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COURSE CODE
Hours
PRICE
Ethical Issues and Decision Making, 2nd Edition (Mandatory)
5 $60.00 PTSC05ET-H
Back to the Books: Return to Learn Strategies for Concussed Student-Athletes
2 $33.00 PTSC02BB-H
Differential Diagnosis in Physical Therapy: Upper Extremity and Lower Quadrant
3 $49.00 PTSC03UE-H
Evaluation and Treatment of the Shoulder Complex
4 $65.00 PTSC04SC-H
Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Lower Quarter
2 $33.00
PTSC02LQ-H
2 $33.00 PTSC02UQ-H
Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Upper Quarter
4 $65.00 PTSC04KT-H
Kinesiology Taping for Orthopedic Conditions
Optimizing Outcomes in Rehabilitation: Motor Learning Principles and Beyond
6 $96.00 PTSC06ML-H
Return to Sport: Running Injuries in Student-Athletes
2 $33.00
PTSC02RU-H
INCLUDED IN THIS BOOK
1
Ethical Issues and Decision Making, 2nd Edition (Mandatory) [5 contact hours]
This intermediate-level course provides physical therapists and physical therapist assistants with an updated primer on the study of ethics and ethical behaviors as they apply to physical therapy practice. The course is designed to help clinicians effectively and efficiently integrate ethical decision-making into their clinical practice. 11 Back to the Books: Return to Learn Strategies for Concussed Student-Athletes [2 contact hours] This course covers how to implement return to learn strategies for student athletes following a concussion. Based on the most up-to-date research on concussions in student athletes, athletic trainers, and healthcare practitioners are provided with best-practice recommendations on how to manage post-concussion recovery and learning. Participants will be able to assess their current return to learn the process and modify it in alignment with current guidelines. 18 Differential Diagnosis in Physical Therapy: Upper Extremity and Lower Quadrant [3 contact hours] As the profession of Physical Therapy has progressed, the importance of differential diagnosis and medical screening has increased, especially with the mandate of autonomous practice. This seminar will give the clinician the ability to screen the multiple body organ systems for diseases and syndromes that are not of musculoskeletal origin. The seminar further addresses effective mechanisms that result in client referrals to appropriate health care practitioners. Through lectures and case studies, the therapist will be able to determine the best course of action with a patient utilizing the best available assessment tools and measures and evidence-based practice to determine diagnosis, need for referral, or method of treatment. 40 Evaluation and Treatment of the Shoulder Complex [4 contact hours] The course provides a general overview of the shoulder complex anatomy before moving into the primary purpose of the course, evaluation and treatment of the shoulder complex through entry-level introduction of manual evaluation techniques of the connective tissue surrounding the shoulder complex. 53 Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Lower Quarter [2 contact hours] This course provides the clinician with an understanding of the treatment concepts, as well as specific techniques, in order to effectively incorporate Instrument-Assisted Soft Tissue Mobilizations (IASTM) to common musculoskeletal disorders of the lower quarter. 61 Instrument-Assisted Soft Tissue Mobilization (IASTM) to the Upper Quarter [2 contact hours] This course provides the clinician with an understanding of the treatment concepts, as well as specific techniques, in order to effectively incorporate Instrument-Assisted Soft Tissue Mobilizations (IASTM) to common musculoskeletal disorders of the upper quarter. 70 Kinesiology Taping for Orthopedic Conditions [4 contact hours] Kinesiology taping is redefining the role of therapeutic taping for rehabilitation professionals. Taping was once used to physically hold structures in place; now kinesiology taping is used to influence fascia and underlying neural tissues to cause functional changes in both the local tissue as well as the central nervous system. Often relegated to the athletic world, kinesiology taping has many orthopedic, neurological, pediatric, geriatric, and other specialty applications. Course content will include orthopedic assessment, adjunctive manual therapies, and kinesiology taping for joint mobility and stability applications. 81 Optimizing Outcomes in Rehabilitation: Motor Learning Principles and Beyond [6 contact hours] By the end of this course, participants will gain a knowledge and understanding of how to optimize rehabilitation outcomes in their patients by using current and evidence-based application of motor learning concepts and principles of neuroplasticity, including contemporary evidence for autonomy support and the effects of improving patient motivation and focus. 95 Return to Sport: Running Injuries in Student-Athletes [2 contact hours] This course focuses on commonly presented running injuries in student-athletes and how to effectively treat those injuries for return to sport. The course is designed for athletic trainers and allied health professionals who work in sport settings, particularly with youth and student-aged athletes. Colibri Healthcare, LLC’s courses meet the standards for physical therapy continuing education activities in South Carolina. South Carolina Board of Physical Therapy (Provider #50-4007).
FREQUENTLY ASKED QUESTIONS
License Expires
Contact Hours Required
Mandatory Subjects
30 (All hours are allowed through home-study)
3 hours of study in ethics, professionalism, and/or South Carolina jurisprudence per renewal.
Biennial renewal. Licenses expire December 31 of the even year.
Are you a South Carolina board-approved provider? Colibri Healthcare, LLC’s courses meet the standards for physical therapy continuing education activities in South Carolina.
South Carolina Board of Physical Therapy (Provider #50-4007). Are my credit hours reported to the South Carolina board?
The South Carolina Board of Physical Therapy uses CE Broker to track and verify your compliance. We report your hours electronically to the Board through CE Broker within two business days. Remember, do not forward your CE documentation to the board, keep your certificate in a safe place for your records. The South Carolina 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, e-mail 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. Implicit bias in healthcare: Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics. 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. ©2024: 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.
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Ethical Issues and Decision Making, 2nd Edition: Summary
Ethical Issues and Decision Making,
ACCESS THE FULL VIDEO PRESENTATION
2nd Edition 5 Contact Hours
Scan the QR CODE to start video or visit https://uqr.to/scethics
Author Bruce H. Greenfield, PT, PhD, FNAP (Fellow National Academies of Practice), FAPTA Bruce H. Greenfield is an Associate Professor in the Division of Physical Therapy and the School of Medicine and Senior Fellow in the Center for Ethics at Emory University. Dr. Greenfield is a well-known physical therapy educator and qualitative researcher. He serves on the APTA Ethics and Judicial Committee, and on the editorial boards of the Journal of Physical Therapy Education, the Journal of Orthopedic and Sports Physical Therapy and the Journal of Humanities in Rehabilitation.
LEARNING OUTCOMES • Identify the differences and commonalities among morality, values, ethics, and the law • Describe the purpose and limitations of the American Physical Therapy Association (APTA) Code of Ethics for Physical Therapists • Identify types of ethical problems and issues in physical therapy
• Describe the ethical approaches, theories, and principles that can guide the physical therapy practitioner in making an ethical decision • Evaluate ethical issues based on an ethical decision-making model • Describe future considerations in ethical decision making
SELF-ASSESSMENT QUESTIONS
1. Which of the following is not considered a moral value? a. Compassion b. Altruism c. Laws d. Integrity 2. What is the purpose of a code of ethics? a. Provide guidance regarding expected behaviors in the workplace b. State the rights of persons with whom members interact c. Include provisions for enforcing the code d. All the above
3. When a situation presents a barrier that blocks a clinician from doing what they perceive is right, the practitioner is facing what type of ethical problem? a. Moral distress b. Locus of authority c. Ethical dilemma 4. “Get the story straight” utilizes which type of ethical approach? a. Narrative approach b. Deontology c. Caring approach d. Virtue ethics ANSWERS: 1: C 2 : D 3: A 4: A
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Ethical Issues and Decision Making, 2nd Edition: Summary
Unlike ethics, laws are defined by the government based on concepts of justice and equality and provide a set of enforced rules that affect liberty, harm, and preventing harm . PTs and PTAs are legally and ethically obligated to practice on the basis of their state practice acts, which are established by the state board of physical therapy. State practice acts are enacted primarily for the purpose of safeguarding public health, safety, and welfare by providing for state administrative control, supervision, and regulation of the practice of physical therapy. CODE OF ETHICS A code of ethics (such as the APTA Code of Ethics) is a set of standards and principles of professional, behavioral, and ethical conduct set by professional groups with the following purposes: • Provide guidance regarding expected behaviors in the workplace • State the rights of persons with whom members interact • Address ethical dilemmas particular to the profession • Include provisions for enforcing the code There are three types of codes of ethics: Aspirational, educational, and regulatory . • Aspirational codes encourage moral behavior but do not provide guidelines for conduct or sanctions for failure to follow the intent of the code (e.g., Code of Ethics for the Physical Therapist) • Educational codes state what constitutes ethical behavior and may provide case examples but do not provide sanctions for failure to follow the code • Regulatory codes spell out the expected conduct and give specific descriptions of sanctions for failure to follow the code Core ethics documents can be found at http://www.apta.org/Ethics/Core/
INTRODUCTION Ethics involves making decisions about what is right or wrong and providing a justification for solutions in ethical problems. The application of evidence to practice entails a clinician’s best judgment about what to do and when to do it, based on the needs and values of each client. To navigate effectively and safely through ethical issues, physical therapists should be well versed in the understanding of their ethical and legal responsibilities under the APTA Code of Ethics for Physical Therapists, APTA Guide for Professional Conduct, APTA Standards of Ethical Conduct for the Physical Therapist Assistant, APTA Guide for Conduct of the Physical Therapist Assistant, and individual states’ practice acts. MORALITY, VALUES, ETHICS, AND THE LAW Morality: A relational concept concerned with how people choose to live together to protect a high quality of life. This includes the values, beliefs, and customs of a person or group that influences behavior and judgments regarding right and wrong. Values: Beliefs that a person or group cherish ○ Moral values: Compassion, courage, altruism, honesty, fairness, integrity
LEARNING TIP! Ethics provides the tools, language, and methods needed to make decisions when faced with moral dilemmas and moral issues.
The basic principles of ethics remain stable, whereas the understanding of morality can change as events and innovations create new situations that may alter behavior or thoughts to address new issue.
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Ethical Issues and Decision Making, 2nd Edition: Summary
COMMON CATEGORIES OF ETHICAL ISSUES
LEARNING TIP! Seven professional core values to guide PT practice (as defined by the APTA): • Accountability • Altruism • Compassion/caring • Excellence • Integrity • Professional duty • Social responsibility
Three categories of ethical issues have been identified to be common in physical therapy practices as described below. • Client rights and welfare: Determining the limits of client confidentiality is most likely to raise ethical issues Case Example Jay is about to be discharged home from the hospital as he recovers from a gunshot wound to the shoulder. He will need PT as well as wound care. Beth is a physical therapist who will be seeing him for PT after his discharge, and she learns that Jay’s sister, Marie, will do most of his wound care. Beth also learns that Jay is HIV positive, and he begs the staff to keep his HIV status confidential—especially from his family. He is afraid his father will evict him. ○ Should Beth maintain confidentiality by keeping Jay’s secret, or does she have an obligation to protect Marie’s welfare? • Professional Responsibilities/Role Case Example Angela and Rod were classmates in school, and both now work as physical therapists at the local hospital. Rod is aware from socializing outside of class that Angela likes to go drinking. Nine months after accepting the job, Rod notices that Angela is consistently late to work, seems sluggish in the morning, and makes numerous documentation errors. Rod walks into the break room at 10 a.m. and sees Angela placing a flask into her locker.
Prototypical Ethical Problems Prototypes are useful in ethics because they help clinicians sharpen the distinction of an ethical issue by clarifying the characteristics and dimensions of a problem or problems that must be navigated to make a successful decision. One of the initial steps in making an ethical decision is to define the type of ethical problem one is dealing with. There are three main prototypes: • Moral distress: A situation presents a barrier that blocks a clinician from doing what they perceive is right • Locus of authority: Arises from the ethical question of who should have the authority to make an important ethical decision. In healthcare, the physician is assumed to be the ultimate authority in decision making • Ethical dilemma: Occurs in the presence of an ethical conflict when one must decide a course of action by balancing two or more values, or ethical principles (obligations), that both equally apply
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Ethical Issues and Decision Making, 2nd Edition: Summary
ETHICAL APPROACHES AND THEORIES • Narrative approach: “Get the story straight” by filling in the gaps in the story • Caring approach: The goal of making an ethical decision is to make a caring response due to the fiduciary role between therapists and patients ○ Example: In discussing her interactions with a client who refuses treatment, a physical therapist states: “I try to discuss and understand his reservations and fears about this treatment. I describe the benefit of treatment and try to reach a compromise that we both can accept” • Deontology: Based on principles and duties without regard to consequences ○ Example: A physical therapist who acts in a certain way based on his perceived duty, regardless of its outcome • Teleology: Based on consequences or “ends”; actions seek the best or least harmful consequence • Virtue ethics: Actions based on certain virtues (courage, integrity, temperance, liberty, wisdom) Ethical Principles • Beneficence: Acting in the client’s best interests. Examples of beneficence include protecting and defending the rights of others, preventing harm from occurring to others, removing conditions that will cause harm to others, helping persons with disabilities, and rescuing persons in danger • Nonmaleficence: To refrain from hurting others (causing harm, inflicting injury, or wronging others). This can include discomfort, humiliation, offense, and annoyance in some situations ○ Due care: Taking sufficient and appropriate care to avoid harm ○ Negligence: The absence of due care. It may be intentional or unintentional
○ In a situation like this, the therapist who suspects inappropriate behavior must have evidence. Protocols need to be followed—not only institutional protocols and Code of Ethics for the Physical Therapist. In addition, most state practice acts have an impaired practitioner clause and specify steps to report substance abuse • Business Relationships and Economic Considerations Case Example Mary is a physical therapist who recently took a position with a home health agency. The agency has negotiated a value-based payment (VBP) model with Medicare that incentivizes cost- effective care. The VBP provides incentives for a few specific elements of a single disease or condition that may neglect the complex care needed for the whole patient. Mary is treating an elderly woman to restore function following a hip fracture. Although the patient’s Medicare reimbursement has an established cost-containment model that rewards outcomes based on cost, Mary’s patient presents with multiple comorbidities that contribute to a slow recovery. Mary is faced with moral distress and a moral dilemma in that her company wants to discharge the patient within the standard parameters and time constraints established by the VBP for patients with hip fractures. Mary believes that the complexity of conditions presented by this patient does not fit the VBP for her primary condition and requires additional physical therapy. ○ What are the physical therapists’ obligations and justifications? What would be the most practical action to take and why?
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Ethical Issues and Decision Making, 2nd Edition: Summary
Types of Ethical Issues in Physical Therapy Practice • Social boundaries ○ Examples: Dating clients, sexual harassment in the workplace, exploitation • O rganizational and management issues ○ Examples: Substance abuse at work, being untruthful in the workplace, breaking a contract, overbilling, being pressured to provide unnecessary services • Competency ○ Example: Providing services you are not trained in or not competent • Documentation ○ Examples: Documenting services that were not provided, documenting inaccurate information, deleting documentation • Student education ○ Example: Cheating, not completing clinical rotations • Licensing ○ Example: Not being up to date with your license, flashing reporting thing on license application, updating license when moving • Scope of practice ○ Example: Providing services outside the scope of practice as a physical therapists or physical therapy assistant • Continuing education ○ Example: Falsely reporting CEU credits, teaching a course without appropriate experience • Supervision of physical therapy assistants ○ Example: Inappropriately supervising PTAs or students, not co-signing notes correctly
• Autonomy: The self-determination principle. PTs must respect the right of an individual to hold views, make choices, and take action based on their values ○ Informed consent: Healthcare professionals are obligated to inform a client of the relevant risks, benefits, and uncertainties of a treatment and each alternative procedure; the consequences of nontreatment; goals of treatment; and the prognosis for achieving the goals • Confidentiality: An extension of privacy, in that an individual has voluntarily disclosed, in a relationship of trust, private information about themselves with the expectation that it will not be divulged without permission • Social justice: Promoting organizational behaviors and business practices to benefit patients and society, including access to services, fairness, and equality • Procedural justice: Implementing decisions according to fair processes that ensure “fair treatment” and following the rules (laws, policies, etc.) • Veracity: Based on virtues of truthfulness, candor, and honesty. This refers to speaking truthfully and ensuring the learner understands as a means to establish trust • Fidelity: Being faithful to one’s commitments and placing the interests of clients above self-interests Ethical Decision-Making Process 1. Get the story straight—gather relevant information 2. Identify the type of ethical problem 3. Use ethics theories or approaches to analyze the problem(s) 4. Explore the practical alternatives. 5. Complete the action 6. Evaluate the process and outcome
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Ethical Issues and Decision Making, 2nd Edition: Summary
Ethics and Emerging Technologies Physical therapy personnel will encounter new and emerging technologies that will present their own unique ethical challenges. There are several types of technologies to consider. • Robotics ○ Goal: To promote motor recovery in neuromuscular injuries ○ Issues: Promoting compensation instead of recovery of an injured area ■ Example: Patient with a recent stroke
Ethics and Healthcare Costs U.S. healthcare spending is growing. The Patient Protection and Affordable Care Act (ACA) attempts to control costs while still providing quality healthcare to millions of uninsured individuals by providing strategies such as the Bundled Payment Care Initiative (BPCI) and Affordable Care Organizations (ACOs) to emphasize reducing expensive and unnecessary services and becoming more cost effective for patients. Hospitals and physicians must meet specific quality benchmarks, which focus on disease prevention, carefully managing patients with chronic diseases, and keeping patients healthy. This raises the question of what metrics to use to measure outcomes and how to store, aggregate, interpret, and disseminate data. Ethical questions that arise are: • Goal of healthcare being tied to financial incentives versus individual’s specific needs • Specific incentives of specific aspects of one disease leading to neglect of the complexity of care for the individual • Healthcare providers “cherry picking” clients who have the most promising outcomes for cost of services
not wanting to use robotics to assist his injured side due to a sense of disembodiment; therefore, the PT must consider their obligation to respect the inherent dignity and autonomy of the individual
• Telehealth ○ Goal: Easier access to healthcare ○ Issues: Client autonomy, rights of making informed decisions about the nature and type of care, license portability, and—most importantly— privacy and confidentiality rights for the patient
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Ethical Issues and Decision Making, 2nd Edition: Summary
CASE STUDY
John works as a physical therapist in a small, privately owned physical therapy practice. Besides John, the professional staff includes the owner, Bill (a physical therapist) and June (a physical therapy assistant). John has worked at this practice for five years and has developed a close relationship with Bill as a friend and mentor. June has been working there three months. Everybody seemed to have a good working relationship.
Therefore, John was perplexed when June approached him in private and told him that since she began working at the practice, Bill has been making inappropriate sexual remarks to her, for example, commenting on her figure and suggesting that she should wear tight clothes to accent her backside and breasts. At this point, June did not know what to do. She really enjoyed and needed this job and was reluctant to confront Bill. She also did not want John to talk with Bill about this, because she did not want to make things worse. John was unsure about the right course of action. What is John’s primary duty in this case? How should he respond to June? What are his obligations to his organization and to his profession? Is there a legal duty in this case? What other information would John need to make a justified decision? Conclusion:
on established evidence, providing continuity of service, ensuring informed consent, maintaining confidentiality, providing just and fair treatment, maintaining proper credentialing, documenting in an accurate and timely manner, stewarding resources, and avoiding conflicts of interest. Physical therapy practitioners should take the opportunity to examine the APTA Code of Ethics for the Physical Therapist and the APTA Guide for Professional Conduct and explore the enforcement procedures used by the APTA with its members.
The APTA Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant are designed to guide PTs toward competency and ethical behavior. PTs are expected to aspire to the highest level of moral standards, which are organized according to six principles: Beneficence, nonmaleficence, autonomy, justice, veracity, and fidelity. Within these principles are important concepts that should be upheld, such as maintaining professional competence, basing intervention
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Ethical Issues and Decision Making, 2nd Edition: Summary
FINAL EXAM QUESTIONS
1.
When faced with a moral issue, practitioners turn to ethics because it: a. Changes over time b. Focuses on beliefs and customs c. Provides tools and language for decision making d. Influences behavior and judgment In contrast to codes of ethics, the law is a compendium of rules that are: a. Aspirational in nature b. Based on core values and principles c. Defined by government and based on concepts of justice and equality d. Based on group norms and standards of behavior The primary purpose of a state practice act is to: a. Delineate the American Physical Therapy Association (APTA) organizational rights and privileges to practice b. Safeguard the safety and health of the public c. Delineate the ethical obligations of practice d. Empower the state physical therapy association to implement rules of practice A code of ethics that does not provide specific guidelines or sanctions for ethical conduct, such as the APTA Code of Ethics for the Physical Therapist, is considered:
5.
The APTA Code of Ethics for the Physical Therapist: a. Describes the rights and privileges of members of that organization b. Describes disciplinary action for ethical violations c. Provides standards of behavior and ethical conduct d. Provides provisions for enforcing the code The APTA defined seven professional core values that guide physical therapy practice. These values were incorporated into the revised Code of Ethics for the Physical Therapist and include: a. Deontology b. Virtue c. Integrity d. Autonomy A physical therapist who is not certain they have the ethical authority to make an ethical choice about treatment is most likely facing: a. External moral distress b. A locus of authority conflict c. A moral dilemma d. Internal moral distress An ethical dilemma is best described as: a. The clash between a legal rule and an ethical principle b. Uncertainty regarding professional authority c. The conflict between two or more ethical principles d. An insurmountable barrier to ethical action
2.
6.
3.
7.
4.
8.
a. Aspirational b. Educational c. Regulatory d. Legally binding
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Ethical Issues and Decision Making, 2nd Edition: Summary
9.
Determining the limits of client confidentiality is most likely to raise ethical issues involving: a. Professional responsibilities and roles b. Client rights and welfare
14. A client’s right to refuse physical
therapy services embodies the principle of:
a. Fidelity b. Veracity c. Procedural justice d. Autonomy 15. Physical therapy practitioners are
c. Business and organizational practices d. Economic considerations and fairness 10. In discussing her interactions with a client who refuses treatment, a physical therapist states, “I try to discuss and understand his reservations and fears about this treatment. I describe the benefit of treatment and try to reach a compromise that we both can accept.” These statements most closely reflect the ethical framework of: a. Teleology b. Deontology c. Consequentialism d. A caring approach 11. A physical therapist who acts in a certain way based on their perceived duty, regardless of its outcome, would justify their behavior based on the ethical theory of: a. Caring b. Deontology c. Virtue d. Consequentialism 12. Joan is a physical therapist assistant who tries to act with integrity and courage as her parents would expect. She justifies her decision-making approach based on the ethical theory of: a. Virtue b. Deontology c. Consequentialism d. Caring 13. The ethical principle that requires an
expected to advocate for equal access to healthcare resources to honor the ethical principle of:
a. Beneficence b. Social justice
c. Procedural justice d. Nonmaleficence 16. A case has just been brought before a chapter ethics committee in which a client’s spouse accuses a physical therapist of unethical conduct. The first step ethics committee members should take is to: a. Identify the type of ethical problem b. Use ethical theories or approaches to analyze the problem c. Get the story straight d. Explore practical alternatives 17. A physical therapy supervisor orders their staff physical therapist to readjust their client’s goals until the client’s Medicare cap is reached. The ethical issue in this scenario involves: a. Competency b. Organizational and management issues c. Scope of practice d. Social boundaries 18. A home health physical therapist is asked by their supervisor to reinsert a client’s intravenous needle that has detached during the night. The client’s home health nurse is unavailable that day. The physical therapist faces an ethical issue involving: a. Scope of practice b. Documentation c. Social boundaries d. Professional behavior
individual to take action by helping others, promoting good, preventing harm, and removing harm is: a. Procedural justice b. Veracity c. Confidentiality d. Beneficence
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Ethical Issues and Decision Making, 2nd Edition: Summary
19. Emerging technologies in healthcare present unique ethical challenges. One ethical challenge that may arise with the use of robotics involves: a. Confidentiality and portability b. Dignity and autonomy c. Equal access to home health care service d. Privacy and genetic determinism
20. A local client who is receiving outpatient physical therapy is unable to attend his weekly session because of car trouble. The physical therapist, who is licensed and practices in the same state as the client, decides to use Skype to reevaluate and treat the client from home. The most concerning ethical issue raised in this case is: a. Safety b. Portability c. Confidentiality d. Autonomy
Access the final exam to this course here!
COURSE CODE: PTSC05ET-H
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Back to the Books: Return to Learn Strategies for Concussed Student-Athletes: Summary
Back to the Books: Return to Learn Strategies for Concussed Student-Athletes 2 Contact Hours
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Author J.D. Boudreaux, EdD, PT, LAT, ATC, SCS
Bachelor of Science degree from McNeese State University, Masters of Physical Therapy from LSU Health Sciences Center-Shreveport, nationally certified as an athletic trainer and obtained his Sports Certified Specialist certification through the American Board of Physical Therapy Specialties, EdD degree from the University of Louisiana.
LEARNING OUTCOMES • Select essential multidisciplinary team members involved in the return to learn (RTL) process • Examine barriers to implementation of RTL protocols for student-athletes • Generate a return to learn plan for student-athletes recovering from concussions
• Apply various techniques to assist the student-athlete throughout the return to learn process • Appraise current communication skills to improve dissemination and activation of RTL plan
SELF-ASSESSMENT QUESTIONS
1. Which factors can influence recovery rates from concussions? a. Severity of initiate symptoms
3. Approximately _____ concussions occur annually in the U.S. due to sports or physical activity. a. 3.8 million b. 2.0 million c. 1.2 million d. 1.8 million 4. Cognitive symptoms of concussion include: a. Headaches b. Fuzzy/blurry vision c. Difficultly thinking clearly d. Balance problems
b. Psychological factors c. Subacute symptoms d. All of the above
2. Concussion sign and symptoms can be categorized into four main groups, including: a. Cognitive, emotional/mood, sleep disturbances, and occupational skills b. Cognitive, physical, emotional/mood, and sleep disturbances c. Cognitive, physical, sleep disturbances, and anger management d. Cognitive, emotional/mood, sleep disturbances, and occupational skills
ANSWERS: 1: D
2 : B
3: A
4: C
12 Back to the Books: Return to Learn Strategies for Concussed Student-Athletes: Summary 12
it's important to remember that concussions can have a variety of effects and that careful management is essential for a full recovery. Concussion symptoms are often functional rather than structural. That is, they reflect disturbances in brain function rather than physical damage to the brain itself. Loss of consciousness is not always a sign of a concussion, so educating people about the nuances of these types of injuries is crucial for ensuring that they are managed safely and effectively. • Symptoms may not be immediate; teachers, coaches, and counselors should be educated to notice signs days after the incident. • Full recovery involves addressing both physical and cognitive impairments, emphasizing integration into the classroom before considering a return to play. • A survey found that less than 25% of high schools had written concussion plans addressing academic adjustments.
INTRODUCTION Understanding concussions is critical for anyone involved in sports or other activities that carry a risk of head or body impacts. To do so, we must first establish a common definition, which can be tricky given the range of possible causes. Some definitions focus on the mental effects of trauma, while others emphasize the role of the brain in behavior and motor function. Whatever definition you choose, Facts and Statistics About Concussions • Approximately 3.8 million concussions occur annually in the U.S. due to sports or physical activity. • Around 80% of sports-related concussions typically recover within three to four weeks. • Severity of initial symptoms, psychological factors, and subacute symptoms like migraines influence recovery rates. • Concussions can occur at any age and are not exclusive to sports-related incidents. The common signs and symptoms of concussions can be categorized into four main groups: Cognitive (thinking and remembering), physical, emotional mood, and sleep disturbances. Healthcare professionals, teachers, counselors, and parents should be well-versed in the nuances of concussions in order to address all categories and not miss any underlying signs. Cognitive • Difficulty thinking clearly • Feeling slowed down • Difficulty concentrating • Difficulty remembering new information
Physical • Headaches –often the most symptom after sustaining a concussion
• Fuzzy or blurry vision • Nausea and vomiting • Dizziness • Sensitivity to light and noise • Balance problems • Fatigue Emotional/Mood • Irritability • Sadness • Emotional or crying outbursts • Nervousness or high anxiety
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Back to the Books: Return to Learn Strategies for Concussed Student-Athletes: Summary
Sleep Disturbances • Sleeping more or less than usual • Difficulty falling asleep
LEARNING TIP! Athletic trainers are often the first to identify injuries and communicate with the medical team. They play a crucial role in facilitating a timely RTL plan and ensuring a seamless transition between the medical, academic, and physical activity teams. Communication across members of the RTL team is essential to ensure proper management of the concussed student.
A return to learn (RTL) plan is a step-by-step process that aims to help students recover while providing them with adequate support and academic adjustments during the school day. This approach involves implementing customized programs that ensure a gradual and individualized return to the classroom, much like return to play protocols. EVIDENCE-BASED PRACTICE RTL protocols should be tailored to the individual student to make sure that they are put in the best environment to return to the classroom. A 2020 study revealed that concussed student-athletes greatly benefit from returning to the classroom using a gradual, stepwise process to ensure that symptoms are not exacerbated by cognitive activities. In order to achieve a successful RTL for student-athletes, it's important to have a multidisciplinary team of experts, including the medical team, the student's family, the school's academic team, and the school's physical activity team. One of the most important members of this team is the athletic trainer. Athletic trainers not only have specialized knowledge in identifying and managing concussions, but they also act as a valuable source of information for both student athletes and school staff.
Identifying a Case Manager A case manager serves as the decision maker who oversees the student’s return to the classroom and manages the scheduling of tests along with other academic aspects. Referring physicians are typically the case managers of choice, but in some cases, an athletic trainer or school counselor may take on this role, acting as a bridge between the medical and academic teams. When developing RTL protocols, it’s important to understand the distinction between adjustments, accommodations, and modifications. Although these terms are sometimes used interchangeably, they each have unique meanings and should be approached as separate considerations. Adjustments • Nonformalized changes within the initial one to three weeks that do not jeopardize curriculum or testing
14 Back to the Books: Return to Learn Strategies for Concussed Student-Athletes: Summary 14
Accommodations • Extend beyond three weeks; may require a formal 504 plan (a customized guide with educational adjustments for cases where recovery extends beyond the expected timeframe) Modifications • Permanent changes to the educational plan; may require an individualized education plan (IEP) • Rare, as most students are expected to return to their full prior level of function;
communication is essential to ensure pro curriculum per management of the concussed student to avoid unnecessary disruptions to the learning • Examples include making major academic changes, altering the overall educational goals for the student The vast majority of concussed student- athletes will stay in the adjustment phase, while a few may move to accommodation. Making significant modifications to a student athlete's educational system should be extremely rare.
Goals of RTL Plans 1. Avoid overexertion : Prevent activities that may exacerbate symptoms. This includes cognitive rest, which involves reducing the level of academic and cognitive challenges following a concussion. Using a concussed brain to learn may worsen concussion symptoms and prolong recovery. 2. Minimize disruptions : Aim to minimize disruptions to the student's life by reintegrating them into school efficiently and safely. 3. Quick return to school : Facilitate the return of the recovering student to school promptly, helping them reintegrate into their social circle and normal routine. 4. Protect the student-athlete : Ensure a gradual recovery of missed coursework to protect the student-athlete from undue stress and prevent symptom exacerbation.
• Conduct teacher and staff education and training sessions, emphasizing strategies for supporting students recovering from concussions • Develop a list of concussion resources for education, consultation, and referral DURING THE SCHOOL YEAR (PREINJURY) • Regularly review and reinforce concussion policies and procedures with staff and educators throughout the school year; RTL documents should be reviewed annually • Continuously monitor for potential injuries, both in practice and during school activities • In the event of an injury, promptly inform parents about the situation, guide them toward appropriate healthcare providers, and outline the plan for gradual return to school
Schools with concussion policies and procedures implemented prior to a student injury will be better prepared to manage sports-related emergencies. As athletic trainers and healthcare providers providing care to student-athletes, there are some things we can do before and during the school year to manage a successful RTL in the event of a concussion. PRE–SCHOOL YEAR PREPARATION • Develop clear concussion management policies and procedures, including plans for both RTL and return to physical activity • Establish a concussion resource team in advance, designating key partners and stakeholders to handle the protocol implementation
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Back to the Books: Return to Learn Strategies for Concussed Student-Athletes: Summary
• Concussed students may be allowed to return while still symptomatic if they are able to tolerate blocks of instructional time; this decision may be made by a parent and family team in consultation with a physician; reassess weekly POSTINJURY MANAGEMENT • Ensure that the injured athlete receives an appropriate medical evaluation • Implement a gradual RTL program, allowing for in-school observation, monitoring, and necessary supports • Seek medical clearance for full return to school; the majority of students typically recover within the first three to four weeks COGNITIVE, SOCIAL-EMOTIONAL, AND BEHAVIORAL STRATEGIES FOR RTL ADJUSTMENTS Cognitive Strategies • Concentrate on general cognitive skills rather than academic content at first • Focus on the student's strengths and gradually expand curriculum as symptoms subside • Incorporate breaks in the school day to prevent cognitive fatigue • Tailor academic assignments and testing methods to align with the student's recovery pace and cognitive capabilities
• Adjust the learning environment to reduce distractions; consider extra time for assignments and tests and reduce auditory stimuli • Assign a peer for note-taking • Record classes for later review • Find diverse ways for students to demonstrate mastery beyond traditional testing Social-Emotional and Behavioral Strategies • Redirect the student to elements of the curriculum where they've experienced success • Provide positive reinforcement for academic achievements and acknowledge progress • Empathize with the student’s frustration and address emotional outbursts • Ensure structure and consistency among teachers implementing the RTL strategies • Remove students from problematic situations without characterizing it as punishment • Involve the student in decision making regarding their academic goals and schedule • Set reasonable expectations for the student’s academic progress
CASE STUDY 1: 10TH-GRADE FOOTBALL PLAYER
• Background : Sustained a concussion during football practice, multiple hits to the head. • Immediate actions : Reported symptoms to the athletic trainer, continued to participate as no concussion symptoms were felt, no loss of consciousness reported. • Symptoms : Difficulty sleeping, reading, and light sensitivity. Immediate dizziness after head contact. Headache, low energy, dizziness, and light sensitivity. Some improvement reported since initial presentation. • Management approach : Graduated, stepwise RTL process. Do not remove from all academic activities. • Adjustments : ○ For sensitivity to light : Reduce computer screen brightness, consider sunglasses or visors. ○ For low energy or fatigue : Supervised rest breaks, later start to school, shortened school day, alternate core curriculum classes.
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CASE STUDY 2: 12TH-GRADE SOCCER PLAYER
• Background : Head injury during a soccer game, elbowed in the right temporal region, fell and hit the ground. No immediate signs or symptoms, able to finish the game. • Symptoms : Delayed onset neck pain, increased fatigue, difficulty concentrating, and increased headache with schoolwork. Occasional dizziness and headache persist despite some improvement. • Management approach : Graduated, stepwise RTL process. Do not remove from all academic activities. • Adjustments : ○ For headaches : Identify and reduce exposure to aggravating factors, allow rest breaks in the nurse's office, allow the athlete to put their head down. ○ For dizziness : Avoid crowded hallways, investigate and address potential vestibular issues.
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