- Lachman test
- Most sensitive test for anterior cruciate ligament (ACL) integrity — anterior tibial translation with the knee flexed 20–30°.
- Anterior drawer test (knee)
- Assesses the ACL — anterior tibial glide with the knee flexed 90°; less sensitive than the Lachman.
- Posterior drawer test (knee)
- Assesses the posterior cruciate ligament (PCL) — posterior tibial glide with the knee flexed 90°.
- McMurray test
- Assesses for a meniscal tear — a palpable click or pain with tibial rotation as the knee is extended from flexion.
- Valgus (abduction) stress test of the knee
- Assesses the medial collateral ligament (MCL); pain or gapping with a valgus force indicates MCL injury.
- Varus (adduction) stress test of the knee
- Assesses the lateral collateral ligament (LCL); pain or gapping with a varus force indicates LCL injury.
- Empty can (Jobe) test
- Assesses the supraspinatus — resisted shoulder abduction at 90° in the scapular plane with the thumb down.
- Neer impingement test
- Passive shoulder flexion/internal rotation that compresses the subacromial structures; pain suggests subacromial impingement.
- Hawkins-Kennedy test
- Shoulder flexed 90° then internally rotated; pain indicates subacromial (supraspinatus) impingement.
- Drop arm test
- Patient slowly lowers an abducted arm; inability to control the descent indicates a rotator cuff (supraspinatus) tear.
- Speed's test
- Resisted shoulder flexion with the elbow extended and forearm supinated; bicipital groove pain suggests biceps long-head tendinopathy.
- Apprehension test (shoulder)
- Abduction + external rotation reproduces apprehension/guarding, indicating anterior glenohumeral instability.
- Phalen test
- Sustained wrist flexion (~60 s) reproduces median-nerve paresthesia, suggesting carpal tunnel syndrome.
- Tinel sign
- Tapping over a nerve (e.g., median at the wrist) produces distal tingling, suggesting nerve compression or regeneration.
- Finkelstein test
- Thumb tucked in a fist with ulnar deviation reproduces radial wrist pain — de Quervain tenosynovitis.
- Thomas test
- Assesses hip flexor (iliopsoas) tightness — the resting thigh rises off the table when the opposite hip is fully flexed.
- Ober test
- Assesses iliotibial band / tensor fasciae latae tightness — the abducted top leg fails to adduct toward the table.
- FABER (Patrick) test
- Flexion, ABduction, External Rotation of the hip; reproduced pain suggests hip joint or sacroiliac pathology.
- Straight leg raise (SLR) test
- Passive hip flexion with the knee extended; radicular pain at 30–70° suggests lumbar nerve-root irritation (sciatica).
- Slump test
- Seated neural tension test for the lumbar spine and sciatic nerve; reproduced radicular symptoms are a positive finding.
- Spurling test
- Cervical extension, lateral flexion, and compression reproduce radicular arm symptoms — cervical nerve-root compression.
- Manual muscle test (MMT) grade 5
- Normal — full ROM against gravity with maximal resistance.
- MMT grade 4
- Good — full ROM against gravity with moderate resistance.
- MMT grade 3
- Fair — full ROM against gravity but no added resistance.
- MMT grade 2
- Poor — full ROM only with gravity eliminated (gravity-minimized position).
- MMT grade 1
- Trace — a palpable or visible muscle contraction with no joint movement.
- MMT grade 0
- Zero — no detectable contraction.
- Normal shoulder flexion ROM
- About 0–180°.
- Normal shoulder abduction ROM
- About 0–180°.
- Normal elbow flexion ROM
- About 0–145–150°.
- Normal hip flexion ROM
- About 0–120° (knee flexed).
- Normal knee flexion ROM
- About 0–135–140°.
- Normal ankle dorsiflexion ROM
- About 0–20°.
- Normal ankle plantarflexion ROM
- About 0–45–50°.
- End-feel: hard (bony)
- Abrupt bone-on-bone stop — normal at elbow extension; abnormal elsewhere (e.g., osteophytes).
- End-feel: firm (capsular)
- A firm, leathery stop from capsule/ligament — normal at hip rotation; abnormal if it appears early (capsular fibrosis).
- End-feel: soft (tissue approximation)
- Soft compression of tissue — normal at knee/elbow flexion.
- Empty end-feel
- Motion limited by intense pain before any tissue resistance — suggests acute inflammation, abscess, or fracture (a red flag).
- Capsular pattern of the shoulder
- External rotation most limited, then abduction, then internal rotation — classic of adhesive capsulitis.
- Adhesive capsulitis (frozen shoulder)
- Painful global loss of glenohumeral motion in a capsular pattern; progresses through freezing, frozen, and thawing phases.
- Osteoarthritis vs rheumatoid arthritis (joint pattern)
- OA = asymmetric, weight-bearing joints, DIP nodes; RA = symmetric, MCP/PIP, morning stiffness > 1 hour.
- Heberden's vs Bouchard's nodes
- Heberden's = DIP joints; Bouchard's = PIP joints — both seen in osteoarthritis.
- Lateral epicondylalgia (tennis elbow)
- Pain over the lateral epicondyle with resisted wrist extension; involves the common extensor (ECRB) origin.
- Medial epicondylalgia (golfer's elbow)
- Pain over the medial epicondyle with resisted wrist flexion; involves the common flexor origin.
- Salter-Harris classification
- Grades pediatric physeal (growth-plate) fractures I–V (SALTR): Slipped, Above, Lower, Through, Crush.
- Wolff's law
- Bone remodels along lines of mechanical stress — load promotes bone deposition; disuse promotes resorption.
- Davis's law
- Soft tissue remodels along lines of stress — the soft-tissue analog of Wolff's law.
- Convex-concave rule (convex on concave)
- When a convex surface moves on a fixed concave one, the joint glide is OPPOSITE the bone's roll/swing direction.
- Convex-concave rule (concave on convex)
- When a concave surface moves on a fixed convex one, the joint glide is in the SAME direction as the bone movement.
- Maitland mobilization grades
- Grades I–IV oscillations (I–II for pain, III–IV for stiffness); Grade V = high-velocity thrust manipulation.
- Open vs closed packed position
- Open (loose) = max joint play, best for mobilization; closed packed = max congruency/ligament tension, least joint play.
- Closed-packed position of the knee
- Full extension with tibial external rotation (screw-home mechanism).
- Screw-home mechanism
- Terminal knee extension couples with tibial external rotation, locking the knee for stability in standing.
- Q angle
- Angle of the quadriceps line of pull to the patellar tendon; normal ~13° (men) / ~18° (women); increased values raise patellofemoral stress.
- Ottawa ankle rules
- Decision rule for which ankle/foot injuries need an X-ray (malleolar/midfoot tenderness or inability to bear weight 4 steps).
- Gout (podagra)
- Acute monoarthritis, classically the first MTP joint, from monosodium urate crystals (negatively birefringent needles).
- Spondylolisthesis
- Anterior slippage of one vertebra on another, often L5 on S1; may cause a palpable step-off and neural symptoms.
- Scoliosis (Cobb angle)
- Lateral spinal curvature measured by the Cobb angle; > 10° defines scoliosis, > 45–50° often warrants surgical consult.
- Upper motor neuron (UMN) lesion signs
- Hypertonia/spasticity, hyperreflexia, clonus, positive Babinski, no significant atrophy — lesion above the anterior horn.
- Lower motor neuron (LMN) lesion signs
- Flaccidity, hyporeflexia/areflexia, fasciculations, and marked atrophy — lesion at or below the anterior horn cell.
- Babinski sign
- Up-going great toe with plantar stroking; abnormal (UMN lesion) in adults, normal in infants under ~1 year.
- Modified Ashworth Scale
- Grades spasticity 0–4 by resistance to passive movement (0 none; 4 rigid in flexion or extension).
- Deep tendon reflex grading
- 0 absent, 1+ diminished, 2+ normal, 3+ brisk, 4+ clonus/hyperactive.
- Dermatome C5
- Lateral arm (over the deltoid).
- Dermatome C6
- Lateral forearm, thumb, and index finger.
- Dermatome C7
- Middle finger.
- Dermatome C8
- Little finger and medial hand.
- Dermatome T4
- Nipple line.
- Dermatome T10
- Umbilicus.
- Dermatome L4
- Medial leg and medial malleolus.
- Dermatome L5
- Dorsum of the foot and great toe.
- Dermatome S1
- Lateral foot, little toe, and the heel.
- Myotome C5
- Shoulder abduction (deltoid) and elbow flexion.
- Myotome C6
- Elbow flexion (biceps) and wrist extension; reflex = brachioradialis.
- Myotome C7
- Elbow extension (triceps) and wrist flexion; reflex = triceps.
- Myotome L4
- Knee extension / ankle dorsiflexion; reflex = patellar.
- Myotome L5
- Great-toe extension (EHL) and ankle dorsiflexion.
- Myotome S1
- Ankle plantarflexion and hip extension; reflex = Achilles.
- Biceps reflex root
- C5–C6.
- Patellar (knee-jerk) reflex root
- L3–L4.
- Achilles reflex root
- S1–S2.
- MCA (middle cerebral artery) stroke
- Contralateral hemiparesis/hemisensory loss, face and arm > leg, and aphasia (dominant) or neglect (nondominant).
- ACA (anterior cerebral artery) stroke
- Contralateral weakness/sensory loss with the leg > arm/face.
- PCA (posterior cerebral artery) stroke
- Contralateral homonymous hemianopia with macular sparing; visual deficits predominate.
- Brunnstrom stages of recovery
- Six stages of post-stroke motor recovery: flaccidity → synergies/spasticity emerge → spasticity peaks → out-of-synergy → near-normal → normal.
- ASIA Impairment Scale A
- Complete — no motor or sensory function preserved in sacral segments S4–S5.
- ASIA Impairment Scale B
- Sensory incomplete — sensory but no motor function preserved below the level (including S4–S5).
- ASIA Impairment Scale C/D
- Motor incomplete — C: more than half of key muscles below the level grade < 3; D: at least half grade ≥ 3.
- Brown-Séquard syndrome
- Cord hemisection: ipsilateral motor + proprioception/vibration loss; contralateral pain/temperature loss.
- Anterior cord syndrome
- Loss of motor and pain/temperature below the lesion with preserved proprioception/vibration; poor prognosis.
- Central cord syndrome
- Greater upper-extremity than lower-extremity weakness; common after hyperextension injury in older adults.
- Autonomic dysreflexia
- Emergency in SCI at/above T6: sudden severe hypertension, pounding headache, sweating above the lesion — sit the patient up and find the noxious trigger (often bladder).
- Parkinson disease cardinal signs (TRAP)
- Tremor (resting, pill-rolling), Rigidity (cogwheel), Akinesia/bradykinesia, and Postural instability.
- Cerebellar dysfunction signs
- Ataxia, dysmetria, dysdiadochokinesia, intention tremor, and a wide-based unsteady gait.
- Multiple sclerosis
- Demyelinating CNS disease with relapsing-remitting deficits; heat worsens symptoms (Uhthoff phenomenon) — avoid overheating in exercise.
- Amyotrophic lateral sclerosis (ALS)
- Progressive degeneration of UPPER and LOWER motor neurons — combined UMN and LMN signs with intact sensation and cognition.
- Guillain-Barré syndrome
- Acute ascending symmetric flaccid paralysis (LMN) after infection; avoid fatiguing/overwork during recovery.
- Glasgow Coma Scale components
- Eye opening (4), verbal (5), motor (6); range 3–15. ≤ 8 indicates a comatose state.
- Romberg test
- Increased sway/loss of balance with eyes closed (vs open) indicates a proprioceptive/dorsal-column deficit.
- Cranial nerve VII (facial) lesion: central vs peripheral
- Bell's palsy (peripheral) affects the whole half of the face; a central (UMN) lesion spares the forehead.
- Gait cycle: stance vs swing (%)
- Stance is about 60% of the cycle; swing is about 40%.
- Initial contact (heel strike)
- Stance subphase where the foot first contacts the ground; the heel rocker begins.
- Loading response
- Stance subphase of weight acceptance/shock absorption from initial contact to opposite toe-off.
- Midstance
- Single-limb support; the body progresses over a stationary foot (ankle rocker).
- Terminal stance
- Heel rises and the body advances ahead of the forefoot (forefoot rocker), ending at opposite initial contact.
- Pre-swing (toe-off)
- Final stance subphase as the limb prepares to leave the ground; double-limb support.
- Swing phases (Rancho Los Amigos)
- Initial swing, mid swing, and terminal swing — the limb advances and prepares for the next contact.
- Trendelenburg gait
- Pelvic drop toward the unsupported swing side from gluteus medius (hip abductor) weakness on the stance side.
- Antalgic gait
- Shortened stance time on the painful limb to limit weight bearing.
- Steppage gait
- Exaggerated hip/knee flexion to clear a foot drop (dorsiflexor/L4–L5 or peroneal-nerve weakness).
- Festinating gait
- Short, shuffling, accelerating steps with a stooped posture — characteristic of Parkinson disease.
- Ataxic gait
- Wide-based, staggering, irregular steps from cerebellar dysfunction.
- Vaulting gait
- Rising onto the toes of the stance limb to clear a long or stiff swing limb (e.g., a locked-knee prosthesis).
- Normal resting heart rate (adult)
- About 60–100 beats per minute.
- Normal blood pressure (adult)
- Less than 120/80 mmHg (ACC/AHA normal category).
- Normal respiratory rate (adult)
- About 12–20 breaths per minute.
- Normal resting oxygen saturation (SpO₂)
- About 95–100% on room air.
- Karvonen (heart-rate reserve) formula
- Target HR = [(HRmax − HRrest) × intensity %] + HRrest.
- Estimated maximal heart rate
- Roughly 220 − age (a population estimate, not exact for any individual).
- Borg RPE (6–20 scale)
- Rating of Perceived Exertion; 12–14 ('somewhat hard') corresponds to moderate-intensity exercise.
- 1 MET (metabolic equivalent)
- Resting oxygen consumption ≈ 3.5 mL O₂/kg/min.
- FITT principle
- Frequency, Intensity, Time, and Type — the framework for prescribing exercise.
- Rate-pressure product
- Heart rate × systolic BP; estimates myocardial oxygen demand (cardiac workload).
- S3 heart sound
- An early-diastolic 'ventricular gallop'; abnormal in adults and associated with heart failure / volume overload.
- S4 heart sound
- A late-diastolic 'atrial gallop' from atrial contraction into a stiff ventricle (e.g., hypertension, ischemia).
- Crackles (rales)
- Discontinuous popping breath sounds from fluid/atelectasis — heard in pulmonary edema or pneumonia.
- Wheezes
- Continuous musical breath sounds from narrowed airways — asthma and COPD.
- Angina vs MI on exertion (PT response)
- Stop exercise for new/worsening chest pain, ECG changes, or a drop in systolic BP; activate emergency response for suspected MI.
- Absolute contraindications to exercise testing (signs)
- Acute MI (<2 days), unstable angina, uncontrolled arrhythmia, decompensated heart failure, acute PE, or acute aortic dissection.
- Postural (orthostatic) hypotension
- A drop of ≥ 20 mmHg systolic or ≥ 10 mmHg diastolic within 3 minutes of standing.
- Pursed-lip breathing
- Prolonged exhalation against pursed lips creates back-pressure to keep airways open; helps dyspnea in COPD.
- Diaphragmatic breathing
- Teaches abdominal/diaphragm-driven breathing to improve ventilation efficiency and reduce accessory-muscle use.
- Postural drainage
- Positioning that uses gravity to drain secretions from specific lung segments toward the central airways.
- Forced expiratory technique (huffing)
- Active forced exhalations through an open glottis to mobilize secretions with less airway collapse than coughing.
- COPD vs restrictive disease (spirometry)
- Obstructive (COPD) = reduced FEV₁/FVC < 0.70; restrictive = reduced FVC and TLC with a normal or high FEV₁/FVC.
- NYHA functional class (heart failure)
- I = no limitation; II = slight limitation; III = marked limitation with ordinary activity; IV = symptoms at rest.
- Sternal precautions (post-CABG)
- Limit lifting (often < 5–10 lb), avoid pushing/pulling and overhead reaching; protect the healing sternotomy ~6–8 weeks.
- Intermittent claudication
- Exertional calf/leg pain relieved by rest from peripheral arterial disease; a graded walking program is first-line therapy.
- Ankle-brachial index (ABI) interpretation
- 0.9–1.3 normal; < 0.9 indicates arterial disease; > 1.3 suggests noncompressible/calcified vessels (often diabetes).
- Homans sign
- Calf pain with passive ankle dorsiflexion suggesting DVT — unreliable; use Wells criteria and duplex ultrasound instead.
- Stages of pressure injury (Stage 1)
- Intact skin with localized non-blanchable erythema.
- Pressure injury Stage 2
- Partial-thickness loss of dermis — a shallow open ulcer or intact/ruptured blister.
- Pressure injury Stage 3
- Full-thickness skin loss; subcutaneous fat may be visible but no exposed bone, tendon, or muscle.
- Pressure injury Stage 4
- Full-thickness tissue loss with exposed bone, tendon, or muscle.
- Unstageable pressure injury
- Full-thickness loss obscured by slough or eschar so the depth cannot be determined until it is removed.
- Arterial vs venous ulcer location
- Arterial ulcers form at distal toes/lateral malleolus (punched-out, painful); venous ulcers form at the medial malleolus (irregular, weepy).
- Venous insufficiency ulcer management
- Compression therapy is the mainstay (after confirming adequate arterial flow with ABI).
- Arterial ulcer management
- Improve perfusion; AVOID compression, which can worsen ischemia. Confirm with a low ABI.
- Burn depth: superficial
- Epidermis only (e.g., sunburn) — red, painful, no blisters; heals without scarring.
- Burn depth: superficial partial-thickness
- Epidermis + upper dermis — blisters, very painful, blanches; heals in ~2–3 weeks.
- Burn depth: deep partial-thickness
- Into the deep dermis — mottled red/white, reduced sensation; may need grafting.
- Burn depth: full-thickness
- Entire dermis (and beyond) — leathery/white/charred, insensate; requires grafting.
- Rule of Nines (adult)
- Estimates total body surface area burned: head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%.
- Wound healing phases
- Hemostasis → inflammation → proliferation (granulation/epithelialization) → maturation/remodeling.
- Selective vs nonselective debridement
- Selective removes only nonviable tissue (sharp, enzymatic, autolytic); nonselective removes viable and nonviable tissue (wet-to-dry, wound irrigation).
- Diabetes diagnostic A1c
- Hemoglobin A1c ≥ 6.5% (one ADA diagnostic threshold).
- Hypoglycemia signs
- Shakiness, sweating, tachycardia, confusion; treat a conscious patient with fast-acting oral carbohydrate (the '15-15 rule').
- Exercise and blood glucose (type 1)
- Avoid exercise if glucose is very high with ketones; check glucose before/after and have carbohydrate available to prevent hypoglycemia.
- Hypothyroidism effect on exercise tolerance
- Fatigue, cold intolerance, weight gain, and reduced exercise tolerance; progress activity gradually.
- Osteoporosis exercise focus
- Weight-bearing and resistance exercise with postural training; AVOID loaded trunk flexion/twisting (fracture risk).
- Cushing syndrome features
- Central obesity, moon face, buffalo hump, skin fragility, and proximal muscle weakness from cortisol excess.
- GERD (gastroesophageal reflux) and positioning
- Avoid the supine/Trendelenburg position soon after meals; elevate the head of the bed.
- Referred pain: cholecystitis
- Right upper-quadrant pain may refer to the right scapula/shoulder.
- Referred pain: appendicitis
- Periumbilical pain that migrates to the right lower quadrant (McBurney point).
- McBurney point
- Point in the right lower quadrant tender in appendicitis (one-third the distance from the ASIS to the umbilicus).
- Stress urinary incontinence
- Leakage with increased abdominal pressure (cough, sneeze, lift); pelvic-floor (Kegel) strengthening is first-line PT.
- Urge urinary incontinence
- Sudden strong urge with leakage (overactive bladder); bladder training and pelvic-floor relaxation/urge-suppression help.
- Pelvic-floor muscle (Kegel) training
- Repeated contraction of the levator ani to improve continence and pelvic support.
- Lymphedema management (CDT)
- Complete decongestive therapy: manual lymphatic drainage, compression bandaging, exercise, and skin care.
- Manual lymphatic drainage (MLD)
- A gentle, superficial technique that moves lymph from congested toward functioning lymphatic regions.
- Lymphedema and blood-pressure cuffs
- Avoid BP cuffs, venipuncture, and constrictive items on a limb at risk for or with lymphedema.
- Stemmer sign
- Inability to pinch/tent the skin at the base of the second toe/finger — a positive sign of lymphedema.
- Stages of tissue healing: acute inflammatory phase
- Days 0–~6: redness, heat, swelling, pain; protect the tissue and control inflammation (PRICE/POLICE).
- Proliferation/repair phase
- Days ~3–21: collagen and granulation form; begin controlled, gentle loading to align fibers.
- Remodeling/maturation phase
- Day ~21 to a year+: collagen matures and aligns to stress; progressive loading and functional training.
- POLICE principle
- Protection, Optimal Loading, Ice, Compression, Elevation — updates RICE to include early controlled loading.
- SAID principle
- Specific Adaptation to Imposed Demands — the body adapts specifically to the type of stress placed on it.
- Overload principle
- To improve, a tissue/system must be stressed beyond its usual demand; underpins progressive resistance.
- DeLorme progressive resistance
- Three sets at 50%, 75%, then 100% of a 10-rep max — a classic strengthening progression.
- Concentric vs eccentric contraction
- Concentric = muscle shortens under load; eccentric = muscle lengthens under load (eccentric generates the most force).
- Type I vs Type II muscle fibers
- Type I = slow, oxidative, fatigue-resistant (endurance); Type II = fast, glycolytic, high force (power).
- Delayed-onset muscle soreness (DOMS)
- Muscle soreness 24–72 hours after unaccustomed (especially eccentric) exercise; resolves on its own.
- Frequency for strength vs endurance
- Strength: heavier loads, ~6–8 reps; endurance: lighter loads, higher reps (15+) — train per the SAID goal.
- Closed-chain vs open-chain exercise
- Closed chain = distal segment fixed (squat); open chain = distal segment free (knee extension machine).
- Reciprocal inhibition
- When an agonist contracts, its antagonist is reflexively inhibited — used to relax a tight antagonist (contract-relax).
- PNF: hold-relax
- An isometric contraction of the tight muscle, then relaxation, to gain passive range — used to improve flexibility.
- PNF diagonal patterns (D1/D2)
- Spiral-diagonal movement patterns that combine motion in three planes to facilitate functional movement.
- Vestibular: BPPV treatment
- Benign paroxysmal positional vertigo is treated with canalith repositioning (e.g., the Epley maneuver).
- Dix-Hallpike test
- Positional test that provokes nystagmus/vertigo to diagnose BPPV (posterior canal).
- Berg Balance Scale
- A 14-item, 0–56 functional balance measure; lower scores indicate greater fall risk.
- Timed Up and Go (TUG)
- Times rising from a chair, walking 3 m, turning, and sitting; ≥ 12–13.5 s suggests increased fall risk.
- Functional Reach Test
- Measures how far one can reach forward in standing; a reach < 6 inches indicates increased fall risk.
- 6-Minute Walk Test
- Submaximal aerobic/endurance test measuring the distance walked in 6 minutes.
- Pediatric: typical age to walk independently
- About 12 months (range ~9–15 months).
- Cerebral palsy (spastic type)
- The most common CP type — UMN signs with spasticity; manage tone, contractures, and functional mobility.
- APGAR score
- Newborn assessment of Appearance, Pulse, Grimace, Activity, Respiration (0–2 each) at 1 and 5 minutes.
- Wheelchair seat width
- Typically the widest part of the hips/thighs plus about 2 inches (~1 inch clearance each side).
- Wheelchair seat depth
- From the posterior buttock to the popliteal fold, minus about 2 inches to avoid pressure behind the knees.
- Standard axillary crutch fit
- Pad ~2–3 finger-widths (about 2 inches) below the axilla; handgrip with the elbow flexed ~20–30°.
- Standard cane height
- Handle at the level of the greater trochanter (or ulnar styloid) with the elbow flexed ~20–30°.
- Hold a cane on which side?
- On the side OPPOSITE the affected/weaker limb to widen the base and reduce load on the affected side.
- Three-point gait pattern
- Used for non-weight-bearing on one limb — both crutches and the involved limb advance, then the sound limb.
- Two-point gait pattern
- One crutch and the opposite leg move together — for partial weight bearing; faster, mimics normal gait.
- Four-point gait pattern
- The most stable pattern — move one crutch, then the opposite foot, alternating; for poor balance/coordination.
- Ascending stairs with an assistive device
- 'Up with the good' — lead with the uninvolved (stronger) leg going up.
- Descending stairs with an assistive device
- 'Down with the bad' — lead with the involved (weaker) leg and the device going down.
- ADA ramp slope
- A maximum slope of 1:12 (1 inch of rise per 12 inches of run) for accessible ramps.
- AFO (ankle-foot orthosis) purpose
- Controls ankle/foot position — commonly used for foot drop to assist swing-phase clearance.
- Transtibial vs transfemoral amputation
- Transtibial = below-knee (preserves the knee, better outcomes); transfemoral = above-knee.
- Residual limb (post-amputation) positioning
- Avoid prolonged flexion (e.g., pillow under a transtibial limb) to prevent flexion contractures; wrap to shape the limb.
- Cryotherapy (ice) physiologic effects
- Vasoconstriction, decreased metabolism, decreased nerve conduction and pain — used acutely for inflammation/edema.
- Superficial heat physiologic effects
- Vasodilation, increased blood flow and tissue extensibility, and decreased pain/muscle guarding (subacute/chronic).
- Contraindication to thermotherapy
- Acute inflammation, impaired sensation, poor circulation, malignancy, or over a deep-vein thrombosis.
- Therapeutic ultrasound (continuous vs pulsed)
- Continuous = thermal (deep heating); pulsed = nonthermal (cavitation/microstreaming for tissue healing).
- Ultrasound frequency and depth
- 1 MHz penetrates deeper (~3–5 cm); 3 MHz heats superficial tissues (~1–2 cm).
- TENS for pain control
- Transcutaneous electrical nerve stimulation; conventional (high-rate) TENS uses the gate-control mechanism for pain.
- NMES (neuromuscular electrical stimulation)
- Stimulates motor nerves to elicit muscle contraction for strengthening or re-education (e.g., quad after knee surgery).
- Iontophoresis
- Uses direct current to drive a charged medication (e.g., dexamethasone) through the skin into tissue.
- Traction (cervical/lumbar) indication
- May reduce nerve-root compression/radicular symptoms by separating vertebral segments.
- Gate control theory of pain
- Non-noxious input (e.g., TENS, rubbing) 'closes the gate' in the dorsal horn, reducing pain transmission.
- Universal (standard) precautions
- Treat all blood and body fluids as potentially infectious — hand hygiene, gloves, and PPE for every patient.
- Most important infection-control measure
- Hand hygiene (handwashing or alcohol-based rub) before and after every patient contact.
- Airborne precautions
- For TB, measles, varicella — negative-pressure room and an N95 respirator.
- Droplet precautions
- For influenza, pertussis, meningococcus — a surgical mask within ~3–6 feet of the patient.
- Contact precautions
- For MRSA, C. difficile (use soap and water, not just alcohol rub, for C. diff) — gown and gloves.
- Order of donning vs doffing PPE
- Don: gown → mask → goggles → gloves. Doff: gloves → goggles → gown → mask (last and away from the face).
- Absolute contraindication to exercise (vitals)
- Resting systolic BP > 200 mmHg or diastolic > 110 mmHg, or unstable cardiac signs — hold exercise.
- Fall-risk safety in the clinic
- Lock wheelchair brakes, use a gait belt, clear the path, and guard on the affected side during transfers/ambulation.
- Signs of DVT (and PT response)
- Unilateral calf pain, swelling, warmth, redness; hold lower-extremity exercise and report immediately (risk of PE).
- Red flags requiring medical referral
- Unexplained weight loss, night pain, bowel/bladder changes, saddle anesthesia, fever, or progressive neuro deficits.
- Cauda equina syndrome
- A surgical emergency: saddle anesthesia, bowel/bladder dysfunction, and bilateral leg weakness — refer immediately.
- Informed consent (PT)
- A patient with capacity voluntarily agrees to treatment after being told its risks, benefits, and alternatives.
- HIPAA
- Federal law protecting the privacy and security of identifiable health information; share only the minimum necessary.
- PT scope: who can a PTA supervise?
- A PTA cannot supervise another PTA's care plan; the PT performs the evaluation and establishes/revises the plan of care.
- Tasks a PT may NOT delegate to a PTA
- The initial examination/evaluation, diagnosis, prognosis, plan of care, and re-evaluation remain the PT's responsibility.
- Beneficence vs nonmaleficence
- Beneficence = act in the patient's best interest; nonmaleficence = 'do no harm.'
- Autonomy
- The patient's right to make their own informed decisions about care, including the right to refuse.
- Documentation: SOAP note
- Subjective, Objective, Assessment, Plan — the standard format for clinical PT notes.
- Cultural competence
- Delivering care that respects each patient's cultural beliefs, language, and values to improve outcomes.
- Mandatory reporting
- PTs must report suspected abuse/neglect of children, elders, or vulnerable adults to the proper authorities.
- Sensitivity (of a test)
- The proportion of people WITH the condition who test positive; high sensitivity (SnNout) rules a condition OUT when negative.
- Specificity (of a test)
- The proportion of people WITHOUT the condition who test negative; high specificity (SpPin) rules a condition IN when positive.
- Positive likelihood ratio
- Sensitivity / (1 − specificity); a higher value increases the post-test probability of disease.
- Reliability vs validity
- Reliability = consistency/reproducibility of a measure; validity = whether it measures what it intends to measure.
- Minimal detectable change (MDC)
- The smallest change in a measure that exceeds measurement error — change beyond it is likely real.
- Minimal clinically important difference (MCID)
- The smallest change in an outcome that a patient perceives as meaningful/beneficial.
- Levels of evidence (highest)
- Systematic reviews/meta-analyses of randomized controlled trials sit at the top of the evidence hierarchy.
- Randomized controlled trial (RCT)
- Random allocation to intervention vs control reduces bias; the strongest single-study design for treatment effects.
- Evidence-based practice (EBP)
- Integrating the best research evidence, clinical expertise, and patient values/preferences in decision-making.
- Type I vs Type II statistical error
- Type I = rejecting a true null (false positive, α); Type II = failing to reject a false null (false negative, β).
- Statistical significance (p value)
- p < 0.05 is the conventional threshold to reject the null hypothesis (a 5% chance of a Type I error).
- Nominal vs ordinal vs interval/ratio data
- Nominal = categories; ordinal = ranked order (MMT grades); interval/ratio = equal intervals (ratio has a true zero).
- Most common rotator cuff muscle torn
- The supraspinatus.
- Rotator cuff muscles (SITS)
- Supraspinatus, Infraspinatus, Teres minor, Subscapularis.
- Action of the supraspinatus
- Initiates shoulder abduction (first ~15–30°).
- Erb's palsy (Erb-Duchenne)
- Upper brachial plexus (C5–C6) injury — the 'waiter's tip' posture (adducted, internally rotated, pronated).
- Klumpke palsy
- Lower brachial plexus (C8–T1) injury — intrinsic hand weakness, a 'claw hand.'
- Median nerve injury (hand)
- 'Ape hand' / loss of thumb opposition and weakness of the first two lumbricals; sensory loss over the lateral palm.
- Ulnar nerve injury (hand)
- 'Claw hand' (4th–5th digits), weak finger abduction/adduction; sensory loss over the little finger.
- Radial nerve injury
- 'Wrist drop' from loss of wrist/finger extensors; commonly from a humeral midshaft fracture.
- Common fibular (peroneal) nerve injury
- Foot drop and loss of dorsiflexion/eversion; sensory loss over the dorsum of the foot.
- Sciatic nerve roots
- L4–S3.
- Carpal tunnel syndrome (nerve)
- Compression of the median nerve at the wrist — night paresthesias in the thumb, index, middle, and half the ring finger.
- Thoracic outlet syndrome
- Compression of the brachial plexus/subclavian vessels at the thoracic outlet — arm paresthesia worse with overhead use.
- Piriformis syndrome
- Sciatic-nerve irritation by the piriformis — buttock pain referring down the leg, worse with sitting.
- Plantar fasciitis
- Heel/medial-arch pain worst with the first steps in the morning; tender at the medial calcaneal tubercle.
- Achilles tendinopathy
- Posterior heel/tendon pain and stiffness; eccentric loading (heel drops) is evidence-based treatment.
- Thompson test
- Squeezing the calf produces no plantarflexion — a positive test for a complete Achilles tendon rupture.
- Most commonly sprained ankle ligament
- The anterior talofibular ligament (ATFL) — injured in inversion sprains.
- Compartment syndrome (5 P's)
- Pain (out of proportion, with passive stretch), Paresthesia, Pallor, Pulselessness, Paralysis — a surgical emergency.
- Complex regional pain syndrome (CRPS)
- Disproportionate pain with autonomic/trophic changes (swelling, temperature/color change) after injury; early motion helps.
- Total hip arthroplasty (posterior approach) precautions
- Avoid hip flexion > 90°, adduction past midline, and internal rotation to prevent dislocation.
- Total knee arthroplasty PT priority
- Restore knee extension (avoid a flexion contracture) and quad control; progress ROM and weight bearing early.
- Ligament healing timeline (early)
- Ligaments are relatively avascular and heal slowly; protect early, then progressively load to align collagen.
- Dizziness with cervical motion (red flag)
- Consider vertebrobasilar insufficiency — avoid sustained end-range cervical rotation/extension; refer if positive.
- Five D's and three N's (VBI screen)
- Dizziness, Diplopia, Dysarthria, Dysphagia, Drop attacks; Nausea, Numbness, Nystagmus — signs of vertebrobasilar insufficiency.
- Wells criteria (DVT/PE)
- Clinical prediction rule estimating pretest probability of DVT or pulmonary embolism.
- Pulmonary embolism signs
- Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxia — a medical emergency; activate emergency response.
- Orthostatic-hypotension PT strategy
- Change positions slowly, use an abdominal binder/compression, and progress to upright gradually (e.g., tilt table).
- Resting metabolic response to detraining
- Aerobic fitness (VO₂max) declines within ~2 weeks of stopping training — reversibility principle.
- Reversibility principle
- Training adaptations are lost when the stimulus is removed ('use it or lose it').
- Stretching: when to use ballistic vs static
- Static stretching is safest for general flexibility; ballistic (bouncing) carries higher injury risk and is reserved for trained athletes.
- Goniometry
- Measurement of joint range of motion in degrees using a goniometer (axis over the joint, arms along the segments).
- Difference: PNF contract-relax vs hold-relax
- Contract-relax uses an isotonic (moving) contraction of the tight muscle; hold-relax uses an isometric contraction.
- Phases of cardiac rehabilitation (Phase I)
- Inpatient phase: early low-level mobility and education after an acute cardiac event.
- Cardiac rehab Phase II
- Early outpatient, monitored exercise program after discharge.
- Talk test (intensity)
- If a person can talk but not sing comfortably, they are likely at moderate intensity.
- Signs to terminate an exercise test
- Drop in systolic BP, ST changes, serious arrhythmia, severe dyspnea, chest pain, or the patient asking to stop.
- Phase of healing to begin aggressive stretching
- Not during the acute inflammatory phase — begin progressive loading/stretch in the proliferation and remodeling phases.
- Glasgow Outcome / consciousness: decorticate posturing
- Flexion of the arms toward the core — indicates a lesion above the midbrain (red nucleus).
- Decerebrate posturing
- Extension of the arms and legs — indicates a more caudal (brainstem) lesion; worse prognosis than decorticate.
- Synergy patterns (post-stroke)
- Stereotyped mass movement patterns (flexor/extensor) that emerge with spasticity; goal is out-of-synergy control.
- Pusher syndrome (lateropulsion)
- After stroke, the patient actively pushes toward the weaker side and resists correction; use visual vertical cues.
- Constraint-induced movement therapy (CIMT)
- Restraining the unaffected arm to force use of the affected arm after stroke (forced use + massed practice).
- Neuroplasticity principle
- Repetition, intensity, salience, and specificity drive cortical reorganization after CNS injury.
- Functional Independence Measure (FIM)
- An 18-item, 7-level scale rating burden of care for ADLs/mobility; higher = more independent.
- Levels of assistance: contact guard assist (CGA)
- The therapist keeps hands on but provides no actual physical assistance.
- Minimal vs moderate vs maximal assist
- Min = patient does 75%+; mod = patient does 50–74%; max = patient does 25–49% of the effort.
- Standby (supervision) assist
- No physical contact; the therapist stays near in case help is needed.
- Body mechanics for lifting
- Keep the load close, bend at the hips/knees (not the back), maintain a neutral spine, and avoid twisting.
- Hemiplegia vs hemiparesis
- Hemiplegia = complete one-sided paralysis; hemiparesis = one-sided weakness.
- Spinal shock
- Transient loss of all reflexes and flaccidity below an acute SCI lesion; reflexes return over days to weeks.
- C6 tetraplegia functional level
- Wrist extension (tenodesis grasp) is present; can be independent with adaptive equipment for many ADLs.
- Heterotopic ossification
- Abnormal bone formation in soft tissue after SCI/TBI/burns; presents as warmth, swelling, and lost ROM.
- Diabetic peripheral neuropathy precaution
- Inspect insensate feet daily and use proper footwear; protect from injury due to lost protective sensation.
- Semmes-Weinstein monofilament
- Tests protective sensation; inability to feel the 5.07 (10 g) monofilament indicates loss of protective sensation.
- Two-point discrimination
- Tests sensory acuity (dorsal column); normal at the fingertips is about 2–4 mm.
- Proprioception
- Awareness of joint position and movement, carried by the dorsal column–medial lemniscus pathway.
- Spinothalamic tract
- Carries pain and temperature sensation; crosses near the level of entry (decussates in the cord).
- Dorsal column–medial lemniscus
- Carries fine touch, vibration, and proprioception; decussates in the medulla.
- Corticospinal tract
- The main descending motor pathway; decussates at the medullary pyramids (lateral corticospinal tract).
- Phases of motor learning (Fitts & Posner)
- Cognitive (understanding the task) → associative (refining) → autonomous (automatic).
- Blocked vs random practice
- Blocked practice improves short-term performance; random practice improves long-term retention and transfer.
- Knowledge of results vs performance
- KR = feedback about the outcome; KP = feedback about the movement quality; faded feedback aids retention.
- Hooklying position
- Supine with hips and knees flexed and feet flat — a common starting position for core/pelvic exercises.
- Lordosis vs kyphosis
- Lordosis = increased lumbar/cervical concavity (sway-back); kyphosis = increased thoracic convexity (hunchback).
- Forward head posture
- Anterior translation of the head increasing upper-cervical extension and lower-cervical flexion; loads the cervical spine.
- Upper-crossed syndrome
- Tight upper trapezius/levator and pectorals with weak deep neck flexors and lower trapezius — a postural muscle imbalance.
- Most common shoulder dislocation direction
- Anterior (anteroinferior) glenohumeral dislocation.
- Bankart vs Hill-Sachs lesion
- Bankart = anteroinferior labral tear; Hill-Sachs = compression fracture of the posterolateral humeral head — both from anterior dislocation.
