Orthotics CPM ROM, MMT and Special Tests Study Guide
*As of the 2025-2026 testing cycle, there is no upper limb content on the Orthotics CPM
exam. This can be verified on the ABC testing site.*
Lower Limb Range of Motion and Manual Muscle Testing:
Key Terms:
Spasticity: An increase involuntary velocity dependent muscle tone that is resistance to
movement.
Tone: The amount of tension in a muscle at rest.
Clonus: Involuntary muscle contractions that present as uncontrollable rhythmic shaking
movements. Oten described in beats – 1 spasm followed by relaxation is 1 beat.
Manual Muscle Testing Grading
Value: Description: Performance:
0 Zero No muscle contraction felt or observed.
1 Trace Muscle contraction is observed, but the body part does not
move.
2 Poor Ability to partially move the body parts against gravity OR able
to fully move the body part in a gravity eliminated position.
3 Fair Ability to move the body part into test position and hold against
gravity.
4 Good Ability to hold the test position against gravity and moderate
force.
5 Normal Ability to hold the test position against gravity and against
maximum force.
ROM Testing at the Ankle:
o Dorsiflexion: 0-20 degrees.
▪ Position: patient is seated with knee flexed.
▪ Normal End Feel: Firm
▪ Goniometer Placement: Proximal arm follows the midline of the
fibula, the fulcrum is aligned over the lateral malleoli, and the distal
arm is parallel to the 5th metatarsal.
, o Plantarflexion: 0-45 degrees.
▪ Position: Seated with knee flexed.
▪ Normal End Feel: Firm.
▪ Goniometer Placement: Proximal arm follows the midline of the
fibula, the fulcrum is aligned over the lateral malleoli, and the distal
arm is parallel to the 5th metatarsal.
o Inversion: 0-35 degrees.
▪ Position: Patient is prone with feet hanging off end of table.
▪ Normal End Feel: Firm
▪ Goniometer Placement: Proximal arm is aligned with the midline of
the posterior leg, fulcrum is positioned posterior and is midway
between the malleoli, and the distal arm is aligned with the posterior
midline of the calcaneus.
o Eversion: 0-20 degrees.
▪ Position: Patient is prone with feet hanging off end of table.
▪ Normal End Feel: Firm.
▪ Goniometer Placement: Proximal arm is aligned with the midline of
the posterior leg, fulcrum is positioned posterior and is midway
between the malleoli, and the distal arm is aligned with the posterior
midline of the calcaneus.
MMT at the Ankle:
o Dorsiflexion:
▪ Primary Position: Seated with knee flexed, practitioner stabilizes the
tibia and fibula to prevent knee/leg motion.
▪ Gravity eliminated position: Patient is supine with knee flexed,
practitioner stabilizes tibia and fibula.
o Plantarflexion:
▪ Primary position: Patient is prone with the knee extended, practitioner
stabilizes tibia and fibula to prevent knee/leg motion.
▪ Gravity Eliminated Position: Patient is side lying, practitioner stabilizes
the tibia and fibula to prevent knee/leg motion.
o Inversion:
▪ Primary Position: Patient is seated with knee flexed and foot is in slight
plantarflexion, practitioner stabilized the tibia and fibula to prevent
knee/leg movement.
▪ Gravity Eliminated position: Same as Primary position.
*As of the 2025-2026 testing cycle, there is no upper limb content on the Orthotics CPM
exam. This can be verified on the ABC testing site.*
Lower Limb Range of Motion and Manual Muscle Testing:
Key Terms:
Spasticity: An increase involuntary velocity dependent muscle tone that is resistance to
movement.
Tone: The amount of tension in a muscle at rest.
Clonus: Involuntary muscle contractions that present as uncontrollable rhythmic shaking
movements. Oten described in beats – 1 spasm followed by relaxation is 1 beat.
Manual Muscle Testing Grading
Value: Description: Performance:
0 Zero No muscle contraction felt or observed.
1 Trace Muscle contraction is observed, but the body part does not
move.
2 Poor Ability to partially move the body parts against gravity OR able
to fully move the body part in a gravity eliminated position.
3 Fair Ability to move the body part into test position and hold against
gravity.
4 Good Ability to hold the test position against gravity and moderate
force.
5 Normal Ability to hold the test position against gravity and against
maximum force.
ROM Testing at the Ankle:
o Dorsiflexion: 0-20 degrees.
▪ Position: patient is seated with knee flexed.
▪ Normal End Feel: Firm
▪ Goniometer Placement: Proximal arm follows the midline of the
fibula, the fulcrum is aligned over the lateral malleoli, and the distal
arm is parallel to the 5th metatarsal.
, o Plantarflexion: 0-45 degrees.
▪ Position: Seated with knee flexed.
▪ Normal End Feel: Firm.
▪ Goniometer Placement: Proximal arm follows the midline of the
fibula, the fulcrum is aligned over the lateral malleoli, and the distal
arm is parallel to the 5th metatarsal.
o Inversion: 0-35 degrees.
▪ Position: Patient is prone with feet hanging off end of table.
▪ Normal End Feel: Firm
▪ Goniometer Placement: Proximal arm is aligned with the midline of
the posterior leg, fulcrum is positioned posterior and is midway
between the malleoli, and the distal arm is aligned with the posterior
midline of the calcaneus.
o Eversion: 0-20 degrees.
▪ Position: Patient is prone with feet hanging off end of table.
▪ Normal End Feel: Firm.
▪ Goniometer Placement: Proximal arm is aligned with the midline of
the posterior leg, fulcrum is positioned posterior and is midway
between the malleoli, and the distal arm is aligned with the posterior
midline of the calcaneus.
MMT at the Ankle:
o Dorsiflexion:
▪ Primary Position: Seated with knee flexed, practitioner stabilizes the
tibia and fibula to prevent knee/leg motion.
▪ Gravity eliminated position: Patient is supine with knee flexed,
practitioner stabilizes tibia and fibula.
o Plantarflexion:
▪ Primary position: Patient is prone with the knee extended, practitioner
stabilizes tibia and fibula to prevent knee/leg motion.
▪ Gravity Eliminated Position: Patient is side lying, practitioner stabilizes
the tibia and fibula to prevent knee/leg motion.
o Inversion:
▪ Primary Position: Patient is seated with knee flexed and foot is in slight
plantarflexion, practitioner stabilized the tibia and fibula to prevent
knee/leg movement.
▪ Gravity Eliminated position: Same as Primary position.
