Click Study Flashcards above to open the flashcard hub — hundreds of NBCOT OTR cards you can flip, match, type, or quiz yourself on. Every card is drawn from the four NBCOT content-outline domains and written to the entry-level occupational therapist standard, so you study exactly what the OTR exam tests.[1] Pair them with our free practice questions and study guide.
NBCOT Flashcard Study Modes
Four modes run off the same 293 cards. Flip lets you study a term and its definition at your own pace, Match times you pairing terms to meanings, Type shows a definition and asks you to key the term back, and Quiz turns the cards into multiple choice. Type is where a front like Goniometry stops being vaguely familiar and becomes something you can produce on demand.
Why Flashcards Work for the NBCOT OTR Exam
Select & Manage Interventions carries 38% of the NBCOT exam and holds 105 cards, the largest block in the deck. These fronts drill intervention approaches, modalities, adaptive equipment, and grading language, so you meet PNF and the Rood approach alongside distinctions such as TENS vs NMES. Practical items like Hip kit, Sensory diet, and Graded cueing keep the treatment vocabulary attached to what you would actually set up with a client.
Evaluation & Assessment is weighted at 23% and brings 73 cards covering screening tools, measurement methods, and the terms used to describe performance. You work through named instruments including COPM, MoCA, and Beery VMI, then foundational language such as Goniometry, Kinesthesia, and the ADL vs IADL comparison that shapes how you frame an evaluation report.
Analysis, Interpretation & Planning shares the same 23% weight and contributes 56 cards. Here the fronts lean toward models and clinical reasoning: MOHO and the PEO model sit next to the CO-OP approach and NDT (Bobath). Deficit terms like Apraxia and Anosognosia appear, along with planning concepts such as Top-down approach and Discharge planning that connect findings to a plan of care.
Competency & Practice Management is weighted at 16% and has 59 cards on ethics, documentation, and supervision. Ethical principles including Autonomy, Veracity, and Fidelity are drilled as distinct terms, and documentation cards break the SOAP note into parts with fronts like S in SOAP and O in SOAP. Role cards such as COTA role cover scope and delegation questions.
That matters on the OTR exam, where facts like the C6 tenodesis grasp, the radial/median/ulnar splint matches, the levels of assistance, and the AOTA ethics principles must be instantly available so you can spend your energy on the clinical reasoning the questions actually test. Used alongside our practice questions and study guide, flashcards turn review time into measurable progress.
NBCOT Flashcards by Domain
The cards are organized by the four NBCOT OTR content-outline domains. Weight your study toward the heaviest one — Select and Manage Interventions is 38% of the exam, the single largest domain — but review every domain, since all four are tested:[1]
| NBCOT OTR domain | Approx. weight |
|---|---|
| Domain 3 · Select and Manage Interventions | 38% |
| Domain 1 · Evaluation and Assessment | 23% |
| Domain 2 · Analysis, Interpretation, and Planning | 23% |
| Domain 4 · Competency and Practice Management | 16% |
Because Domain 3 is over a third of the exam, most of your flashcard reps should fall there — the interventions, splinting, spinal-cord-injury levels, modalities, and adaptive strategies. Domains 1 and 2 — evaluation and clinical reasoning — make up another 46% combined.
How to Get the Most Out of These Flashcards
- Start with the heaviest block. Select & Manage Interventions is 38% of the exam and 105 cards, so open there and give it more passes than any other domain.
- Type-drill the precise terms. Fronts like TENS vs NMES and Goniometry reward exact recall, and typing them exposes the ones you only half remember from Flip mode.
- Use Match for the acronyms. Model and tool names such as MOHO, COPM, and PEO model pair quickly under the timer, which is the point of that mode.
- Move to the practice test once recall holds. When Quiz on a domain stops surprising you, switch to the practice test for case-style questions and use the study guide for gaps.
- Keep a rotating cadence. With 293 cards, work one domain per session, then reshuffle weak cards from all four domains into a short mixed review before you finish.
NBCOT Flashcards FAQ
Hundreds of free NBCOT flashcards, organized across the four OTR content-outline domains tested on the NBCOT certification exam — from Evaluation and Assessment through Competency and Practice Management. They're free with no account required.
Yes. Flashcards use active recall — retrieving an answer from memory — which research shows is one of the most effective ways to make information stick, especially in short sessions over several days. That helps anchor facts like the C6 tenodesis grasp, the splint-to-nerve matches, and the levels of assistance, which you then apply in clinical-reasoning questions.
All four OTR domains: Evaluation and Assessment (the OT process, OTPF-4, MMT, ROM, pediatric development), Analysis, Interpretation, and Planning (frames of reference, precautions), Select and Manage Interventions (the largest domain — splinting, spinal cord injury, neuro, ADLs, modalities), and Competency and Practice Management (roles, ethics, infection control, documentation).
Yes. Every card is written to the entry-level occupational therapist standard the OTR exam actually tests — clinical recognition, the safest and most client-centered next step, and occupation-based reasoning — not to a specialist level.
Mix the modes: flip to learn, type to test recall, match for speed, and quiz to check yourself. Spend the most time on Select and Manage Interventions (Domain 3, 38% of the exam) — the largest domain — and review every domain, since all four are tested.
Yes — 100% free, all four study modes, no paywall.
NBCOT flashcard bank
All 293 cards, by topic
A reference copy of every card in this deck. Each answer stays hidden until you choose to show it. To study with Flip, Match, Type and Quiz modes and track what you have mastered, use Study Flashcards at the top of the page.
Evaluation & Assessment (73)
- Tenodesis grasp
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A functional pinch made when active wrist extension passively tightens the finger flexors; the key grasp at the C6 SCI level.
- Occupational profile
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The first part of the OT evaluation — the client's story: history, values, roles, routines, and chief occupational concerns.
- Analysis of occupational performance
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The second part of evaluation — observing and measuring performance skills, client factors, and context to find supports and barriers.
- Which comes first: profile or analysis?
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The occupational profile comes first; the analysis of occupational performance follows.
- OTPF-4 five domain areas
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Occupations, contexts, performance skills, performance patterns, and client factors.
- OTPF-4 three client factors
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Values/beliefs/spirituality, body functions, and body structures.
- OTPF-4 three performance skills
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Motor skills, process skills, and social-interaction skills.
- OTPF-4 performance patterns
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Habits, routines, roles, and rituals.
- OTPF-4 process side
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Evaluation, intervention (plan → implement → review), and outcomes.
- ADL vs IADL
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ADLs are basic self-care (feeding, dressing, bathing, toileting); IADLs are complex community tasks (cooking, finances, meds, driving).
- MMT grade 3/5 (Fair)
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Full range of motion against gravity with no added resistance — the pivot of the 0–5 scale.
- MMT grade 5/5 (Normal)
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Full ROM against gravity with maximal resistance.
- MMT grade 4/5 (Good)
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Full ROM against gravity with moderate resistance.
- MMT grade 2/5 (Poor)
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Full ROM only with gravity eliminated.
- MMT grade 1/5 (Trace)
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A palpable or visible contraction with no joint movement.
- MMT grade 0/5 (Zero)
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No contraction is felt or seen.
- Below MMT grade 3 is tested how?
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In a gravity-eliminated plane; grades above 3 add manual resistance.
- Goniometry
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Measuring joint range of motion in degrees with a goniometer, compared to AAOS normal values.
- Normal shoulder flexion ROM
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About 0–180°.
- Normal elbow flexion ROM
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About 0–150°.
- Normal wrist flexion / extension ROM
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About 0–80° flexion and 0–70° extension.
- Normal hip flexion ROM
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About 0–120°.
- Normal knee flexion ROM
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About 0–135°.
- Normal ankle dorsiflexion / plantarflexion ROM
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About 0–20° dorsiflexion and 0–50° plantarflexion.
- Criterion-referenced test
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Compares performance to a fixed mastery cutoff — 'did the client meet the skill?'
- Norm-referenced test
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Compares performance to a population sample — 'how does the client rank vs peers?'
- Standardized vs nonstandardized assessment
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Standardized has fixed administration and scoring; nonstandardized (interview, observation) is flexible.
- FIM (Functional Independence Measure)
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An 18-item scale scored 1 (total assistance) to 7 (complete independence) that quantifies burden of care.
- Barthel Index
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A measure of independence in basic ADLs, scored 0–100.
- COPM
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Canadian Occupational Performance Measure — the client rates performance and satisfaction on self-identified occupational problems.
- Standard error of measurement (SEM)
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A statistic showing a test score is an estimate within a band, not an exact value; used to build confidence intervals.
- MMSE
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Mini-Mental State Exam — a /30 cognitive screen; scores below ~24 suggest impairment.
- MoCA
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Montreal Cognitive Assessment — a /30 screen more sensitive than the MMSE to mild cognitive impairment (≥26 normal).
- Semmes-Weinstein monofilaments
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A graded set of filaments used to test light-touch/protective sensation thresholds.
- Stereognosis
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The ability to identify an object by touch alone, without vision.
- Beery VMI
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A pediatric assessment of visual-motor integration.
- Sensory Profile
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A questionnaire assessing a child's sensory processing patterns.
- Bayley Scales
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A standardized assessment of infant and toddler development.
- Pincer grasp age
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About 9–12 months.
- Palmar grasp (voluntary) age
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About 6 months.
- Sits independently age
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About 6–8 months.
- Walks independently age
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About 12–15 months.
- ATNR integration age
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About 4–6 months ('fencing' reflex).
- Moro reflex integration age
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About 4–6 months (startle reflex).
- STNR integration age
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Emerges ~4–6 months and integrates by about 8–12 months (before crawling).
- Plantar grasp integration age
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About 9 months (before walking).
- Rooting reflex integration age
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About 3–4 months.
- Persistent primitive reflex significance
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A reflex that persists past its integration age is a red flag for a neuromotor problem such as cerebral palsy.
- Activity analysis
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Breaking a task into its demands, required performance skills, and contextual facilitators and barriers.
- Occupation
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A meaningful, goal-directed activity or role that occupies a person's time and identity.
- Performance skills (definition)
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Observable, goal-directed actions — motor, process, and social-interaction — used during an occupation.
- Habits vs routines vs roles
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Habits are automatic behaviors; routines are sequences of tasks; roles are sets of expected behaviors tied to identity.
- Health management (OTPF-4)
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An occupation in OTPF-4 covering activities to develop, manage, and maintain health and wellness.
- Rest and sleep (OTPF-4)
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A distinct occupation in OTPF-4 covering rest, sleep preparation, and sleep participation.
- Two-point discrimination
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A sensory test of the smallest distance at which two points are felt as separate; finer in the fingertips.
- Proprioception
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The sense of joint position and movement, tested with eyes closed by mirroring or describing limb position.
- Kinesthesia
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Awareness of the direction and extent of joint movement.
- Dexterity assessments
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Tests like the Nine-Hole Peg Test, Box and Block Test, and Purdue Pegboard measure fine and gross hand coordination.
- Edema measurement
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Volumetry (water displacement) or circumferential tape measurement to track limb swelling.
- Grip and pinch strength tools
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A dynamometer measures grip; a pinch gauge measures lateral, tip, and three-jaw-chuck pinch.
- Screening vs evaluation
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A screening decides whether a full evaluation is warranted; the evaluation gathers detailed data to plan care.
- Norm-referenced score: percentile
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Shows the percent of the comparison sample a client scored at or above.
- Developmental milestone: rolls over
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About 4–6 months.
- Developmental milestone: crawls
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About 9 months.
- Developmental milestone: pulls to stand
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About 9–12 months.
- Tripod pencil grasp age
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About 3.5–4 years.
- Protective extension reaction
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A postural reaction emerging ~6–9 months where the arms extend to catch a fall.
- Righting reactions
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Postural reactions (~6 months on) that keep the head and body aligned in space.
- Equilibrium reactions
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Balance reactions (~9–21 months) that maintain the center of gravity over the base of support.
- Allen Cognitive Level Screen (ACLS)
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A standardized leather-lacing task used to estimate a client's Allen Cognitive Level.
- Reflex testing position
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Primitive reflexes are tested by presenting the specific stimulus (e.g., head turn for ATNR) and observing the response.
- Norm- vs criterion-referenced (peds)
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Norm-referenced ranks a child against peers; criterion-referenced checks whether a specific skill was mastered.
- Functional cognition assessment
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Observing real tasks (cooking, money management) to judge how cognition affects daily performance.
Analysis, Interpretation & Planning (56)
- Top-down approach
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Starting intervention from the occupations the client needs and wants to do — the approach NBCOT rewards.
- Bottom-up approach
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Starting from underlying impairments (strength, ROM, cognition); risks treating components in isolation.
- Frame of reference
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A theory-based guide that links assessment findings to intervention choices.
- Biomechanical frame of reference
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Addresses ROM, strength, and endurance for orthopedic conditions with an intact central nervous system.
- Rehabilitative (compensatory) frame
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Adapts the task, tool, or environment and teaches compensation when remediation isn't realistic.
- MOHO
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Model of Human Occupation — explains occupation through volition, habituation, and performance capacity within the environment.
- MOHO volition / habituation / performance capacity
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Volition = motivation; habituation = habits and roles; performance capacity = physical and mental abilities.
- Sensory Integration (Ayres)
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A pediatric frame using vestibular, proprioceptive, and tactile input and the 'just-right challenge.'
- NDT (Bobath)
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A neuro approach that inhibits abnormal tone and facilitates normal movement after stroke or in cerebral palsy.
- PEO model
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Person-Environment-Occupation — performance is the fit among the person, the environment, and the occupation.
- EHP (Ecology of Human Performance)
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A model emphasizing that context strongly drives performance.
- Behavioral frame of reference
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Uses reinforcement, shaping, and conditioning to change behavior.
- Motor learning approach
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Uses practice schedules and feedback (knowledge of results/performance) for task-specific training.
- CO-OP approach
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Cognitive Orientation to daily Occupational Performance — a problem-solving approach used in DCD and other conditions.
- Just-right challenge
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An activity graded so it is achievable yet challenging enough to promote growth.
- Grading an activity
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Adjusting the demand of a task up or down to match the client's current ability.
- Adapting an activity
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Modifying the task, tool, or environment so the client can perform it.
- Long-term vs short-term goal
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An LTG is the overall functional outcome; STGs are the measurable steps that build to it.
- Components of a good OT goal
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Measurable, functional, occupation-based, time-bound, and graded to the client.
- Posterior total hip precautions
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Avoid hip flexion past 90°, adduction past midline, and internal rotation to prevent dislocation.
- Total hip adaptive equipment
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Raised toilet seat, reacher, sock aid, long-handled shoehorn, and an abduction wedge.
- Total knee replacement early precautions
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Avoid kneeling, squatting, and pivoting early in recovery.
- Sternal precautions (post open-heart)
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Avoid lifting more than ~8–10 lb and pushing or pulling up through the arms for several weeks.
- Autonomic dysreflexia
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A hypertensive emergency in SCI at or above T6 from a noxious stimulus below the lesion (often a full bladder).
- Autonomic dysreflexia first action
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Sit the client upright, loosen restrictive clothing, and remove the noxious stimulus; get medical help.
- Unilateral neglect
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An attentional deficit (often after a right-hemisphere stroke) where the client ignores the affected side despite intact vision.
- Unilateral neglect treatment
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Visual scanning and awareness training toward the affected side, with anchoring cues and environmental setup.
- Homonymous hemianopsia
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A visual-field cut losing the same half of the field in both eyes; managed with compensatory head turns.
- Neglect vs hemianopsia
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Neglect is an attention problem (treat with scanning); hemianopsia is a visual-field loss (treat with head turns/setup).
- Frame-of-reference mismatch trap
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An otherwise-correct option is wrong if it conflicts with the frame of reference named in the question stem.
- Therapeutic use of self
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The OT's intentional use of personality, insight, and rapport as part of the therapeutic relationship.
- Standard score / z-score
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A score expressed in standard-deviation units relative to a mean; z = (score − mean) / standard deviation.
- Caregiver training in planning
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Educating family/caregivers, accounting for health literacy, so the plan can be carried out safely at home.
- OT process placement
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The correct next action depends on whether the scenario is at screening, evaluation, planning, intervention, reevaluation, or discharge.
- Evaluation before intervention rule
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You evaluate before you intervene unless an immediate safety threat overrides.
- Determining service eligibility
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Synthesizing assessment results against criteria to decide whether the client qualifies for and needs skilled OT.
- Maslow in answer selection
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Meet physiological and safety needs before higher-order, self-actualizing goals.
- Reevaluation / monitoring the plan
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Measuring progress toward goals and modifying the approach, context, or goals through clinical reasoning.
- Psychodynamic frame of reference
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Addresses unconscious conflicts and the therapeutic relationship in mental-health practice.
- Cognitive-behavioral therapy (CBT)
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A frame that restructures maladaptive thoughts to change feelings and behavior.
- Dialectical behavior therapy (DBT)
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A skills-based approach for emotion regulation, distress tolerance, and interpersonal effectiveness.
- Clinical reasoning types
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Procedural, interactive, conditional, narrative, and pragmatic reasoning guide OT decisions.
- Anosognosia
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A lack of awareness of one's own deficit, common with right-hemisphere stroke and neglect.
- Apraxia
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Difficulty performing a learned motor task on command despite intact strength and sensation.
- Discharge planning
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Determining the safest setting and supports for the client as skilled OT ends.
- Setting whiplash trap
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Adjacent questions can be in completely different settings — re-orient to the client and setting each time.
- Safety as the top tie-breaker
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When options compete, eliminate any that introduce risk; the safest option wins the tie.
- Client-centered care
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Decisions support the client's stated goals, values, and culture rather than clinic efficiency.
- Caregiver health literacy
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Adapt teaching to the caregiver's reading and comprehension level so the plan is followed.
- Occupation-based vs preparatory
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Occupation-based intervention uses meaningful activity itself; preparatory methods set the stage for it.
- Weight-bearing precautions
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NWB, TTWB/TDWB, PWB, WBAT, and FWB statuses gate transfers and lower-body ADL training.
- Cardiac precaution in planning
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Monitor vital signs and exertion; stop activity for symptoms or when systolic BP exceeds ~180.
- Brunnstrom in planning
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Use the client's recovery stage to choose between facilitation, synergy work, and isolated-movement tasks.
- Conditional reasoning
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Imagining the client's whole future context to shape the intervention plan.
- Narrative reasoning
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Understanding the client's life story and the meaning of illness to guide care.
- Pragmatic reasoning
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Accounting for practical constraints (time, resources, reimbursement, setting) in planning.
Select & Manage Interventions (105)
- C6 SCI key milestone
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Wrist extension produces a functional tenodesis grasp; train it and support it with a tenodesis orthosis.
- C5 SCI function
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Elbow flexion (biceps) and deltoids; uses a mobile arm support and universal cuff, needs setup.
- C7 SCI function
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Elbow extension (triceps) → independent transfers, most ADLs, and a manual wheelchair.
- C4 SCI function
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Diaphragm and neck control; dependent for ADLs; uses a power chair with sip-and-puff or mouth-stick controls.
- C8–T1 SCI function
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Finger flexion and intrinsics → independent in ADLs.
- SCI mnemonic C5/C6/C7
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Flexion at C5, tenodesis grasp at C6, extension at C7.
- Radial nerve injury
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Causes wrist drop (loss of wrist and finger extension).
- Radial nerve splint
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A dynamic wrist and finger extension orthosis.
- Median nerve injury
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Causes loss of thumb opposition — the 'ape hand.'
- Median nerve splint
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An opponens or thumb-positioning splint.
- Ulnar nerve injury
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Causes a claw hand of the ring and little fingers.
- Ulnar nerve splint
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An anti-claw or MCP-block splint.
- Carpal tunnel splint
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A resting or cock-up splint holding the wrist in neutral.
- Orthosis categories
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Immobilization (protect healing), mobilization (dynamic, restore motion), and restriction (block a harmful range).
- Before fabricating an orthosis
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Perform a sensory evaluation, pad bony prominences, and use a graded wear schedule.
- Brunnstrom stage 1
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Flaccidity with no voluntary movement after a stroke.
- Brunnstrom stage 6
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Spasticity gone; near-normal isolated, coordinated movement.
- Brunnstrom stages overview
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Motor recovery from flaccidity through emerging then resolving spasticity/synergy to near-normal movement (1–6).
- NDT goal
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Inhibit abnormal tone and facilitate normal movement patterns.
- PNF
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Proprioceptive neuromuscular facilitation — uses diagonal, proprioceptive movement patterns.
- Rood approach
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Uses sensory stimulation to evoke a motor response.
- Constraint-induced movement therapy
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Restrains the unaffected limb to force use and recovery of the affected limb after stroke.
- Rancho Los Amigos levels
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A scale of cognitive/behavioral recovery after TBI (classically I–VIII; revised to X).
- Rancho Level IV
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Confused-agitated — needs maximal assistance and a calm, low-stimulation, safety-first environment.
- Allen Cognitive Levels
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Rate global cognitive ability (1 = profoundly impaired to 6 = normal) to match task complexity and supervision.
- Energy conservation: the four P's
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Plan, prioritize, pace, and position to reduce fatigue.
- Joint protection principles
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Use larger and stronger joints, avoid sustained grips and positions of deformity, and distribute load.
- Energy conservation populations
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Cardiac disease, COPD, rheumatoid arthritis, multiple sclerosis, and other low-endurance conditions.
- Forward vs backward chaining
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Forward teaches step 1 first; backward teaches the last step first so the client ends on success.
- Graded cueing
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Providing the least assistance needed and fading cues as the client improves.
- Dysphagia positioning
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Sit the client upright at about 90° and use a chin tuck during swallowing.
- Dysphagia adaptive equipment
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Adaptive utensils, a plate guard, and a scoop dish, with cautious texture progression.
- Adaptive ADL equipment examples
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Reacher, sock aid, long-handled sponge, dressing stick, and button hook.
- Superficial vs deep heat
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Superficial heat = hot packs, paraffin, fluidotherapy; deep heat = ultrasound.
- Cryotherapy use
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Cold applied for acute or inflammatory conditions.
- TENS vs NMES
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TENS is used for pain control; NMES is used for muscle strengthening and re-education.
- Physical agent modalities role
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They are preparatory methods — they prepare tissue for occupation and are never the end goal of treatment.
- MET level grading
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Under 3 METs is light, 3–6 is moderate, and 6 or more is vigorous activity.
- Burns: anti-deformity positioning
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Position joints opposite the expected contracture (e.g., an axillary burn → shoulder abduction).
- Rule of Nines (adult)
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Head 9%, each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, genitals 1%.
- Burn rehab interventions
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Anti-deformity positioning, splinting, ROM during healing, scar management, and pressure garments.
- Wheelchair seat width
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The widest point of the hips or thighs plus about 2 inches.
- Wheelchair seat depth
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From the posterior buttocks to about 2 inches short of the popliteal fossa.
- Wheelchair hip angle
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About 90° of hip flexion for postural stability.
- Pressure relief for SCI in a wheelchair
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Perform weight shifts about every 15–30 minutes and use a pressure-relief cushion.
- Transfer toward which side?
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Set up transfers toward the client's stronger or uninvolved side for safety and leverage.
- RA joint deformities
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Ulnar drift, swan-neck, and boutonnière deformities; teach joint protection to slow them.
- Low vision interventions
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Improve lighting and contrast, reduce glare, use magnification, and teach scanning and eccentric viewing.
- Amputation pre-prosthetic care
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Residual-limb shaping/wrapping, desensitization, ROM, edema control, and addressing phantom limb pain.
- Cerebral palsy
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A non-progressive motor disorder; spastic is the most common type; managed with NDT, positioning, and adaptive equipment.
- Autism (ASD) OT focus
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Sensory processing, self-regulation, social participation, and ADL independence.
- Sensory integration systems
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Targets the vestibular, proprioceptive, and tactile systems.
- School-based OT under IDEA
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OT is a related service that must support the student's educational goals.
- IEP vs IFSP
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An IEP serves school-age children (3–21); an IFSP serves early intervention (birth–3).
- Mosey's group levels
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Parallel → project → egocentric-cooperative → cooperative → mature.
- Cole's seven steps of group leadership
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Introduction, activity, sharing, processing, generalizing, application, and summary.
- Recovery model
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A mental-health approach centered on hope, empowerment, self-direction, and person-centered care.
- Phantom limb pain
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Pain perceived in a missing limb after amputation; addressed with desensitization, mirror therapy, and education.
- Hemiplegia after stroke
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Weakness on the side opposite the brain lesion (a right-hemisphere stroke causes left-sided weakness).
- Shoulder subluxation after stroke
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Manage with proper positioning and support to protect the flaccid shoulder.
- Alzheimer's disease
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The most common dementia — insidious, progressive memory loss.
- Vascular dementia
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A stepwise cognitive decline following strokes or infarcts.
- Lewy body dementia
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Fluctuating cognition with visual hallucinations and parkinsonism.
- Frontotemporal dementia
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Early changes in personality, behavior, or language.
- Fall prevention / home modification
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Remove throw rugs, add grab bars and a raised toilet seat, improve lighting, and address polypharmacy and vision.
- Aging in place
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Modifying the home and routines so an older adult can live safely and independently at home.
- Backward chaining example
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Teaching shirt donning by having the client complete the final step so they finish with success.
- Mobile arm support
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A device that supports the arm against gravity so a client with proximal weakness (e.g., C5 SCI) can self-feed.
- Universal cuff
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A strap that holds a utensil or tool in the palm for clients who cannot grip.
- Built-up handles
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Enlarged handles that reduce the grip needed — useful in arthritis and weak grasp.
- Sliding board transfer
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A board bridges two surfaces so a client (e.g., C6–C7 SCI) can scoot across with less lift.
- Stand-pivot transfer
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A transfer in which the client stands, pivots toward the destination, and sits, often toward the stronger side.
- Wheelchair tilt vs recline
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Tilt keeps the seat-to-back angle and redistributes pressure; recline opens the angle and can cause shear.
- Pressure ulcer prevention
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Pressure relief, repositioning, appropriate cushions, and skin checks; the Braden scale screens risk.
- Scar management
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Pressure garments, silicone, and massage to limit hypertrophic scarring after burns or injury.
- Desensitization
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Graded sensory input to reduce hypersensitivity after nerve injury or amputation.
- Mirror therapy
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Using a mirror reflection of the intact limb to reduce phantom limb pain or aid stroke recovery.
- Splint wear schedule
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Begin with short periods and increase gradually while monitoring skin and tolerance.
- Hand: resting hand splint
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Positions the wrist and hand in a functional resting position to prevent contracture.
- Tendon repair protocols
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Graded early controlled motion protocols protect a repaired tendon while preventing stiffness.
- Spasticity management
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Positioning, stretching, weight-bearing, splinting, and (medically) tone-reducing agents.
- Cognitive rehabilitation
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Remedial (restore) and compensatory (memory aids, external cues) strategies for cognitive deficits.
- Errorless learning
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Teaching that prevents mistakes during acquisition, useful for clients with significant memory impairment.
- Metacognitive strategy training
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Teaching the client to self-monitor and self-correct performance (e.g., goal-plan-do-check).
- Work simplification
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Reorganizing tasks and the environment to reduce steps and energy demand.
- Visual scanning training
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Structured practice of attending across the visual field, used for neglect and field cuts.
- Driving / community mobility
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Assessed for safety, with adaptive controls or alternative transportation recommended as needed.
- Feeding texture progression
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Advance from purees to soft to regular textures cautiously, coordinated with the dysphagia evaluation.
- Adaptive feeding equipment
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Plate guard, scoop dish, weighted or built-up utensils, and a nosey cup for safer self-feeding.
- Borg RPE scale
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A 6–20 rating of perceived exertion used to grade and monitor activity intensity.
- Burn depth classifications
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Superficial (1st degree), partial-thickness (2nd degree), and full-thickness (3rd degree).
- Spinal precautions / log roll
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Maintain spinal alignment and log-roll the client when spinal stability is a concern.
- Hemiplegic dressing technique
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Dress the affected arm first and undress it last to ease the task.
- One-handed techniques
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Adaptive methods (e.g., rocker knife, suction brushes) that let a hemiplegic client do ADLs independently.
- Group intervention purpose
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Provides peer support, social skills practice, and graded activity in mental-health and rehab settings.
- Sensory diet
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An individualized schedule of sensory activities to help a child stay regulated.
- Handwriting Without Tears
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A structured, multisensory handwriting program used in pediatric school-based practice.
- Brunnstrom stage 3
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Spasticity peaks and the client can move within synergy patterns voluntarily.
- Flexor synergy (UE)
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Scapular retraction, shoulder abduction/external rotation, elbow flexion, forearm supination.
- Extensor synergy (UE)
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Scapular protraction, shoulder adduction/internal rotation, elbow extension, forearm pronation.
- Compensation vs remediation
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Remediation restores the impaired skill; compensation adapts the task or environment around it.
- Cock-up (wrist extension) splint
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A static splint supporting the wrist in extension, used for wrist drop and carpal tunnel relief.
- Dynamic vs static splint
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A dynamic splint applies a mobilizing force to restore motion; a static splint holds a fixed position.
- Aspiration precautions
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Upright positioning, chin tuck, appropriate textures, slow pace, and supervision to prevent food entering the airway.
- Hip kit
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A set of adaptive tools — reacher, sock aid, long-handled shoehorn, dressing stick — for total hip precautions.
Competency & Practice Management (59)
- OTR responsibilities
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The OTR performs the initial evaluation, interprets results, and owns the intervention plan and discharge decision.
- COTA role
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The COTA delivers intervention under OTR supervision and contributes data, but does not independently evaluate or set the plan.
- Can a COTA do the initial evaluation?
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No — the initial evaluation and its interpretation cannot be delegated; only the OTR performs it.
- OT aide role
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Aides perform only non-skilled, delegated tasks under supervision.
- What sets COTA supervision level?
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The COTA's competence, the client's complexity, the setting, and state practice acts.
- Federal vs state practice acts
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When a state practice act is stricter than federal rules, follow the stricter standard.
- Standard precautions
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Treat all blood and body fluids as potentially infectious with every client, every time.
- Airborne precautions + PPE
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Tuberculosis, measles, varicella → N95 respirator and a negative-pressure room.
- Droplet precautions + PPE
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Influenza, pertussis, meningitis → a surgical mask within close range.
- Contact precautions + PPE
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MRSA, C. difficile, scabies → gown and gloves.
- C. difficile hand hygiene
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Use soap and water — alcohol-based hand rub does not kill its spores.
- AOTA Code of Ethics principles
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Beneficence, nonmaleficence, autonomy, justice, veracity, and fidelity.
- Beneficence
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The duty to do good and promote the welfare of others.
- Nonmaleficence
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The duty to do no harm.
- Autonomy
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Respecting the client's right to self-determination, confidentiality, and informed consent.
- Justice (ethics)
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Providing fair, equitable treatment and complying with laws and policies.
- Veracity
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Being truthful and representing information accurately.
- Fidelity
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Treating colleagues and clients with respect, fairness, and integrity.
- Practicing beyond competence
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Is unethical; when competency is in question, seek supervision, mentoring, or continuing education.
- Evidence-based practice steps
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Form a clinical question, appraise the research, derive a clinical bottom line, and apply it.
- SOAP note
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Subjective, Objective, Assessment, Plan — the standard documentation format.
- S in SOAP
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Subjective — what the client reports.
- O in SOAP
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Objective — measurable data and observations from the session.
- A in SOAP
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Assessment — the clinician's interpretation, progress, and justification of skilled need.
- P in SOAP
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Plan — next steps, frequency and duration, and goals.
- Skilled documentation purpose
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To justify the medical necessity of skilled OT services for reimbursement.
- Levels of assistance: Independent
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The client performs 100% safely, in a timely way, with no help and no device.
- Levels of assistance: Modified independent
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The client is independent but uses adaptive equipment or extra time.
- Levels of assistance: Supervision
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The therapist gives verbal cues only, with no physical contact.
- Levels of assistance: Contact guard
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The therapist's hands are on the client for safety, with little or no actual effort.
- Levels of assistance: Minimal assist
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The client performs 75% or more of the task.
- Levels of assistance: Moderate assist
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The client performs 50–74% of the task.
- Levels of assistance: Maximal assist
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The client performs 25–49% of the task.
- Levels of assistance: Dependent
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The client performs less than 25%; the therapist does the task.
- Body mechanics for the therapist
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Bend at the knees, keep the load close, avoid twisting, and use a wide base of support to prevent injury.
- Population health / prevention
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Wellness, fall prevention, aging in place, and burnout prevention for self and staff.
- Continuous quality improvement
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Ongoing measurement and refinement of services to improve outcomes and safety.
- Informed consent
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The client with capacity voluntarily agrees to treatment after hearing the risks, benefits, and alternatives.
- Service competency
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Documented evidence that a COTA performs a delegated skill consistently and correctly as the OTR would.
- NBCOT Code of Conduct
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NBCOT's professional standards governing certified practitioners' integrity and conduct.
- Reimbursement: medical necessity
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Skilled OT must be reasonable and necessary and require the skills of a therapist to be reimbursed.
- Medicare basics for OT
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Part A covers inpatient; Part B covers outpatient OT; documentation must justify skilled, defensible care.
- Incident reporting
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Document and report adverse events (falls, errors) to support safety and quality improvement.
- Confidentiality / HIPAA
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Protect client health information; share only what is necessary and authorized.
- Mandatory reporting
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Practitioners must report suspected abuse or neglect of vulnerable clients to the proper authorities.
- Cultural competence
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Delivering care that respects the client's culture, beliefs, and preferences.
- Supervision documentation
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Record supervisory contacts and service competency to comply with regulation and payer rules.
- Accreditation vs licensure vs certification
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Accreditation evaluates programs; licensure is the legal right to practice; certification (NBCOT) verifies competence.
- OTR credential maintenance
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NBCOT certification renews every 3 years with required professional development units (PDUs).
- Quality / outcome measurement
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Using standardized outcomes and program evaluation to demonstrate effectiveness.
- Emergency response: seizure
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Protect the client from injury, do not restrain or put anything in the mouth, time it, and position on the side after.
- Burnout prevention
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Self-care, workload management, and supervision to sustain safe, competent practice.
- Delegation rules
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Delegate only tasks within the assistant's or aide's competence and scope, with appropriate supervision.
- Ethics: distributive justice
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Fair allocation of limited resources and services across clients.
- Informed refusal
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A client with capacity may decline treatment after understanding the consequences; document it.
- Standard precautions vs transmission-based
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Standard precautions apply to all clients; transmission-based add specific PPE for known/suspected infections.
- Plan of care frequency/duration
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Documentation specifying how often and how long skilled OT will be provided toward the goals.
- Code of conduct violation response
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Report and address conduct that breaches NBCOT or AOTA standards through proper channels.
- Scope of practice
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The range of services an OTR or COTA is legally and competently permitted to provide.
References
- 1.National Board for Certification in Occupational Therapy (NBCOT). “2022 OTR Examination Content Outline.” NBCOT. ↑
- 2.American Occupational Therapy Association (AOTA). “Occupational Therapy Practice Framework (OTPF-4).” aota.org. ↑
- 3.National Institute of Neurological Disorders and Stroke (NINDS). “Spinal Cord Injury.” ninds.nih.gov. ↑
- 4.Centers for Disease Control and Prevention (CDC). “Transmission-Based Precautions.” cdc.gov. ↑
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