Ptp&M013 Npte 1

PHYSICAL THERAPY PRINCIPALS & METHODS
PTP&M013/1 Revision: 02 Page: 1 of 229
NATIONAL PHYSIOTHERAPY EXAM PREP GUIDE
NOTICE: This specification, and the subject matter disclosed therein, embody proprietary information which is the confidential property of
Mullsons Health & Wellness, which shall be copied, reproduced, disclosed to others, published, and could be used in whole or part, for
any purpose, without the express advance written permission of a duly authorized agent of the Company. This specification is subject
to recall by Mullsons Health & Wellness at any time.
MEDICINE: IT’S A NOBLE PROFESSION, IT SERVES HUMANITY.
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PASSAGE TO THE USA, VIA CAPE OF NPTE.
NATIONAL PHYSIOTHERAPY EXAMINATION-PART-1
SPEC. BY: Abdulrehman S. Mulla
DATE: 03/21/2009
REVISION HISTORY
REV. DESCRIPTION CN No. BY DATE
01 Initial Release PT0013 ASM 04/25/2009
02/02 Replace the Front cover poster PT0014 ASM 05/02/2009

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TABLE OF CONTENTS PAGE
NPTE SYLLABUS:.......................................................................................................................................................................................... 11
1.0 NPTE (NATIONAL PHYSIOTHERAPYEXAMINATION):.............................................................................................................................. 11
1.1 WHY HAVE A LICENSURE EXAM? ...................................................................................................................................................... 12
1.2 NPTE DEVELOPMENT:......................................................................................................................................................................... 12
1.3 PT PASSING STANDARD REVIEW:..................................................................................................................................................... 13
1.3.1 WHY THE STANDARD REVIEW FOR THE PTA EXAM?..................................................................................................... 13
1.4 LINKING ADMISSIONS CRITERIA TO PERFORMANCE ON NPTE:................................................................................................... 13
1.5 ARE NPTE QUESTIONS GETTING HARDER? .................................................................................................................................... 13
1.6 DO NPTE ITEMS HAVE MORE THAN ONE RIGHT ANSWER? .......................................................................................................... 13
1.5 RECALLED NPTE QUESTIONS:........................................................................................................................................................... 14
1.5.1 A QUESTION FROM A STUDENT: ....................................................................................................................................... 14
1.5.2 CAN I TALK TO MY STUDENTS ABOUT THE NPTE AFTER THEY HAVE TAKEN IT? .................................................... 14
1.6 ENHANCING NPTE TEST ITEMS: ........................................................................................................................................................ 14
1.7 CAN YOU PROVIDE THE BACKGROUND ON THE 20 PT NPTE SCORES THAT WERE INVALIDATED IN 2007? ........................ 15
1.8 SCHOOL PASS RATE REPORTS:........................................................................................................................................................ 16
1.9 WHY DO YOU POST ULTIMATE PASS RATES:.................................................................................................................................. 16
1.10 HOW DO I ORDER SCHOOL REPORTS?............................................................................................................................................ 16
1.11 HOW DO I FIND OUT MY SCHOOL CODE AND PASSWORD IN ORDER TO LOG ON? .................................................................. 16
1.12 WHAT KIND OF REPORTS DO YOU OFFER?..................................................................................................................................... 17
1.13 CAN I PAY WITH A PURCHASE ORDER? ........................................................................................................................................... 17
1.14 WHAT IS THE “MY STUDENTS” LISTING? .......................................................................................................................................... 17
1.15 WHY DO MY REPORTS EXPIRE AFTER 30 DAYS? ........................................................................................................................... 17
1.16 IF MY REPORTS EXPIRE AFTER 30 DAYS, WHY HAVE A SUBSCRIPTION FOR A YEAR? ........................................................... 18
1.17 PRACTICE EXAM AND ASSESSMENT TOOL (PEAT): ....................................................................................................................... 18
1.17.1 DISCOUNTS FOR GROUP PURCHASES OF THE PRACTICE EXAM & ASSESSMENT TOOL (PEAT)?......................... 18
1.18 HINTS: ............................................................................................................................................................................................... 18
1.19 STATE PRACTICE ACTS: ..................................................................................................................................................................... 19
1.20 THE KEYS TO TAKE YOUR TEST ARE: .............................................................................................................................................. 19
1.21 DEVELOPING CONTENT VALIDITY: practice analysis to test content outline:.................................................................................... 19
1.21.1 PURPOSE OF A PRACTICE ANALYSIS:.............................................................................................................................. 19
1.21.2 A STANDARD APPROACH: .................................................................................................................................................. 19
1.21.3 PREVIOUS AND FUTURE PRACTICE ANALYSES: ............................................................................................................ 20
1.21.4 OVERVIEW OF A PRACTICE ANALYSIS:............................................................................................................................ 20
1.21.5 PHASES OF A PRACTICE ANALYSIS:................................................................................................................................. 20
1.21.6 THE OVERSIGHT PANEL AND TASK FORCES: ................................................................................................................. 20
1.21.7 SURVEY DEVELOPMENT: ................................................................................................................................................... 21
A. FREQUENCY OF PERFORMANCE: 21
B. SURVEY PARTICIPATION: 21
C. SURVEY ANALYSIS: 21
1.22 NPTE EXAM INFORMATION:................................................................................................................................................................ 22
1.23 EXAM BREACHES:................................................................................................................................................................................ 23
2.0 MUSCULOSKELETAL PHYSIOTHERAPY:.................................................................................................................................................. 25
2.1 UNDERSTANDING THE MUSKULOSKEELETAL SYSTEM:................................................................................................................ 25
2.1.1 HUMAN SKELETON: ............................................................................................................................................................. 26
A. AXIAL SKELETON: 27
B. APPENDICULAR SKELETON: 28
C. CHARACTERISTICS OF BONE: 29
I. TYPES OF BONE: 29
II. TYPES OF BONE CELLS: 29
1. OSTEOCYTES: 30
2. OSTEOBLASTS: 30
3. OSTEOCLASTS: 30
III. BONE MATRIX: 31
IV. MAJOR TYPES OF HUMAN BONES: 32
V. JOINTS: 33
1. TYPES OF JOINTS: 33
2. ADJACENT BONES: 34
3. ORIENTATION OF FACET JOINTS: 34

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4. BONES OF THE HAND & FOOT: 34
5. HAND ANATOMY: 35
6. ANKLE: 36
7. KNEE JOINT & COMMON KNEE PROBLEMS: 37
VI. COMMON KNEE PROBLEMS: 38
1. ACUTE INJURY: 38
2. MEDIAL KNEE PAIN: 38
3. MCL TEAR: 38
4. MENISCUS TEAR: 39
5. CHONDRAL INJURY: 39
6. LATERAL KNEE PAIN: 39
7. LCL TEAR: 40
8. MENISCUS TEAR: 40
9. CHONDRAL FRACTURE: 41
10. PATELLAR SUBLUXATION / DISLOCATION: 41
11. ACL TEAR: 42
12. CHRONIC PROBLEMS: 43
a. Anterior knee pain, chondromalacia, arthritis of the patella: 43
b. "Chronic pain leads to poor tracking, poor tracking causes chronic pain." 43
c. Treatment: 44
d. Arthritis: 45
e. Surgical treatment: 45
13. JOINT PROTECTION: 46
a. Client in for about joint protection: 46
14. HUMERUS: 48
15. ELBOW AND WRIST: 53
16. THE AXILLA: 53
a. Boundaries: 53
b. Spaces: 54
c. Contents: 54
d. Vasculature: 54
17. THE ARM: 55
18. THE SHOULDER GIRDLE: 56
a. Components of the shoulder girdle: 56
b. Muscles acting on the shoulder girdle: 56
c. Stability of the shoulder girdle: 57
d. Movements of the sternoclavicular joint: 58
e. Movements of the scapula: 59
f. Movements of the glenohumeral joint: 59
g. Clinical anatomy of the shoulder joint: 60
E. LEVERS: 63
I. THE FORCES INVOLVED: 65
II. POSTURE AND BODY MECHANICS: 65
F. MUSCULAR SYSTEM: 66
I. SKELETAL MUSCLES: 67
II. MUSCLE ATTACHMENT AND FUNCTION: 67
III. STRUCTURAL ORGANIZATION OF A MUSCLE FIBER: 68
IV. MYOFILAMENTS: 68
V. SARCOPLASM: 69
VI. EXCITATION: 70
VII. CONTRACTION: 71
VIII. MUSCLE TWITCH: 71
IX. TETANUS: 71
X. ENERGY SOURCES: 71
G. TYPES OF MUSCLE FIBERS: 71
H. CAPSULAR PATTERN: 72
I. PHYSIOTHERAPY SPECIAL TESTS: 74
I. STORK TEST: 75
J. PHYSIOTHERAPY ASSESSMENT: 75
K. TYPES OF FRACTURES: 76
2.1.2 MUSCULOSKELETAL CONDITIONS AND TREATMENTS:................................................................................................. 77

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A. LEGG-CALVE-PERTHES DISEASE: 78
B. DEVELOPMENTAL DYSPLASIA OF THE HIP: 78
C. SLIPPED CAPITAL FEMORAL EPIPHYSIS: 79
D. POLYMYALGIA RHEUMATICA: 79
E. SYSTEMIC LUPUS SERYTHEMTOSUS: 80
F. SCLERODERMA: 80
G. RHEUMATOID ARTHRITIS: 80
H. JUVENILE RHEUMATOID ARTHRITIS: 81
I. PAGET’S DISEASE: 81
J. OSTEOARTHRITIS: 81
K. GOUT: 81
L. FIBROMYALGIA: 82
M. DUCHENNE MUSCULAR DYSTROPHY: 82
N. ANKYLOSING SPONDYLITIS: 83
O. COMPARTMENT SYNDROME: 83
P. MCMURRAY: 84
Q. COXA VARA/VALGA: 85
R. ROTATOR CUFF REPAIR: 86
2.1.3 GAIT ANATOMY: ..................................................................................................................................................................... 88
A. FUNCTIONS OF THE LOWER EXTREMITY: 88
I. WEIGHT BEARING PROPERTIES: 88
II. CENTER OF GRAVITY: 88
III. STABILITY: 88
B. LOCOMOTION: 89
I. POSITION OF THE LOWER EXTREMITY: 89
II. MOVEMENTS OF THE LOWER EXTREMITY: 89
C. THE GAIT CYCLE: 89
I. DEFINITION: 89
II. PHASES 89
II. ANALYSIS OF THE GAIT CYCLE - JOINT POSITION: 90
III. MUSCLE ACTIVITY (Chart I) 92
D. INITIAL CONTACT: 92
E. LOADING RESPONSE: 92
F. MIDSTANCE: 93
G. TERMINAL STANCE: 93
H. PRESWING: 93
I. TERMINAL CONTACT: 93
J. INITIAL SWING: 93
K. MIDSWING: 93
L. TERMINAL SWING: 94
M. GAIT RLA: 94
2.1.4 ROM OF A PATIENT: .............................................................................................................................................................. 95
A. ROM: 95
B. PAIN: 96
2.1.5 AMBULATING A PATIENT: ..................................................................................................................................................... 97
3.0 NEUROMUSCULAR PHYSICAL THERAPY:.................................................................................................................................................. 98
3.1 PNF (PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION): ........................................................................................................ 101
3.1.1 DEFINITION (S) ..................................................................................................................................................................... 101
3.1.2 PHILOSOPHY: ....................................................................................................................................................................... 101
3.1.3. TREATMENT PURPOSE:...................................................................................................................................................... 102
3.1.4. DEVELOPMENTAL ISSUES:................................................................................................................................................. 102
3.1.5 PATTERNS: ....................................................................................................................................................................... 103
3.1.6 BASIC PNF PRINCIPLES:..................................................................................................................................................... 103
A. MANUAL CONTACT (MC): 103
I. MOTOR RESPONSES AFFECTED BY MC: 103
1. STRENGTH OR POWER: 103
2. DIRECTION OF MOVEMENT: 104
II. APPLICATION OF APPROPRIATE MC: 104
B. PT BODY POSITION AND MECHANICS: 104
I. BODY POSITION: 104
II. BODY MECHANICS: 104

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C. APPROPRIATE RESISTANCE: 105
D. TRACTION AND APPROXIMATION: 105
I. TRACTION: 105
II. APPROXIMATION: 105
E. QUICK STRETCH (QS): 106
F. VERBAL COMMANDS (VC): 106
G. VISUAL STIMULI: 106
H. NORMAL TIMING: 107
I. REPETITION: 107
3.1.7 TECHNIQUES:....................................................................................................................................................................... 107
A. TECHNIQUES(MOTOR CONTROL): 107
B. TECHNIQUES TO PROMOTE MOBILITY: 108
C. CONTRACT RELAX (CR): 109
D. TECHNIQUES TO PROMOTE STABILITY: 109
3.3 HAND MOTOR SEGMENTS:................................................................................................................................................................. 110
3.4 EMG DIAGNOSTIC: ............................................................................................................................................................................... 111
3.4.1 PREPARATION:..................................................................................................................................................................... 111
3.4.2 PROCEDURE: ....................................................................................................................................................................... 111
3.4.3 HOW IT FEELS: ..................................................................................................................................................................... 111
2.2.4 SPINAL SPECIALIZATION: ................................................................................................................................................... 112
3.5 NERVE INJURY: .................................................................................................................................................................................... 113
3.6 PHASES AND SYNNERGY PATTERNS AFTER CVA:......................................................................................................................... 114
3.6.1 LOWER EXTREMITY:............................................................................................................................................................ 114
3.6.2 UPPER EXTREMITY: ............................................................................................................................................................ 114
3.7 BRACHIAL PLEXUS: ............................................................................................................................................................................. 115
3.7.1 BRAIN LOBES: ...................................................................................................................................................................... 116
A. FORMATION OF THE BRACHIAL PLEXUS: 116
I. ROOTS: 116
II. TRUNKS: 116
III. DIVISIONS: 116
a. Cords 116
IV. TERMINAL BRANCHES: 117
V. BRANCHES: 117
VI. DISTRIBUTION OF ROOTS: 118
VII. LESIONS OF THE BRACHIAL PLEXUS: 119
3.8 DERMATOMES AND PEREPHIRAL INNERVATION:........................................................................................................................... 120
3.8.1 DERMATOMES:..................................................................................................................................................................... 120
A. CLINICAL SIGNIFICANCE: 120
B. IMPORTANT DERMATOMES AND ANATOMICAL LANDMARKS: 121
3.8.2 PERIPHERAL NERVE INNERVATION:................................................................................................................................. 123
A. PERIPHERAL NERVE INNERVATION OF LOWER EXTREMITY: 123
II. MOTOR: 124
3.8.3 CNS: ....................................................................................................................................................................... 125
A. THE HUMAN CENTRAL NERVOUS SYSTEM: 126
I. THE SPINAL CORD: 126
1. WHITE MATTER VS. GRAY MATTER: 126
2. THE MENINGES: 126
3. THE EXTRACELLULAR FLUID (ECF) OF THE CENTRAL NERVOUS SYSTEM: 126
4. THE SPINAL CORD: 127
5. CROSSING OVER OF THE SPINAL TRACTS: 127
II. THE BRAIN: 128
1. THE HUMAN BRAIN: 128
2. THE HINDBRAIN: 129
3. PONS: 129
4. CEREBELLUM: 129
5. THE MIDBRAIN: 129
6. THE FOREBRAIN: 130
7. DIENCEPHALON: 130
a. Thalamus: 130
b. Hypothalamus: 130
c. Posterior lobe of the pituitary: 130

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d. The Cerebral Hemispheres: 130
8. MAPPING THE FUNCTIONS OF THE BRAIN: 131
9. DAMAGE TO THE BRAIN: 132
10. STIMULATING THE EXPOSED BRAIN WITH ELECTRODES: 132
11. CT = X-RAY COMPUTED TOMOGRAPHY: 133
12. PET = POSITRON-EMISSION TOMOGRAPHY: 133
13. MRI = MAGNETIC RESONANCE IMAGING: 134
14. FMRI = FUNCTIONAL MAGNETIC RESONANCE IMAGING: 134
15. THE PROBABLE MECHANISM: 134
16. MAGNETOENCEPHALOGRAPHY (MEG): 134
2.2.11 CRANIAL NERVES:............................................................................................................................................................... 135
2.2.12 SEGMENTAL TESTING:........................................................................................................................................................ 136
2.3 CARDIOVASCULAR PHYSICAL THERAPY ......................................................................................................................................... 137
2.3.1 SYMPTOMS AFFECTING THE HEART:............................................................................................................................... 137
A. HEART DEFINITIONS: 137
2.3.2 SYMPTOMS AFFECTING THE BRAIN: ................................................................................................................................ 138
2.3.3 SYMPTOMS OF CARDIOVASCULAR DISEASE IN THE LEGS, PELVIS, OR ARMS:........................................................ 138
2.3.4 EXERCISE FOR THE PREVENTION AND MANAGEMENT OF CARDIOVASCULAR DISEASE: ...................................... 138
2.3.5 ETT: ....................................................................................................................................................................... 139
2.3.6 CARDIOLOGY: ...................................................................................................................................................................... 140
A. ANGINA: 143
B. SILENT MI OR PAINLESS MI: 143
C. ANSWER THE QUESTIONS: 145
D. ANSWER THE CONDITIONS AS TO METABOLIC/RESPIRATORY, ACIDOSIS /ALKALOTIC. 147
2.4 PULMONARY PHYSICAL THERAPY:................................................................................................................................................... 149
2.4.1 RESTRICTIVE DISEASES:.................................................................................................................................................... 149
2.4.2 OBSTRUCTIVE DISEASES:.................................................................................................................................................. 149
2.4.3 ABERRANT BREATHING PATTERNS:................................................................................................................................. 149
2.4.4 PHYSICAL THERAPY MANAGEMENT OF THE PATIENT WITH PULMONARY DISEASE:............................................... 150
A. CASE TYPE / DIAGNOSIS: 150
B. INDICATIONS FOR TREATMENT: 150
C. CONTRAINDICATIONS / PRECAUTIONS / CONSIDERATIONS FOR TREATMENT: 150
I. CONTRAINDICATIONS: 150
II. PRECAUTIONS: 151
III. CONSIDERATIONS: 151
IV. DISEASE SPECIFIC CONSIDERATIONS FOR TREATMENT: 151
V. PULMONARY FUNCTION TESTS (PFT): 151
VI. OBSTRUCTIVE SLEEP APNEA: 151
1. SLEEP APNEA CAUSES: 152
2. RISK FACTORS: 152
3. SIGNS AND SYMPTOMS: 153
4. OSA COMPLICATIONS: 154
5. SLEEP APNEA DIAGNOSIS: 154
6. OSA TREATMENT: 156
a. Oral Appliances: 156
b. Positive Pressure Therapy: 157
7. SURGERY: 158
a. Minimally Invasive Treatment: 158
b. Surgical Treatment: 159
VII. MECHANICAL VENTILATION: 160
1. NEGATIVE PRESSURE MACHINES: 160
2. POSITIVE-PRESSURE VENTILATORS: 161
3. INDICATIONS FOR USE: 161
4. TYPES OF VENTILATORS: 162
5. MODES OF VENTILATION: 163
a. Conventional ventilation: 163
b. Breath termination: 163
c. Breath initiation: 163
d. High Frequency Ventilation (HFV) 165
e. Non-invasive ventilation (Non-invasive Positive Pressure Ventilation or NIPPV): 166
f. Proportional Assist Ventilation (PAV): 166

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g. Adaptive Support Ventilation (ASV) 167
h. Neurally Adjusted Ventilatory Assist (NAVA) 167
6. CHOOSING AMONGST VENTILATOR MODES: 168
7. INITIAL VENTILATOR SETTINGS: 168
a. Tidal volume, rate, and pressures 168
b. Sighs: 169
c. Initial FiO2: 169
d. Positive end-expiratory pressure (PEEP): 169
f. Positioning: 170
g. Sedation and Paralysis: 170
h. Prophylaxis: 171
8. MODIFICATION OF SETTINGS: 171
9. When to withdraw mechanical ventilation: 171
10. Connection to ventilators: 172
11. TERMINOLOGY 173
D. EXAMINATION: 174
I. CHART REVIEW: 174
II. SOCIAL HISTORY: 174
III. PHYSICAL EXAMINATION: 175
IV. COGNITIVE-PERCEPTUAL AND PSYCHOLOGICAL CONSIDERATIONS: 175
E. EVALUATION / ASSESSMENT: 175
F. TREATMENT PLANNING / INTERVENTIONS: 176
I. INTERVENTION: 176
II. PATIENT/FAMILY EDUCATION: 176
III. AVAILABLE HANDOUTS: 177
IV. FREQUENCY OF TREATMENT: 177
V. RECOMMENDED REFERRALS TO OTHER PROVIDERS: 177
G. RE-EVALUATION / ASSESSMENT 177
H. DISCHARGE PLANNING: 178
I. CHEST PHYSIOTHERAPY (CPT): 178
2.4.5 MEDICATIONS: ..................................................................................................................................................................... 178
2.4.6 BENEFITS OF PULMONARY REHABILITATION: ................................................................................................................ 178
2.4.7 LUNG DRAINAGE:................................................................................................................................................................. 179
2.4.5 LUNG VOLUME CAPACITIES:.............................................................................................................................................. 180
2.5 INTEGUMENTARY PHYSICAL THERAPY............................................................................................................................................ 181
2.5.1 DRESSINGS: ....................................................................................................................................................................... 181
2.5.2 SKIN DISORDERS:................................................................................................................................................................ 181
2.5.3 BURNS: ....................................................................................................................................................................... 182
2.6. GI, GU AND METABOLIC/ENDOCRINE AND PSYCHOLOGICAL CONDITIONS: .............................................................................. 183
2.6.1 GASTROINTESTINAL DISEASES: ....................................................................................................................................... 183
A. GI CAN CAUSE: 183
B. GASTROINTESTINAL PHYSIOTHERAPY: 183
C. PHYSIOTHERAPY FOR ACTIVE LIFESTYLE: 184
2.6.2 GU/RENAL (DISEASES OF THE GENITOURINARY (GU) TRACT):................................................................................... 185
A. INCONTINENCE: 186
I. MANAGING INCONTINENCE: 186
II. CATHETER CARE: 187
B. URINARY TRACT INFECTION: 188
C. OBSTRUCTIVE UROPATHY: 189
I. CAUSES OF OBSTRUCTION: 189
II. MANAGING OBSTRUCTIVE UROPATHY: 189
D. BLOOD IN THE URINE (HEMATURIA): 189
E. PELVIC FLOOR MUSCLE TRAINING FOR MEN: 190
F. PELVIC FLOOR MUSCLE TRAINING FOR WOMEN: 191
I. IDENTIFYING THE PELVIC FLOOR MUSCLE: 191
II. FREQUENCY OF PELVIC MUSCLE EXERCISES: 191
2.6.3 RENAL DISEASE:.................................................................................................................................................................. 193
A. ROLE OF PHYSIOTHERAPY IN RENAL REHABILITATION: 193
I. THE NEED FOR EXERCISE: 193
II. PLANNING OF EXERCISE: 195
III. CARDIOVASCULAR EXERCISE TRAINING: 195

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IV. ASSESSMENT: 196
VI. EXERCISE APPROACH: 197
2.6.4 PSYCHIATRIC PHYSIOTHERAPY:....................................................................................................................................... 198
A. PSYCHIATRIC AND PSYCHOSOMATIC PHYSIOTHERAPY: 198
B. PHYSIOTHERAPIST’S OFFER: 198
C. PHYSIOTHERAPY TREATMENT: 199
D. METHODS IN THE TREATMENT: 199
E. TREATMENT OF CHILDREN: 199
F. BENEFICIARIES OF THE TREATMENT: 199
2.7 PEDIATRIC PHYSICAL THERAPY:....................................................................................................................................................... 200
2.7.1 BONES, JOINTS AND MUSCLES:........................................................................................................................................ 201
A. GAIT PROBLEMS: 201
B. MUSCULAR DYSTROPHY (MD): 202
I. WHAT ARE THE FIRST SYMPTOMS OF MUSCULAR DYSTROPHY? 202
II. HOW IS MUSCULAR DYSTROPHY DIAGNOSED? 203
III. TYPES OF MUSCULAR DYSTROPHY: 203
IV. CARING FOR A CHILD WITH MUSCULAR DYSTROPHY: 204
1. PHYSICAL THERAPY AND BRACING: 204
2. PREDNISONE: 204
3. SPINAL FUSION: 205
4. RESPIRATORY CARE: 205
5. ASSISTIVE DEVICES: 205
2.7.2 BRAIN & NERVOUS SYSTEM: ............................................................................................................................................. 207
2.7.3 SYSTEM & LUNG: ................................................................................................................................................................. 208
A. ASTHMA: 208
B. CYSTIC FIBROSIS: 208
2.7.4 EQUIPMENT USED WHILE UNDERGOING PHYSIOTHERAPY: ........................................................................................ 209
2.7.5 ERICKSON STAGES:............................................................................................................................................................ 209
2.7.6 GRASPS: ....................................................................................................................................................................... 211
2.8 GERIATRIC PHYSICAL THERAPY: ...................................................................................................................................................... 212
2.8.1 PHYSICAL ACTIVITY IN GERIATRICS:................................................................................................................................ 212
A. FUNCTIONAL DIAGNOSIS: 213
B. PROGRAM DEVELOPMENT: 214
C. EXAMPLE OF EXERCISE PROGRAM: 214
D. SELECTION OF THE DIFFERENT EXERCISES: 214
E. MUSCLE STRENGTH: 214
F. AEROBIC EXERCISE: 215
G. FOR ALL TYPES OF EXERCISES: 215
H. THE EXERCISES: 215
I. CONTINUITY IN THE EXERCISE PROGRAM: 215
2.9 THERAPEUTIC EXERCISE FOUNDATIONS:....................................................................................................................................... 216
2.9.1 STRETCHING: ....................................................................................................................................................................... 216
A. PROCEDURE: MUSCLE FLEXIBILITY AND STRETCHING: 216
B. EQUIPMENT / SUPPLIES NEEDED: 217
I. STRETCHING METHODS: 217
II. ADVANTAGES: 217
III. PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF) STRETCHING TECHNIQUES: 217
IV. PATIENT EDUCATION: 218
2.9.2 THERAPEUTIC EXERCISE:.................................................................................................................................................. 218
A. CONTROL INFLAMMATION: 218
B. STRETCHING AND FLEXIBILITY: 219
C. RESTORE RANGE OF MOTION: 220
D. JOINT MOBILIZATION: 221
E. DEVELOPING MUSCULAR STRENGTH, ENDURANCE, AND POWER: 221
F. PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION: 222
G. PLYOMETRICS: 223
H. RETURN TO SPORT ACTIVITY: 224
2.9.3 EFFECTS OF JOINT MOBILIZATION: .................................................................................................................................. 225
A. NEUROPHYSIOLOGICAL EFFECTS: 225
B. NUTRITIONAL EFFECTS: 225
C. MECHANICAL EFFECT: 225

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D. CRACKING NOISE MAY SOMETIMES OCCUR: 225
I. CONTRAINDICATIONS FOR MOBILIZATION: 225
E. MAITLAND JOINT MOBILIZATION GRADING SCALE: 226
F. ALWAYS EXAMINE PRIOR TO TREATMENT: 227
G. JOINT MOBILIZATION APPLICATION: 227
H. TREATMENT FORCE & DIRECTION OF MOVEMENT: 227

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PHYSIOTHERAPY:
Now a day, physiotherapy is becoming much popular among the people but still 70 percent of the people in
India including Jammu are unaware of this branch of medical science.
Now, let us understand what the physiotherapy is, well, it is a branch of medical science, which employs
treatment by including the use of electro medical equipments and various physical and remedial exercises. i.e. the
treatment by this branch of medical science is applied by means of electrotherapy and exercise therapy.
Electrotherapy includes the use of light rays like infrared UV rays, short wave, long waves, medium frequency
currents and many more. Whereas exercise therapy includes manipulation, mobilization of the joints and many
exercises which helps and benefits the patient in his recovery from various ailments.
It is the most beneficial treatment in bringing a person in his normal functioning after fractures, in the early
management of various deformities like deformities of the back scoliosis, khyposis, lordosis etc. deformities of
knee, hip, foot, shoulder, elbow, wrist etc. It helps in increasing the muscle power of the muscles by various
exercises and modalities.
Physiotherapy helps in aiding the body of the person to develop, improve, restore, prevent and maintain: -
 Strength
 Endurance and cardiovascular fitness.
 Mobility and flexibility
 Stability
 Relaxation
 Co-ordination, balance and functional skill.
A physiotherapist plans and implements the treatment of the patient, depending upon the muscle power and
according to degree of dysfunction. Physiotherapy is helpful and result oriented in different orthopedical and
neurological conditions like Ankylosing spondylitis, poliomyelitis, Arthritis, shoulder syndromes, cervical
syndromes, low back ache, paralysis, CP neuropathies etc.
People suffering from such problems should go for physiotherapeutic treatment for proper relief. There are so
many other therapies which are related with the physiotherapy like occupational therapy (include any physical or
mental occupation given to the patient as an aid to recovery from an illness.
Occupations can be like
 Knitting,
 Pottery,
 Playing with toys for cerebral palsy children etc)
Occupational therapy is almost confined to make a disabled person to do his occupation i.e. to make him
independent for his ADL’s (Activities of daily living). Occupational therapy is the most beneficial therapy.
Physiotherapy is also related to speech therapy, vocational therapy, orthotics, prosthetist etc.

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NPTE SYLLABUS:
1. NPTE POLICIES, PROCEDURES & FREQUENTLY ASKED QUESTIONS
2. MUSCULOSKELETAL PHYSICAL THERAPY
3. NEUROMUSCULAR PHYSICAL THERAPY
4. CARDIOVASCULAR PHYSICAL THERAPY
5. PULMONARY PHYSICAL THERAPY
6. INTEGUMENTARY PHYSICAL THERAPY
7. OTHER SYSTEMS INCLUDING GI, GU AND METABOLIC/ENDOCRINE AND PSYCHOLOGICAL
CONDITIONS
8. PEDIATRIC PHYSICAL THERAPY
9. GERIATRIC PHYSICAL THERAPY
10. THERAPEUTIC EXERCISE FOUNDATIONS
11. PHYSICAL AGENTS AND MODALITIES
12. FUNCTIONAL TRAINING AND ORTHOTIC, PROSTHETIC AND SUPPORTIVE DEVICES
13. PROFESSIONAL ROLES AND MANAGEMENT
14. EDUCATION & CONSULTATION
15. RESEARCH AND EVIDENCE-BASED PRACTICE
16. PATHOLOGICAL
1.0 NPTE (NATIONAL PHYSIOTHERAPYEXAMINATION):
In order to be certified or licensed as a physiotherapist or physiotherapist assistant, individuals must
pass the National Physiotherapy Examination (NPTE) or the National Physiotherapy Assistant Examination
(NPTAE). These exams were developed by the Federation of State Boards of Physiotherapy to establish a
minimum level of competency for physiotherapist and physiotherapist assistants. The exam for
physiotherapists consists of 250 multiple-choice questions, and must be completed within 5 hours. The
major content areas covered by the exam for physiotherapists are as follows: Patient Examination (52
questions); Evaluation, Diagnosis, Prognosis, and Outcomes (45 questions); Intervention (83 questions);
and Standards of Care (20 questions). The exam for physiotherapist assistants consists of 200 multiple-
choice questions, and must be completed within 4 hours. The major content areas covered by the exam for
physiotherapist assistants are as follows: Tests and Measures (32 questions); Intervention (90 questions);
and Standards of Care (28 questions).
Each of the exams contains pre testing questions that are not scored and are used to develop future
versions of the exam. The number of questions answered correctly determines exam scores. This raw
score is converted into a score on a scale of 200 to 800. There is no deduction for incorrect answers, so
candidates should guess at those questions they do not know. The examination is scored by the FSBPT
and this body to the relevant licensing authority gives results. The passing score is typically a 600. The
NPTE is a computerized exam. Thomson Prometric administers it throughout the year at locations around
the country. To register, visit the FSBPT website.(FSBPT candidate handbook)

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1.1 WHY HAVE A LICENSURE EXAM?
Why do licensing boards require passing the NPTE for licensure? Why isn’t graduation from a
CAPTE-accredited program sufficient?
There are a few points that need to be considered when answering this question.
The purpose of the NPTE is different from the purpose of PT or PTA programs. The programs’
primary purpose is to educate PTs and PTAs. The educational component provides a broad range of
knowledge, education and skills, including a clinical component, so that PTs and PTAs understand
the role of physiotherapists and physiotherapist assistants in providing healthcare to patients.
Programs teach skills and knowledge that might not be used by entry-level practitioners, but will be
used as individual becomes more experienced. The NPTE ‘s specific purpose is to protect the public
by testing candidates on the minimum knowledge and education necessary for safe and competent
entry-level work; it does not include a clinical component.
Programs can be subject to many different pressures – the pressure to graduate a certain number of
students or to maintain a certain passing rate on the NPTE are two that come to mind. Development
of the NPTE is subject to a different requirement – the Federation must be able to provide evidence to
licensing boards that the NPTE is a valid and reliable tool for measuring entry-level competence of
PTs and PTAs.
Even though all programs are accredited by CAPTE, there is a variation in programs. This includes
coursework and grading standards. The NPTE provides licensing boards with one standard to which
everyone is held accountable.
Completion of a broad educational program and passing a specific exam that measures entry-level
competence provides licensing board members with the assurance that they are licensing or
certifying competent entry-level practitioners who will be able to grow and mature in their profession.
1.2 NPTE DEVELOPMENT:
I have heard that the questions on the NPTE take a long time to develop and validate. Since the
profession of Physiotherapy is rapidly changing and is becoming much more evidence based, how do
you assure that the questions on the exam are current?
It is critical that a high stakes licensing examination covers current practice. While it is a challenge to
maintain this currency, the item writers and exam committees work very hard to assure the exam
reflects current practice. Currency is maintained via the following steps:
The exam blueprint or content outline is revised at a minimum of every five years. The exam blueprint
determines the content of the exam and assures that the content is relevant to current practice.
Currency is stressed at item-writer workshops; item writers are required to reference questions to
recognized authoritative texts that have been published within the past five years.
Items are not used where there may be conflicting references or viewpoints in the literature
An item goes through committee review multiple times and each time, it is reviewed for currency.
The item goes through a final review for currency (among other things) prior to each and every time it
is being released as an operational question.

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1.3 PT PASSING STANDARD REVIEW:
In 2005, the Federation conducted a Standard Review for the PT exam with a resulting adjustment in
the passing standard (passing score).
1.3.1 WHY THE STANDARD REVIEW FOR THE PTA EXAM?
It is the Federation of State Board of Physiotherapy Board of Director’s responsibility to
assure that the quality and integrity of the NPTE is always maintained. In doing this, there are
many quality assurance processes and procedures that are continually being conducted. In
reviewing some of the outcomes of the quality assurance procedures, there were several
things that pointed to the need for a standard review for the PT exam. These included
variable pass rates from 1996 through 2004 and significant stakeholder feedback from PT
program faculty and employers. Neither of these sources was observed for the PTA exam.
1.4 LINKING ADMISSIONS CRITERIA TO PERFORMANCE ON NPTE:
As a PTA program, we maintain very high admissions criteria for our students. However, with the
increased pressure to admit diverse populations as well as the pressure to admit most anyone at the
community college level, we are having a hard time justifying this standard. Have there been studies
linking admission criteria to performance on the PTA exam?
Most of the studies looking at admission criteria and pass/fail performance on the NPTE have been
focused on physiotherapist programs. However, several researchers are beginning to look at this
topic related to PTA programs. You may want to contact your colleagues to see what efforts are being
conducted related to NPTE performance of PTA programs.
1.5 ARE NPTE QUESTIONS GETTING HARDER?
The pass rate for the NPTE for physiotherapists dropped in 2003. Many stakeholders have asked if
more difficult questions are being included on the NPTE, which in turn has made the examination
more difficult to pass. Individuals have speculated that as FSBPT improves the quality of items written
for the NPTE, the reliability of these items improves, and it becomes more and more difficult for
candidates to determine the correct answer through the powers of deduction and logic.
High quality items are more difficult to answer correctly for students who do not know the material.
However, test questions on the NPTE are not becoming more difficult. The FSBPT monitors item- and
form-level difficulty as a standard part of its psychometric procedures. Test forms are assembled to
be as similar as possible with respect to content and difficulty. Forms administered from 2001 through
2005 vary slightly in average item difficulty but do not show a consistent trend toward increasing
difficulty. It is important to note that even if the average item-level difficulty across forms had
increased, this should not influence the pass rate because all test forms are equated so that a form
with more difficult items will have a lower passing score than a form with easier items.
1.6 DO NPTE ITEMS HAVE MORE THAN ONE RIGHT ANSWER?
I have been told that the exam is structured in such a way that there are two "right" answers, but that
one is a better choice. Is the exam scored using a partial credit model to account for an individual
who might select the less favorable of the correct choices? Or is it an all-or-none credit system?
There is only one correct answer for each question. The item writers and exam committees go
through great lengths assuring that there is one correct answer and three incorrect answers. Each
option must be backed up with a rationale and reference as to why it is either correct or incorrect.
Beyond this, statistics are collected on the item that also helps support the one correct answer. There
is no “partial credit” for an answer. It is either correct or incorrect.

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1.5 RECALLED NPTE QUESTIONS:
1.5.1 A QUESTION FROM A STUDENT:
As an exam candidate who just completed my examination, i recall several questions on
the exam where i was not sure of the answer. Is it ok for me to discuss the questions with my
instructor?
On the surface, it may seem natural for you to go to a faculty member to discuss specific
questions on your licensing examination. You may want to be assured that you answered the
item correctly. You may also be motivated to “learn from mistakes” and a discussion of the
question could be a productive learning experience. This is particularly true if you find you
have failed the exam. You certainly want to pass the next time! However, by doing this you
are putting yourself and your instructor in jeopardy.
Every item on the exam is copyright protected. When a candidate takes the exam, the
candidate agrees not to share any question or part of a question with anyone else. Good
intentions do not nullify this agreement or the copyright protection of the exam. The bottom
line is that it is illegal for a candidate to share a test question with an instructor or anyone
else. You might say: “Ok, so it is technically illegal, but what is the harm if I discuss the item
with my instructor? I can trust her. She would not share the information. So, no harm no foul.”
Basically, it is not for you to decide when you can break the law or when you can’t. The law is
the law.
1.5.2 A PARALLEL QUESTION FROM AN INSTRUCTOR: CAN I TALK TO MY
STUDENTS ABOUT THE NPTE AFTER THEY HAVE TAKEN IT?
Certainly general comments about the exam are not a violation of copyright law.
However, if your students discuss specific items or specific characteristics of the exam with
you, they are in violation of the confidentiality terms that they agree to when they take the
exam. Included in these terms is not disclosing the content of examination items. Legal action
could be taken against candidates who violate these terms including criminal prosecution.
Ultimately the student may risk being able to ever obtain a license.
Educators may unwittingly cross the line by asking students questions about the exam or
by listening to a student share a question from the exam. It is important that educators defend
the integrity of the licensure process by making students and colleagues aware of these
critical issues and reporting violations when they occur. You can also report any violations to
security@fsbpt.org.
Educators can find accurate information regarding the exam in the “For
Candidates/Licensees” section of the website. The entire candidate Handbook is found at
“For Candidates/Licensees”/ “NPTE.” The test content outline can be found at “For
Candidates/Licensees”/ “NPTE” / “Exam Development.” More detailed information on the
NPTE can be obtained by attending a NPTE Workshop for Faculty. Information on upcoming
workshops can be found in the “News and Events” section.
1.6 ENHANCING NPTE TEST ITEMS:
Currently, the NPTE contains questions that include graphics. Does the Federation have plans to add
other testing technologies such as “hot spots” or video?
The Federation has been exploring other testing formats for some time. While we have the technical
capabilities of utilizing these formats, we are not planning on adding these types of test questions in
the immediate future. These types of questions create a host of additional issues and complexities.

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For example, a question that requires the examinee to review to a video clip of a gait pattern and
determine the dysfunction may seem like the perfect question for a Physiotherapy licensing
examination. However, before such a question can be used, several issues have to be addressed.
How much time needs to be allowed for a question that requires the viewing of a video as compared
to a standard multiple choice question? How many times should the candidate be allowed to re-run
the video? Is the video clip clear enough that all candidates are able to see the action taking place
clearly? How does one account for the psychometric differences between the video question and
other questions?
Another reason we are waiting prior to implementing additional test question formats is to continue to
allow our tests to remain stable for a period of time before implementing any significant test format
changes.
In spite of these factors, we do believe there may be some advantages to utilizing different test
formats at some point in the future and will continue to review the literature and address the questions
mentioned above. Ultimately, it is critical to determine whether or not these additional test formats
provide us with better information related to the competency of the entry-level physiotherapist.
1.7 CAN YOU PROVIDE THE BACKGROUND ON THE 20 PT NPTE SCORES THAT WERE
INVALIDATED IN 2007?
The following information was taken from the “news and events” section.
Forensic Analysis Conducted to Investigate Effect of Trafficking in Recalled Test Items Leads to
Invalidation of 20 Candidate Test Scores
On Friday, August 17, 2007, the Board of Directors of the Federation of State Boards of
Physiotherapy approved the invalidation of 20 candidates’ National Physiotherapy Exam (“NPTE”)
test results. This decision resulted from an extensive forensic analysis of the test performances of all
candidates who sat for the NPTE between March 1, 2005 and June 5, 2007.
The forensic analysis, conducted by Caveon, a test security company, was commissioned in
response to the unlawful trafficking of NPTE questions by Philippines-based exam prep centers.
Through its own private investigation efforts, as well as Philippines government surveillance and raids
of two Manila test centers in January 2007, FSBPT has confirmed that the centers have distributed to
customers compilations of actual NPTE test questions memorized and shared by prior test takers
(“recalled items”). In an effort to assess the potential effects of this practice of using recalled test
items, Caveon analyzed approximately 23,512 test performances of all NPTE candidates, regardless
of place of education.
Caveon’s analysis conclusively establishes that at least twenty individuals benefited unfairly from
advance access to recalled test items. All twenty candidates are Philippines-educated, some but not
all of whom are already licensed to practice physical therapy. FSBPT’s assessment and review of the
Caveon forensic analysis is continuing, so as to determine whether additional candidate score
invalidation is appropriate.
In identifying these twenty candidates, the forensic analysis used three statistical indices to identify
aberrant candidate performances. First, performance on compromised test questions (those known to
be compromised by distribution at Philippines-based test prep centers) was compared to performance
on non-compromised test items. Second, the similarity among candidate response choices was
examined, with higher degrees of similarity suggesting the possibility of prior knowledge of test
content. Third, the analysis computed the probability that each test taker had attended a course at
which recalled items were used. In each case, the percentage of candidates flagged as aberrant was
highest for Philippines-educated test takers.
FSBPT limited the universe of “aberrant” test performances under each of the three indices to those
test results whose likelihood of occurring by chance was at least 1 in 10,000 (one in ten thousand).
The twenty invalidated candidate scores are those that appeared aberrant based on all three

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statistical indices. The likelihood of aberrant performance on all three statistical indices is extremely
unlikely and at least less than 1 in one million.
“As with every decision we’ve made in addressing the troubling use of recalled items, the FSBPT
Board did not take this action lightly,” stated E. Dargan Ervin, Jr., FSBPT President. “We made the
decision only after careful consideration of the issues and in light of the overwhelming statistical data
that calls into question the legitimacy of these scores.”
1.8 SCHOOL PASS RATE REPORTS:
Please explain the timing and rationale for posting pass rates.
When are pass rate data updated on FSBPT’s websites?
Pass rate data are updated quarterly on the following schedule:
 February 1
 May 1
 August 1
 November 1
When will the 2005-2007 ultimate pass rates be posted?
The 2005-2007 ultimate pass rates will be posted on May 1, 2009. The reason for this is that ultimate
pass rates do not become stable until 15 months after graduation. This delay in reporting ensures that
the Federation publishes stable data for all PT and PTA programs, including those with late
graduation dates.
When will the 2008 pass rates (exam year, graduation year, rank order) be posted?
The 2008 pass rates will also be posted on May 1, 2009. This allows time for students of programs
graduating late in the year to have taken the NPTE before the pass rates are posted.
When are exam year pass rates posted?
Exam years end on February 28th. Since updates are posted quarterly (see above), the first quarter
the exam year pass rate can be published is May 1st.
1.9 WHY DO YOU POST ULTIMATE PASS RATES:
FOR INDIVIDUAL PROGRAMS AND NOT FIRST TIME PASS RATES ON THE PUBLIC SITE?
The intent of the FSBPT Board of Directors is to post first time pass rates as well as ultimate pass
rates. However due to some of the historical fluctuations in pass rates, the Board decided to hold off
on posting first-time pass rates until they became more stable. The Board will revisit the posting of
first -time pass rates in two to three years.
1.10 HOW DO I ORDER SCHOOL REPORTS?
School administrators will need to go back to “For Faculty” and click on “School Reports” to order
school report subscriptions.
1.11 HOW DO I FIND OUT MY SCHOOL CODE AND PASSWORD IN ORDER TO LOG ON?
If you have not yet subscribed or don’t know/don’t remember your school code and password, please
send an email to schoolreports@fsbpt.org. From there, go to “For Faculty”/ “School Reports” on
www.fsbpt.org and log in to either request a free subscription (reports are mailed twice a year at
specific intervals determined by the Federation) or purchase an online subscription.

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1.12 WHAT KIND OF REPORTS DO YOU OFFER?
We offer four types of reports. Before you order any subscription, it is a good idea to review the
sample reports first. That way you can be sure you’re ordering the report that provides the information
you really want. Go to “For Faculty”/ “School Reports” on www.fsbpt.org. Look to the right of the
SCHOOL ADMINISTRATOR LOGIN box. You will find report descriptions and links to sample reports.
1. Basic Mail Subscription (Free): Includes two "Basic Reports" that are sent via mail at specific
intervals determined by the Federation. If you would like to receive the free basic mail
subscription, you must subscribe to it through this online website. This report is available for the
current year and it will include information for two prior years.
2. Basic Online Subscription ($100): Includes two "Basic Reports" that are accessible via the
Schools Home website. Basic reports show pass rates for most current graduating classes and
two prior years. They include names of student in those graduating classes, although they do not
include individual student’s scores on the NPTE.
3. Enhanced Subscription ($200): Includes two "Enhanced Reports" that are accessible via the
Schools Home website. The format of the enhanced report is the same as the Basic Reports but
in addition, Enhanced Reports provide individual students’ scores on each attempt to pass the
exam.
4. Content Area Subscription ($200): Includes two "Content Breakdown Reports" that are accessible
via the Schools Home website. This report is available for graduating classes of 2003 until
present. It compares your first time test takers to first time test takers from all U.S. CAPTE
accredited schools during the same period on each area of the examination.
1.13 CAN I PAY WITH A PURCHASE ORDER?
The online system has two payment options; credit card or invoice. If you pay by credit card, your
reports are available to be run the same day. If you prefer to have your institution send a check, you
can choose to pay by invoice. When you choose to pay by invoice, the last screen of the purchase
process is the official invoice. The invoice can be printed and submitted to your accounts payable
department so that a check can be issued and mailed to the Federation with the invoice. Please do
not send a purchase order - use the invoice you printed at the time you registered online for your
subscription.
1.14 WHAT IS THE “MY STUDENTS” LISTING?
The “My Students” listing is a critical component of the school report process. Immediately prior to
running each report you should review “My Students” to verify that all the students on the listing did
indeed graduate from your institution. If you find a student listed that did not graduate from your
program, there is a link to “Request a Correction” for each graduating class on the My Students page.
Remember to review the “My Students” listing prior to running every report.
Additionally, you can view the “My Students” listing to see how many candidates have tested (and
when they tested) so that you can decide when the best time is to run your report. For instance, you
probably would not want to run a report that includes candidates for 2007 if only a small portion of
those candidates have tested.
1.15 WHY DO MY REPORTS EXPIRE AFTER 30 DAYS?
The Federation simply does not have the “storage space” to maintain all school reports for an
unlimited period of time. Instead, you should print the reports or to save them as Excel files on your
own computers so that you have a permanent record.

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1.16 IF MY REPORTS EXPIRE AFTER 30 DAYS, WHY HAVE A SUBSCRIPTION FOR A
YEAR?
The first reason is so that you can choose when you would like to run your reports during the year.
You may choose to run one report mid-year and another report at the end of the year. The second
reason is that by having a subscription, you can request additional reports at a discounted rate of only
$50.
1.17 PRACTICE EXAM AND ASSESSMENT TOOL (PEAT):
1.17.1 DO YOU OFFER DISCOUNTS FOR GROUP PURCHASES OF THE PRACTICE
EXAM & ASSESSMENT TOOL (PEAT)?
 Yes. In order to qualify for a group PEAT discount, 15 or more students must be
registered. If the group pays by check, the cost will be $72 per PEAT ($74 per PEAT if
paid by credit card).
 To purchase PEAT as a group, you’ll need to send an email to peat@fsbpt.org. Please
request a registration form and instruction sheet. Each student will need to register as
individuals, indicating “pay later by Visa or MasterCard” for the method of payment. The
students will each need to provide the school with a social security and transaction
number (obtained once the student has signed up for PEAT).
 Once the students have signed up (everyone must be registered in order to process the
payment), a confirmation email will be sent to each individual with his/her product key.
The school will also receive the returned registration list with each student’s product key
and transaction code.
1.18 HINTS:
1. Many times, students will see the following message when they log on to PEAT. “Thank you for
visiting FSBPT. PEAT is now running in another browser window.” In this case, the student will
need to disable their pop-up blocker in order to see PEAT. They should allow pop-ups for the
duration of the PEAT.
2. PEAT can only be accessed through Microsoft’s Internet Explorer browser – no other browser will
work.
3. PEAT expires 30 days after the first practice exam has been accessed. However, students can
download and print the supplemental materials and this won’t count toward the 30 days.
4. After taking the first exam and reviewing their performance report as well as the references and
rationales for each question, students can move to the second practice exam. The performance
reports and study material for both PEAT exams will be available for the duration of the student’s
access period.
5. An extension is available for 15 days if the student has not completed both practice exams. The
extension fee is $45 and can be purchased by going to “Home” and selecting the “Purchase
PEAT” shortcut.
6. Confirmation emails for PEAT purchases are generally received within 2-3 hours. The exception
is YAHOO accounts (they seem to be sent to junk mail or filtered as spam). If the student hasn’t
received the confirmation email, they can call or email FSBPT and receive the product key and
confirmation email.

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1.19 STATE PRACTICE ACTS:
We’d like to be able to see what our state’s practice act allows, such as whether it allows temporary
licensure or direct access to Physiotherapy services. Does the Federation maintain that kind of
regulatory information?
Yes, you can find all kinds of regulatory information in the Jurisdiction Licensure Reference Guide on
the Federation’s public website. This guide compares some of the major similarities and differences
among the jurisdictions’ practice acts. It may be used as a reference for educational programs,
students, licensing boards, professional associations, and others. Information is listed in aggregate
and by individual jurisdiction. To review the information, go to “Regulatory Tools” and click on
“Licensure Reference Guide.”
1.20 THE KEYS TO TAKE YOUR TEST ARE:
 Don't stress out about the exam.
 Referred to other medical professionals if you don't know the answer to a patient's problem.
 Do No Harm- with patient care.
 Set-up a dedicated study plan.
 Understand the content before you start taking practice tests.
Be familiar with format of the exam prior to test day.
1.21 DEVELOPING CONTENT VALIDITY: practice analysis to test content outline:
What types of knowledge need to be covered on the National Physical Therapy Examination (NPTE)
in order to determine if an individual is minimally competent to work as an entry-level PT or PTA? It's
a key question that ultimately is answered through a process referred to as a practice analysis. A
practice analysis is a study that systematically determines these responsibilities or "activities," and
the knowledge and skill requirements (KSRs) for performing the activities. The results of a practice
analysis are useful for informing decisions about the test content outline and for providing evidence of
content validity.
1.21.1 PURPOSE OF A PRACTICE ANALYSIS:
FSBPT uses practice analysis to:
Verify current entry-level practice in the physical therapy profession;
Determine the knowledge and skill requirements (KSRs) required to perform at an entry level;
and maintain the content validity of the NPTE by ensuring that the test content outline
continues to measure entry-level knowledge and skills important for public protection.
The practice analysis conducted by the FSBPT is not intended to encompass the entire
physical therapy profession or what it “should be.” It also is not intended to be a curriculum
outline or synopsis of physical therapy education, an evaluation of advanced knowledge and
skills for physical therapy, or to express an opinion or a position on physical therapy.
1.21.2 A STANDARD APPROACH:
The practice analyses conducted by the Federation reflect best practices and meet criteria
set forth in the Standards for Education and Psychological Testing developed by the
American Education Research Association, the American Psychological Association and the
National Council on Measurement in Education for defensible methods of establishing
content validity in licensure and certification testing. The frequency with which a practice
analysis should be conducted depends on how rapidly job requirements change; for the
physical therapy profession, practice analyses are typically conducted every five years.

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1.21.3 PREVIOUS AND FUTURE PRACTICE ANALYSES:
The Federation conducted a study in the United States and Canada in 1995-1996, with
individual content outlines for PTs and PTAs in each country. The last study in the United
States was completed in 2002. The Federation has just begun its 2006 Analysis of Practice of
physical therapists and physical therapists assistants.
1.21.4 OVERVIEW OF A PRACTICE ANALYSIS:
Job responsibilities differ for PTs and PTAs. As a result, a different examination is developed
for each occupation. The practice analyses for physical therapist and physical therapist
assistant NPTEs also are parallel but separate processes. The Federation first develops and
pilots surveys to obtain information on activities of entry-level PTs and PTAs and the
knowledge and skill requirements (KSRs) for these activities. The pilot surveys are then
revised and distributed to a nationally representative sample of PTs and PTAs. To the
Federation, that means sending surveys to physical therapists and physical therapist
assistants in all 53 licensure jurisdictions.
The survey data are analyzed to determine the set of activities and KSRs critical for entry-
level practice. The results are used to update the PT and PTA NPTE test content outlines,
which ensures that the tests continue to measure important information in the right
proportions.
1.21.5 PHASES OF A PRACTICE ANALYSIS:
 Conduct a literature review of current physical therapy practice documents to develop a
list of potential activities and KSRs for the surveys
 Develop and pilot surveys for entry-level PT and entry-level PTA activities and KSRs
(knowledge and skill requirements)
 Develop final surveys based on data from pilot surveys
 Distribute final surveys to a nationally representative sample of PTs and PTAs
 Analyze survey data to determine critical activities
 Link critical activities to KSRs
 Use the findings to update the content outlines for the PT and PTA NPTE
1.21.6 THE OVERSIGHT PANEL AND TASK FORCES:
The Federation solicits nominations from member jurisdictions and professional physical
therapy groups and sections in order to ensure the oversight panel and task forces represent
the profession in terms of physical therapy practice settings, ethnicities, ages, lengths of
practice and regions of the United States.
The Practice Analysis Oversight Panel is appointed to oversee the practice analysis process
and task forces. Members of the panel are familiar with the NPTE development process, its
content outlines and current practice issues in physical therapy. The panel reviews the pilot
surveys, activity lists and KSRs, providing advice and guidance to the task forces and staff
throughout the process.
Two task forces are appointed, one for the PT practice analysis and one for the PTA practice
analysis. They produce the pilot and final surveys and use the survey results to build new
content outlines for the PT and PTA examinations. The task forces participate in two
assignments: (1) developing lists of job activities and knowledge and skill requirements; and
(2) reviewing preliminary survey and linkage results. The results of those assignments are
used to update the PT and PTA test content outlines.

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1.21.7 SURVEY DEVELOPMENT:
Both pilot and final surveys ask for demographic and professional background information
from the individual taking the survey. They include lists of activities and KRS, which will be
rated on scales to assess their importance to entry-level practice. Typical scales include: 1)
acquisition level, 2) consequence of incorrect performance, and 3) frequency of performance.
The pilot survey also asks general questions about the survey itself such as "Did we forget an
activity that was essential?" and "Was some activity not physical therapy?"
Acquisition Level: At what level of practice are the knowledge requirements and skills
necessary to independently perform this activity typically required?
Consequence of Incorrect Performance: When considering the risk of unnecessary
complications, impairment of function or serious distress to patients, how much physical or
psychological harm will the incorrect performance of this activity most likely cause the
patient?
A. FREQUENCY OF PERFORMANCE:
Task force members review the pilot survey findings and revise the survey as suggested
by the respondents. Revisions included clarifying confusing areas, condensing the survey
and including the amount of time needed to complete the survey in the request to
participate.
B. SURVEY PARTICIPATION:
The survey of activities is representative, meaning that the number of pilot and final
survey participants are based on the total number of PTs and PTAs in jurisdictions. The
ideal survey subjects have up to five years of experience so they are not too far from
entry-level practice. They represent the same diversity as the profession in key areas
such as gender, age, ethnicity, region and various clinical settings. All have passed the
exam and are licensed or certified.
A sophisticated distribution plan is used to elicit as many responses as possible. For
instance, an alert letter may be offered the survey on a web link. Non-respondents
receive a follow-up letter with a paper survey. This communication may be followed up
with a postcard, then a second follow-up letter with another paper survey.
The typical respondent to the last practice analysis survey (done in 2000) was female,
white, licensed or certified between 1996 and 2000, full-time/salaried, working in direct
patient care (especially ambulatory/outpatient and acute care) and more likely to report
obtaining an MPT or MSPT credential.
C. SURVEY ANALYSIS:
Ratings from the activity survey are combined into a single index of criticality, with the
entry-level activities having consequence for public protection receiving the most weight.
Knowledge and skills required to perform these important entry-level activities are linked
to the critical activities and then structured into a preliminary content outline for each
exam. The task forces are reconvened to review and finalize the test content outlines. It
should be noted that activities may be dropped from a content outline if they are part of
advanced practice or too infrequently performed to warrant inclusion. Once the test
content outline is finalized, new forms of the NPTE are assembled to meet the updated
test content outlines.
A Status Report on the 2006 Practice Analysis To date, the Practice Analysis Oversight
Panel and task forces have been appointed. They have generated a list of activities and
KSRs, which are currently being used to develop the pilot surveys. The pilot surveys will

22
be sent in late spring this year and the national survey will be sent this summer. We
expect to finalize test content outlines by early fall.
1.22 NPTE EXAM INFORMATION:
In order to become certified as a physical therapist or a physical therapist assistant, individuals need
to pass the National Physical Therapy Examination. This exam has been developed by the
Federation of State Boards of Physical Therapy to maintain high standards in the practice of physical
therapy, and to ensure that professional standards are consistent from jurisdiction to jurisdiction. The
NPTE exam is required for licensure or certification in all fifty states.
The NPTE exam for physical therapists is divided into the following four sections:
Examination (26% of the exam);
Evaluation, Diagnosis, Prognosis, and Outcomes (22.5%);
Intervention (41.5%);
Standards of Care (10%).
The NPTE exam for physical therapist assistants is divided into the following three sections:
Tests and Measures (21.3%);
Intervention (60%);
Standards of Care (18.7%).
On both exams, the systems of the body are covered in the following approximate proportions:
Musculoskeletal (24%);
Neuromuscular (24%);
Cardiovascular/pulmonary (13%);
Integumentary (7%);
Non-system (32%).
 The physical therapist examination consists of 250 questions and must be completed within 5
hours;
 The physical therapist assistant examination consists of 200 questions and must be completed
within 4 hours. There is a fifteen-minute break scheduled for the middle of the exam.
 Fifty of the exam questions are pre-test questions, which do not count towards a grade but are
used to develop future versions of the exam. It will not be possible to tell which questions are pre-
test questions.
 Scoring is based on the number of correct answers, so candidates should select the best answer
when they are unsure.
 The raw score (number of questions answered correctly) will be converted into a score on a scale
of 200 to 800; the scaled score takes into account differences in difficulty between versions of the
exam. The minimum passing score is a 600.
 The test administrator to the relevant licensing jurisdiction will deliver exam results; Candidates
will obtain their scores from their licensing authority. The NPTE exam is administered by
Thomson Prometric throughout the year at locations around the country; prospective test-takers
can register at the Prometric website. Test-takers must arrive at the testing location at least thirty
minutes before the examination with two forms of identification: one government-issued photo ID
and one ID with the name pre-printed and a signature (a credit card, for instance).

23
1.23 EXAM BREACHES:
IMPACT ON BOARDS AND CANDIDATES NEWPORT BEACH, CA:
September 20, 2008
Exam Breaches: A Problem for Everyone
Test Developers and Administrators
Licensed Professionals
General Public
Licensing Boards
Candidates
Innocent Bystanders
Immigration Authorities
Vendors
Universities/Programs
Governments
Employers
Test Prep Companies
Recruiters
BUT ANYTIME SOMEONE KNOWINGLY OBTAINS AN UNFAIR ADVANTAGE . . .
THE FREE QUESTIONS ON THIS SITE ARE PRIMARILY FOR PHYSIOTHERAPISTS.
The FSBPT hosts the NPTE exam for physiotherapists and assistants. FSBPT stands for The Federation of
State Boards of Physical Therapy. NPTE stands for the National Physiotherapy Examination.

24
Note:
The topics covered herein are to give you an idea and it is a fraction of what will be asked for in the NPTE
test. Hence the best practice is revising the 1st
, 2nd
, 3rd
and 4th
year syllabus. Many a physiotherapists have
passed the exams in their first attempts, yet others have made several attempts. (Remember the king and the
ant story “try try till you succeed)
“Success comes to those who seek it”
Good Luck

25
2.0 MUSCULOSKELETAL PHYSIOTHERAPY:
Musculoskeletal Physiotherapy is the term used to describe the field of physiotherapy, which relates to
disorders of the musculoskeletal system. The term musculoskeletal refers to muscles, bones, joints, nerves,
tendons, ligaments, cartilage, and spinal discs. Musculoskeletal Physiotherapy utilizes the basic sciences of
anatomy, physiology and biomechanics as background theory in the assessment and management of
patients. Approaches to management in the field of musculoskeletal physiotherapy involve ‘manipulation’, but
also manual assessment and treatment techniques, specific therapeutic exercise, electrotherapy and advice
on posture and movement disorders.
2.1 UNDERSTANDING THE MUSKULOSKEELETAL SYSTEM:

26
 The human musculoskeletal system (also known as the locomotor system) is an organ
system that gives humans the ability to move using the muscular and skeletal systems. The
musculoskeletal system provides form, stability, and movement to the human body.
 It is made up of the body's bones (the skeleton), muscles, cartilage, tendons, ligaments,
joints, and other connective tissue (the tissue that supports and binds tissues and organs
together). The musculoskeletal system's primary functions include supporting the body,
allowing motion, and protecting vital organs. The skeletal portion of the system serves as the
main storage system for calcium and phosphorus and contains critical components of the
hematopoietic system.
 There are, however, diseases and disorders that may adversely affect the function and
overall effectiveness of the system. These diseases can be difficult to diagnose due to the
close relation of the musculoskeletal system to other internal systems. The musculoskeletal
system refers to the system having its muscles attached to an internal skeletal system and is
necessary for humans to move to a more favorable position.
 The musculoskeletal system describes how bones are connected to other bones and muscle
fibers via connective tissue such as tendons and ligaments. The bones provide the stability to
a body in analogy to iron rods in concrete construction. Muscles keep bones in place and
also play a role in movement of the bones. To allow motion joints connect different bones.
Cartilage prevents the bone ends from rubbing directly on to each other. Muscles contract
(bunch up) and extend (stretch) to move the bone attached at the joint.
2.1.1 HUMAN SKELETON:
THE HUMAN SKELETAL SYSTEM
PART OF THE SKELETON
NUMBER OF
BONES
Axial Skeleton 80
Skull 22
Ossicles (malleus, incus and stapes) 6
Vertebral column 26
Ribs 24
Sternum 1
Hyoid 1
Appendicular Skeleton 126
Upper extremities 64
Lower extremities 62

27
A. AXIAL SKELETON:
The axial skeleton consists of 80 bones forming the trunk (spine and thorax) and skull.
 Vertebral Column: The main trunk of the body is supported by the spine, or
vertebral column, which is composed of 26 bones, some of which are formed by the
fusion of a few bones. The vertebral column from superior to inferior consists of 7
cervical (neck), 12 thoracic and 5 lumbar vertebrae, as well as a sacrum, formed by
fusion of 5 sacral vertebrae, and a coccyx, formed by fusion of 4 coccygeal
vertebrae.
 Ribs and Sternum: The axial skeleton also contains 12 pairs of ribs attached
posteriorly to the thoracic vertebrae and anteriorly either directly or via cartilage to the
sternum (breastbone). The ribs and sternum form the thoracic cage, which protects
the heart and lungs. Seven pairs of ribs articulate with the sternum (fixed ribs)
directly, and three do so via cartilage; the two most inferior pairs do not attach
anteriorly and are referred to as floating ribs.
 Skull: The skull consists of 22 bones fused together to form a rigid structure which
houses and protects organs such as the brain, auditory apparatus and eyes. The
bones of the skull form the face and cranium (brain case) and consist of 6 single
bones (occipital, frontal, ethmoid, sphenoid, vomer and mandible) and 8 paired
bones (parietal, temporal, maxillary, palatine, zygomatic, lacrimal, inferior concha and
nasal). The lower jaw or mandible is the only movable bone of the skull (head); it
articulates with the temporal bones.
 Other Parts: Other bones considered part of the axial skeleton are the middle ear
bones (ossicles) and the small U-shaped hyoid bone that is suspended in a portion of
the neck by muscles and ligaments.

28
B. APPENDICULAR SKELETON:
The appendicular skeleton forms the major internal support of the appendages—the
upper and lower extremities (limbs).
 Pectoral Girdle and Upper Extremities: The arms are attached to and suspended
from the axial skeleton via the shoulder (pectoral) girdle. The latter is composed of
two clavicles (collarbones) and two scapulae (shoulder blades). The clavicles
articulate with the sternum; the two sternoclavicular joints are the only sites of
articulation between the trunk and upper extremity.
 Each upper limb from distal to proximal (closest to the body) consists of hand, wrist,
forearm and arm (upper arm). The hand consists of 5 digits (fingers) and 5
metacarpalbones. Each digit is composed of three bones called phalanges, except
the thumb, which has only two bones.
 Pelvic Girdle and Lower Extremities: The lower extremities, or legs, are attached
to the axial skeleton via the pelvic or hip girdle. Each of the two coxal, or hip bones
comprising the pelvic girdle is formed by the fusion of three bones—illium, pubis, and
ischium. The coxal bones attach the lower limbs to the trunk by articulating with the
sacrum.

29
C. CHARACTERISTICS OF BONE:
Bone is a specialized type of connective tissue consisting of cells (osteocytes) embedded
in a calcified matrix that gives bone its characteristic hard and rigid nature. Bones are
encased by a periosteum, a connective tissue sheath. All bone has a central marrow
cavity. Bone marrow fills the marrow cavity or smaller marrow spaces, depending on the
type of bone.
I. TYPES OF BONE:
There are two types of bone in the skeleton:
 Compact bone
 Spongy (cancellous) bone.
1. Compact Bone: Compact bone lies within the periosteum, forms the outer
region of bones, and appears dense due to its compact organization. The living
osteocytes and calcified matrix are arranged in layers, or lamellae. Lamellae may
be circularly arranged surrounding a central canal, the Haversian canal, which
contains small blood vessels.
2. Spongy Bone: Spongy bone consists of bars, spicules or trabeculae, which
forms a lattice meshwork. Spongy bone is found at the ends of long bones and
the inner layer of flat, irregular and short bones. The trabeculae consist of
osteocytes embedded in calcified matrix, which in definitive bone has a lamellar
nature. The spaces between the trabeculae contain bone marrow.
II. TYPES OF BONE CELLS:
The cells of bone are
 Osteocytes,
 Osteoblasts,

30
 Osteoclasts.
1. OSTEOCYTES:
Osteocytes are found singly in lacunae (spaces) within the calcified matrix and
communicate with each other via small canals in the bone known as canaliculi.
The latter contain osteocyte cell processes. The osteocytes in compact and
spongy bone are similar in structure and function.
2. OSTEOBLASTS:
Osteoblasts are cells which form bone matrix, surrounding themselves with it,
and thus are transformed into osteocytes. They arise from undifferentiated cells,
such as mesenchymal cells. They are cuboidal cells that line the trabeculae of
immature or developing spongy bone.
3. OSTEOCLASTS:
Osteoclasts are cells found during bone development and remodeling. They are
multinucleated cells lying in cavities, Howship’s lacunae, on the surface of the
bone tissue being resorbed. Osteoclasts remove the existing calcified matrix
releasing the inorganic or organic components.

31
III. BONE MATRIX:
Matrix of compact and spongy bone consists of collagenous fibers and ground
substance that constitute the organic component of bone. Matrix also consists of
inorganic material that is about 65% of the dry weight of bone. Approximately 85% of
the inorganic component consists of calcium phosphate in a crystalline form
(hydroxyapatite crystals). Glycoproteins are the main components of the ground
substance.

Ptp&M013 Npte 1

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