NBCOT COTA Mnemonics: 12 Memory Tricks for OTA Students

Primitive reflexes and when they integrate

“Fencer by 6, Cat by 12”

1. RootingBirth to about 3-4 months: stroke the cheek, head turns toward the touch
2. MoroTo about 4-6 months: sudden head drop, arms abduct and extend then flex (startle)
3. Palmar graspTo about 4-6 months: pressure in the palm makes the fingers flex
4. ATNRTo about 4-6 months: head turns, face-side arm extends, skull-side arm flexes (fencer)
5. TLRTo about 6 months: prone increases flexion, supine increases extension
6. STNRAbout 6-8 to 8-12 months: head up, arms extend and legs flex (cat)
7. Plantar graspTo about 9-12 months: pressure on the ball of the foot curls the toes; fades before standing

Use it when: When a stem describes a child who cannot bring the hands to midline when the head turns (retained ATNR) or who creeps with a bunny-hop pattern (retained STNR) and asks what is interfering or what to report to the OTR.

Careful: Integration ages differ by several months between sources, so items usually ask which reflex persists longest or what a retained reflex interferes with, not an exact week. Use corrected age for children born preterm, typically until about age 2.

Pencil grasp progression

“Please Don't Stop Drawing”

1. PPalmar-supinate grasp: about 1-1.5 years
2. DDigital-pronate grasp: about 2-3 years
3. SStatic tripod: about 3.5-4 years
4. DDynamic tripod: about 4.5-6 years

Use it when: When a stem gives a child's age and grasp and asks whether it is typical, or which grasp to expect next.

Careful: Research shows mature alternatives such as the dynamic quadrupod and lateral tripod produce writing as fast and legible as the dynamic tripod, so 'retrain to a tripod' is not automatically right for a functional writer. Ages are approximate.

Autonomic dysreflexia response

“Sit up, Loosen, Look, Let them know”

1. Sit upRaise the head and lower the legs to bring blood pressure down
2. LoosenLoosen clothing, abdominal binders, leg-bag straps and compression garments
3. LookFind the trigger: bladder first (kinked catheter, full bag), then bowel, then skin and tight items
4. Let them knowNotify nursing or the physician and keep checking BP every 2-5 minutes; call EMS if it does not resolve

Use it when: When a client with an SCI at T6 or above suddenly has a pounding headache, flushing or sweating above the injury and high blood pressure during a session.

Careful: Defined in adults as a systolic rise of more than 20 mmHg over the person's baseline, which may be only 90-110 mmHg in tetraplegia, so a 'normal' reading can be dysreflexia. Do NOT lay the client flat: that is the response for orthostatic hypotension, the opposite problem.

Orthostatic hypotension

“20 / 10 in 3”

A drop of at least 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing (or head-up tilt) is orthostatic hypotension. Return the client to sitting or lying with the legs raised, then progress position changes slowly; compression stockings and abdominal binders help in SCI.

Use it when: The first time a client gets up after bed rest, or in SCI, Parkinson's disease or after a new blood pressure medication, when dizziness or pallor appears during a transfer.

Careful: The response is the opposite of autonomic dysreflexia (lie back and raise the legs vs sit up). Stop for symptoms such as lightheadedness, dimming vision or pallor even before you have the numbers, and report the readings to the OTR and nurse.

Hip precautions by surgical approach

“Posterior: don't Bend, Cross or Turn in. Anterior: don't step Back or Turn out”

1. BendPosterior: no hip flexion past 90 degrees (raised toilet seat, no low chairs, reacher, sock aid)
2. CrossPosterior: no adduction past midline (pillow between the legs, no crossing legs)
3. Turn inPosterior: no internal rotation (toes pointing up or slightly out)
4. Back / Turn outAnterior (anterolateral): no hip extension past neutral and no external rotation

Use it when: When a stem asks which ADL technique, device or handout instruction is safe for a client after total hip arthroplasty.

Careful: Precautions follow the surgeon's approach and orders and last for the period the surgeon sets; many anterior and some posterior procedures now have few or no restrictions. Some protocols also include adduction for the anterolateral approach. With a hip kit, dress the operated leg first and undress it last.

Energy conservation

“The 4 Ps”

1. PPrioritize: drop or delegate tasks that are not essential
2. PPlan: gather supplies first, spread heavy tasks across the day and week
3. PPace: work at a steady rate and rest before you are exhausted
4. PPosition: sit to work, keep items between hip and shoulder height, avoid bending and reaching overhead

Use it when: When a stem involves COPD, heart failure, multiple sclerosis or cancer-related fatigue and asks which instruction or task modification to teach.

Careful: Energy conservation is not the same as joint protection for rheumatoid arthritis, though they overlap. Pacing means resting before fatigue, not after. Teach exhaling during the effort phase (pursed-lip breathing in COPD) and avoiding breath-holding.

Safe (intrinsic-plus) hand position

“Wrist up, knuckles bent, fingers straight, thumb out”

1. Wrist upWrist in about 15-30 degrees of extension
2. Knuckles bentMCP joints in about 60-90 degrees of flexion (collateral ligaments on stretch)
3. Fingers straightPIP and DIP joints in full extension (volar plates on stretch)
4. Thumb outThumb in palmar abduction to keep the web space open

Use it when: When a stem asks how to position a hand after a dorsal burn, crush injury or significant edema, or which orthosis prevents a claw deformity.

Careful: A palmar burn is the exception: everything goes into extension. The functional resting position (fingers partly flexed) is a different orthosis used for rest in arthritis. Check the skin after the first wear; redness that does not fade within about 20-30 minutes means the orthosis needs adjusting.

Dressing with hemiplegia

“Weak side in first, weak side out last”

When dressing, put the affected arm or leg into the garment first. When undressing, take the unaffected side out first and the affected side out last. The same rule applies to the operated leg after hip surgery.

Use it when: When a stem asks for the correct sequence for donning a shirt, pants or socks after a stroke, or which instruction to give the client or caregiver.

Careful: The hook flips if you start thinking about the strong side. Teach dressing seated in a stable chair, and with neglect cue the client to check that the affected sleeve is pulled fully up to the shoulder.

Who does what: OTR and COTA

“The OTR owns E-P-D; the COTA reports”

1. EEvaluation: the OTR directs it and interprets results; the COTA may contribute data and give delegated assessments once service competency is established
2. PPlan: the OTR establishes the intervention plan; the COTA contributes to it and implements it
3. DDischarge: the OTR decides; the COTA contributes to discharge planning
4. RReport: the COTA reports changes in client status to the OTR, who decides whether the plan changes

Use it when: When a stem asks whether a task is an appropriate COTA assignment, or what the COTA should do when a client's response changes.

Careful: The amount and type of supervision is set by state law, payer rules and the COTA's demonstrated competence, not by years of experience. Medicare Part B private practice moved from direct to general supervision of OTAs on January 1, 2025. Aides do not perform skilled services.

Seizure first aid

“Stay, Safe, Side”

1. StayStay with the person and time the seizure
2. SafeMove hard or sharp objects away, cushion the head, do not restrain, put nothing in the mouth
3. SideTurn the person onto the side if not awake and aware, to keep the airway clear

Use it when: When a client has a seizure during a session and the stem asks for the first or best action.

Careful: Call 911 if the seizure lasts 5 minutes or longer, seizures repeat without recovery, it is a first seizure, it happens in water, or the person is injured, pregnant or has trouble breathing afterward. Never put anything in the mouth: the 'swallowing the tongue' myth still appears as a distractor.

Treating low blood glucose

“The 15-15 rule”

For a conscious client who can swallow, with glucose below 70 mg/dL or signs of hypoglycemia (shaky, sweaty, pale, hungry, confused): give 15 g of fast-acting carbohydrate (about 4 oz of juice or regular soda, or glucose tablets), recheck after 15 minutes, repeat if still below 70, then give a snack or meal.

Use it when: When a client with diabetes becomes shaky, sweaty or confused during a session and the stem asks what to do first.

Careful: Not for a client who is unconscious or cannot swallow: call EMS. Chocolate and other high-fat foods absorb slowly. Signs of high glucose (flushed, dry skin, thirst, fruity breath, deep breathing) need medical help, not sugar.

Body mechanics for safe transfers

“BACK”

1. BBroad base of support: feet shoulder-width apart, one slightly forward
2. AAlign and avoid twisting: pivot with the feet, not the spine
3. CClose: keep the client or load close to your center of gravity; use a gait belt
4. KKnees bend: lift with the legs and keep the back neutral

Use it when: When a stem asks for the safest way to assist a transfer or lift, or what the COTA should do before moving a client.

Careful: NIOSH research (Waters, 2007) recommends a maximum of about 35 lb of patient weight for manual lifting under ideal conditions; above that, use a mechanical lift or other assistive device. Before any transfer lock the brakes, swing away the footrests and put on the gait belt. In hemiplegia, transfer toward the stronger side unless the plan is to train the weaker side.