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What is the NBCOT® Exam?



To become a board-certified Occupational Therapist (OT) or Occupational Therapy Assistant (OTA) one must first pass the NBCOT® exam, which is administered by NBCOT®, the National Board for Certification in Occupational Therapy.  There are two versions of the NBCOT® exam, the OT exam and the OTA exam.  

What is the Length of the NBCOT® Exam?

The NBCOT® exam is a marathon, consisting of 4 hours of testing. Candidates will be at the testing center for slightly more than 5 hours total. Breaks are permitted, but the clock keeps running while you are taking a break.  Go to the NBCOT® exam website to schedule your test if you have not already done so.

What is the Format of the NBCOT® Exam?

NBCOT® exams are administered via computer. The OT exam contains 3 clinical simulation test items (CST) and 170 three and four-option multiple choice questions. The OTA test includes three and four-option multiple choice questions as well as multi-select questions with 6 answer choices. Three choices must be selected before the examine is allowed to proceed to the next question.  

The content of the exam is derived from practice analysis studies and is designed to ensure that candidates have the knowledge required to work as entry-level registered Occupational Therapists and Occupational Therapy Assistants.

Four main areas are covered in the exam:

  • Domain 1-17% of the exam- Acquire information regarding factors that influence occupational performance throughout the occupational therapy process.
  • Domain 2-28% of the exam – Formulate conclusions regarding client needs and priorities to develop and monitor an intervention plan throughout the occupational therapy process.
  • Domain 3-45% of the exam – Select interventions for managing a client-centered plan throughout the occupational therapy process.
  • Domain 4-10% of the exam – Manage and direct occupational therapy services to promote quality in practice.

Recommended Amount of Time to Study for the NBCOT® Exam

As you will see in the Topics to Study below, there is a lot of information to be absorbed to enable OT and OTA candidates to pass the NBCOT® exam.  We recommend 8-10 weeks of study to prepare for the exam. Many students have crammed in 2-4 weeks and have been successful, but most students need more time.

The NBCOT® Exam Cost

The exam registration is $550 each time a student takes the exam.  What we have found is that there is a significant additional cost that comes with not passing the NBCOT® exam on your first try.  For more on that, check out #9 on our Top 10 Mistakes Students Make article.

What is the average NBCOT® exam score and Passing Rates?

Passing rates of the NBCOT® exam continue to decline year-over-year.  For Occupational Therapists (OT) the passing rate declined from 78% in 2015 to 74% in 2016 and 72% in 2017.  Similarly, Occupational Therapy Assistants (OTA) passing rates have decreased from 67% to 64% to 63% in the same years.  Often, because students can score lower on their second attempt, this exam can seem even more daunting and overwhelming without a proper strategy and it could also be hard for a student to remain motivated while studying.  This process can also be quite stressful on family members and loved ones.  To learn more about what students wish they knew before taking the NBCOT® exam, go here.

Introduction to OT Theory and Medical Conditions 

This section covers the basics of occupational therapy, including frames of reference, service provision, rules and regulations, research and continuing education, as well as some helpful tips on how to take the exam and use our course.

Frame of Reference 

A frame of reference is a theoretical basis for a treatment approach. When studying occupational therapy treatments, try to provide examples of how the frames of references can be applied. Frames of references that use more complicated or structured approaches are sometimes called models.


To receive NBCOT® certification requires at least 36 Professional Development Units (PDUs) accrued during the 3-year renewal cycle for both Registered Occupational Therapists and Certified Occupational Therapy Assistants. One Professional Development Unit (PDU) is earned for each contact hour spent in structured learning. For conversion purposes, one (1) CEU equates to 10 PDUs.

OT Settings

Traditional settings an Occupational therapist works in include the school system, work clinics, and hospitals. Non-traditional settings include homeless shelters, fitness centers, community rehab programs, and onsite at job sites.

Code of Ethics

The Occupational Therapy Code of Ethics was developed by the American Occupational Therapy Association (AOTA) to document the core values and ethical principles that govern occupational therapy practice in the United States. The core values include Altruism, Equality, Freedom, Justice, Dignity, Truth and Prudence. There are also six Principles and Standards of Conduct. They are Beneficence, Nonmaleficence, Autonomy, Justice, Veracity, and Fidelity.

OT Process and 4 Levels of Intervention

When reading a question on the NBCOT® exam, always ask yourself what stage is the question referring to in the OT Process: referral, screening, evaluation, intervention, or discharge?


Roles of OT’s, OTA’s, and OT Aides

It is important to understand the difference between an OT and a OTA. An OT is responsible for all aspects of evaluation and treatment with the patient whereas a OTA assists with the evaluation and provides treatment under the supervision of the OT. An OT Aide does not provide skilled occupational therapy services and is not licensed in the field of occupational therapy.


Research and Statistics

As therapists, you will need to be able to access the large database of research related to occupational therapy practice. As you study, review the process and terminology behind using research to develop your occupational therapy practice as an entry level practitioner. Understand the types of research and hierarchy of evidence, important terminology, psychometric properties of assessments, qualitative research, quantitative research, sampling methods, statistical analysis, descriptive statistics, and normal distribution.


Payment for OT Services

The primary sources of payment for OT services in the United States include Medicare, Medicaid, and private insurance. It is important to understand coverage for Durable Medical Equipment (DME), what an occupational therapist can do if payment is denied, and utilization review.


Prevention Stages

There are three types of prevention; primary, secondary, and tertiary. Primary prevention reduces the risk of disease or disability in a healthy population. Secondary prevention attempts to prevent the disease from progressing by detecting it early. Tertiary prevention attempts to reduce the damage caused by symptomatic disease by focusing on mental, physical, and social rehabilitation.


The section on pediatrics covers topics related to the provision of occupational therapy services to children in a variety of settings, including clinical settings, public school, and birth to three programs.

Child Development: When reviewing child development  it is helpful to study according to age groups and categories. 0-3 months, 4-6 months, 7-10 months, 11-18 months, 19-24 months, 2-3 years, 3-4 years, 4-5 years, and 5-6 years. Some of the major categories to understand for these age groups are self-care skills including dressing and toileting, gross motor skills, fine motor skills, reflexes, and social/emotional development.

Childhood Occupations and Milestones: From birth to 14 years old a child has important milestones that develop in relation to gross motor skills, fine motor skills, feeding, and daily living skills.

Reflexes: The most important reflexes to study for the exam include rooting, suck-swallow, morrow, Galant, ATNR, palmar grasp, tonic labyrinthine-supine/prone, optical righting, Landau, STNR, Downward/Forward/Sideways/Backward parachute, and Babinski. Understand the definition and what it looks like in a photo.

Pediatric Diagnoses: Review some of the more common pediatric diagnoses, including causes, common problems, and occupational therapy interventions related to Acquired Brain injury, ADHD, Autism Spectrum Disorder, Cystic Fibrosis, Developmental Delay, Dyspraxia, Down Syndrome, Intellectual Disability, Spina Bifida, Traumatic Brain Injury, and Visual Impairments.

Down Syndrome: Down syndrome is the most common and readily identifiable chromosomal condition associated with mental retardation. Some of the major treatment interventions include adapting cardiovascular activities, providing an alternative method of communication, avoiding activities that place the neck in extreme flexion, and discouraging hyperflexible postures.

Spina Bifida: This condition is a neural tube defect involving the vertebral arches and the spinal column, resulting from genetic, intrauterine, and/or environmental factors. The types of Spina Bifida include Spina Bifida Occulta, Spina bifida Meningocele and Spina Bifida Myelomeningocele.

Cerebral Palsy: Types of Cerebral Palsy include spastic (the most common type), dyskinetic, ataxic, and mixed. These patients have various impairments, such as intellectual impairments, seizures, and growth problems. Most common interventions include neurodevelopmental therapy (NDT), orthotics, and positioning devices.

Hearing Loss: Children with deficits in hearing or deafness demonstrate significant delays in integration, balance, and the ability to carry out complex motor sequences. Occupational therapists are in a unique position to evaluate and treat sensorimotor and sensory integration problems in children with hearing loss.

IEP’s: An individualized education program, or IEP, is a written plan that specifies goals and objectives for learning for students in the public school system that have been identified as having a disability. IEPs are mandated for students with disabilities by the Individuals with Disabilities Education Act (IDEA) of 2004. Each IEP is prepared by a team and is tailored to meet the individual needs of each student.

Sensory Integration:  The basic premise of this theory is that adequate sensory processing in the nervous system plus the integration of sensory information in the brain will lead to adaptive behavior and functional abilities.

Handwriting: Handwriting is a fundamental skill for anyone school age and above. The underlying skills, such as visual motor, visual memory, and visual discrimination, required for handwriting, as well as ideas for therapeutic activities to address handwriting with children, are important to review for the exam.

IDEA: There are five parts of providing services to infants and toddlers with disabilities. They include 1) determining who needs services and referring them according, 2) determining if they are eligible for services, 3) developing the individualized family service plan (IFSP), 4) service delivery, and 5) transitioning the child from early intervention to another program at age 3.

Section 504: To receive occupational therapy services under Section 504, a student must understand what type of patient meets the requirements, how a patient would qualify for services in public school, and some examples of accommodations that might be provided under the plan.

Pediatric Assessments: It is important to know the most commonly used pediatric assessments such as the Beery, Sensory Profile, and the Bayley Assessment for the exam. As you study, focus on the purpose, method and population.

Physical Dysfunctions and Treatment Methods

This section reviews the evaluation and treatment of physical conditions, including injuries and disease processes, as well as the relation of physical function to activities of daily living.

Hands and Upper Extremities: Hands and Upper Extremities can be one of the most difficult topics to study for the exam. Many students find it helpful to study this topic in categories. This includes breaking up the conditions according to upper extremity anatomy, nerve compression syndromes, nerve lacerations, tendonitis, tendon lacerations, muscle overuse, ligament injuries, arthritis, bone fractures, and shoulder conditions.

Splints: Splints are rigid or semi-rigid devices used to either support or immobilize an extremity. As you study, focus on general considerations, splinting precautions, types of splints (static/dynamic), and casting.

Range of Motion: Range of motion refers to the directions and limits of movement in each joint of the body. During evaluation, range of motion is measured using a full circle, half circle, or finger goniometer. Understand the terms that are related, joint and motion measurements, contractures, and treatment techniques to increase range of motion.

MMT: Manual muscle testing is a method used to test the strength of individual muscles in isolation, as well as specific muscle groups. The testing method helps to determine a muscle’s functional performance during a movement against gravity and resistance. As you study it is important to think about treatment techniques for patients at each level.

PAM’s: Physical agent modalities use various forms of energy to modulate pain, modify tissue healing, increase tissue extensibility, modify skin and scar tissue and decrease edema/inflammation. PAMs are used in preparation for or concurrently with purposeful and occupation-based activities. As you study, learn the indications, administration techniques, precautions, and contraindications.

Grasp Patterns: Grasp patterns are the coordinated movements the hand uses to pick up and hold objects. These patterns affect how people learn and interact with the environment. They have a significant effect on how people participate in functional activities. Grasp patterns can influence the level of independence a person has during daily tasks. As you study, understand these patterns including if thumb opposition is required, as well as what each person can grasp and not grasp.

MET Levels and Cardiac Rehab: The Metabolic Equivalent of Task, or MET level, is the approximate amount of energy a person uses during physical activity. These levels are used as a reference point during cardiac rehabilitation. For each MET level range know the activity restrictions, sample activities, and how to monitor patients.

COPD: Chronic obstructive pulmonary disease, abbreviated COPD, involves chronic inflammation of the lungs that reduces airflow. Know the symptoms, treatments, precautions, and the exertion scale.

Semmes Weinstein Monofilament Test: This test is used to evaluate cutaneous sensation levels throughout the body. It helps to diagnose nerve compression syndromes, peripheral neuropathy, thermal injuries, and postoperative nerve repair.

FIM Levels: The Functional Independence Measure, or FIM, is an assessment tool used to track outcomes in hospitals and skilled nursing facilities. It is important to review the functional levels and what the numbers mean in term of a patient’s level of independence related to activities of daily living, mobility, and cognitive tasks.

Occupational Therapy Terms, Conditions Caused by Injury, and Conditions Related to Aging

Information pertinent to the treatment of certain conditions are included in this section, addressing injuries caused by trauma and conditions related to aging. Terms used to refer to certain aspects of occupational therapy treatment are also addressed.


When reviewing functional status by spinal cord level, for each level review the key muscles innervated, movements possible, patterns of weakness, functional potential/ADLs, bowel and bladder management, mobility, and assistive equipment.


Burns: When a burn occurs, the injury is classified by severity and total body surface exposed. Understand the phases of wound healing, medical management, ways to evaluate and treat, and positioning/splinting options.


Amputations and Prosthetics: A loss of a limb can occur from congenital deformity, traumatic amputation, or surgical amputation. Have a good understanding of amputation management, treatment techniques, types of prosthetics, components of a prosthetic, treatment techniques, and prosthetics for children.


Hip, Knee, and Back: These three procedures, total hip replacement, total knee replacement, and low back surgery all involve precautions related to bending. While studying review precautions for each operative procedure, occupational therapy treatment techniques, and adaptations to compensate for bending.


Rancho Los Amigos Levels:  The Rancho Los Amigos levels are designed to indicate the behavior and progression of function as the brain injury patient participates in treatment. Focus mainly on levels 4,5, and 6.


Neurological Treatment Approaches: While reviewing this topic review the traditional neurological treatment approaches of Neurodevelopmental Treatment (NDT), Proprioceptive Neuromuscular Facilitation (PNF), the Brunnstrom approach and the Rood approach. Have a good understanding of the treatment techniques, reactions, and the principles.


Adaptive Eating: Adaptive eating utensils are used by people who have problems grasping standard utensils. Conditions such as arthritis, Parkinson’s disease, CVA, multiple sclerosis, and numerous others cause deficits in fine motor skills and tactile sensation that make grasping and manipulating utensils difficult. It is important to review a variety of adaptive eating utensils, as well as adaptive cups, plates, bowls, and other accessories that people with disabilities might use during meals.


Bottom vs. Top Approach: The term bottom up” and top down” refer to the approach occupational therapists take when evaluating and treating patients. As you study, focus on the definitions and differences between these two approaches.


Vision: It is important to review the anatomy of the eye and the more common conditions that can lead to visual impairment, as well as the roles of health care professionals in the treatment of low vision and therapeutic interventions for low vision.


Aging in Place: Aging in Place is the idea that an elderly person will be able to live in the residence of his or her choice for as long as possible. To age in place a person must be able to have their needs met and maintain quality of life. It is important to review some of the physical and cognitive changes that may occur as people age and the adaptations that can be provided to allow people to continue to live at home.

Neurological Conditions and Topics Related to Independent Living

This section includes a review of degenerative neurological disorders, as well as adaptations to compensate for disability in the areas of mobility, technology, driving, and return to work.

Neurodegenerative Disorder – As you study neurodegenerative and neuromuscular disorders review the definitions, symptoms, and interventions for multiple sclerosis, amyotrophic lateral sclerosis, Parkinson’s disease, Guillain-Barre Syndrome, and myasthenia gravis.


CVAA CVA, commonly known as a stroke, is a complex neurological dysfunction that is caused by a lesion in the brain. As you study, review the causes and symptoms of CVA, as well as occupational therapy treatment methods.


Parkinson’s DiseaseParkinson’s disease is a progressive disorder of the nervous system. As you study, review causes and symptoms of this disease, as well as occupational therapy evaluations, treatments, and adaptations.


Huntington’s DiseaseHuntington’s Disease is a progressive neurological disorder. It is important to review the motor control, cognitive and psychiatric symptoms, and implications for occupational therapy treatment.


WheelchairsAs you review types of wheelchairs, it is important to know the different types of wheelchairs, the different parts of a wheelchair, various assistive technology items that people who use wheelchairs utilize, how that item is used, and who would best use that item.


Assistive TechnologyAssistive technology is a broad term that can include any device that helps a person to increase independence during a task. In the field of occupational therapy, most low-tech devices are referred to as adaptive equipment rather than assistive technology, so for the purposes of studying for this test, assistive technology will be limited to electronic devices, computer software, and apps that help people to function independently when using high tech items, including computers, tablets, smartphones, communication devices, and environmental controls. It is important to know the more commonly used assistive technology items.


Work and vocational rehabOccupational therapists play a vital role in helping people to gain the functional skills they need to return to work or to obtain employment. It is important to review the various aspects of occupational therapy intervention in the areas of work reconditioning and vocational rehabilitation, what to consider when providing services to clients who want to return to work or who want to start working in the first place, and how OT’s and OTA’s are involved in this process.


Driver RehabilitationOccupational Therapists who specialize in this area of practice, help people who have lost the ability to drive due to disability, to regain their driving abilities. As you study, have an overall review of the requirements to practice in this area, the evaluation process, clinical interventions, and assistive technology available for people with specific disabling conditions.


ApraxiaApraxia is a movement disorder that results in difficulty with motor planning. The terms apraxia and dyspraxia are often confused and sometimes used interchangeably. Understand the differences between the various terms and how to label the characteristics.

Mental Health Issues and Treatment Methods

The various aspects of occupational therapy intervention for mental health disorders and cognitive impairment, including Alzheimer’s Disease, are included in this section. Strategies for group treatment are also addressed here.

Mental Health Diagnoses: As you study the different mental health diagnoses, play close attention to the symptoms, challenges, support/ treatment, and interventions for each.  


Mental Health Terms: Terms related to mental health include acceptance, apraxia, clubhouse, community-based mental health services, delusions, denial, hallucinations, supported employment, and long-term hospitalization.


Activity Groups: There are 6 types of activity groups (evaluation, task, developmental, topical, and instrumental). Review the key element to therapeutic approach, the role of the therapist, and types of group interventions.


Developmental Groups: A group starts from the most basic level and then develops and advances. The 5 developmental groups are parallel, project, egocentric-cooperative, cooperative, and mature). Review the key element to therapeutic approach, the role of the therapist, and types of group interventions.


ACL: The Allen Cognitive Levels Screening Test, abbreviated ACL, is a functional assessment that helps to determine a person’s cognitive level. The test is a standardized screening that is used to obtain a quick measure of a person’s cognitive abilities, including processing, learning, problem solving, and applying cognitive processes to functional activities. It goes from level 1 to level 6.


Alzheimer’s Disease: Review the 7 stages of Alzheimer’s Disease progression, including symptoms, and treatment examples.


Cognitive and Perceptual Assessments: There are 7 main cognitive and perceptual assessments to understand for this test. It is important to know the purpose, the method, and the population for each.

How to Study for the NBCOT® Exam

Let us show you a better way to prepare with our highly beneficial AATM method.

The Pass the OT Approach – Assess, Address, Test, Master


When you begin studying, it is important to start with an assessment exam to find out where your strengths and weaknesses lie in order to prevent feeling overwhelmed as you work through the preparation process.

Using a 200-question or 100-question timed assessment test that mimics the actual exam and analyzes your results to show the sections where you have more difficulty. You should concentrate your efforts on these areas, study your weakest topics first, and gradually work your way to your strongest. This will reduce your test anxiety and increase your confidence as you get closer to the actual exam. It will also give you more time to learn the information that tends to be more difficult.



Create and follow a study schedule so you know exactly what to study every day until you take the exam.


Using a program that addresses the major topics that are covered in the NBCOT® exam and breaks them down into structured organized modules, as well as eliminates the guesswork of what to study and when can make studying a lot easier, more enjoyable, and a lot more effective. Students often get overwhelmed by too much information or don’t have a plan of attack to address all the areas covered in the exam. It is important to master one topic at a time and then move on to the next topic. Some topics such as pediatric development require much more time and concentration compared to other topics such as Glasgow coma scale. One needs to allocate time accordingly.



Use timed and untimed quizzes after all the key topic areas that simulate the actual test.

We recommend taking these quizzes after you feel you have mastered the material. It is most important that you focus on the clinical applications and the rationale behind the questions. We have found that if students don’t test themselves with quizzes that are similar to the NBCOT® exam with the added pressure of time, when it comes to the actual test, they aren’t ready for it from a stamina or pressure standpoint.


Study the rationale behind your wrong answers first. Since 50% of the actual exam is based on clinical applications, it is most important that you focus on the clinical applications and the rationale behind the questions. If you get a question wrong, think about why the answer is correct and how the other answer choices would be correct in a different situation. Reviewing incorrect questions is one of the most important facets of studying. Appropriate time should be put into it.



Work with an expert so that you can truly understand the material you are struggling with

Often, students tend to study over and over and continually get the same test score. This happens when a student is not mastering the material they need to and may be missing something.  

Working one-on-one with a tutor, a certified OT and/or OTA professional who goes through extensive training and has a proven track record, can make a tremendous impact in your test preparation and on your performance on the exam. A tutor for the NBCOT® exam can test your critical thinking, go through interventions related to different topics, help you break down questions especially when two answer choices seem correct, hold you accountable, build your confidence, reduce test anxiety, and give you that extra push. They also can make sure that you clearly understand the questions that are being asked as well as the clinical reasoning behind the answers. This in turn will lead to higher scores and more correct answers.

Different approaches to studying for different types of learners

Everyone learns differently, and everyone approaches tests differently. Not everyone learns best from reading a large, boring textbook or from taking random test questions from all different topics at once.  Knowing the learning style that works best for you can be extremely helpful and it can make your studying much more efficient. Some students can study effectively by reading a book all day long while others are more auditory, visual, and kinesthetic learners. Pass The OT offers a multitude of ways to cater to these different learning styles such as tutors, audio recordings and videos.


  • Visual learners often prefer using charts, pictures, diagrams, and videos. They also may be most comfortable focusing on pictures and watching videos.
    • Here is an example of one of our videos:

  • Verbal learners prefer learning from words, whether written or spoken.  They find repeating the words out loud or recording themselves explaining topics very useful.  Working with a tutor can be very useful for this type of learner. You can learn more about our amazing tutors and the results they have achieved.
  • Auditory learners prefer listening over reading books or watching videos.  This type of learner often understands material best when listening to audio recordings or matching long reading lists to music or songs.
    • Example of one of our audio recordings:

[s3bubbleAudioSingle bucket=”nbcotlessonaudio” track=”pnf-vs-ndt-group-call.mp3″ autoplay=”false” download=”false” style=”bar” preload=”auto”/]

  • Kinesthetic or tactile learners tend to prefer a more physical style of learning, whether that’s writing flash cards or drawing splints on their own arm.

Pass the OT provides flashcards to assist in the study process. You can gain access to them when you sign up for a free trial at passtheot.com

What to avoid

Excerpt from: What to Avoid When Studying for the NBCOT® Exam

  1. Memorizing endless amounts of test questions but not understanding the rationale.
  2. Using resources that are outdated, overwhelming or, don’t have sufficient structure.
  3. Not making your studying time count – we all get distracted, but we need to make sure that the studying is efficient. 

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