%)

3 = Moderate assist (50–74%)

2 = Max assist (25–49%)

1 = Total assist (<25%)

⭐ Higher score = more independence.

Visual Closure

Ability to identify an object when only part of it is visible.

Example:
Recognizing a shoe that's partially covered by a blanket.

Deficit:
Difficulty recognizing incomplete visual information.

KELS (Kohlman Evaluation of Living Skills)

Ability to live independently.

Used For:

• Self-care

• Safety & health

• Money management

• Transportation/telephone

• Work & leisure

Remember ⭐⭐
Determines if a client can live independently or needs assistance.

MMSE (Mini-Mental State Examination)

Measures:
Global cognitive function.

Used For:
Cognitive screening.

Scores ⭐⭐

• 24–30: Normal

• 18–23: Mild impairment

• 0–17: Severe impairment

Remember ⭐⭐
Quick cognitive screen—not a functional assessment.

BOT-2 (Bruininks-Oseretsky Test of Motor Proficiency)

Measures:
Fine and gross motor proficiency.

Used For:
Children 4–21 years with suspected motor delays.

Remember ⭐⭐
Excellent for evaluating coordination, balance, strength, agility, and fine motor skills.

Jebsen-Taylor Hand Function Test

Measures:
Functional hand performance.

Used For:
Timed hand tasks including:

• Writing

• Page turning

• Picking up objects

• Feeding simulation

• Stacking

Remember ⭐
Measures functional hand use, not grip strength.

AMPS (Assessment of Motor and Process Skills)

Quality of ADL performance.

Used For:
Observing clients performing meaningful ADLs.

Evaluates:

• Motor skills

• Process skills

Remember ⭐⭐
One of the most functional OT assessments.

ECT(H) Criteria (Evaluation Tool of Children's Handwriting)

Handwriting quality.

Used For:
Evaluating:

• Letter formation

• Spacing

• Alignment

• Legibility

Remember ⭐
Used for school-aged children with handwriting concerns.

Barthel Index

Independence in ADLs.

Used For:
Rehabilitation settings.

Scores ⭐⭐

• 0–20: Total dependence

• 21–60: Severe dependence

• 61–90: Moderate dependence

• 91–99: Slight dependence

• 100: Independent

Remember ⭐⭐
Higher score = greater independence.

RBMT (Rivermead Behavioral Memory Test)

Functional memory.

Used For:
Assessing everyday memory abilities.

Examples:

• Remembering names

• Messages

• Appointments

Remember ⭐⭐
Looks at real-world memory, not just recall on paper.

BaFPE (Bay Area Functional Performance Evaluation)

Cognitive and functional performance.

Used For:
Psychiatric and cognitive rehabilitation.

Evaluates:

• ADLs

• Social interaction

• Cognitive abilities

Remember ⭐
Assesses functional performance in everyday tasks.

Trail Making Test Part B (TMT-B)

Measures:
Executive function.

Used For:
Assessing:

• Cognitive flexibility

• Divided attention

• Sequencing

Task:
Alternate numbers and letters (1-A-2-B...).

Remember ⭐⭐
Much harder than Part A because it requires task switching.

SCOPE (Short Child Occupational Profile)

Occupational participation.

Used For:
Children.

Based on:

• MOHO

• Volition

• Habituation

• Communication

• Motor skills

• Environment

Remember ⭐⭐
Think MOHO for pediatrics.

TEA (Test of Everyday Attention)

Attention.

Used For:
Assessing:

• Sustained attention

• Selective attention

• Divided attention

• Switching attention

Remember ⭐
Evaluates attention in functional situations.

TUG (Timed Up and Go)

Functional mobility and fall risk.

Used For:
Older adults and neurological populations.

Scores ⭐⭐

• <10 sec: Normal

• <20 sec: Independent mobility

• >30 sec: High fall risk/dependent

Remember ⭐⭐
Higher time = greater fall risk.

BRIEF (Behavior Rating Inventory of Executive Function)

Executive functioning in daily life.

Used For:
Children and adolescents.

Evaluates:

• Organization

• Working memory

• Inhibition

• Emotional control

• Planning

Remember ⭐⭐
Completed by parents/teachers to assess real-world executive function.

JFK Coma Recovery Scale–Revised (CRS-R)

Measures:
Level of consciousness after severe brain injury.

Used For:
Tracking recovery from coma.

Evaluates:

• Auditory

• Visual

• Motor

• Oromotor/verbal

• Communication

• Arousal

Remember ⭐⭐
Helps distinguish vegetative state from minimally conscious state and monitor recovery.

Unilateral Spatial Neglect

Failure to attend to one side of body/environment (usually left after right hemisphere stroke).

Used for:

• Stroke rehab

• ADLs (dressing, eating, grooming)

Interventions ⭐⭐

• Visual scanning training

• Anchoring techniques

• Position important items on neglected side

• Environmental cueing

Common Confusion ⚠
Not a visual field cut (vision is intact).

Apraxia

Inability to perform learned motor task despite intact strength, sensation, and comprehension.

Used for:
Neurological conditions (stroke, dementia).

Types (high yield):

• Ideomotor: knows task, can’t execute on command

• Ideational: cannot sequence multi-step task

Common Confusion ⚠
Problem is motor planning—not weakness.

Remember ⭐⭐
“Can’t do the action correctly.”

Agnosia

Definition:
Inability to recognize objects despite intact sensory input.

Used for:
Cortical damage (often stroke).

Types:

• Visual agnosia

• Tactile agnosia

Common Confusion ⚠
Sensation is intact; brain cannot interpret input.

Remember ⭐⭐
“Can’t recognize what it is.”

Perseveration

Repetition of a response even when no longer appropriate.

Used for:
Brain injury, dementia, frontal lobe dysfunction.

Examples:

• Repeating same drawing/writing

• Stuck on same answer in conversation

Remember ⭐⭐
“Stuck in response loop.”

Concrete Thinking

• Schizophrenia

• Cognitive impairment

• Brain injury

Implications:

• Difficulty with proverbs, abstract reasoning

• Needs simple, literal instructions

Remember ⭐
“Everything is literal.”

Tangential Speech

Speech that goes off-topic and does not return to original point.

Used for:

• Schizophrenia

• Mania

Example:
Asked about lunch → talks about food → then unrelated story → never answers question.

Remember ⭐⭐
“Never comes back to the point.”

Object Permanence

Understanding that objects still exist even when out of sight.

Used for:
Infant cognitive development.

Typical Age ⭐⭐
~8–12 months

If absent:
Infant behaves as if object “disappears” when hidden.

Remember ⭐
Foundational cognitive milestone in early development.

Flexor Tendon Repair (OT precautions)

Surgical repair of flexor tendon (hand/finger flexion structures).

Early Rehab Goal:
Protect repair while preventing adhesions.

Key OT Precautions ⭐⭐

• NO active flexion early phase (depends on protocol)

• Use dorsal blocking splint

• Controlled passive flexion (protocol-dependent)

• Avoid forceful gripping

Splint Position ⭐⭐

• Wrist: ~20–30° flexion

• MCP: flexed (~50–70°)

• IPs: slight flexion

Remember ⭐⭐
Protect repair > restore motion early.

Fracture Types (High Yield OT)

Closed (simple):

• Bone broken, skin intact

Open (compound):

• Bone breaks through skin → infection risk

Comminuted:

• Bone shattered into multiple pieces

Greenstick (kids):

• Incomplete break (one side bends)

Impacted:

• Bone ends driven into each other

Remember ⭐⭐
Open = infection risk, Comminuted = severe trauma.

Amputations (High Yield OT Concepts)

• Transradial (below elbow)

• Transhumeral (above elbow)

• Transtibial (below knee)

• Transfemoral (above knee)

OT Focus ⭐⭐

• Residual limb care (shaping, desensitization)

• Edema control (shrinker sock)

• ADL training

• Phantom limb management

Immediate Post-op Priority

• Positioning to prevent contractures:

  • Avoid hip flexion/abduction (LE amps)

  • Avoid elbow flexion contracture (UE amps)

Remember ⭐⭐
Prevent contractures early = critical NBCOT point.

Volar Wrist Cock-Up Splint

Position:

• Wrist: neutral to slight extension

Used For:

• Carpal tunnel syndrome

• Wrist sprain

• Tendonitis

• Post-fracture support

Remember ⭐⭐
Most common functional wrist splint.

Dorsal Blocking Splint

• Wrist flexed (~20–30°)

• MCP flexed (~50–70°)

• Fingers supported in flexion

Used For:

• Flexor tendon repair (early phase)

Purpose ⭐⭐
Prevents active extension of fingers to protect repair.

Remember ⭐⭐
“Tendon repair protection splint.”

Thumb Spica Splint

Position:

• Immobilizes thumb CMC + MCP joints

Used For:

• De Quervain’s tenosynovitis

• Thumb sprain

• Gamekeeper’s thumb

Remember ⭐⭐
“Thumb pain = thumb spica.”

Resting Hand Splint

• Wrist: slight extension

• MCP: flexed

• IP joints: extended

Used For:

• Neurological conditions (stroke, spasticity)

• Prevent contractures

Remember ⭐⭐
“Anti-deformity splint for neuro patients.”

Ulnar Gutter Splint

• Immobilizes 4th and 5th digits (ring + small finger)

Used For:

• Boxer's fracture (5th metacarpal)

Remember ⭐⭐
“Boxer’s fracture splint.”

Allodynia

Pain caused by a stimulus that normally does NOT cause pain.

Example:

• Light touch feels painful

• Clothing or breeze feels painful

Used For:

• Neuropathic pain conditions

• CRPS (complex regional pain syndrome)

OT Focus ⭐⭐

• Desensitization techniques

• Graded exposure

• Gradual texture progression

• Stress loading (if CRPS)

Remember ⭐⭐
“Non-painful touch = painful response.”

Closed Kinetic Chain (CKC) Movement

Definition:
Distal segment is fixed/weight-bearing

Examples:

• Squats (feet fixed)

• Push-ups (hands fixed)

• Standing balance activities

Characteristics ⭐⭐

• More joint stability

• More functional, weight-bearing activity

• Multiple joints work together

Used In OT For:

• Functional mobility

• Rehab progression

• Weight-bearing tolerance

Remember ⭐⭐
“Fixed end = stable, functional movement.”

Open Kinetic Chain (OKC) Movement

Back:

Definition:
Distal segment is free to move

Examples:

• Leg extensions

• Bicep curls

• Reaching tasks without weight-bearing

Characteristics ⭐⭐

• Isolated muscle/joint movement

• Less stability demand

• More controlled strengthening

Used In OT For:

• Early rehab strengthening

• Isolated muscle training

• ROM exercises

Remember ⭐⭐
“Free end = isolated movement.”

Complete Decongestive Therapy (CDT)

Treatment for lymphedema involving manual lymph drainage, compression, exercise, and skin care to reduce swelling and improve lymph flow.

What is scleroderma?

Autoimmune connective tissue disorder causing skin thickening, tightness, and possible internal organ fibrosis (lungs, GI, heart).

Cerebral Palsy Types

What are the main types of cerebral palsy?
Back: Spastic, dyskinetic (athetoid), ataxic, mixed.

What is diplegia in cerebral palsy?

Motor impairment primarily affecting bilateral lower extremities more than upper extremities.

What is the ASIA impairment scale used for?

Classifies spinal cord injury severity:
A = complete
B = sensory only
C = motor function <50% key muscles <3/5
D = motor function ≥50% ≥3/5
E = normal

Seizure Types

• Focal (partial)

• Generalized (tonic-clonic, absence, myoclonic, atonic, tonic, clonic)

Congenital Torticollis

Tight or shortened sternocleidomastoid muscle causing head tilt toward affected side and rotation away.

What is the most specific lab marker for MI?

Troponin I and T (most specific and sensitive for cardiac muscle damage).

What is the IPS model in OT?

Person–Environment–Occupation model focusing on interaction between intrinsic factors, person skills, and environmental demands to support occupational performance.

What is Manual Muscle Testing (MMT)?

trace
2 = full ROM gravity eliminated
3 = full ROM against gravity
4 = against moderate resistance
5 = normal strength