NPTE High Yield Charts Neuromuscular

LEFT CVA — hallmark deficits

Aphasia (Broca's/Wernicke's), slow/cautious behavior, right-sided weakness/sensory loss

LEFT CVA — motor/tone pattern

Right spasticity; UE flexor synergy, LE extensor synergy

LEFT CVA — PTA assess

Communication, right-sided proprioception, language comprehension

LEFT CVA — PTA treat

Simple commands, demos, extra time; emphasize safety & sequencing

RIGHT CVA — hallmark deficits

Spatial-perceptual deficits, impulsive/poor judgment, left neglect, left-sided weakness/sensory loss

RIGHT CVA — motor/tone pattern

Left spasticity; trunk/LE extensor tone dominance

RIGHT CVA — PTA assess

Attention, left neglect, safety awareness, visual scanning

RIGHT CVA — PTA treat

Cue to left side, mirror feedback, close guard; teach safety awareness

BRAINSTEM STROKE — hallmark deficits

Bilateral weakness, dysphagia/dysarthria, CN involvement, altered consciousness

BRAINSTEM STROKE — tone pattern

Mixed tone; severe deficits likely

BRAINSTEM STROKE — PTA focus

Airway, swallowing, eye movement, postural control

BRAINSTEM STROKE — PTA treat

Positioning, head/neck control, respiratory & swallowing safety

CEREBELLAR STROKE — hallmark deficits

Ataxia, dysmetria, hypotonia, intention tremor, balance loss, nystagmus

CEREBELLAR STROKE — tone/pattern

Hypotonia initially; poor coordination

CEREBELLAR STROKE — PTA assess

Balance, coordination, oculomotor control

CEREBELLAR STROKE — PTA treat

Controlled movement, weight shifting, visual feedback; avoid early dual tasks

ACA STROKE — hallmark deficits

Contralateral leg > arm weakness, urinary incontinence, apraxia, flat affect (abulia)

ACA STROKE — tone/pattern

LE spasticity > UE

ACA STROKE — PTA focus

Gait and LE tone

ACA STROKE — PTA treat

Gait/balance training, sequencing, cognitive cueing

MCA STROKE — hallmark deficits

Face/arm weakness > leg, homonymous hemianopsia; L MCA: aphasia; R MCA: neglect

MCA STROKE — tone/pattern

UE flexor synergy; LE extensor synergy

MCA STROKE — PTA focus

UE tone, vision, speech/neglect

MCA STROKE — PTA treat

PNF/NDT to manage synergy, constraint-induced therapy, sensory re-education

PCA STROKE — hallmark deficits

Visual field loss, thalamic pain, agnosia, memory deficits

PCA STROKE — tone/pattern

Variable tone

PCA STROKE — PTA focus

Visual tracking, balance, sensation

PCA STROKE — PTA treat

Visual scanning, compensatory safety training

LACUNAR INFARCT — hallmark deficits

Pure motor or sensory stroke (often internal capsule)

LACUNAR INFARCT — tone/pattern

Spasticity; motor loss without cortical signs

LACUNAR INFARCT — PTA focus

Strength, tone, coordination

LACUNAR INFARCT — PTA treat

Strengthening, functional retraining, task-specific practice

STROKE RECOVERY — Stage 1 (Flaccid)

No movement; hypotonia

PTA for Stage 1

Prevent contractures, positioning, PROM

STROKE RECOVERY — Stages 2-3 (Spasticity developing)

UE flexor synergy; LE extensor synergy; spasticity peaks

PTA for Stages 2-3

Tone inhibition (slow rocking, weight bearing), tone management

STROKE RECOVERY — Stages 4-5 (Voluntary movement emerging)

Movement combos appear; tone decreasing

PTA for Stages 4-5

Facilitation (tapping, quick stretch), PNF, task-specific practice

STROKE RECOVERY — Stage 6+ (Functional recovery)

Isolated movement & coordination returning

PTA for Stage 6+

Task-specific training, strengthening, gait/endurance

UE FLEXION SYNERGY — components

Scap retraction/elevation; shoulder abduction & ER; elbow flexion; forearm supination; wrist/finger flexion

UE EXTENSION SYNERGY — components

Scap protraction; shoulder adduction & IR; elbow extension; forearm pronation; wrist/finger flexion

LE FLEXION SYNERGY — components

Hip flexion/abduction/ER; knee flexion; ankle DF/inversion; toe extension

LE EXTENSION SYNERGY — components

Hip extension/adduction/IR; knee extension; ankle PF/inversion; toe flexion

CLINICAL KEY — Right vs Left CVA

Right CVA = impulsive; Left CVA = cautious

CLINICAL KEY — UE vs LE synergy

UE flexor synergy typically more problematic than LE

CLINICAL KEY — Named approaches

Brunnstrom (recovery stages); Rood/PNF/NDT (facilitate/inhibit tone)

CLINICAL KEY — PTA role

Manage tone, improve function, monitor vitals, cue safety, report new deficits immediately

CLINICAL KEY — Early session dosing

Avoid fatigue early; promote motor learning & neuroplasticity

C1-C3 — Function/abilities

Limited head/neck control; diaphragm impaired (ventilator dependent); communicates via assistive tech

C1-C3 — Equipment/mobility

Ventilator; power wheelchair with head/chin/breath control; electric bed; environmental control unit

C1-C3 — PTA focus

Total assist for ADLs/transfers; caregiver training; positioning; prevent contractures/pressure sores

C4 — Function/abilities

Partial diaphragm innervation; shoulder elevation via trapezius; improved respiration

C4 — Equipment/mobility

Power wheelchair with head control or sip-and-puff; ventilator possibly needed

C4 — PTA focus

Respiratory hygiene/assisted cough; dependent transfers; positioning

C5 — Function/abilities

Biceps, brachialis, deltoid active → elbow flexion & shoulder abduction; no wrist/hand movement

C5 — Equipment/mobility

Manual or power wheelchair with joystick; hand splints; universal cuff; mobile arm support

C5 — PTA focus

Self-feeding/grooming with adaptations; protect shoulders; dependent transfers

C6 — Function/abilities

Wrist extensors (ECRL/B) active; tenodesis grasp; improved shoulder stability

C6 — Equipment/mobility

Manual wheelchair with projection rims; slide board; standing frame; universal cuff for feeding

C6 — PTA focus

Independent slide-board transfers, feeding, grooming; train tenodesis; pressure relief education

C7 — Function/abilities

Triceps, wrist flexors, finger extensors active → functional elbow extension

C7 — Equipment/mobility

Manual wheelchair; car with hand controls; shower chair

C7 — PTA focus

Independent transfers/dressing/wheelchair propulsion; UE endurance and conditioning

C8 — Function/abilities

Finger flexors/extensors → full grasp & release

C8 — Equipment/mobility

Manual wheelchair; adaptive ADL devices as needed

C8 — PTA focus

Potential for independent living; fine motor and grip strengthening

T1-T8 — Function/abilities

Full UE control; limited trunk stability; partial intercostals

T1-T8 — Equipment/mobility

Manual wheelchair; standing frame; KAFOs for exercise ambulation

T1-T8 — PTA focus

Independent transfers/wheelchair mobility; posture and endurance training

T9-T12 — Function/abilities

Abdominals & lower trunk control; improved sitting/standing balance

T9-T12 — Equipment/mobility

Manual wheelchair for community; KAFOs/RGO/HKAFO for exercise ambulation

T9-T12 — PTA focus

Short-distance ambulation possible with orthoses; train trunk stability & efficiency

L1-L2 — Function/abilities

Hip flexors (iliopsoas) active

L1-L2 — Equipment/mobility

KAFOs/AFOs; forearm crutches; wheelchair for distance

L1-L2 — PTA focus

Short household ambulation feasible; manage high energy cost

L3-L4 — Function/abilities

Quadriceps, adductors, partial hamstrings

L3-L4 — Equipment/mobility

AFOs or KAFOs; crutches/cane

L3-L4 — PTA focus

Community ambulation with orthoses; wheelchair may be needed for long distances

L5 — Function/abilities

Hamstrings, gluteus medius, tibialis anterior; weak plantar flexors

L5 — Equipment/mobility

AFO; possibly cane

L5 — PTA focus

Ambulates with minimal device; monitor limited endurance

S1-S2 — Function/abilities

Gastrocnemius and gluteus maximus strong; plantar flexors fully functional

S1-S2 — Equipment/mobility

No orthosis or minimal assistive device

S1-S2 — PTA focus

Normal/near-normal gait & ADLs; watch for overuse fatigue

Central cord syndrome — Lesion

Cervical hyperextension; central gray matter damage

Central cord syndrome — Features

UE > LE weakness; variable sensory loss; possible bladder dysfunction

Central cord syndrome — PTA focus

Emphasize UE strengthening & fine motor; gait often recovers earlier

Brown-Sequard syndrome — Lesion

Hemisection of cord (e.g., stab wound, tumor)

Brown-Sequard syndrome — Features

Ipsilateral motor/proprioception loss; contralateral pain/temperature loss

Brown-Sequard syndrome — PTA focus

Generally good prognosis; balance/coordination training

Anterior cord syndrome — Lesion

Flexion injury; anterior 2/3 cord damage

Anterior cord syndrome — Features

Loss of motor, pain, temperature; preserved light touch & proprioception

Anterior cord syndrome — PTA focus

Poor prognosis; compensatory strategies and strong safety emphasis

Posterior cord syndrome — Lesion

Posterior columns (tumor, infarct)

Posterior cord syndrome — Features

Loss of proprioception, vibration, light touch; motor and pain/temp preserved

Posterior cord syndrome — PTA focus

Use visual cues for balance & safety

Cauda equina — Lesion

Lumbosacral nerve roots (L1 and below)

Cauda equina — Features

Flaccid paralysis; areflexia; saddle anesthesia; bowel/bladder dysfunction

Cauda equina — PTA focus

LMN management: strengthening, compensatory mobility, bladder training