- Physical therapist assistant (PTA)
- A clinician who delivers selected interventions and collects data under a physical therapist's direction and supervision; the PTA does not evaluate, diagnose, or establish the plan of care.
- Plan of care (POC)
- The PT's written program of goals and interventions; only the PT may establish or change it, and the PTA carries it out within its limits.
- PTA scope — what a PTA may NOT do
- Perform the initial examination/evaluation, interpret findings to diagnose, establish or change the plan of care, or perform discharge planning — these are the PT's role.
- Direction and supervision
- The relationship in which the PT directs and is responsible for the PTA's work; supervision may be general, direct, or direct-personal depending on setting and regulation.
- Patient falls outside the plan of care
- The PTA's correct action: ensure safety, collect data, and communicate the change back to the supervising physical therapist — not re-evaluate or change the plan.
- Patient refuses treatment
- Honor the competent patient's right to refuse, document the refusal, and notify the supervising physical therapist.
- Informed consent
- A patient's voluntary agreement to treatment after being told its nature, risks, benefits, and alternatives; the PTA respects autonomy throughout care.
- HIPAA Privacy Rule
- Protects individually identifiable protected health information (PHI) and limits its use and disclosure to authorized purposes such as treatment, payment, and operations.
- Permitted PHI disclosure
- Sharing patient information for treatment — e.g., a PTA discussing the plan of care with the supervising PT — is permitted; sharing with unauthorized people is not.
- Autonomy
- The ethical principle of respecting a patient's right to make their own informed decisions, including the right to refuse care.
- Beneficence vs nonmaleficence
- Beneficence = act in the patient's best interest; nonmaleficence = do no harm. Both anchor PT/PTA ethical conduct.
- Evidence-based practice
- Integrating the best available research evidence with clinical experience and patient values to guide care delivered within the plan of care.
- Hierarchy of evidence
- From strongest to weakest: systematic reviews/meta-analyses of RCTs, then RCTs, cohort and case-control studies, case series/reports, and expert opinion.
- Reliability
- The consistency of a measurement — whether it gives the same result on repetition (test-retest), between raters (inter-rater), or within a rater (intra-rater).
- Validity
- Whether a test actually measures what it claims to measure; a test can be reliable without being valid, but not valid without being reliable.
- Sensitivity (SnNout)
- A test's ability to correctly identify those with the condition; a highly sensitive test with a NEGATIVE result helps rule the condition OUT.
- Specificity (SpPin)
- A test's ability to correctly identify those without the condition; a highly specific test with a POSITIVE result helps rule the condition IN.
- Inter-rater reliability
- Agreement between two or more raters measuring the same thing — e.g., two PTAs obtaining the same goniometric reading.
- Vital signs (resting normals)
- HR 60–100 bpm, BP < 120/80 mmHg, RR 12–20 breaths/min, SpO₂ ≥ 95% on room air — the PTA monitors these before, during, and after activity.
- Rate of perceived exertion (Borg)
- A patient's subjective rating of effort (6–20 or 0–10) the PTA uses to gauge and grade exercise intensity, useful when medications blunt heart rate.
- Ankle-brachial index (ABI)
- Ankle systolic pressure ÷ brachial systolic pressure; a screen for peripheral arterial disease.
- ABI interpretation
- 1.0–1.4 normal; 0.91–0.99 borderline; ≤ 0.90 arterial insufficiency; > 1.40 suggests noncompressible, calcified vessels (common in diabetes).
- Deep vein thrombosis (DVT)
- A clot in a deep vein causing unilateral calf swelling, warmth, redness, and tenderness; a red flag to hold exercise and report because it can cause a pulmonary embolism.
- Wells criteria
- A clinical decision rule that estimates the pretest probability of DVT (or PE); it guides next steps but does not by itself diagnose.
- Orthostatic hypotension
- A drop > 20 mmHg systolic / 10 mmHg diastolic on standing; change positions gradually and monitor, common in immobilized or SCI patients.
- Adverse exercise response — STOP signs
- Chest pain/tightness, severe dyspnea, dizziness, a sharp BP change, or falling SpO₂: stop, ensure safety, monitor, and report to the PT.
- Angina
- Chest pain from myocardial ischemia; stable angina is exertional and relieved by rest/nitroglycerin — stop activity and rest if it appears.
- COPD
- Chronic obstructive pulmonary disease; manage with airway clearance, breathing exercises (pursed-lip), energy conservation, and paced activity.
- Pursed-lip breathing
- Exhaling slowly through pursed lips to keep airways open longer, reduce air trapping, and ease dyspnea in obstructive lung disease.
- Postural drainage
- Positioning a patient to use gravity to clear secretions from specific lung segments, often combined with percussion and vibration.
- Heart failure exercise caution
- Watch for weight gain, edema, and worsening dyspnea; grade intensity to tolerance and report decompensation to the PT.
- Pulse oximetry (SpO₂)
- Noninvasive measure of arterial oxygen saturation; a fall below ~88–90% during activity warrants a pause, recovery, and report.
- Goniometry
- Measurement of joint range of motion in degrees using a goniometer; reliability depends on consistent positioning, bony landmarks, and technique.
- Manual muscle test (MMT) scale
- Grades strength 0–5: 0 none, 1 flicker, 2 full range gravity-eliminated, 3 full range against gravity, 4 against moderate resistance, 5 against maximal resistance.
- MMT grade 3 (Fair)
- The gravity pivot — full active range of motion against gravity with no added resistance; below 3 is tested gravity-eliminated.
- MMT grade 2 (Poor)
- Full range of motion in a gravity-eliminated (gravity-minimized) position.
- Active vs passive range of motion
- Active ROM is moved by the patient; passive ROM is moved by the clinician with the patient relaxed; active-assisted is a blend.
- End-feel
- The quality of resistance felt at the end of passive ROM — normal (soft, firm, hard) or abnormal (empty, springy, boggy) — clues to the limiting structure.
- Sprain
- An overstretch or tear of a LIGAMENT (bone-to-bone), graded I–III by severity; most common at the ankle.
- Strain
- An overstretch or tear of a MUSCLE or its TENDON, graded I–III by severity.
- Tissue-healing phases
- Inflammatory (acute), proliferative (repair), and remodeling (maturation); the phase guides how aggressively the plan progresses exercise.
- PRICE / POLICE
- Acute soft-tissue management: Protection, (Optimal Loading), Rest, Ice, Compression, Elevation — POLICE replaces rest with optimal loading.
- Posterior total hip precautions
- After a posterior-approach total hip replacement: no hip flexion past 90°, no adduction past midline, no internal rotation — these risk dislocation.
- Genu recurvatum
- Knee hyperextension; on goniometry it reads as motion past 0° into the negative.
- Open- vs closed-chain exercise
- Open chain = distal segment free (knee extension machine); closed chain = distal segment fixed (squat), generally more functional and joint-stable.
- Concentric vs eccentric contraction
- Concentric = muscle shortens under load; eccentric = muscle lengthens under load (controls a descent) and generates the most force/soreness.
- Osteoarthritis vs rheumatoid arthritis
- OA is degenerative wear of weight-bearing joints; RA is a symmetric autoimmune inflammatory disease — avoid aggressive exercise during RA flares.
- Stretching for contracture
- Low-load, prolonged stretch (often with heat first) increases tissue extensibility more safely than brief, forceful stretching.
- Stabilizing the proximal segment
- Holding the segment proximal to a joint during MMT/goniometry to prevent substitution that would inflate the measurement.
- Upper motor neuron (UMN) lesion
- Damage to brain or spinal cord producing spasticity, hyperreflexia, clonus, a positive Babinski, and little atrophy (e.g., stroke, SCI, MS).
- Lower motor neuron (LMN) lesion
- Damage to the anterior horn, root, or peripheral nerve producing flaccidity, hyporeflexia/areflexia, fasciculations, and marked atrophy.
- Spasticity
- Velocity-dependent increased muscle tone from a UMN lesion — resistance to passive stretch rises with the speed of movement.
- Clonus
- Rhythmic involuntary muscle contractions in response to a quick stretch; a sign of an upper motor neuron lesion.
- Babinski sign
- Extension (dorsiflexion) of the great toe with fanning when the sole is stroked; positive in adults indicates an upper motor neuron lesion.
- Brunnstrom stages of recovery
- Six stages after stroke: (1) flaccidity, (2) emerging synergies/spasticity, (3) peak spasticity with voluntary synergies, (4)–(5) synergies decline, (6) near-normal isolated movement.
- Brunnstrom intervention principle
- Help the patient gain voluntary control of the synergies first, then progress toward breaking out of them into isolated movement.
- Autonomic dysreflexia
- A medical emergency in SCI at/above T6: a noxious stimulus below the lesion spikes BP with a pounding headache, flushing, and sweating above the lesion.
- Autonomic dysreflexia — PTA response
- Sit the patient upright to lower blood pressure, then find and remove the noxious trigger (often a full bladder/kinked catheter) and call for help.
- Glasgow Coma Scale (GCS)
- Rates eye, verbal, and motor responses (3–15) to grade level of consciousness after brain injury; lower scores mean greater impairment.
- Parkinson disease
- A progressive disorder with resting tremor, rigidity, bradykinesia, and postural instability; PT focuses on large-amplitude movement, gait, and balance.
- Multiple sclerosis exercise caution
- Avoid overheating and fatigue (Uhthoff's phenomenon worsens symptoms with heat); use frequent rest and cooling.
- Dermatome
- An area of skin supplied by a single spinal nerve root; mapping sensory loss helps localize the level of a nerve lesion.
- Myotome
- A group of muscles supplied by a single spinal nerve root; weakness in a myotome helps localize a root-level problem.
- Cerebellar dysfunction signs
- Ataxia, dysmetria, intention tremor, and impaired coordination — train balance and coordination with the activity graded for safety.
- Decerebrate vs decorticate posturing
- Decerebrate = extension of all limbs (worse, brainstem); decorticate = arms flexed toward the core, legs extended — both indicate severe brain injury.
- Proprioceptive neuromuscular facilitation (PNF)
- Diagonal movement patterns and techniques (e.g., contract-relax) that use the body's proprioceptors to facilitate or strengthen movement.
- Pressure injury staging
- Stage 1 = intact skin, nonblanchable redness; 2 = partial-thickness loss/blister; 3 = full-thickness exposing fat; 4 = exposes muscle, tendon, or bone.
- Pressure injury prevention
- Repositioning on a schedule, offloading bony prominences, pressure-relieving surfaces, skin inspection, and managing moisture — the top PTA action.
- Mechanical (wet-to-dry) debridement
- Removing devitalized tissue by applying a saline-moistened gauze that is allowed to dry and then removed, taking debris with it (nonselective).
- Hypoglycemia signs
- Shakiness, sweating, hunger, confusion, tachycardia; if alert and able to swallow, give ~15 g fast-acting carbohydrate, wait ~15 min, and recheck (15/15 rule).
- Exercise and high blood glucose
- Hold aerobic exercise if blood glucose is above 250 mg/dL with ketones present, because exercise can worsen the metabolic state.
- Diabetic foot care
- Inspect insensate feet before and after activity, watch for skin breakdown, and ensure proper footwear — neuropathy hides injury.
- Lymphedema
- Protein-rich swelling from impaired lymphatic drainage, often after lymph-node removal; managed with complete decongestive therapy.
- Complete decongestive therapy (CDT)
- Lymphedema management: manual lymphatic drainage, compression bandaging/garments, exercise, and meticulous skin care.
- Manual lymphatic drainage
- Light, slow, rhythmic skin-stretching strokes directed toward functioning lymph nodes to move lymph fluid out of a congested region.
- System interactions
- Items that require integrating across systems — e.g., a diabetic with PAD and an insensate foot needs combined skin, vascular, and neuro vigilance.
- Bladder-retraining (timed voiding) program
- Scheduled voiding to gradually retrain the bladder to hold larger volumes and reduce urgency/incontinence episodes.
- Constipation and mobility
- Increasing general physical activity and progressing out-of-bed mobility helps relieve constipation in an immobile patient.
- Assistive device stability order
- From most to least support: walker > axillary crutches > forearm crutches > cane. More base/contact points = more stable but slower.
- Cane placement
- Hold the cane in the hand OPPOSITE the involved (affected) leg, advancing the cane and the affected leg together.
- Weight-bearing — NWB
- Non-weight-bearing: no weight at all on the limb; the foot does not touch the floor.
- Weight-bearing — TTWB
- Toe-touch / touch-down weight-bearing: only the toes rest on the floor for balance (~weight of the leg), not body weight.
- Weight-bearing — PWB / WBAT / FWB
- PWB = a set percentage of body weight; WBAT = as much as comfort allows; FWB = no restriction (full body weight).
- Three-point vs two-point gait
- Three-point keeps weight off one limb (most stable for NWB/PWB); two-point moves an opposite arm and leg together (faster, less stable).
- Wheelchair seat depth
- Measured from the posterior buttock to the popliteal fold, then subtract about two inches to avoid pressure behind the knee.
- Wheelchair armrest height
- Set so the elbow rests at about 90° with the forearm comfortably supported and the shoulders neither elevated nor depressed.
- Wheelchair back height
- A lower back (below the inferior scapular angle) frees scapular and arm movement for efficient propulsion in an active user.
- Ankle-foot orthosis (AFO)
- An orthosis that controls the ankle and foot — commonly used to manage drop foot and assist push-off/clearance during gait.
- Transtibial (below-knee) prosthesis
- A prosthesis for amputation below the knee; gait deviations often trace to socket fit and foot/alignment settings.
- Circumduction gait (prosthesis)
- Swinging the prosthetic leg out in an arc, often caused by a prosthesis that is functionally too long or a knee that won't flex enough in swing.
- Prosthetic skin checks
- Inspect the residual limb for redness/breakdown, monitor socket fit, reinforce the wearing schedule, and report problems to the PT.
- Cryotherapy (cold)
- Cold causing vasoconstriction that reduces swelling, pain, and metabolism — best in the acute phase (first 24–72 h) of injury.
- Cryotherapy contraindications
- Cold hypersensitivity/urticaria, Raynaud's, impaired sensation, and impaired circulation over the treatment site.
- Superficial heat (hot pack)
- Heat causing vasodilation that raises blood flow and tissue extensibility — for subacute/chronic problems, NOT acute injury.
- Hot pack layering
- Use six to eight layers of toweling to insulate the skin and prevent a burn while allowing comfortable heat transfer.
- Heat contraindications
- Acute injury, active bleeding, malignancy, impaired sensation, and impaired circulation over the area.
- Therapeutic ultrasound
- A deep agent (continuous = thermal, pulsed = nonthermal); avoid over malignancy, the pregnant uterus, eyes, heart, pacemaker, and open growth plates.
- TENS
- Transcutaneous electrical nerve stimulation for pain control; conventional (high-rate) TENS uses ~100 pulses/sec at a comfortable sensory intensity.
- NMES
- Neuromuscular electrical stimulation used for muscle re-education and strengthening by eliciting a muscle contraction.
- Iontophoresis
- Using direct current to drive a charged medication through the skin; like charges repel, so the drug is delivered from the same-charge electrode.
- Dexamethasone iontophoresis
- Dexamethasone is negatively charged, so it is delivered from beneath the negative (cathode) electrode.
- Electrotherapy contraindications
- Avoid placing electrodes over the carotid sinus, a pacemaker, the pregnant uterus, or an active malignancy.
- Mechanical traction
- Distraction used for cervical/lumbar radicular symptoms; avoid with instability, RA, osteoporosis, malignancy, or cord-compression signs.
- Universal modality cautions
- Two cross-cutting contraindications: impaired sensation and active malignancy over the treatment site — when present, withhold and consult the PT.
- Standard precautions
- Infection-control practices used with EVERY patient, every time: hand hygiene, gloves for body-fluid contact, and PPE as the task requires.
- Hand hygiene timing
- Clean hands before AND after every patient contact — even if gloves were worn — and after contact with the patient's environment.
- C. difficile hand hygiene
- Use soap and water (not alcohol-based rub) because alcohol does not kill C. difficile spores.
- Contact precautions
- Add a gown and gloves (and dedicated/cleaned equipment) for MRSA, VRE, C. difficile, and draining wounds.
- Droplet precautions
- Add a surgical mask within ~3–6 feet for influenza, pertussis, and bacterial meningitis (spread by large respiratory droplets).
- Airborne precautions
- Add an N95 respirator and a negative-pressure room for tuberculosis, measles, and varicella (spread by small airborne particles).
- Transmission-based precautions
- Always used IN ADDITION to standard precautions, never instead of them; matched to how the organism spreads.
- Doffing PPE order
- Generally remove the most contaminated first: gloves and gown, perform hand hygiene, then face shield/mask, then hand hygiene again.
- Needlestick / sharps exposure
- Immediately wash the wound thoroughly with soap and running water, then report and follow the facility's exposure protocol.
- Safe transfer setup
- Lock the wheelchair, clear the path, use a gait belt, and position to guard on the patient's weaker side.
- Gait belt
- A belt secured around the patient's waist that gives the PTA a secure hold to guard, assist, and control during transfers and gait.
- Body mechanics
- Keep loads close, maintain a neutral spine and wide base of support, and lift with the legs — not the back.
- Fall-risk reduction (environment)
- Remove throw rugs and clutter, ensure adequate lighting, and provide stable support along the walking path.
- Intrinsic fall-risk factors
- Lower-extremity weakness, impaired balance, and orthostatic hypotension raise fall risk and call for closer guarding.
- Guarding a balance activity
- Stay close with a gait belt and a stable support nearby while challenging balance at a safe, progressive level.
