Neuromuscular and Nervous Systems

24% of the NPTE · blueprint NPTE-PT content outline effective January 2024 (v1.1)

Short answer

Neuromuscular and nervous systems account for 39-48 of the 180 scored items. Content covers stroke and traumatic brain injury rehabilitation, spinal-cord injury levels and expected functional outcomes, neurodegenerative conditions such as Parkinson disease and multiple sclerosis, vestibular and balance disorders, peripheral neuropathies and nerve injuries, paediatric developmental conditions, and the motor-control and motor-learning principles that govern how any of it is trained.

Why it matters on this exam

Second-largest system and the one most often tested through functional outcome: given this lesion, what should the patient be able to do, and what do you train next?

Key concepts

Spinal-cord injury: ASIA levels and expected functional outcomes (C6 tenodesis grasp, C7 independent transfers, T1 and below full upper-limb function), autonomic dysreflexia recognition and immediate response.
Stroke: hemisphere-specific presentations, synergy patterns, neglect versus hemianopsia, pusher syndrome, and constraint-induced therapy criteria.
Motor control and learning: blocked versus random practice, massed versus distributed, knowledge of results versus knowledge of performance, feedback frequency and the retention paradox.
Vestibular: BPPV canal identification and repositioning manoeuvres, unilateral hypofunction and gaze-stabilisation exercises, central versus peripheral signs.
Parkinson disease: Hoehn and Yahr staging, freezing and cueing strategies, amplitude-focused training.
Peripheral nerve: root versus peripheral distributions, Wallerian degeneration timelines, tendon-transfer implications.
Paediatrics: developmental milestones, cerebral-palsy classifications, reflex integration ages.

Common mistakes

Choosing the intervention that improves performance during the session rather than retention, which is what motor learning actually asks about.
Missing autonomic dysreflexia because the blood pressure is only "high for the patient".

Worked example

A C6 complete tetraplegia patient wants independent transfers. Tenodesis grasp is available but triceps are not, so a sliding-board transfer with momentum and head-hips relationship is the trained method; a lateral push-up transfer needs C7.

Original practice questions

Neuromuscular and Nervous SystemsDifficulty 3/5

A patient with complete C6 tetraplegia is learning transfers. Which method matches the available musculature?

ASliding-board transfer using momentum and the head-hips relationship
BIndependent standing pivot transfer with a hemi-walker for support
CDependent mechanical lift transfer for all surfaces and situations
DLateral push-up transfer using triceps to lift and clear the trunk

Show answer and rationale

Correct: A. C6 provides wrist extension and tenodesis grasp but no triceps, so a sliding board with momentum and the head-hips relationship is the achievable independent method. Lateral push-up transfers require C7 triceps.

D — Triceps innervation begins at C7, not C6.
B — Standing pivot requires lower-limb motor function absent in complete tetraplegia.
C — C6 complete injury is compatible with independent transfers, so a lift underestimates the potential.

Neuromuscular and Nervous SystemsDifficulty 3/5

Which practice schedule best promotes long-term retention of a motor skill, even though in-session performance may look worse?

ABlocked practice of one task repeated until performance stabilises
BRandom practice interleaving several tasks within the session
CMassed practice with minimal rest between all repetitions
DConstant practice of a single parameter with unchanging conditions

Show answer and rationale

Correct: B. Random or interleaved practice depresses performance during acquisition but improves retention and transfer — the contextual-interference effect. Blocked practice flatters the session and fades afterwards.

A — Blocked practice improves acquisition performance but produces weaker retention.
C — Massed practice affects rest distribution rather than contextual interference.
D — Constant practice limits transfer to novel task variations.

Neuromuscular and Nervous SystemsDifficulty 3/5

A patient with a T4 spinal-cord injury develops a pounding headache, blood pressure of 180/110 and flushing above the lesion. What is the immediate action?

AApply a cold pack to the neck and provide reassurance about the headache
BLay the patient flat and elevate the legs to restore cerebral perfusion
CSit the patient upright, check for bladder distension and other triggers
DContinue the session at a lower intensity and monitor blood pressure

Show answer and rationale

Correct: C. This is autonomic dysreflexia, a medical emergency in injuries at or above T6. Sitting upright lowers blood pressure by orthostatic effect while the noxious stimulus — most often bladder distension — is identified and removed.

B — Lying flat raises blood pressure further and worsens the crisis.
D — Continuing any activity ignores a potentially fatal hypertensive event.
A — Symptom comfort measures do not address the underlying trigger.

All 3 Neuromuscular and Nervous Systems questions →

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Primary references

NPTE-PT Test Content Outline, effective January 2024 (v1.1) — Federation of State Boards of Physical Therapy (FSBPT) · primary · retrieved 2026-09-22, verified 2026-09-22

Last reviewed: 2026-09-22Next review by: 2026-12-21Draft — pending editorial reviewHow we verify facts