NPTE PTA Mega Review: Physical Therapy Exam Prep

• NPTE Final Frontier PTA Mega Review took place in January 2025.
• The class follows strict FSBPT and APTA security and safety regulations.
• Group members posting questions from previous NPTE or PEAT exams are blocked.
• The class, including all audio conversations, is recorded.

PTA Content Outline

• The NPTE covers various body systems and non-system topics.
• The content includes physical therapy data collection, diseases/conditions impacting treatment, and interventions.
• The total number of questions is 140.

Manual Muscle Testing: Against Gravity

• Muscles are tested against gravity in supine, prone, and side-lying positions.
• Specific muscles are listed for each position.

Manual Muscle Testing

• A zero grade means there is no visible or palpable contraction.
• A trace grade (1) means there is no observable motion, but there is a palpable muscle contraction.
• A poor grade (2) means there is at least 50% but not full ROM with gravity minimized, or gravity eliminated. ‐ A fair grade (3) means full ROM against gravity.
• A good grade (4) means full ROM against gravity with moderate resistance.
• A normal grade (5) means full available ROM against gravity with strong manual resistance.

Isometric Strength Testing

• Strong and painless isometric contraction indicates a normal finding.
• Strong and painful indicates a minor lesion.
• Weak and painless indicates complete rupture, disuse atrophy, or neurological disorder.
• Weak and painful indicates a partial rupture, acute inflammation or damage inhibiting function.

End Feels

• Hard end feel is a "bone-to-bone" stiff yet painless sensation.
• Soft end feel is a yielding compression that feels mushy.
• Firm end feel is an elastic resistance towards the end of ROM.

Key Landmarks for Dermatomes

• Dorsum of the foot.
• Thumb and index finger.
• Clavicle.
• Umbilicus.
• Groin/genital region.
• Greater trochanter.
• Nipple line.

Glasgow Coma Scale

• The Glasgow Coma Scale rates eye opening, motor response, and verbal response.
• Scores of 8 or less are severe, 9-12 are moderate, and 13-15 are mild.
• The scale's activity components include spontaneous eye opening, response to speech or pain, and no eye opening.
• The scale looks for the best motor response like following commands, localizing pain, withdrawing, abnormal flexion or extension, and no response
• The scale tests verbal response by looking for orientation, confused conversation, inappropriate words, incomprehensible sounds, and no response

Auscultation

• The aortic valve should be auscultated at the right 2nd intercostal space, parasternal line (PSL).
• The pulmonic valve should be auscultated at the left 2nd intercostal space, parasternal line (PSL).
• The tricuspid valve should be auscultated at the left 4th intercostal space, parasternal line (PSL).
• The mitral valve should be auscultated at the left 5th intercostal space, midclavicular line (MCL).
• Splitting of S2 is best heard during inspiration at tricuspid site.
• Mitral site is the best spot to auscultate for S3 if present.

Borg RPE Scale

• The Borg RPE Scale measures Rate of Perceived Exertion
• 6 means "No exertion".
• 7.5 means "Extremely Light".
• 9 means "Very Light".
• 11 means "Light".
• 13 means "Somewhat Hard".
• 15 means "Hard (Heavy)".
• 17 means "Very Hard".
• 19 means "Extremely Hard".
• 20 means Maximal Exertion.

THA Precautions:

• Precautions following total hip arthroplasty are dependent on surgical approach.

Scoliosis

• Findings with scoliosis include side-bend, rotation, altered spinous process position, rib hump, tight and weak muscles, decreased lung capacity, and higher iliac crest on one side with thoracolumbar curves.

Gastroesophageal Reflux Disease (GERD)

• GERD is caused by reflux of gastric contents into the esophagus, leading to heartburn.
• GERD results from failure of the lower esophageal sphincter to regulate flow of food from esophagus into stomach.
• Heartburn occurs 30 minutes after eating and when lying down at night (nocturnal).

CVA Symptoms by Hemisphere

• Right CVA: L side affected, L side weakness/paralysis, L neglect, spatial and perceptual deficits, poor judgment, impulsivity, overestimates abilities, very positive, impaired perception, rigidity, short attention span, cognitive deficits, responds to verbal cues.
• Left CVA: R side affected, R side weakness/paralysis, aphasia, cautious, slow, insecure, frustration, depression, impaired information processing, needs new information, responds to gestures.

Neuromuscular Conditions

• Multiple Sclerosis: Demyelination of oligodendrocytes, plaques in white matter, heat sensitivity and Uthoff's phenomenon, Lhermitte's sign, Charcot triad, bowel & bladder dysfunction, optic nerve symptoms, unilateral symptoms vary by patient, can affect motor and sensory, female>male, age 20-40, may relapse or remit, UMN presentation.
• Myasthenia Gravis: Postsynaptic neuromuscular junction,fatigue with repeated contractions, improves with rest, facial drooping, vision disturbances, proximal muscles more affected, motor only involvement, female > male, age 20-40, exacerbations and recoveries, normal life expectancy, LMN presentation
• Guillain-Barre: Demyelination of Schwann cells, rapid onset and progression, follows infection, distal to proximal loss of function, motor/sensory involvement, male > female, progresses peaks and then recovers, good prognosis if survive nadir, 6 -12 month recovery, LMN presentation.
• Amyotrophic Lateral Sclerosis: Degeneration of anterior horn cells, corticospinal tracts, atrophy, denervation of muscles, weakness, spasticity, hyperreflexia, clonus, cervical extensors often weak, distal>proximal, unilateral symptoms, motor only, male > female, poor prognosis,symptom management, average of approximately 5 years life expectancy after diagnosis, both UMN and LMN presentation.

Neurodegenerative Disorders Treatment

• It is important not to overfatigue patients.
• Energy conservation is key in managing symptoms
• Assistive devices should be used as needed to optimize function
• Endurance and duration should be prioritized over intensity and power.
• Attention to prescribed positioning and positioning schedule.
• Caregiver education and support are important if needed.

Hydrotherapy Treatment Temps:

• Aerobic exercise: 78-82 F (26-28 C).
• Therapeutic exercise: 82-91 F (26-33 C).
• Multiple Sclerosis pts: 80-85 F.
• Less than 77 F may cause difficulty maintaining core body temperature.

Multiple Sclerosis Treatment:

• Avoid overfatigue or overheating.
• Morning exercise is best.
• Emphasize energy conservation.
• Endurance over intensity.
• Optimize mobility.
• Include coordination and balance training.
• Manage spasticity with positioning and cryotherapy.
• Use PNF and prolonged stretching.
• Observe for signs of UTI or respiratory infections.
• Frequency: 3-5x/week, alternating days based on PMH
• intensity should be at low (3-5 METS) and 50-70% VO2 (SUBMAX)
• sessions can typically last 30 mins
• Exercise should be be cycling ,walking, swimming, or circuit training.

Lymphedema Stages

• Stage 0 (Latency): No clinical edema, Stemmer sign negative, tissue and skin appear normal.
• Stage I (Reversible Stage): Edema is present (soft and pitting), increases with standing and activity, Stemmer sign negative.
• Stage II (Spontaneously Irreversible): Edema present, may still be soft and pitting in early stage II but then progresses to non-pitting "brawny" edema, Stemmer sign positive (although it may still be negative at early stage II), and tissue appears fibrosclerotic.
• Stage III (Lymphostatic Elephantiasis): Edema present, severe "brawny," non-pitting edema, Stemmer sign positive, and skin changes (papillomas, deep skinfold, warty protrusions, hyperkeratosis, mycotic infections, etc.).

Lymphedema Treatment

• Complete Decongestive Therapy/Manual Lymph Drainage involves decongesting proximal segments/nodes, then proximal to distal decongestion; with low-pressure effleurage, stroking distal to proximal.
• One should use Short (low) stretch bandages for compression with high working pressure, low resting pressure
• 20-40 mm hg for UE.
• 30-60 mm hg for LE.
• Include exercise that's proximal to distal and includes circular motions, functional or general mobility/fitness, aquatics
• Skin Care involves hygiene, skin care, nail care, moisturize, skin protection
• Patient Education involves management, self MLD, exercise, skin care, compression garments

Gait Deviations AKA Stance Phase

• Lateral bend could be caused by weak abductors or a short limb, prosthetic could be too short with an inadequate lateral wall
• Abduction could be caused by abduction contracture or knee instability, prosthetic could be too long or abducted hip joint
• Lordosis could be caused by hip flexion contracture or tight extensors, prosthetic could have anterior socket wall discomfort
• Forward flexion could be caused by weak quadriceps, prosthetic could have unstable knee joint or be too short of a walker

Heart Failure Treatment

• Initiate when patient is stable with no signs of decompensation (SOB, sudden weight gain, increased LE edema, cough, fatigue, dizziness).
• Use RPE scale due to impaired HR response.
• Monitor for signs of intolerance.
• Avoid Valsalva.
• Include Energy conservation.
• Training of the Inspiratory muscles.
• Aerobic and resistance training of upper and lower body
• Progress total minutes of daily activity.

Balance Strategies

• Fixed Support Strategies: Strategies used to control the COM over a fixed base of support are ankle and hip strategy.
• Change-in-Support Strategies: Strategies involving movements of the limbs to make a new contact with the support surface like stepping and/or reaching.

Claudication

• Vascular: Caused by lack of blood supply to working muscles, it can occur with mild arterial disease, bilateral LE cramping, aching pain, may involve pallor of LE, improves with rest & walking
• Neurogenic: Caused by spinal nerve root compression, bilateral LE tingling and numbness, improves with rest or flexing the spine.

Lumbar Exercise Biases:

• Flexion Biases: Spondylosis/Degenerative joint disease, facet dysfunction, stenosis (central/lateral), spondylolysis, spondylolisthesis.
• Extension Biases: Herniated disc, osteoporosis, Scheuermann's disease, and ankylosing spondylitis.

ACL Injuries

• Nonoperative: RICE, PWB or WBAT, avoid pivoting, quad sets/quad control priority, then progress as tolerated, focus on balance and perturbation training, neuromuscular control.
• Post ACLR: The graft is most vulnerable at 6-8 weeks, focus on extension ROM & quad strength, progress grafted muscle cautiously, do not allow knees over toes with CKC/squats, avoid CKC 60-90 degrees, avoid OKC 0-45 degrees, no ankle cuff weights distal to knee.

Levels of Assistance

• Listed from most independent to least independent, the levels are: Complete Independence, Modified Independence, Supervision, Minimal Assist, Moderate Assist, Maximal Assist, Dependent

TBI - Rancho Level IV Intervention.

• Motor Goals should include: Increase endurance, maintain joint mobility, decrease risk of secondary impairments.
• Intervention should focus include prepare multiple activities, and give patient choices.
• Behavioral Goals should include: Decrease outbursts, decrease agitation.
• Intervention should focus include: Be calm, be consistent (same treatment time, therapist, location), provide orientation and know when to stop or change activities.

Functional Electrical Stimulation Common Uses

• Dorsiflexion During Gait Cycle: flaccid paralysis or weakness with electrodes on peroneal nerve near head of Fibula or Anterior Tibialis and activated during swing phase
• Plantarflexors for push-off.
• Hamstrings for late swing phase.
• Quadriceps or gluteals for stance phase.

Emergency and Medical Response:

• If the situation is medical crisis and someone is in danger, the PT should determine if they can help and if not, call for help.
• If there's no crisis, determine what the situation is, if you're trained to handle it resolve the issue and if not, contact the PT.
• S/s requiring raising the head: redness/flushed, headache, blurred vision, sweating, nausea/vomiting, SOB, anxiety and a high BP
• S/s that requires raising the tail "feet": The person exhibits palor, dizziness, lightheadedness, unsteadiness, loss of consciousness

Upcoming

• On Thursday 1/2 at 5:00 pm PST (8:00 pm EST) there will be a class on Cardiopulmonary Intervention (PT/PTA).
• On Saturday 1/4 at 8:30 am PST (11:30 am EST) there will be an Other Systems Bootcamp (PT/PTA).
• On Sunday 1/5 at 8:30 am PST (11:30 am EST) there will be a PTA Focus Topics (last class!).

Questions cover key topics for the Physical Therapist Assistant National Physical Therapy Examination (NPTE). Focus on review content, ethical guidelines, and patient assessment. Includes MMT scoring and isometric strength testing.