NPTE-PTA Mnemonics: 12 Memory Tricks for PTA Students

Posterior total hip precautions

“Don't be FAIR to a posterior hip”

1. FFlexion past 90 degrees: avoid (low chairs, bending to tie shoes)
2. AAdduction past midline: avoid (crossing the legs; keep a pillow between the knees)
3. IRInternal Rotation: avoid (turning the knee and toes inward)

Use it when: When a stem asks which activity, position or piece of equipment is safe after a posterior-approach hip replacement, such as a raised toilet seat, a reacher, or a pillow between the knees.

Careful: The approach decides the precautions. After an anterior approach, the motions to avoid are mainly hip extension and external rotation, close to the opposite of these. Many surgeons now limit or drop precautions, so always follow the surgeon's protocol in the plan of care. Do not confuse this with the FAIR test for piriformis syndrome.

Trendelenburg gait (gluteus medius weakness)

“The sound side sags”

When the patient stands on the leg with a weak gluteus medius, that muscle cannot hold the pelvis level, so the pelvis drops on the opposite (sound, swing) side. A right Trendelenburg sign means the right gluteus medius is weak and the left side of the pelvis drops during right stance.

Use it when: When a gait-analysis item describes a pelvic drop or a lateral trunk lean and asks which muscle is weak, or which side to strengthen.

Careful: In the compensated pattern the patient leans the trunk TOWARD the weak stance side to move the center of mass over the hip, so you may see a lean instead of a drop. A cane in the hand opposite the weak hip reduces the load on that gluteus medius.

Autonomic dysreflexia response

“Sit up, strip, search”

Sit up: raise the head and lower the legs to bring blood pressure down. Strip: loosen anything tight, such as an abdominal binder, compression stockings, leg-bag straps or clothing. Search: look for the trigger, bladder first (kinked or blocked catheter, full bladder), then bowel, then skin (pressure, ingrown nail, tight shoes). Keep checking blood pressure every few minutes and get help if it stays high.

Use it when: When a patient with a spinal cord injury at T6 or above suddenly has a pounding headache, flushing or sweating above the injury, a stuffy nose, and a blood pressure well above baseline.

Careful: Do not lie the patient flat; that is the response to orthostatic hypotension, the opposite problem in the same population. Judge the reading against the patient's baseline: a systolic of 120 can already signal dysreflexia in a person with tetraplegia whose usual systolic pressure is around 90.

Parkinson's disease cardinal signs

“TRAP”

1. TTremor at rest (pill-rolling)
2. RRigidity (lead-pipe or cogwheel)
3. AAkinesia/bradykinesia (slow, small movements)
4. PPostural instability

Use it when: When a stem describes a patient's movement and asks which finding fits Parkinson's, or which impairment an intervention such as large-amplitude movement or cueing is targeting.

Careful: The tremor is a RESTING tremor that lessens with purposeful movement; an intention tremor points to cerebellar disease instead. Rigidity is velocity-independent, unlike spasticity, which increases with faster stretch. Freezing and a festinating gait are common exam add-ons.

When to stop exercise

“CHEST”

1. CChest pain or angina (or an anginal equivalent such as jaw or arm pain)
2. HHypotensive response: systolic BP falls more than 10 mmHg as the workload rises
3. EExcessive BP: systolic above 250 or diastolic above 115 mmHg
4. SSigns of poor perfusion: pallor, cyanosis, cold sweat, dizziness, confusion, ataxia
5. TTold to stop: the patient asks to stop, or reports severe fatigue or shortness of breath

Use it when: When a stem gives vitals or symptoms during exercise and asks whether to continue, modify or stop.

Careful: The 250/115 limits come from ACSM's exercise-test termination criteria; many facilities and plans of care set lower limits, and the plan of care wins. A new arrhythmia or a drop in SpO2 also means stop. In patients on beta-blockers, heart rate rises less than expected, so watch symptoms and RPE as well as heart rate.

Borg RPE and heart rate

“Add a zero”

On the original Borg 6-20 scale, the rating times 10 roughly matches heart rate in a healthy young adult: an RPE of 13 is about 130 beats per minute. Moderate intensity is 12-13 (somewhat hard) and vigorous is 14-17.

Use it when: When a patient's heart-rate response is blunted or unreliable, such as on beta-blockers or with atrial fibrillation, and the stem asks how to monitor intensity.

Careful: Adding a zero is only an approximation in healthy young adults and does not hold for patients on beta-blockers or older adults. Do not mix up the 6-20 scale with the 0-10 category-ratio (CR10) scale, where 3 is moderate and there is no zero to add.

Stair training with a cane or crutches

“Up with the good, down with the bad”

Going up, the stronger (good) leg steps first, then the weaker leg and the device follow. Going down, the device and the weaker (bad) leg go first, then the stronger leg. The good leg always does the lifting; the device stays with the bad leg.

Use it when: When a stem asks for the correct sequence on stairs or a curb with a cane, crutches or a walker.

Careful: The cane is held in the hand OPPOSITE the involved leg but moves WITH it. If there is one handrail, the patient uses it and carries the cane in the other hand, even if that changes which hand normally holds the cane. Guarding goes below the patient when descending and behind when ascending.

Fitting a cane, walker or axillary crutches

“Crease, bend, two fingers”

Crease: the handgrip of a cane, walker or crutch is level with the wrist crease (or the greater trochanter) with the arm hanging relaxed. Bend: with the hand on the grip, the elbow is flexed about 20-30 degrees. Two fingers: the top of an axillary crutch sits about 2-3 finger widths (about 2 inches, 5 cm) below the armpit.

Use it when: When a stem describes a patient with a device and asks whether it fits, or which complaint (wrist pain, armpit numbness, stooped posture) comes from a fitting error.

Careful: Weight goes through the hands, not the armpits; resting on the crutch top can compress the radial nerve. A walker set too low causes forward flexed posture, and too high causes the patient to hike the shoulders. Fit with the patient wearing the shoes they will walk in.

Electrical stimulation contraindications

“Please Check All The Pads”

1. PPacemaker or implanted defibrillator (demand-type cardiac devices)
2. CCarotid sinus: no electrodes over the anterior neck
3. AArrhythmia that is unstable: no electrodes over or near the chest
4. TThrombosis or thrombophlebitis in the area
5. PPregnancy: no electrodes over the abdomen, pelvis or low back

Use it when: When a stem gives a patient's history and asks whether e-stim may be used, or where electrodes must not go.

Careful: Malignancy, impaired sensation or cognition, open skin and cardiac disease are precautions or local contraindications rather than this core list, and textbooks differ on some of them. TENS is used for labor pain in pregnancy, so the pregnancy rule is about placement over the trunk, not a ban on all stimulation.

Sensations during cold application

“CBAN”

1. CCold
2. BBurning
3. AAching
4. NNumbness (analgesia): the usual end point

Use it when: When a stem asks what a patient should expect during an ice pack or ice massage, or when to end the treatment.

Careful: Numbness usually comes within about 10-20 minutes depending on the method. Do not apply cold over superficial nerves such as the fibular nerve at the fibular head or the ulnar nerve at the elbow, because prolonged cold can cause nerve palsy. Cold urticaria, cryoglobulinemia, paroxysmal cold hemoglobinuria and Raynaud's phenomenon are contraindications.

What only the PT can do

“PREDD stays with the PT”

1. PPlan of care: establish it or change it
2. RRe-examination and re-evaluation
3. EExamination and evaluation at the start of care
4. DDiagnosis and prognosis
5. DDischarge: the decision and the discharge summary

Use it when: When a stem asks whether the PTA may perform a task, or what the PTA should do when the patient needs a new plan or is ready for discharge.

Careful: The PTA may collect data, carry out and progress interventions within the plan of care, and contribute data to the discharge summary, but cannot sign off any PREDD task. Supervision rules differ by state and payer: since January 1, 2025, Medicare allows general supervision of PTAs in PT private practice, but stricter state rules still apply.

When the PTA must contact the PT

“CALL the PT”

1. CChange in the patient's status: new symptoms, a fall, abnormal vitals, a new diagnosis
2. AAdverse response to an intervention
3. LLack of progress, or goals met: the plan needs re-evaluation or discharge
4. LLimits: the request is outside the plan of care or outside the PTA's competence or scope

Use it when: When a stem ends with 'What should the PTA do NEXT?' after something unexpected happens in a session.

Careful: Contacting the PT does not replace immediate safety steps. In an emergency, stop, keep the patient safe and activate the emergency response first, then notify the PT. Progressing an exercise within the plan's parameters does not require a call.