A physical therapist assistant is treating a 68-year-old man three weeks after a left middle cerebral artery stroke with dense right hemiplegia. The supervising PT's plan of care includes bed mobility and transfer training. During a sit-to-stand transfer the patient's right arm hangs at his side, and a family member reaches to pull him up by that arm. Which of the following is the MOST appropriate action?

Stop the family member, explain that the flaccid shoulder must never be pulled, and teach a transfer that supports the arm and uses a gait belt

Allow the assist, since pulling on the arm provides a stable handhold during the transfer

Have the family member pull on both arms equally so the load is symmetrical

Place the right arm in a sling for all transfers and ask the family member to pull on the sling strap

A physical therapist assistant is working on sitting balance with a 74-year-old woman two weeks after a right hemisphere stroke. In sitting she leans strongly toward her left (hemiparetic) side, pushes with her right arm and leg to increase the lean, and resists the PTA's attempts to bring her to midline. The supervising PT's plan of care includes midline orientation training. Which of the following strategies is MOST appropriate?

Position her next to a wall on the right side and have her reach toward it while using visual vertical cues such as a doorframe to find midline

Provide firm manual pressure to push her back toward the right side until she is vertical

Discontinue sitting activities until the pushing behavior resolves on its own

Have her lean further to the left so she learns from the loss of balance

A physical therapist assistant is performing mat activities with a 29-year-old man with a complete T4 spinal cord injury. Midway through the session the patient reports a sudden pounding headache, the PTA notes his face is flushed and sweating above the level of injury, and his blood pressure is 180/100 mm Hg compared with his usual 100/60. Which of the following is the MOST appropriate FIRST action?

Sit the patient upright, loosen any tight clothing or straps, and check the urinary catheter and tubing for kinks or a full bag

Lay the patient supine with the legs elevated to improve venous return

Continue the activity at a lower intensity and recheck the blood pressure in ten minutes

Apply ice to the forehead to relieve the headache and reduce facial flushing

A physical therapist assistant is reviewing the supervising PT's plan of care for a 24-year-old woman with a complete C6 spinal cord injury. The plan emphasizes tenodesis grasp training and independent transfers using a sliding board. The patient asks why she is being trained to grasp with her wrist when she cannot move her fingers. Which of the following is the MOST accurate explanation?

Active wrist extension, which is preserved at C6, tightens the paralyzed finger flexors so the fingers passively close around an object

Finger movement will return within six months, and wrist training prepares the hand for that recovery

The wrist training is intended to prevent the fingers from ever curling, so the hand stays flat for pushing a wheelchair

The grasp comes from the triceps, which is the key muscle preserved at the C6 level

A physical therapist assistant is conducting a gait training session with a 71-year-old man with Parkinson's disease whose plan of care includes rhythmic auditory cueing and amplitude-based training. Forty minutes into the session he reports he is "wearing off," his steps have shortened noticeably, and he nearly freezes turning in the hallway. The PTA notes that his next levodopa dose is due in twenty minutes. Which of the following is the MOST appropriate action?

Shorten or end the gait portion of the session, use seated activities, and schedule future sessions during the patient's medication "on" period, reporting the timing issue to the supervising PT

Push through the remaining session time, since fatigue is expected and training during difficulty builds endurance

Give the patient his levodopa dose early so the session can continue

Switch to fast-paced treadmill walking to override the freezing

A physical therapist assistant is treating a 42-year-old woman with relapsing-remitting multiple sclerosis in an outpatient clinic. The supervising PT's plan of care includes aquatic exercise for endurance and balance. The clinic's therapy pool is kept at 94 degrees Fahrenheit. After fifteen minutes in the water the patient reports blurred vision in one eye and heaviness in her legs that she did not have before the session. Which of the following is the MOST appropriate action?

Remove the patient from the warm water, allow her to cool down and rest, and report the response to the supervising PT so the pool temperature or the intervention can be changed

Continue the session, since blurred vision and leg heaviness are expected effects of exercise in multiple sclerosis

Increase the exercise intensity to warm the muscles and work through the heaviness

Place the patient in the hot tub to relax the leg muscles before continuing

A physical therapist assistant is treating a 23-year-old man in an inpatient rehabilitation unit six weeks after a severe traumatic brain injury. He is currently functioning at Rancho Los Amigos Level IV (confused and agitated). During a transfer attempt he begins shouting, swings an arm toward the PTA, and tries to climb out of the wheelchair. Which of the following is the MOST appropriate response?

Stay calm, reduce stimulation by lowering your voice and simplifying the environment, redirect him to a familiar automatic activity, and ensure his safety without physical confrontation

Firmly explain that his behavior is unacceptable and that the session will end if it continues

Apply wrist restraints so the transfer can be completed safely

Leave the patient alone in the room until he settles down

A physical therapist assistant is treating a 60-year-old woman whose supervising PT diagnosed right posterior canal benign paroxysmal positional vertigo and performed a canalith repositioning maneuver yesterday. The plan of care includes habituation exercises and patient education. Today the patient reports that the brief spinning when she rolls to her right in bed is much less intense and shorter, lasting only a few seconds. Which of the following is the MOST appropriate response?

Reassure the patient that brief, improving positional vertigo after repositioning is an expected course, continue the plan of care, and report the progress to the PT

Immediately stop all activity and contact the supervising PT, because any remaining vertigo indicates treatment failure

Perform the canalith repositioning maneuver again yourself, since the first attempt was clearly incomplete

Instruct the patient to avoid moving her head in any direction for the next two weeks

A physical therapist assistant is treating a 35-year-old man with a common fibular (peroneal) nerve injury sustained when his leg was pinned against a car door. The supervising PT's plan of care includes gait training with an orthosis. During ambulation the PTA observes that the patient lifts his right knee abnormally high and slaps the foot down at initial contact. Which of the following orthotic interventions is MOST appropriate within the plan of care?

An ankle-foot orthosis that holds the ankle in neutral dorsiflexion to prevent foot drop during swing and control plantarflexion at initial contact

A knee-ankle-foot orthosis with a locked knee joint to control the entire limb

A rigid supramalleolar orthosis to limit inversion only

A heel lift inside the right shoe to shorten the limb and clear the toe more easily

A physical therapist assistant is treating a 66-year-old woman for balance training eight weeks after a left hemisphere stroke, per the supervising PT's plan of care. She has been progressing well. Today, during the session, she develops new slurred speech, her right-sided facial droop appears worse than at the start of the session, and she cannot lift her right arm to shoulder height when she could do so last visit. Which of the following is the MOST appropriate action?

Stop the session, keep the patient safe and seated, and activate the emergency response system immediately, then notify the supervising PT

Document the findings and inform the supervising PT at the end of the day

Continue with seated balance activities and reassess at the next session

Apply electrical stimulation to the right arm to restore the lost strength

10 Free NPTE-PTA Neuromuscular Practice Questions (2026)

About This Content Area

NPTE-PTA Neuromuscular Content Breakdown

The neuromuscular and nervous systems make up the second largest content area on the NPTE-PTA, 27 to 35 of the 140 scored items per the official FSBPT NPTE-PTA content outline, effective January 2024. FSBPT splits those items into physical therapy data collection (8 to 10 items), diseases and conditions that impact effective treatment (9 to 12), and interventions (10 to 13), and the interventions category specifically includes motor control and motor learning. Try our free 20-question NPTE-PTA practice test, Musculoskeletal practice questions, or the 10 general NPTE-PTA practice questions to see how this content sits alongside the rest of the exam.

What the PTA neuromuscular section covers

→Data collection: tone and spasticity grading, deep tendon reflexes, sensory tests (light touch, proprioception, two-point discrimination), cranial nerve screening, coordination tests such as the finger to nose test, balance measures, and functional scales such as Rancho Los Amigos and ASIA

→Central nervous system conditions: stroke (cerebrovascular accident, CVA) with hemiparesis, traumatic brain injury, spinal cord injury, Parkinson’s disease, multiple sclerosis, cerebellar lesion

→Pediatric and developmental conditions: cerebral palsy, Down syndrome, myelomeningocele (spina bifida), developmental milestones and primitive reflexes

→Peripheral and autonomic conditions: peripheral neuropathy and nerve injury, Guillain-Barré syndrome, autonomic dysreflexia, orthostatic hypotension

→Vestibular disorders: BPPV, unilateral hypofunction, central versus peripheral signs

→Interventions: handling and positioning, neuromuscular re-education, gait and transfer training with cueing, motor control and motor learning principles, orthotic use including ankle-foot orthoses (AFO) and knee-ankle-foot orthoses (KAFO), assistive devices

→Adverse effects and complications, including those from interventions on other systems

The PTA frame changes what a neuromuscular question asks. The NPTE-PT neuromuscular questions expect you to localize a lesion and select the intervention. The NPTE-PTA expects you to deliver the intervention the PT selected, with the handling rule, cue, and precaution that condition demands, and to recognize the findings that require escalation to the PT or to emergency services. See our full NPTE-PTA exam format breakdown for how these items fit into the 180-question structure.

Findings the neuromuscular section expects you to recognize

→Cerebellar lesion: dysmetria on the finger to nose test, intention tremor that worsens as the hand nears the target, ataxic gait with a wide base

→Upper motor neuron signs: spasticity, hyperactive deep tendon reflexes, clonus, a positive Babinski; lower motor neuron signs: flaccidity, diminished reflexes, atrophy

→Stroke by territory: middle cerebral artery involvement produces contralateral hemiparesis with the arm and face worse than the leg, plus aphasia on the dominant side and neglect on the non-dominant side

→Sensory tests: light touch, sharp and dull, proprioception, two-point discrimination; a loss of proprioception changes every balance and gait decision

→Cranial nerve screening: facial droop (CN VII), swallowing and gag (CN IX and X), tongue deviation (CN XII) as the findings that change feeding and airway precautions

→Gait: foot drop with a steppage pattern in swing phase points to dorsiflexor weakness and an AFO; a hemiparetic gait with circumduction points to a stiff, extended limb in swing

The pattern to recognize

Every neuromuscular vignette hides a condition-specific rule that overrides ordinary practice: no traction on a flaccid shoulder, no heat for multiple sclerosis, no supine positioning during dysreflexia, no rushing a patient with Parkinson’s, no reasoning with a Rancho Level IV patient. The wrong answers apply the ordinary rule. Identify the diagnosis, recall the rule that goes with it, and the correct option is the one that honors it while staying inside the plan of care.

Cross-Content Reasoning

Where Neuromuscular Content Connects Across the NPTE-PTA

Neuromuscular items reach into every other section. The transfer and gait training in these vignettes depend on the weight-bearing rules and precautions from the musculoskeletal section, and the orthotic and assistive device choices (the AFO for foot drop, the wheelchair setup after spinal cord injury) are scored under equipment and devices in the non-systems section, along with the emergency response and safety items that the stroke and dysreflexia questions draw on.

The cardiopulmonary section supplies the vital-sign layer that makes several of these questions work: the blood pressure spike of autonomic dysreflexia, the orthostatic hypotension of a newly upright SCI patient, and the exercise tolerance of a deconditioned stroke survivor. Conditions that span systems, such as a diabetic patient with peripheral neuropathy or a stroke survivor with a hip fracture, are written as system-interaction items and counted under other systems.

And the medication thread runs through the whole section: levodopa timing decides when a Parkinson’s session works, anticoagulants after a cerebrovascular accident change every fall-risk judgment, and antispasticity drugs such as baclofen alter the spasticity the PTA grades. The exam expects a PTA to know how a drug changes the session, not to prescribe or administer it. The pediatric conditions follow the same logic: cerebral palsy, Down syndrome, and myelomeningocele each carry a handling rule (tone management, atlantoaxial instability precautions, latex allergy and skin checks over insensate areas) that the PTA applies within the plan.

Study tip

Make one card per condition with four lines: the handling or positioning rule, the cueing strategy, the precaution, and the emergency. Stroke, SCI by level, Parkinson’s, MS, Guillain-Barré syndrome, TBI by Rancho level, cerebral palsy, BPPV, and peripheral neuropathy cover most of what the section tests, and the Rancho and ASIA scales are worth memorizing outright. Then run a question bank or a timed NPTE-PTA practice test to see which cards you actually retrieve under pressure. Our complete NPTE-PTA study guide shows how to fold the cards into a full study plan.

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