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COURSE CODE
HOURS PRICE
Components of Ethics for Healthcare Professionals (Mandatory)
2 $37 PTCA02CE-H
Aging Spine Fitness: Evidence-Based Strengthening Techniques for Seniors from Frail to Active
3 $55 PTCA03AS-H
Evidence-Based Balance Rehabilitation and Fall Prevention
6 $105 PTCA06FP-H
Supportive Living Environments for Older Adults
5 $89 PTCA05SL-H
Understanding and Implementing Trauma-Informed Care for Clients in Pain
4 $72 PTCA04UN-H
Vestibular Rehab for Non-Dizzy Patients
6 $105 PTCA06VR-H
This 26-Hour Summary Book
26 $260 PTCA2627HB
Book Expiration Date: 12/31/2027
INCLUDED IN THIS BOOK
1
Components of Ethics for Healthcare Professionals (Mandatory) [2 contact hours]
Ethical behavior is a fundamental component of all healthcare professions, regardless of where or how they practice. The purpose of this course is to provide healthcare professionals a broad overview on the study of ethical behavior and action as it is applied to practice, education, and research. The course will define terms used in discussing ethics, describe general principles and values of ethics and standards of conduct, and explain a decision-making process for analyzing ethical issues and potential disciplinary actions or sanctions that might occur if unethical behavior is determined by professional and/ or credentialing organizations. Case studies are included throughout to stimulate reflection and direct application to practice examples. 10 Aging Spine Fitness: Evidence-Based Strengthening Techniques for Seniors from
Frail to Active [3 contact hours]
Back pain is a common condition in older adults, affecting 21 to 68% of adults older than 60 years of age. Providing rehabilitation to this population is often complicated by age related changes to the spine, co- morbid conditions, and decreased functional mobility. This course will look at important biomechanical concepts regarding spine strengthening and how these biomechanics change with aging. We will look at common spine diagnoses in older adults and outline how to effectively prescribe strengthening exercises that are safe and effective. The goal is to improve your clinical confidence and success in treating older adults with back pain. 19 Evidence-Based Balance Rehabilitation and Fall Prevention [6 contact hours] This course is intended for physical therapy, occupational therapy and athletic training practitioners who address balance impairments and work to reduce falls in their patients and communities. This course defines balance and its components, describes how the various balance issues fall into these component categories and categorizes these impairments accordingly. It will outline how to assess balance and interpret the many varied assessment tools available. Taking this information, clinicians will see how to systematically approach balance rehabilitation, including how to prioritize needs, account for patient background and resources, and work towards long term falls reduction. Finally, this course discusses current guidelines for community level fall prevention strategies and how therapists can be more involved with this process. 28 Supportive Living Environments for Older Adults [5 contact hours] This course provides a detailed description of varied options supporting the well-being of older adults throughout the trajectory of the senior life course. While the term aging in place expresses a desire shared by many older adults, it is imperative for the environment to support the realities of the aging body, physical and mental changes, and the ability to access meaningful relationships that can ensure psychosocial needs are met. Identifying other solutions to support healthy aging is important for healthcare professionals who can serve as resources for older patients, educating them about options and opportunities for healthy aging and the ability to thrive throughout life. This course will provide learners with knowledge on communities designed around aging adults, supportive services, innovative technologies, and devices designed create safer environments—all in an effort to maintain a sense of independence in any home and/or community.
COURSE LIST CONTINUED ON NEXT PAGE ►
INCLUDED IN THIS BOOK (CONTINUED)
36 Understanding and Implementing Trauma-Informed Care for Clients in Pain [4 contact hours] This course explores the principles and practices of a new trauma-informed healthcare system and how we can be a part of that transformative change today. Participants will review the prevalence and impact of chronic pain and trauma in society to help understand the implications this can have on our clients. The course provides clear guidelines for maintaining professional boundaries while effectively supporting those experiencing pain and trauma. The curriculum includes an in-depth study of the autonomic nervous system, focusing on the vagus nerve’s role in stress, connection, and safety. Additionally, participants will learn about polyvagal theory and its application in working with clients suffering from trauma and chronic pain. By the end of the course, participants will be equipped with the knowledge and skills to adopt a trauma-informed perspective in their professional practice, promoting better outcomes for their clients and themselves. 47 Vestibular Rehab for Non-Dizzy Patients [6 contact hours] Balance dysfunction is one of the leading causes of functional limitation and even disability among elderly patients. And when working to improve a patient’s balance, the vestibular system is often overlooked, which is regrettable, as a large portion of our balance is derived from this system. This course focuses on adding specific vestibular assessment and training tools to a therapist’s skills to further maximize a patient’s reduced fall risk and overall functional independence.
Colibri Healthcare, LLC’s courses are approved by Colibri Healthcare, LLC, a recognized Approval Agency by the Physical Therapy Board of California (PTBC).
FREQUENTLY ASKED QUESTIONS
License Expires
CE Hours Required
Mandatory Subjects
2 hours Ethics, Laws, and Regulations 4 hours Basic Life Support for Health Care Professionals
Biennial renewal. Licenses are required to renew by the last day of their birth month every two years
30 (26 hours are allowed through home-study)
Are you a California board-approved provider? Colibri Healthcare, LLC’s courses are approved by Colibri Healthcare, LLC, a recognized Approval Agency by the Physical Therapy Board of California (PTBC). Are my credit hours reported to the California board? No. The California Board of Physical Therapy performs random audits at which time proof of continuing education must be provided. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Physical-Therapy you will see our robust FAQ section that answers many of your questions. Simply click FAQs at the top of the page, email us at office@elitelearning.com, or call us toll-free at 1-888-857-6920, Monday - Friday 9:00 am - 6:00 pm EST, Saturday 10:00 am - 4:00 pm EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. Disclosures: Resolution of conflict of interest Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners. Disclaimer: The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.
©2026: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers.
1
Components of Ethics for Healthcare Professionals (Mandatory) 2 Contact Hours
ACCESS THE FULL PRESENTATION Scan the QR CODE ► to start video or visit https://qr2.mobi/EthicsHCPros
Author Elizabeth D. DeIuliis, OTD, OTR/L, CLA, FNAP, FAOTA
Ms. Deluliis has over 20 years of experience as a credentialed occupational therapy practitioner. She serves as a clinical associate professor and program director in the Department of Occupational Therapy at Duquesne University. She is a fellow in both the National Academies of Practice and the American Occupational Therapy Association (AOTA). Dr. DeIuliis has earned her academic leadership credential through AOTA's Academic Leadership Institute and has authored several textbooks; published numerous peer-reviewed articles; and presented at state, national, and international conferences on topics including professionalism, ethics, experiential learning pedagogies, and interprofessional education.
LEARNING OUTCOMES ● Define ethics terms, theories, principles, and sources of ethical issues common across healthcare professions and settings. ● Recognize general ethical principles, standards of conduct, and basic enforcement procedures.
● Recall a general decision-making process to resolve ethical questions/dilemmas across healthcare professions and settings.
SELF-ASSESSMENT QUESTIONS
1.
Here is an example statement from a code of ethics document: "Providers shall respect the inherent dignity and worth of individuals." This statement is: a. A directive statement b. A nondirective statement c. A general statement d. All of the above The six-step model presented for analyzing ethical decision making aligns with: a. Metaethics
3.
When considering the ethical principle of nonmaleficence in healthcare practice, which
of the following is MOST accurate? a. It requires taking positive action to help others
b. It is less strict than the principle of beneficence c. It focuses primarily on fair resource distribution d. It is derived from the Hippocratic oath's "Do no harm" In the context of ethical decision-making, which step should be completed FIRST when faced with an ethical dilemma?
2.
4.
b. Normative ethics c. Teleology theory d. Deontology theory
a. Explore practical alternatives b. Complete the chosen action c. Gather relevant information d. Evaluate the outcome
ANSWERS: 1: b 2: b 3: d 4: c
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Components of Ethics for Healthcare Professionals: Summary
COMMUNICATION APPROACHES IN CODES OF ETHICS
INTRODUCTION
Professional codes of ethics employ two distinct types of communication approaches: Directive and nondirective statements. Understanding these approaches is crucial for healthcare professionals to properly interpret and apply ethical guidelines. LEARNING TIP! Directive statements address required conduct and use specific language to indicate expected behaviors. These statements employ words
FOUNDATIONAL ETHICS CONCEPTS Ethics represents the systematic study of moral judgment and standards of conduct within the broader field of moral philosophy. The field encompasses two main subdivisions: Normative ethics, which focuses on determining morally right and wrong actions, and metaethics, which analyzes the theoretical foundations of moral theories. This understanding is crucial as ethics continues to evolve with societal changes and new healthcare challenges. This course delves into ethical theories, particularly deontological theory, which emphasizes duties and rights, and teleological theory, which focuses on consequences. These theories are examined through various lenses, including social norms, authority figures, religious orientations, traditional wisdom, and contemporary cultural contexts. Understanding these theoretical frameworks helps healthcare professionals navigate complex ethical decisions in their practice. PROFESSIONAL CODES AND STANDARDS Healthcare professionals are guided by codes of ethics that organize and articulate the most important ethical principles within their profession. A code of ethics is defined as a set of standards and principles of professional conduct that helps guide decision-making and behavior in professional settings. There are three distinct types of codes of ethics that serve different purposes in healthcare professions: 1. Aspirational codes encourage competent and moral behavior but do not provide specific guidelines for ethical conduct or sanctions for violations. These codes set forth ideals that practitioners should strive to achieve in their professional practice 2. Educational codes state what constitutes ethical behavior and may provide case examples as illustrations. While these codes define and explain ethical conduct, they typically do not include sanctions for failing to follow the code 3. Regulatory codes are the most comprehensive, as they spell out expected behavior, state specific guidelines for conduct, and provide detailed descriptions of sanctions for violations. These codes serve as enforceable standards with clear consequences for ethical breaches Most professional organizations maintain codes that combine elements of all three types, providing both aspirational goals and specific regulatory requirements. These codes must be regularly reviewed and updated to reflect changing societal values and new challenges in healthcare delivery.
such as: • Shall • Will • Must • Require • Responsible
Conversely, terms like do not , shall not , and will not indicate behaviors that must be avoided. For example, "Employees are prohibited from engaging in conflicts of interest and must disclose any potential conflict to the appropriate authorities" represents a directive statement. LEARNING TIP! Nondirective statements come in two forms: • Statements addressing permitted conduct, which often contain words such as may and not prohibited • Statements addressing recommended (but not required) behavior, which typically use words like should and should not The course provides an illustrative example from the physical therapy code of ethics: "shall encourage colleagues with physical, psychological, or substance- related impairments that may adversely impact their professional responsibilities to seek assistance or counsel." This represents a directive statement due to its use of shall . Understanding these communication approaches helps healthcare professionals interpret the intent and requirements of their professional codes of ethics. When reviewing ethical guidelines, practitioners should pay particular attention to the specific language used, as it indicates whether an action is mandatory, recommended, or permitted.
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ETHICAL THEORIES AND SOURCES Ethical theories provide essential frameworks for understanding and evaluating moral dilemmas in healthcare. Two fundamental theories represent seminal knowledge in ethics literature: Deontological theory and teleological theory. Deontological theory is based on the concept of duties and rights . Under this framework, healthcare professionals have a duty to protect and fulfill their patients' rights, regardless of the consequences of those actions. For example, a patient's right to autonomy must be respected by the healthcare professional regardless of whether they agree with the patient's choices or whether the patient has cognitive deficits. According to the deontological approach, certain actions are inherently moral or immoral, regardless of their outcomes. Teleological theory, in contrast, is based on consequences or ends . Also referred to as consequentialist ethics, actions are evaluated based on their utilitarian value and seek the best outcome or least harmful consequences. For example, if two treatment techniques are equally effective according to current research, the healthcare professional should consider which technique will bring the most benefit and provide the best outcome for the client within their unique situation. Sometimes these two theories coincide. In those instances, the duty to act aligns with the best action. For example, in preventing a patient from falling, the duty to avoid harm (deontological) coincides with warning the patient about a slippery floor to prevent injury (teleological/consequential). However, these theories can sometimes produce opposing views. Consider a scenario where a patient requires painful stretching to prevent muscle contracture. The practitioner must weigh their duty to provide beneficial treatment against the consequence of causing pain, even if that pain serves a therapeutic purpose. The understanding of ethical behavior is derived from multiple sources.: • Social norms that guide action through example • Authority figures who provide direction • Religious orientations that offer moral guidelines • Traditional wisdom transmitted by experienced practitioners who “know best” • Contemporary culture that shapes current ethical thinking This theoretical foundation helps healthcare professionals navigate complex ethical decisions while considering both their duties and the consequences of their actions. While ethics and laws are related, they serve distinct purposes in healthcare practice.
LEARNING TIP! Laws are defined by government and contain formal rules for resolving complex problems, while codes of ethics are defined by professional groups and organizations. Laws state the minimum standard of behavior that must be met, while ethical codes present ideal or best behaviors. Additionally, laws are upheld by rules, regulatory authorities, and courts, whereas codes of ethics are upheld through professional standards, discussion, and persuasion. This distinction is important because healthcare professionals must navigate both legal requirements and ethical standards in their practice. Sometimes these align perfectly, but in other situations, what is legally permissible may not necessarily be the most ethical choice, or what seems ethically right may face legal constraints. Understanding this relationship helps practitioners make better decisions when faced with complex situations. CORE ETHICAL PRINCIPLES 1. Beneficence The principle of beneficence establishes healthcare professionals' fundamental obligation to act for patient benefit. This requires genuine concern for well-being and proactive efforts to promote positive outcomes. This involves providing competent and compassionate care, advocating for patients’ needs, and striving to optimize health outcomes . Beneficence manifests through: ○ Evidence-based interventions ○ Appropriate referrals ○ Health promotion activities ○ Professional competence maintenance ○ Patient advocacy 2. Nonmaleficence The "Do no harm" principle derived from the Hippocratic oath establishes a stricter standard than beneficence. This includes: • Avoiding potential risks: Nonmaleficence includes an obligation not to impose risks of harm even if the potential risk is without malicious or harmful intent. This involves minimizing risks and avoiding actions that could cause harm, while also considering the potential benefits and risks of medical interventions • Maintaining proper credentials • Following safety protocols • Preventing negligence: The principle of nonmaleficence is closely tied to the concept of negligence in healthcare practice. Negligence occurs when a healthcare provider fails to use due care to protect a client from harm. Malpractice suits are most
4
Components of Ethics for Healthcare Professionals: Summary
often based on acts of negligence. This negligence may be either intentional (when a person knowingly fails to use due care) or unintentional (when a person carelessly or inadvertently imposes harm). • Protecting and being mindful of vulnerable populations ○ Note: Scenarios that involve difficult end-of- life care decisions such as withholding and withdrawing life-sustaining treating, medically administered nutrition and hydration and in pain and other symptom control often involve complex decision making around beneficence and nonmaleficence. 3. Autonomy Patient autonomy emphasizes the right to make informed healthcare decisions, including: ○ Informed consent processes: The patient has the right to informed consent, which is a necessary part of the process that leads to the patient agreeing to accept services ○ Right to refuse treatment: Autonomy is often referred to as the self-determination ethical principle. This principle emphasizes the importance of patient consent, confidentiality, and the right to refuse treatment ○ Privacy protection ○ Confidentiality maintenance: Confi-dentiality refers to the duty of healthcare providers to safeguard the privacy and confidentiality of patient information, ensuring that sensitive medical and personal details are not disclosed without the patient’s consent or unless required by law. This includes protecting patient records, maintaining confidentiality in communications, and disclosing patient information only with appropriate consent or when required by law ○ Self-determination respect 4. Justice The principle of justice ensures fair and equitable treatment through:
behavior. More serious violations may warrant formal disciplinary actions, which include reprimands; censures; probation; suspension; and in the most severe cases, revocation of credentials or licenses.
LEARNING TIP! A reprimand represents a formal written
communication indicating disapproval of conduct, while censure takes this a step further by making the disapproval public. Censures identify the person’s name and are usually correlated to which ethical principles were not upheld. This is a formal written communication, and it is communicated publicly. Probation involves placing specific conditions on continued practice for a defined period, often requiring the practitioner to demonstrate compliance with certain requirements or to complete additional training. Suspension temporarily removes the practitioner's right to practice, while revocation permanently terminates their credentials or license. PROFESSIONAL DOCUMENTATION AND RECORD-KEEPING Proper documentation serves as a cornerstone of ethical practice in healthcare. Healthcare professionals must maintain accurate, timely, and complete records that reflect all aspects of patient care. This includes detailed treatment plans, progress notes, assessment results, and any relevant correspondence. The documentation must be sufficient to allow another qualified professional to understand the nature and course of treatment provided. In writing up the results of a patient assessment that will be submitted for reimbursement, it is important for the practitioner to ensure that documentation is in accordance with applicable laws. In today's digital age, special consideration must be given to the security and confidentiality of electronic health records, with practitioners needing to implement appropriate safeguards to protect patient information. ETHICAL DECISION-MAKING IN PRACTICE Healthcare professionals must regularly navigate complex ethical situations requiring careful analysis and thoughtful decision making. The following six-step model provides a structured approach. First, practitioners must gather all relevant information to fully understand the situation. This includes reviewing patient histories, consulting relevant policies and guidelines, and considering all stakeholder perspectives. Next, they must identify whether the issue truly represents an ethical dilemma and which ethical principles are involved.
○ Nondiscriminatory practices ○ Resource allocation fairness ○ Cultural competence ○ Access to services ○ Professional standards adherence
DISCIPLINARY ACTIONS AND PROFESSIONAL ACCOUNTABILITY
The healthcare field recognizes several levels of disciplinary actions that may be taken when ethical violations occur. Nondisciplinary actions serve as initial interventions and include verbal warnings, written warnings, and advisory opinions. These are typically used for minor infractions or first-time occurrences where education and guidance may be sufficient to correct the
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The third step involves analyzing the problem through various ethical frameworks, such as deontological (duty-based) and teleological (consequence-based) approaches. This analysis should consider core principles like beneficence, nonmaleficence, autonomy, and justice. Fourth, practitioners must explore practical alternatives, weighing the potential benefits and drawbacks of each option. The fifth step involves implementing the chosen action, while the final step requires evaluation of both the process and the outcome to inform future decision making. SPECIAL TOPICS IN HEALTHCARE ETHICS Telehealth and Digital Ethics The rapid evolution of healthcare delivery through digital platforms has introduced new ethical considerations. Healthcare professionals must carefully navigate privacy, confidentiality, and security concerns when providing telehealth services. The COVID-19 pandemic accelerated the adoption of virtual care delivery, highlighting the importance of maintaining ethical standards across digital platforms. Practitioners must ensure secure communication channels, obtain appropriate informed consent for telehealth services, and maintain professional boundaries in virtual environments. Cultural Competency and Ethical Practice Cultural competency has become increasingly recognized as a crucial component of ethical healthcare delivery. Healthcare professionals must develop awareness of their own cultural biases, gain knowledge about diverse populations, and acquire skills for cross- cultural communication. This includes understanding how cultural values and beliefs influence healthcare decisions, respecting diverse perspectives on autonomy and decision making, and ensuring equitable access to care across different cultural groups.
Research Ethics and Evidence-Based Practice The ethical conduct of research and implementation of evidence-based practice requires careful attention to several principles. Researchers must protect participants’ rights through informed consent, maintain confidentiality, and ensure fair subject selection. When implementing evidence-based interventions, practitioners must balance scientific evidence with individual patient preferences and circumstances. This includes considering both the benefits and potential risks of interventions, and Maintaining appropriate professional boundaries is essential for ethical practice. Healthcare professionals must navigate complex relationships with patients, colleagues, and other stakeholders while upholding professional standards. This includes avoiding dual relationships, maintaining appropriate self-disclosure, and professionally managing their social media presence. The increasing use of digital communication platforms has added new dimensions to boundary maintenance. Documentation and Record-Keeping communicating these clearly to patients. Professional Boundaries and Relationships Ethical documentation practices are fundamental to healthcare delivery. Records must be accurate, timely, and complete while protecting patient privacy and confidentiality. Electronic health records have introduced new considerations regarding data security, access controls, and information sharing. Healthcare professionals must ensure their documentation practices comply with both legal requirements and ethical standards.
SIX STEP MODEL FOR ETHICAL DECISIONS
1. Get the story straight ○ Gather all relevant information and facts
○ Understand the full context ○ Identify stakeholders involved ○ Review applicable laws, regulations, and professional codes ○ Take time to collect all pertinent details without bias
2. Identify the type of ethical problem ○ Determine if it's truly an ethical dilemma versus a legal issue ○ Identify which ethical principles are involved ○ Reference professional codes of ethics, workplace rules, and state regulations
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Components of Ethics for Healthcare Professionals: Summary
SIX STEP MODEL FOR ETHICAL DECISIONS
3. Use ethics theories or approaches to analyze the problem ○ View the issue through different ethical lenses like: ■ Deontological approach: Focus on rights and duties ■ Teleological approach: Focus on consequences ■ Utilitarian approach: Focus on producing the most good/least harm ○ Apply relevant ethical principles: Beneficence, nonmaleficence, autonomy, justice 4. Explore the practical alternatives ○ Assess different possible courses of action ○ Consider consequences, benefits, and drawbacks of each option ○ Weigh effects on patient and others involved (practical, emotional, spiritual, financial) ○ Evaluate how each option aligns with ethical principles
5. Complete the action ○ Choose and implement the most ethically justifiable course of action ○ Recognize that an optimal solution may not exist ○ Accept that some ethical dilemmas cannot be perfectly resolved 6. Evaluate the process and outcome ○ Reflect on results and consequences ○ Assess if the chosen action effectively addressed the issue ○ Consider lessons learned for future situations ○ Ask questions like: ■ What went well? ■ What was most challenging? ■ What was learned? ■ What could be done differently next time?
The model emphasizes that ethical decision making is a systematic process that requires careful consideration at each step. The final evaluation step is considered particularly critical for developing ethical reasoning skills and preparing for future ethical dilemmas. The following case highlights the importance of: • Maintaining current credentials • Using proper documentation practices • Individualizing patient care • Using evidence-based methods • Complying with professional standards • Understanding potential consequences of ethical violations
The final outcome would depend on factors such as: • Duration of violations • Number of violations • Previous corrective actions • Juan's response to the investigation • Any legal implications
WORKS CITED https://qr2.mobi/component-ethics
7
JUAN'S ETHICS INVESTIGATION CASE STUDY
Background: Juan, a healthcare professional and five-year member of his discipline's professional organization, received a letter from the Ethics Review Committee chairperson indicating he was under investigation for possible code of ethics violations. The complaint was initially filed by Juan's state regulatory board after being reported by his direct supervisor.
Key Issues Under Investigation: 1. License status ○ Investigation into whether Juan practiced with an expired license ○ Required to provide evidence of current license and timely renewals over past three years ○ Potential violation of competence, education, and training standards 2. Documentation concerns ○ Missing or incomplete records and reports ○ Required to provide evidence of timely documentation filing ○ Potential violation of documentation and reimbursement standards 3. Evaluation and treatment planning ○ Using nearly identical evaluations and intervention plans for multiple clients ○ Changing only dates on documentation ○ Required to provide samples of individual evaluations and care plans ○ Violation of individualized care standards 4. Treatment techniques ○ Questions about safety and effectiveness of treatment methods ○ Required to provide evidence of peer-reviewed research supporting his techniques ○ Concern over lack of evidence-based practice Potential Outcomes : The Ethics Review Committee could implement any of the following actions: 1. Dismissal of charges ○ If no violations are found ○ Written notification that charges are dismissed 2. Reprimand ○ Formal written communication indicating disapproval ○ Private communication 3. Censure ○ Formal written communication made public ○ Reported to regulatory agencies 4. Probation ○ Public reporting with specific end point ○ May include requirements like:
■ Submitting continuing education certificates ■ Providing documentation of compliance ■ Meeting specific terms set by the committee
5. Suspension ○ Removal of membership for a designated period of time ○ Public sanction ○ Notification to other regulatory agencies ○ Could affect license to practice 6. Revocation
○ Permanent removal of membership ○ Never eligible to rejoin organization ○ Public sanction ○ Notification to other regulatory agencies ○ Could result in license revocation
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Components of Ethics for Healthcare Professionals: Summary
FINAL EXAM QUESTIONS
1.
The study of ethics is a branch of: a. Political science
8.
An ethical guideline that reads, “The professional shall act with compassion and respect with every person” is an example of what kind of statement? a. Directive
b. Philosophy c. Psychology d. Sociology
b. Nondirective c. Aspirational d. Educational
2.
Teleological theory is concerned primarily with: a. Duty b. Obligations c. Consequences d. Rights Which kind of ethics is concerned with determining what is morally right or wrong? a. Metaethics
9.
An ethical guideline that reads, “The professional should attend continuing education on an annual basis” is an example of what kind of statement? a. Directive
3.
b. Nondirective c. Aspirational d. Educational
b. Normative ethics c. Utilitarian ethics d. Deontology theory
10.
Which of the following ethical principles requires the healthcare professional to act with genuine concern for the well-being and safety of their patients by providing competent and compassionate care? a. Beneficence b. Nonmaleficence c. Autonomy d. Justice Which of the following ethical principles aligns with the Hippocratic oath? a. Beneficence b. Nonmaleficence c. Autonomy d. Justice Malpractice suits are most often based on acts of:
4.
Which kind of ethics is concerned with the concepts of duties and rights? a. Metaethics
b. Normative ethics c. Utilitarian ethics d. Deontology theory
5.
Unlike codes of ethics, the law: a. May be aspirational b. Guides problem resolution c. Is defined by government d. Lists professional standards
11.
6.
When understanding norms that shape ethical behavior, which example is transmitted from older generations by “knowing best”? a. Authority figures b. Religions c. Cultural customs d. Transitional wisdom There are three main types of codes of ethics: aspirational, educational, and: a. Regulatory b. Federal
12.
a. Fidelity b. Veracity c. Negligence d. Justice
7.
13.
Being mindful of vulnerable populations is important for healthcare professionals due to what ethical principle? a. Beneficence b. Nonmaleficence c. Autonomy d. Justice
c. Local d. Moral
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14.
An example of justice is: a. Providing services in a fair and equitable manner b. Ensuring that confidentiality of information is maintained c. Recording and reporting client information accurately d. Taking responsibility for professional development Dealing with end-of-life decisions involves complex ethical decision making around which ethical principles?
20.
All data and information obtained from or about recipients of services, students, research participants, colleagues, or employees should be treated as: a. Public information b. Confidential information c. Electronic-access-only information d. Directory information Censure due to an ethical violation means that: a. There was no true breach of a code of ethics; however, the behavior is not completely in keeping with its principles b. The state regulatory board must issue a letter stating that conditions such as completing a rehabilitation program have been met c. A formal public expression of disapproval will appear in a publication d. A professional will have their membership suspended for a specified period of time If a healthcare professional shares information with their family members or friends about a client’s personal history or treatment plan without the client’s permission, the healthcare professional may be violating the concept of: a. Confidentiality b. Autonomy c. Nonmaleficence d. Morals The final step in the six-step model to make ethical decisions is which of the following?
21.
15.
a. Beneficence and nonmaleficence b. Nonmaleficence and due care c. Justice and beneficence d. Informed consent and justice
16.
In conducting a research study, researchers are expected to avoid inflicting harm or injury on the research participants in order to fulfill the ethics principle of: a. Autonomy
22.
b. Justice c. Veracity d. Nonmaleficence
17.
In writing up the results of a patient assessment that will be submitted for reimbursement, it is important for the practitioner to: a. Take appropriate steps to facilitate meaningful communication b. Establish a collaborative relationship with the recipient of the service c. Ensure that documentation is in accordance with applicable laws d. Educate the public about the value of occupational therapy The process whereby patients agree to receive services is known as: a. Confidentiality b. Public Policy c. Informed consent d. Self-Rule The right to refuse services is an example of the principle of:
23.
a. Completing the action b. Exploring alternatives c. Evaluating the process and outcome d. Identifying the ethical problem
18.
TO ACCESS THE FINAL EXAM TO THIS COURSE ►
19.
a. Fidelity b. Veracity c. Procedural justice d. Autonomy
Course content code: PTCA02CE-H
Aging Spine Fitness: Evidence-Based Strengthening Techniques for Seniors: Summary 10
Aging Spine Fitness: Evidence-Based Strengthening Techniques for Seniors
ACCESS THE FULL VIDEO PRESENTATION Scan the QR CODE ► to start video or visit https://uqr.to/spine-seniors
3 Contact Hours
Author Dr. Lorie Schleck, PT
Dr. Lorie Schleck is a graduate of the University of Minnesota and Evidence in Motion Institutes of Health Professions. She has authored and taught dozens of continuing education courses focused on sports medicine, orthopedic, and geriatric topics, as well as instructing classes for physical therapy doctorate and physical therapy assistant students. She currently works in clinical and operational quality for Presbyterian Homes Rehabilitation in St. Paul, Minnesota.
LEARNING OUTCOMES • Identify normal age-related changes to spinal structures and their impacts on function and occupational performance in older adults. • List common spine pathologies in older adults, including degenerative disc disease, spinal stenosis, and osteoporosis. • Recognize biomechanical principles to safely prescribe spine strengthening exercises for seniors with varying levels of function.
• Recall progressive exercise programs that address muscle imbalances common in the aging spine. • Understand functional strengthening techniques that improve functional mobility and occupational independence in older adults with spine conditions. • Modify spine strengthening exercises appropriately for extremely frail to active older adults.
SELF-ASSESSMENT QUESTIONS
1.
Which of the following best describes the role of the gluteus medius in spinal health for older adults? a. It extends the hip and supports upright posture. b. It stabilizes the pelvis during walking and single-leg stance, reducing lateral trunk shift. c. It flexes the lumbar spine and assists with forward bending. d. It compresses the intervertebral discs to improve disc hydration. When prescribing exercises for a patient with spinal stenosis, which position would MOST likely reduce symptoms by increasing spinal canal space? a. Standing upright with lumbar extension b. Prone lying with a pillow under the abdomen c. Seated or flexed posture d. Side-lying with the spine in neutral
3.
Which of the following exercise principles is MOST important when designing a strengthening program for a patient with osteoporosis? a. Prioritize high-impact aerobic activity to stimulate bone remodeling. b. Focus on trunk rotation exercises to improve spinal mobility. c. Emphasize trunk flexion to strengthen the anterior core. d. Avoid trunk flexion and focus on extension and weight-bearing exercises
2.
ANSWERS: 1: b 2: c 3: d
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Aging Spine Fitness: Evidence-Based Strengthening Techniques for Seniors: Summary 11
The disc provides spacing that allows the joint to function optimally. During flexion and extension, motion occurs at the two facet joints, which in turn affects the disc. The disc compresses in different areas as the spine moves through its range of motion. Segmental motion at each level contributes to gross trunk motion. IMPORTANT MUSCLES FOR SPINE MOTION AND STABILITY Posterior Muscles Erector Spinae The erector spinae is a large, superficial group of three muscles: Iliocostalis (most lateral), longissimus (intermediate), and spinalis (most medial). Their primary functions include bilateral back extension, controlling descent during forward trunk bending, and unilateral sidebend/rotation. Importantly, the erector spinae may become hypertonic when the multifidus is weak or atrophied. A tight, painful erector spinae is often a sign of underlying multifidus weakness, not a simple muscle strain. Because the erector spinae spans multiple levels, tightness increases axial compression through the spine and creates an extension moment. Quadratus Lumborum (QL) The QL is the deepest back muscle, running from the iliac crest to the transverse processes of L1–L5 and the 12th rib. Its primary functions are fixing the 12th rib to stabilize the diaphragm during inspiration and working with the contralateral gluteus medius to maintain frontal plane stability of the pelvis. In single-leg stance, the QL on one side and the gluteus medius on the opposite side work together to keep the pelvis level. Multifidus The multifidus spans the length of the spine but is most prominent in the lumbar spine. It runs lateral (transverse process) to medial (spinous process), spanning 2–5 vertebral segments. Although sometimes called a deep rotator, its primary function is segmental stability of the spine. Research has shown that when there is spinal dysfunction or pain, the multifidus will preferentially weaken, similar to how the quadriceps atrophy with knee pain or the gluteus maximus atrophies with sacroiliac pain. Multifidus weakness also contributes to erector spinae hypertonicity. Strengthening the multifidus should be a goal with every back pain patient. Anterior (Abdominal) Muscles Rectus Abdominis The rectus abdominis (the ”six-pack” muscle) runs vertically from the pubic crest to the xiphoid process and costal cartilage of ribs 5–7. It functions to flex the trunk, approximate the rib cage to the pelvis, assist in forced exhalation, and provide core stability and posture.
INTRODUCTION
Back pain is extremely prevalent among older adults, with estimates ranging from 21–75% of adults over 60 years of age. The prevalence increases with age and affects women more than men. Back pain is associated with significant functional disability that can limit a person's independence. Clinical Reasoning Framework for Prescribing Spine Exercises • Diagnosis : Often based on imaging that may not correlate well with patient symptoms. Even asymptomatic individuals can have significant structural changes on imaging. • Posture : Reveals how the spine is functioning and whether deviations are flexible or rigid. • Segmental mobility : Assesses how individual spinal segments are moving. • Muscle influences : Identify what is tight and what is weak. THE NORMAL SPINE The S-Curve A normal spine has a lordosis in the cervical and lumbar areas and a kyphosis in the thoracic area, creating an S-curve. This S-curve is optimal for shock absorption, segmental mobility and stability, and muscle function. As people age, they may develop an accentuated lordosis, accentuated kyphosis, or a flat back; all of which affect how the spine functions. Relative Motion in the Thoracic and Lumbar Region Different regions of the spine specialize in different movements. Flexion and extension are primarily functions of the lumbar spine and lower thoracic spine. Lateral side bending is distributed more evenly throughout the spine. Rotation is predominantly a thoracic spine function— most rotation occurs through the thoracic spine. This is clinically important when prescribing exercises: To mobilize lumbar segments, use flexion/extension rather than rotation. The Three-Joint Complex
LEARNING TIP! The spine is a three-joint complex: The
intervertebral disc and two facet joints function together to provide physiological spinal motion.
Aging Spine Fitness: Evidence-Based Strengthening Techniques for Seniors: Summary 12
the lesser trochanter of the femur. It is a powerful hip flexor that, when tight, causes axial compression through the spine and forces the spine into lumbar lordosis. Research indicates a person must stand 3–4 hours per day to avoid iliopsoas contracture. Most older adults fall far short of this. The rectus femoris, part of the quadriceps, has a pelvic attachment and, when tight, pulls the pelvis into anterior rotation, further increasing lumbar lordosis. Both muscles tend toward tightness and must be regularly stretched. Muscle Imbalance Pattern in Older Adults Because of sedentary lifestyles and the aging process, older adults predictably develop the following muscle imbalance pattern: • T ight : Hip flexors (iliopsoas, rectus femoris), erector spinae, anterior chest • Weak : Gluteus maximus, gluteus medius, transversus abdominis/abdominals, multifidus The treatment approach follows directly from this pattern: Stretch the iliopsoas, stretch the rectus femoris, strengthen the multifidus, strengthen the abdominals, strengthen the gluteus maximus, and strengthen the gluteus medius. SPINAL STRUCTURES AND AGE-RELATED CHANGES Intervertebral Disc The intervertebral disc is a largely avascular structure composed of three components: The nucleus pulposus (gel-like center, 66–88% water), the annulus fibrosus (concentric circles of collagen with alternating fiber orientations for strength), and two vertebral endplates (which cover the superior and inferior aspects of the disc, binding it to the vertebral body and allowing nutrient diffusion). The disc acts as a shock absorber and provides flexibility and stability to the spine. Age-Related Changes to the Nucleus Pulposus The aging nucleus pulposus undergoes the following changes: • Loss of hydration: Loses water, resulting in decreased cushioning ability. • Increased stiffness: Loss of water and changes in the extracellular matrix (ECM) decrease shock absorption ability. • Reduced disc height: Because of loss of water and ECM changes Disc degeneration is seen in 80% of asymptomatic older adults. The aging annulus fibrosus also undergoes decrease in water content and proteoglycans, collagen degradation, delamination of layers, and development of cracks and fissures. The vertebral endplates thin because of decreased bone mineral density, undergo ossification (impeding nutrient flow), and become more concave.
LEARNING TIP! Transversus Abdominis (TA)
The transversus abdominis (TA) is the deepest abdominal muscle. Its fibers run horizontally, wrapping around the trunk from front to back. It segmentally stabilizes the spine, preventing excess motion and twisting. The TA works in synchrony with the multifidus. Together, they are the primary segmental stabilizers of the spine. It also maintains abdominal tension and supports lumbopelvic motion. Obliques (External and Internal) The external obliques are the most superficial abdominal muscles, functioning in trunk flexion, rotation to the opposite side, lateral flexion, and increasing abdominal pressure. The internal obliques lie between the external obliques and the TA, running perpendicular to the external obliques. They function in sidebend and rotation (unilateral), forced exhalation, and pelvic stabilization. Because the obliques run diagonally, exercises must include a diagonal stress component to adequately strengthen them. Hip Muscles with Spinal Influence Gluteus Maximus The gluteus maximus originates from the posterior ilium, sacrotuberous ligament, dorsal sacrum, lateral coccyx, and gluteal aponeurosis, inserting into the gluteal tuberosity of the femur and iliotibial band. It extends and externally rotates the hip, controls pelvic motion, and influences lumbar spine movement and stability through pelvic control. It is part of the posterior oblique system, linking the gluteus maximus on one side with the latissimus dorsi on the other side via the thoracolumbar fascia, contributing to core stability during reciprocal activities like walking and running. The gluteus maximus tends toward weakness in older adults. Gluteus Medius The gluteus medius runs from the gluteal surface of the ilium to the lateral surface of the greater trochanter. While commonly described as a hip abductor, its primary functional role is as a lateral pelvic stabilizer during single-leg stance and gait. It works with the contralateral QL to keep the pelvis level. Weakness is evidenced by a hip drop (Trendelenburg sign) or compensatory trunk sidebend during gait. The gluteus medius tends toward weakness in older adults and is a key exercise target. When the pelvis drops, the lumbar spine side bends making gluteus medius stability critical for spinal health. Hip Flexors (Iliopsoas and Rectus Femoris) The iliopsoas (fusion of iliacus and psoas) originates from the transverse processes of L1–L5, anterior vertebral bodies of T12–L5, and intervertebral discs, inserting into
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