PTA NPTE Final Frontier Orientation Flashcards

The content is divided into System-specific and Non-system categories with associated question ranges for Physical Therapy Data Collection, Diseases/Conditions, and Interventions.

Manual Muscle Testing (MMT) Positions

• Supine (Against Gravity): Abdominals, Anterior Deltoid, Biceps, Brachioradialis, Finger flexors, Finger extensors, Iliopsoas, Infraspinatus, Lateral rotators of shoulder, Medial rotators of shoulder, Neck flexors, Pectoralis Major, Pronators, Sartorius, Pectoralis Minor, Supinators, Tensor Fasciae Latae (TFL), Teres Minor, Thumb muscles, Tibialis Anterior, Tibialis Posterior, Toe extensors, Toe flexors, Serratus Anterior, Wrist extensors, Wrist flexors, Triceps.

• Sidelying: Gluteus Medius, Gluteus Minimus, Hip adductors, Lateral abdominals.

• Prone: Back extensors, Gastrocnemius, Gluteus Maximus, Hamstrings, Lateral rotators of shoulder, Latissimus Dorsi, Middle and Lower Trapezius, Medial rotators of shoulder, Neck extensors, Posterior Deltoid, Quadratus Lumborum, Rhomboids, Soleus, Teres Major, Triceps.

MMT Muscle Grading Scale

Phases of Rehabilitation

Acute Phase

• Impairments: Inflammation, spasm, pain, loss of Range of Motion (ROM), edema/effusion, loss of function.

• Interventions: Control of pain, edema, and spasm; PRICE (Protection, Rest, Ice, Compression, Elevation); massage; gentle mobilizations; Passive ROM (PROM) > Active-Assistive ROM (AAROM) > Active ROM (AROM); isometrics within pain-free range; proximal and distal exercises; adaptive equipment.

• Contraindications (AVOID): Stretching and resistive exercises involving the inflamed tissue.

Subacute Phase

• Impairments: Pain at end ROM, decreased edema/effusion, development of contractures and weakness, loss of function.

• Interventions: Patient education; decreased use of immobilizers/assistive devices; scar mobility; stretching; PROM > AAROM > AROM within pain-free range; multiangle isometrics > isotonic > progressive resistance; control, mechanics, weight bearing, and stabilization; resumption of normal activities as tolerated.

• Constraint (AVOID): Therapy should not cause lasting pain or discomfort.

Chronic Phase

• Impairments: Joint and tissue contractures, poor muscle performance, decreased function, inability to participate fully in activities.

• Interventions: Patient education; stretching, mobilizations, and cross-friction massage; complex multiplane movements; proximal stability with distal motions; aerobic exercise; specificity and function.

• Constraint (AVOID): Lasting pain or pain requiring pain medication.

Modified Ashworth Scale (MAS)

Hypertonicity Terms

• Spasticity: Velocity-dependent resistance to passive stretch.

• Synergy: Mass patterns of movement that are primitive and lack isolation.

• Rigidity: Non-velocity dependent resistance to passive movement in both agonist and antagonist muscles.

Balance Strategies

• Fixed Support Strategies: Movement strategies used to control the Center of Mass (COM) over a fixed Base of Support (BOS).

  • Ankle Strategy: Used for small perturbations. Activation occurs distal to proximal.

  • Hip Strategy: Used for larger or faster perturbations. Activation occurs proximal to distal.

Muscle Activation Order for Sway

• Forward Sway (Ankle Strategy): Gastrocnemius \rightarrow Hamstrings \rightarrow Paraspinals.

• Forward Sway (Hip Strategy): Abdominals \rightarrow Quadriceps.

• Backward Sway (Ankle Strategy): Tibialis Anterior \rightarrow Quadriceps \rightarrow Abdominals.

• Backward Sway (Hip Strategy): Paraspinals \rightarrow Hamstrings.

Cardiopulmonary System and Exercise Testing

Exercise Tolerance Tests (ETT)

• Maximal Test: Target end point Heart Rate (HR) is predetermined using the Karvonen formula. Higher risk of adverse effects; necessitates trained personnel and monitoring equipment.

• Sub-maximal/Graded Exercise Test (GXT): Target end point is $85\%$ of age-predicted max HR, or terminated due to symptoms. Generally safe in all settings, but the patient must be cleared to test.

Termination Criteria for Exercise Testing

• Onset of angina or angina-like symptoms.

• Drop in Systolic Blood Pressure (SBP) of $\ge 10\,mmHg$ with increased workload.

• SBP rises to > 250\,mmHg and/or Diastolic Blood Pressure (DBP) > 115\,mmHg.

• Shortness of breath (SOB), wheezing, leg cramping, or claudication.

• Signs of poor perfusion: lightheadedness, confusion, pallor, ataxia, cyanosis.

• Failure of HR to increase with increased workload.

• Noticeable changes in heart rhythm or failure of testing equipment.

• Subject requests to stop or expresses severe fatigue.

Gait Patterns and Assistive Devices

Assistive Device Patterns

• 4-point: Two devices used. Sequence: Left (L) Assistive Device (AD) $\rightarrow$ Right (R) foot $\rightarrow$ R AD $\rightarrow$ L foot.

• 2-point: Two devices used. Sequence: L AD and R foot simultaneously $\rightarrow$ R AD and L foot simultaneously.

• Modified 2-point: Single AD. Sequence: L AD and R foot simultaneously $\rightarrow$ L foot.

• Modified 4-point: Single AD. Sequence: L AD $\rightarrow$ R foot $\rightarrow$ L foot.

• 3-point: Two ADs or walker (Non-weightbearing). Sequence: Bilateral ADs $\rightarrow$ Weighted foot.

• 3-1 point: Two ADs (Partial Weightbearing). Sequence: Bilateral ADs and PWB foot simultaneously $\rightarrow$ Weighted foot.

Gait Key Words

• "2 point": Moving foot and device together; more natural, faster cadence, community functional.

• "3 point": Restricted weight bearing (NWB or PWB); requires bilateral devices.

• "4 point": Slower; safe ambulation using "then, then, then" sequence.

• "Modified": Indicates the use of a single assistive device.

Blood Pressure Emergencies

Autonomic Dysreflexia (AD)

• Definition: SBP increases $\ge 20-40\,mmHg$ above baseline in response to a noxious stimulus.

• Signs/Symptoms (Red): Flushed face, headache (HA), blurred vision, sweating, nausea, SOB, anxiety, high BP.

• Immediate Management:

  1. Sit patient upright and supported (Raise the head).

  2. Check for triggers (e.g., kinked catheter, clothing restriction, bowel impaction) and alleviate.

  3. Monitor vitals.

  4. If symptoms persist, call $9-1-1$.

Orthostatic Hypotension

• Definition: SBP drops $\ge 20\,mmHg$ or DBP drops $\ge 10\,mmHg$.

• Signs/Symptoms (Pale): Pallor, dizziness, lightheadedness, unsteadiness, loss of consciousness.

• Immediate Management:

  1. Lay the patient down and raise legs (Raise the tail).

  2. Monitor vitals.

  3. If loss of consciousness or major symptoms occur, call $9-1-1$.

Emergency Logic Flowchart: "Who You Gonna Call?"

1. Is it a crisis/emergency where someone is in danger?

   • No: Is there a modifiable cause? If yes, fix it (e.g., kinked catheter) and update PT/Doctor once safe. If no modifiable cause, modify activity and contact PT/MD.

   • Yes: Are you trained/equipped? If yes, take care of it and update the team. If no, activate an emergency system or call the doctor immediately.

Practice Question Bank

• Question 1: Which muscle is MOST ASSOCIATED with strength assessment of the C6 myotome?

  • Options: A. Levator Scapulae, B. Deltoid, C. Sternocleidomastoid, D. Extensor carpi radialis longus.

• Question 2.1: Patient in supine can abduct the left hip through full range without resistance. Document muscle and grade.

  • Options: A. Gluteus Medius, Poor; B. Iliopsoas, Trace plus; C. Iliopsoas, Fair; D. Gluteus Medius, Poor plus.

• Question 2.2 (Trochanteric Bursitis Interventions): MOST APPROPRIATE intervention?

  • Options: A. LE bike, B. Isometric contractions of glute med/max, C. Continue stairs at work, D. End range stretching into hip abduction.

• Question 2.3 (Progression criteria): Which indicates progression is appropriate?

  • Options: A. Soreness resolved in $24$ hours, B. Weakness when climbing stairs next day, C. Took Ibuprofen after session, D. Antalgic gait when exiting clinic.

• Question 3 (Modified Ashworth): Considerable increase in tone, passive movement difficult, but range can be completed. Grade?

  • Options: A. Grade 1, B. Grade 2, C. Grade 3, D. Grade 4.

• Question 4 (Balance): Large amplitude push on unstable surface; patient recovers without stepping. Muscle activation order?

  • Options: A. TA, Quad, Abdominals; B. Paraspinals, Hamstrings, Gastroc; C. Gastroc, Hamstrings, Paraspinals; D. Abdominals, Quad, TA.

• Question 5 (Exercise Termination): Baseline $126/86\,mmHg$, $72\,bpm$, $20\,rpm$. Which indicates termination?

  • Options: A. PVC on ECG, B. HR plateaus with increased workload, C. DBP $96\,mmHg$, D. SBP $118\,mmHg$.

• Question 6 (Cane Use): Mild L LE weakness; single point cane. Accurate description?

  • Options: A. PTA cannot perform initial training, B. Cane in R UE and advanced with L LE, C. Cane in L UE and advanced with R LE, D. Patient in two-point gait pattern.

• Question 7 (AD Response): Most immediate response?

  • Options: A. Sit patient upright, B. Lay patient supine with LEs raised, C. Call $9-1-1$ immediately, D. Check for kinked catheter.