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Exam Code: NBCOT-COTA
Exam Name: Certified Occupational Therapy Assistant (COTA)
Number of Questions: 190 questions, consisting of single-response multiple-choice items (3 or 4 options) and six-option multi-select items where candidates must choose the three best answers.
Time Allotted: 4 hours to complete the exam. The total appointment time at the testing center is approximately 4 hours and 45 minutes, including check-in, optional tutorials (which do not count against exam time), and other administrative procedures.
Passing Marks: The exam is scored on a standardized scale from 300 to 600, with a minimum scaled score of 450 required to pass. This is a criterion-referenced exam, and the passing standard is based on the total number of questions answered correctly, not a percentage or domain-level performance.

1. Impact of typical development and aging on occupational performance, health, and wellness across the life span
2. Expected patterns, progressions, and prognoses associated with conditions that limit occupational performance
• signs and symptoms of disease
• stages of disease
• secondary complications
3. Impact of body functions and body structures on occupational performance
• cognitive impairments
• congenital anomalies
4. Influence of lived experiences and identity on occupational performance
• history of trauma and adverse childhood events
• socioeconomic status
• gender, race, culture, religion

1. Resources for acquiring information about the clients current condition and occupational performance
• referrals
• client records
• developmental history
• Individualized Education Program (IEP) plans
2. Purpose, advantages, limitations, and service competency needs related to the administration of standardized and nonstandardized exams and screening methods
• criterion-referenced tests
• norm-referenced tests
• client and caregiver interviews
• observation
3. Internal and external factors influencing a clients engagement in occupation
• roles, habits, routines, and rituals
• environmental context
• family and social supports
• medication side effects and interactions
• mental health

1. Task requirements, steps to task completion, and task demands across contexts or settings
2. Personal and environmental factors that facilitate or inhibit task completion or occupational
engagement
• compensation patterns
• role of performance context
• influence of current conditions

1. Roles and responsibilities among interprofessional teams when coordinating client care and
providing services
• referral to and consultation with other services
• interprofessional communication methods
• scope of practice

2. Processes for supporting interprofessional intervention plans
• Individualized Education Program (IEP) plans
• discharge plans
• transition plans
• palliative and hospice care plans

3. Client-centered approaches and considerations for coordinating occupational therapy services
• therapeutic use of self
• advocacy
• frequency/duration of intervention
• level of service delivery

4. Factors used to prioritize intervention goals and activities in collaboration with the client and family, teacher, caregiver, and relevant others
• client-reported outcomes
• level of support required
• context of service delivery
• progress toward goals

5. Strategies for addressing and enhancing health literacy with the client and relevant others
• caregiver training
• teaching-learning models
• methods for making health information accessible
• informed decision-making
• navigating challenges to professional expertise

1. Factors for determining and managing context and activities to meet individual and group intervention goals and objectives
• client needs and priorities
• response to intervention

2. Strategies for monitoring the effectiveness of individual and group intervention
• client-reported outcomes
• reevaluation results
• progress toward goals

3. Clinical decision-making for prioritizing goals and implementing modifications to the intervention plan based on client responses, under the supervision of the OTR
• physiological changes
• behavioral reactions
• emotion regulation
• developmental needs

4. Precautions or contraindications associated with a client condition or stage of recovery
• postsurgical precautions
• vital signs
• laboratory values
• suicidal ideation

1. Considerations for selecting, preparing, and adapting the intervention technique to support optimal engagement and promote goal achievement
• client condition
• client safety
• theoretical approach and frame of reference

2. Considerations for selecting, preparing, and adapting the intervention environment to support optimal engagement and promote goal achievement
• ensuring privacy during telehealth sessions
• equipment safety
• line management

3. Indications, contraindications, and precautions associated with wounds and maintaining skin integrity
• stage of wound healing
• prevention and management of pressure ulcers

4. Indications, contraindications, precautions, and clinical application of superficial thermal agents
• dry whirlpool
• hot packs
• cryotherapy

1. Interventions for supporting leisure and play
2. Methods for grading an activity, task, or technique based on level of development, client status, response to intervention, and client needs
3. Considerations for facilitating individual and group participation in shared activities
• group processes
• group dynamics
• group type and function

4. Interventions to support cognitive, visual-motor, visual, and perceptual processing and sensory arousal
• sensory modulation
• proprioceptive input
• vestibular strategies
• low vision strategies

5. Compensatory and remedial strategies for managing cognitive and perceptual deficits or developmental disabilities
• graded cueing
• chaining
• metacognition
• memory aids

6. Adaptive and preventive strategies for supporting optimal engagement in occupation
• use of technology/apps
• joint protection
• task simplification
• energy conservation

7. Intervention strategies and techniques used to facilitate oral motor skills for drinking, eating, and swallowing
• hand-to-mouth patterns
• mastication
• adaptive utensils
• positioning at mealtime

8. Prevocational, vocational, and transitional services, options, and resources for supporting strengths, interests, employment, and lifestyle goals across the life span
9. Strategies, techniques, and client-centered education to facilitate functional transfers
10.Strategies for promoting wellness and mental health
• relaxation
• sleep hygiene
• addiction management

1. Methods for grading therapeutic exercise and conditioning programs consistent with indications and precautions
2. Techniques for sensory and motor reeducation, pain management, desensitization, edema reduction, and scar management
• manual edema mobilization
• nerve gliding
• neuromuscular reeducation
• constraint-induced movement

3. Techniques for promoting improved postural stability, dynamic balance, body mechanics, and breathing patterns during functional tasks

1. Types and functions of immobilization, mobilization, and restriction orthoses for managing specific conditions and congenital anomalies across the life span
2. Types and functions of prosthetic devices for upper and lower extremity amputations
3. Implications of anatomical, physiological, biomechanical, cognitive, and socioeconomic factors and healing principles for orthotic selection, design, fabrication, and modification
4. Client-centered education and training methods for the safe and effective use of orthotic and prosthetic devices

1. Factors related to measuring, selecting, monitoring the fit of, and recommending modifications to seating systems, positioning devices, and mobility aids
• equipment components
• biomechanical considerations
• usability and maintenance

2. Types, characteristics, and features of high- and low-tech assistive technology and adaptive devices
• interface options and processor parameters
• equipment components
3. Mobility options, vehicle adaptations, and alternative devices for supporting participation in community mobility
• adapted driving controls
• wheelchair tie downs
• alternative transportation options
• dynamic mobile standers
• navigation apps

4. Client factors influencing successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment
• developmental, physical, functional, cognitive, and mental health status
• prioritized needs
5. Client-centered education and training methods for successful use and maintenance of assistive technology options, adaptive devices, mobility aids, and other durable medical equipment

1. Principles of ergonomics and universal design for identifying, recommending, and implementing features and reasonable accommodations in the workplace, home, and virtual and public spaces
2. Processes and procedures for identifying, recommending, and implementing modifications in the workplace, home, and virtual and public spaces

1. Methods for locating, reviewing, and interpreting scholarly research to guide practice-relevant decision-making
• applying the Patient, Intervention, Comparison, Outcome (PICO) model
• identifying best evidence

2. Methods for contributing to continuous quality improvement processes and procedures related to occupational therapy service delivery
• program evaluation
• acquiring information to measure outcomes

3. Types of evidence-based programming for advancing population health outcomes
• aging in place
• fall prevention
• health and wellness
• community support groups

1. Infection control procedures and universal precautions for reducing transmission of contaminants
• PPE
• isolation precautions
• cleaning equipment
2. Responses to adverse reactions, minor injuries, and emergency situations
• minor burns and cuts
• seizures
• diabetic reactions
3. Preventive measures for minimizing risk and promoting safety
• proper body mechanics
• safety data sheet (SDS)
• standard operating procedures
• equipment maintenance
• emergency preparedness
• personal safety in the clients environment
4. Strategies and resources to prevent professional burnout
• exam of personal needs
• self-advocacy regarding workload
• stress management

1. Application of federal regulations, state practice acts, facility policies, and accreditation
guidelines related to service delivery across occupational therapy practice settings
• health care legislation
• accreditation organizations
• licensing and credentialing
2. Influence of reimbursement policies and guidelines on occupational therapy service delivery
3. Accountability processes and procedures for justifying, tracking, and monitoring outcomes
• relevant practice terminology
• documentation guidelines

1. Methods for identifying, documenting, and monitoring service competency and professional development needs
• competency self-assessment
• mentoring
2. Application of ethical decision-making and professional behaviors guided by the NBCOT Practice Standards and Code of Conduct\