Indiana Physical Therapy Ebook Continuing Education

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INDIANA Physical Therapy Continuing Education

GET THIS BOOK (and more!) FREE WITH MEMBERSHIP ONE CONVENIENT BOOK Includes 2-Hour Ethics & Indiana Jurisprudence Requirement S ee I nside F ront C over F or D etails

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Don’t need all 22 hours but want to complete an individual course? We have you covered! Find the course code found in the table below and enter it at EliteLearning.com/Book Hours PRICE Ethics and Jurisprudence for the Indiana Physical Therapy Professional, 2nd Edition (Mandatory) 2

COURSE CODE

$37.00 PTIN02EJ-H

Allen Cognitive Levels: An Introduction to Theory & Assessment

6 $105.00 PTIN06AC-H

Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition

$72.00 PTIN04BF-H

Concussion Management for Healthcare Professionals

$55.00 PTIN03CM-H

Evaluations and Treatment of the Cervical Spine, 2nd Edition

$55.00 PTIN03CS-H

Manual Therapy and Therapeutic Exercise for Common Orthopedic Conditions and Functional Mobility

$72.00 PTIN04MT-H

This 22-Hour Summary Book

22 $195.00 PTIN2226H

Book Expiration Date: 7/8/2026

INCLUDED IN THIS BOOK

1 Ethics and Jurisprudence for the Indiana Physical Therapy Professional, 2nd Edition [2 contact hours] This course covers the principles and standards of ethical practice for physical therapists and assistants, as well as the Indiana Administrative code §25-27 and the Indiana Practice Act (title 844, Article 6). Both of these topics are mandatory for the physical therapy professionals within the state of Indiana. Section I will present the theory, practice, and scope of ethics for the physical therapy professional. Section II will discuss the regulatory and legislative aspects. Therefore, this course will satisfy the two-hour mandatory requirement. 8 Allen Cognitive Levels: An Introduction to Theory & Assessment [6 contact hours] Allen Cognitive Levels: An Introduction to Theory & Assessment is a comprehensive course that provides in- depth instruction on the Allen Cognitive Levels Screen,5th Edition (ACL-5), a vital assessment tool for evaluating functional cognition across populations with cognitive deficit-based disorders. Through three 2-hour modules, participants will explore theoretical foundations, standardized assessment procedures, and evidence-based intervention planning strategies. 15 Blood Flow Restriction Training: Understanding the Safety, Mechanisms, and Efficacy, 2nd Edition [4 contact hours] Blood flow restriction training (BFRT) is an exercise technique that is transforming how we prescribe exercises therapy. By partially restricting blood flow to the muscles using specialized cuffs or bands, BFRT offers a range of benefits from muscle activation to advanced rehab training. Discover the benefits of blood flow restriction training with this course. From increasing muscle activation and muscle growth to enhancing strength and endurance. BFRT can even help reduce pain. BFRT is a science-based approach—over 800 articles published in the last 10 years—that can be safely prescribed to diverse populations from young to old, from patients to athletes. 23 Concussion Management for Healthcare Professionals [3 contact hours] Annually, there are approximately 30-50 million concussion cases that occur globally, with 3-4 million new cases within the U.S. Concussion incidences continue to rise with each passing year (Strauss, 2022). The importance of concussion education has become apparent with these statistics. This course delves into a comprehensive overview of what is a concussion, how to treat and/or manage concussion symptoms, and prevention strategies. Gaining a good understanding of the ideas and concepts around concussions will aid in the management, diagnosis, rehabilitation, and education of the patient in regards to this condition. This course can aid healthcare professionals in promoting better patient outcomes and a quicker return to daily and occupational activities. 36 Evaluations and Treatment of the Cervical Spine, 2nd Edition [3 contact hours] This course is intended for all healthcare professionals who care for clients who experience pain and dysfunction of the cervical spine. This course utilizes the most recent research for effective evaluation and treatment options for treating the cervical spine. Participants will learn methods for evaluating the cervical spine to classify the conditions and determine if it is safe to proceed with treatment. Participants will also learn the most effective treatment methods according to the most recent research. 50 Manual Therapy and Therapeutic Exercise for Common Orthopedic Conditions and Functional Mobility [4 contact hours] Manual therapy and therapeutic exercise are foundational interventions when treating orthopedic conditions. Recently, research has focused on the effectiveness of using both manual therapy and therapeutic exercise to treat orthopedic conditions as compared to other interventions or compared to using just manual therapy or just therapeutic exercise. There is a growing body of evidence to support the use of these interventions together as they seem to augment the effectiveness of each other.

FREQUENTLY ASKED QUESTIONS

License Expires

CE Hours Required

Mandatory Subjects

22 (All hours are allowed through home study)

June 30th of even-numbered years

2 hours of Ethics and Indiana Jurisprudence

Are you an Indiana board-approved provider? Colibri Healthcare, LLC’s courses meet the standards for physical therapy continuing education activities in Indiana. Colibri Healthcare, LLC’s Ethics and Jurisprudence courses are approved by the APTA Indiana. Are my credit hours reported to the Indiana board? No, the board 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.

Ethics and Jurisprudence for the Indiana Physical Therapy Professionals, 2nd Edition: Summary 1

Ethics and Jurisprudence for the Indiana Physical Therapy Professionals, 2nd Edition 2 Contact Hours

ACCESS THE FULL PRESENTATION Scan the QR CODE ► to start video or visit https://uqr.to/IN-ethics2

Author Dr. Morgan Rotella, PT, DPT

Dr. Morgan Rotella received her doctorate degree in physical therapy from The Ohio State University in 2019. She has been working as an outpatient orthopedic and vestibular physical therapist for more than four years now and is a certified vestibular and concussion rehabilitation specialist per the American Institute of Balance. Outside of working as a clinician, she works as an author and editor for health blogs and video content to ensure appropriate information is available regarding common medical conditions and physical therapy considerations. Furthermore, she has experience in reviewing, summarizing, editing, and contributing to a number of physical therapy continuing education courses.

LEARNING OUTCOMES • Define the standards and principles for ethical practice from the American Physical Therapy Association Code of Ethics for Therapists and Assistants • List and explain the five roles of physical therapy • Identify and give examples of the scope of practice for physical therapy professionals • State the purpose, mission, and vision of the Model Practice Act for Physical Therapy

• Define dual- and multiple-role relationships between practitioners and clients and strategies to maintain boundaries • Identify and define the steps for ethical decision making using the RIPS model • Discuss the Indiana Administrative Code as it pertains to the physical therapy professional • Summarize the legislative and regulatory components of the Indiana Practice Act

SELF-ASSESSMENT QUESTIONS

According to the RIPS model for ethical decision making, what are the four steps in the correct order? a. Recognize, Implement, Prioritize, Solve b. Reflect, Identify, Process, Strategize c. Recognize, Reflect, Decide, Implement d. Review, Interpret, Plan, Supervise Under the Indiana Practice Act, how many days can a physical therapist evaluate and treat a patient without a referral?

What are the continuing competency requirements for physical therapists and physical therapist assistants in Indiana? a. 10 hours biennially, including 1 hour in ethics b. 22 hours biennially, including 2 hours in ethics and Indiana jurisprudence c. 30 hours biennially, including 5 hours in ethics d. 15 hours annually, including 3 hours in Indiana jurisprudence

a. 14 days b. 24 days c. 42 days d. 60 days

ANSWERS: 1: c 2 : c 3 : b

Ethics and Jurisprudence for the Indiana Physical Therapy Professionals, 2nd Edition: Summary 2

APTA CODE OF ETHICS FOR PHYSICAL THERAPISTS The Code of Ethics serves multiple purposes: • Define ethical principles forming the foundation of physical therapist practice • Provide standards of behavior for professional accountability • Provide guidance for physical therapists facing ethical challenges • Educate physical therapists, students, other healthcare professionals, regulators, and the public • Establish standards for determining unethical conduct The Code is built upon the five roles of the physical therapist (management of patients/clients, consultation, education, research, and administration), the core values of the profession, and multiple realms of ethical action. Principles of the Code of Ethics Principle #1: Physical therapists shall respect the inherent dignity and rights of all individuals. • Act respectfully toward each person regardless of background or characteristics • Recognize personal biases and avoid discrimination Principle #2: Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients/clients. • Adhere to core values and act in patients' best interests and avoid any exploitation or abuse of the patient • Provide services with compassion and cultural sensitivity • Provide information for informed decisions • Collaborate with patients in healthcare decisions • Protect confidential information Principle #3: Physical therapists shall be accountable for making sound professional judgments. • Demonstrate independent and objective judgment • Base judgments on professional standards and evidence • Practice within scope and collaborate when necessary • Avoid conflicts of interest • Provide appropriate direction to assistants and support personnel

INTRODUCTION Across all practice, educational, and research settings, physical therapists face issues that involve ethical questions. To navigate ethical issues and problems, physical therapy practitioners should be well versed in the knowledge and skills of ethical decision making. They need to understand their ethical and legal responsibilities under the APTA Code of Ethics for Physical Therapists, the APTA Standards of Ethical Conduct for the Physical Therapist Assistant, and the Indiana state practice act. Although ethics education has become better integrated into physical therapy education over the past decade, many endorse that ethical decision-making requires more skill than simply following a code of ethics in the physical therapy profession since the professional duties are linked to social exception of ethical behavior as well. Many also believe that entry level education is not sufficient enough on a world scale for physical therapy, requiring multiple sources for learning to develop an ethical decision-making framework. SECTION I: ETHICS Understanding Ethics in Physical Therapy Ethics is derived from the Greek word "ethos" (character) and the Latin word "mores" (customs), which together define how individuals interact with one another. In physical therapy, codes of ethics state the principles and rules of conduct to guide professionals in making decisions between right and wrong actions. These codes protect patient welfare and standardize practice. The Federation of State Boards of Physical Therapy (FSBPT) administers the National Physical Therapy Examination (NPTE) and governs practice through collaboration with state regulatory boards and the APTA. The FSBPT's mission is to protect the public by providing service and leadership that promotes safe and competent physical therapy practice. Scope of Practice The APTA defines scope of practice as having three components: 1. Professional scope : Practice grounded in the profession's unique body of knowledge, supported by educational preparation, based on evidence, and linked to existing or emerging practice frameworks. 2. Jurisdictional scope : Established by the Model Practice Act governing the specific physical therapist's license and the rules adopted pursuant to that act. 3. Personal scope : Activities for which an individual physical therapist is educated and trained and competent to perform.

Ethics and Jurisprudence for the Indiana Physical Therapy Professionals, 2nd Edition: Summary 3

Principle #4: Physical therapists shall demonstrate integrity in their relationships. • Provide truthful and accurate information • Avoid exploitation of supervisory relationships • Report misconduct and abuse • Maintain appropriate professional boundaries • Avoid harassment Principle #5: Physical therapists shall fulfill their legal and professional obligations. • Comply with applicable laws and regulations • Supervise physical therapist assistants and support personnel • Protect research participants • Address colleague impairment • Ensure continuity of care Principle #6: Physical therapists shall enhance their expertise through lifelong learning. • Maintain professional competence • Take responsibility for professional development • Evaluate evidence before integrating new techniques • Support professional development environments Principle #7: Physical therapists shall promote organizational behaviors and business practices that benefit patients/ clients and society. • Support autonomous and accountable professional judgments • Seek reasonable remuneration • Avoid conflicts of interest • Ensure accurate documentation and coding Principle #8: Physical therapists shall participate in efforts to meet health needs of people locally, nationally, or globally. • Provide pro bono services or support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured • Advocate to reduce health disparities • Be responsible stewards of healthcare resources • Educate the public about physical therapy benefits Standards of Ethical Conduct for Physical Therapist Assistants The Standards of Ethical Conduct for Physical Therapist Assistants parallel the Code of Ethics for Physical Therapists but are tailored to the assistant's role. Key standards include: • Standard #1 : Respect the inherent dignity and rights of all individuals.

• Standard #2 : Be trustworthy and compassionate in addressing patient/client rights and needs. • Standard #3 : Make sound decisions in collaboration with the physical therapist within legal boundaries. • Standard #4 : Demonstrate integrity in relationships with patients, colleagues, and others. • Standard #5 : Fulfill legal and ethical obligations. • Standard #6 : Enhance competence through lifelong learning. • Standard #7 : Support organizational behaviors and business practices that benefit patients and society. • Standard #8 : Participate in efforts to meet health While sexual relationships between therapists and clients are prohibited, not all multiple and dual relationships are unethical. When identifying potential dual relationships, therapists should consider: • Whether the relationship could impair judgment or effectiveness in treatment • Potential loss of objectivity • Risk of exploitation or harm to the patient • Whether the relationship promotes patient health and welfare • Public perception of the relationship Ethical Decision Making: The RIPS Model The Realm-Individual Process-Situation (RIPS) Model of Ethical Decision Making includes: Components of RIPS: • Environmental context: Individual, organizational/ institutional, societal • Individual process: Ethical sensitivity, judgment, motivation, or courage • Situation: Ethical issue/problem, dilemma, distress, moral temptation Four Steps: 1. Recognize and define ethical issues : Examine facts and analyze the realm, individual process, and type of ethical situation. 2. Reflect : Interpret information, identify stakeholders, consider consequences, and apply relevant principles. 3. Decide the right thing to do : Resolve ethical dilemmas through rule-based, ends-based, or care- based approaches. 4. Implement, evaluate, reassess : Develop an implementation plan, evaluate outcomes, and reflect on professional growth. needs locally, nationally, or globally. Multiple and Dual Relationships

Ethics and Jurisprudence for the Indiana Physical Therapy Professionals, 2nd Edition: Summary 4

SECTION II: INDIANA JURISPRUDENCE Indiana Practice Act and Administrative Code The Indiana Code §25-27 (Indiana Practice Act) and Indiana Administrative Code, Title 842, Article 1 govern physical therapists and physical therapist assistants in Indiana. Key changes from Senate Enrolled Act No. 586 (effective July 1, 2019) include: • Creation of a five-member physical therapy board • Extension of "direct access" days from 24 to 42 days • Addition of dry needling to the scope of practice • Improved title protections • Removal of physicians' ability to supervise physical therapist assistants • Definition of "physical therapy aide" • Limitation of NPTE attempts to 6 Key Definitions and Scope of Practice Physical therapy is defined as care and services provided by or under the direction and supervision of a physical therapist, including: • Examining, evaluating, and testing patients with impairments or limitations • Alleviating impairments through various interventions (therapeutic exercise, manual therapy, etc.) • Using dry needling to treat neuromusculoskeletal pain (with proper training) • Reducing risk of/preventing injuries and promoting wellness • Engaging in administration, consultation, education, and research Licensure Requirements The Indiana board of physical therapy is responsible for: • Evaluating qualifications of applicants • Providing examinations • Licensing and certifying qualified applicants • Adopting rules for competent practice Applicants for licensure must: • Complete the application process and pay fees • Graduate from an accredited program • Pass the examination • Submit to a criminal background check • Meet continuing competency requirements Renewal and Continuing Competency • Licenses and certificates expire on the date specified in even-numbered years. Licensees must renew their license on or before July 1st every even-numbered year.

• 22 hours of continuing competency activities are required for biennial renewal ○ 2 hours must be in ethics and Indiana jurisprudence ○ A licensee must certify completion of continuing competency activities and retain verification of completion of continuing competency activities for 3 years after the last renewal date ○ If a license or certification is valid for fewer than 12 months, no continuing competency activity is required for renewal • At least 10 hours must be in Category I courses ○ Category I activities include the following and must be at least one (I) contact hour in length: ■ Formally organized courses ■ Workshops ■ Seminars ■ Symposia ■ Home study programs including computer, audio and video instructional programs ■ Approved “for credit” courses that are related to the practice of physical therapy from an approved organization ○ Category II activities include the following: ■ Professional writing/research ■ Teaching as an adjunct responsibility at an accredited PT or PTA program ■ Participation as a presenter in an approved workshop, continuing education course, seminar or symposium ■ Supervision of physical therapy or physical therapy assistant students ■ In-house or in-service seminars related to physical therapy practice ■ Actively participate with professional organizations related to physical therapy practice ■ Certification of clinical specialization by the American Board of Physical Therapy Specialties (ABPTS) ■ Certificate of Advanced Proficiency for the PTA by the APTA ■ Attendance at the INAPTA state or distract meetings ■ Other scholarly or educational activities related to the practice or management of physical therapy • Continuing competency hours must be obtained within the biennial renewal period • Each licensee is responsible for providing the board with a current address, telephone number, and name change, as applicable, within thirty (30) days of the change

Ethics and Jurisprudence for the Indiana Physical Therapy Professionals, 2nd Edition: Summary 5

Standards of Professional Conduct Physical therapy practitioners must: • Maintain the confidentiality of all knowledge and information regarding a patient, including the patient’s diagnosis, treatment, and prognosis • Provide truthful information about patient conditions • Exercise reasonable care based on scientific principles • Practice within their scope and competence • Document accurately—A practitioner shall maintain adequate patient records • Report misconduct • Maintain professional boundaries The supervising physical therapist shall examine each patient to review treatments and progress not less than: • Every 14 days for inpatients in either a hospital or comprehensive rehabilitation facility; • The earlier of every 90 days or 6 physical therapy visits for patients in a facility for the developmentally disabled (DD) and school system patients • The earlier of every 30 days or every 15 physical therapy visits for all other patients If this daily consultation is not face-to-face, the physical therapist may not supervise more than the equivalent of 3 full time physical therapist assistants. Consultation between a supervising physical therapist and the physical therapist assistant may be in person, by telephone, or by a telecommunications device for the deaf (TDD), so long as there is interactive communication concerning patient care. Dry Needling Requirements • Charge reasonable fees • Avoid conflicts of interest Standards or Practice for PT Services To perform dry needling, physical therapists must: • Complete a minimum of 50 hours of education specific to dry needling theory, practice, and technique • Ensure 40 of these hours are completed in person

• Bright-line rule : An objective rule that resolves legal questions in a straightforward, predictable manner. A bright-line rule is easy to administer and produces certain—though arguably, not always—equitable results • Dual or multiple relationships : A multiple relationship occurs when a therapist or assistant is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the therapist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person • Informed consent : Informed consent is a process, not just a form. Information must be presented to enable persons to voluntarily decide whether to participate. It is a fundamental mechanism to ensure respect for persons through provision of thoughtful consent for a voluntary act. The procedures used in obtaining informed consent should be designed to educate the subject population in terms that they can understand. Therefore, informed consent language and its documentation must be written in lay language, that is, understandable to the people being asked to participate. The written presentation of information is used to document the basis for consent and for the subjects’ future reference. The consent document should be revised when deficiencies are noted or when additional information will improve the consent process • Fiduciary duty : The responsibility to act in the best interest of a person or organization • Personal bias : The action of supporting or opposing a particular person or thing in an unfair way, because of allowing of personal opinions to influence • Veracity : The principle that one should tell the truth, that honesty is the best policy Conclusion This course covered the mandatory principles and standards of ethical practice for physical therapy professionals in Indiana, as well as the legal requirements governing practice. Understanding these ethical principles and legal requirements is essential for maintaining professional standards and protecting patient welfare.

• Maintain documentation of training • Not delegate dry needling to others GLOSSARY

• Altruism : The primary regard for or devotion to the interest of patients/clients, thus assuming the fiduciary responsibility of placing the needs of the patient/client ahead of the physical therapist’s self- interest • Autonomy : Self-directing freedom and especially moral independence

WORKS CITED

https://qr2.mobi/ethicsIN

Ethics and Jurisprudence for the Indiana Physical Therapy Professionals, 2nd Edition: Summary 6

FINAL EXAM QUESTIONS

In the physical therapy profession, _________ state(s) the principles and rules of conduct to guide professional therapists and assistants to make decisions between right and wrong actions. a. morality b. codes of ethics c. laws d. regulations _________ is defined as the “self-directing freedom and especially moral independence.” a. Altruism b. Dual relationship c. Veracity d. Autonomy According to the APTA, a physical therapist stands in a relationship of _________ to each patient and has an ethical obligation to act in the patient’s best interest and to avoid any exploitation or abuse of the patient. a. exploitation b. trust c. permissiveness d. obligation According to the core value of social responsibility, physical therapists “shall provide _________ physical therapy services or support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured.” a. a sliding scale fee b. 10% off c. pro bono d. pricey According to the Indiana APTA, the scope of practice is limited to the care and services provided by, or under the direction and supervision of, a physical therapist. What is NOT one of the four points? a. Examining histories, system reviews, and tests and measures b. Alleviating impairment and functional limitations c. Preventing injury, impairment, functional limitation, and disability d. Discussing patients, services, and diagnoses with other professionals in the physical therapy profession

How many members are on the Indiana board of physical therapy? a. Six b. Five

c. Three d. Seven

Changes of address, telephone number, and name change are required to be provided to the state of Indiana within how many days of the change? a. 60 b. 365 A practitioner shall maintain the _________ of all knowledge and information regarding a patient, including the patient’s diagnosis, treatment, and prognoses. a. files b. confidentiality c. data d. applicable information c. 90 d. 30

9. The practitioner shall _________ adequate patient records. a. maintain b. destroy c. share d. read 10. During each two-year license period, a physical therapist or physical therapist assistant must complete how many hours of continuing competency activities? a. 20 b. 22 c. 26 d. 18 11. Which of the following is not one of the three components of the scope of practice as described by the APTA? a. Professional b. Jurisdictional c. Personal d. Ethical 12. During each two-year license period, how many hours of continuing competency activities must be in ethics and Indiana jurisprudence course?

a. One b. Two c. Four d. Six

Ethics and Jurisprudence for the Indiana Physical Therapy Professionals, 2nd Edition: Summary 7

13. How long must a license holder retain verification of continuing competency activities? a. Until the next renewal period b. Only for the current licensing period c. For three years after the last renewal date d. For five years after the last renewal date 14. Which of the following is not considered a category II continuing competency activity? a. Poster presentation b. Teaching at an accredited PT/PTA program c. Supervising a PT or PTA student d. Completing a workshop 15. ____ is defined as the primary regard for or devotion to the interest of the patient/client, thus assuming the fiduciary responsibility of placing the needs of the patient/client ahead of the PT’s self-interest. a. Altruism b. Autonomy c. Compassion d. Veracity a. If a license or certification is valid for fewer than 12 months, no continuing competency activity is required for renewal. 16. Which of the following is true? b. If a license or certification is valid for less than 12 months, five (5) hours continuing competency activity are required for renewal. c. If the license or certification is valid for 12 to 23 months, ten (10) hours of continuing competency activities are required for renewal. d. If a license or certification is valid for less than 23 months, no continuing competency activity is required for renewal. 17. How many hours of education specific to dry needling theory, practice, and technique must be completed to be deemed competent to perform dry needling? a. 20 b. 30 c. 40 d. 50 18. How many hours of education specific to dry needling must be completed in person to be deemed competent to perform dry needling?

19. How long can a PT treat an individual without a referral? a. A PT is not allowed to perform an evaluation or treatments without a referral. b. A PT can perform the evaluation but must receive a referral within one week of the evaluation to continue treatment. c. No longer than 42 days from the initiation of treatment without a referral. d. A referral is not necessary. 20. Which of the following is NOT true regarding how often the supervising PT must examine each patient? a. No less than every 14 days for inpatients b. Every 6 PT visits or 90 days (whichever is earlier) in a facility for people with intellectual disabilities or in a school c. Every 30 days or every 15 PT visits in an outpatient clinic d. For the initial evaluation and discharge only, regardless of the length of the plan of care 21. How often must a physical therapist holding a license renew their license? a. Biennially, on or before July 1 of each even- numbered year b. Annually on or before July 1 or each even- numbered year c. Biennially, on or before January 1 of each even numbered year d. Biennially, on or before January 1 of each odd numbered year 22. _________ is defined as the principle that one should tell the truth, that honesty is the best policy.

a. Veracity b. Altruism c. Autonomy d. Inclusion

To Complete this Course: n Scan the QR code o Proceed to exam p Log into your account

a. 20 b. 30 c. 40 d. 50

Course content code: PTIN02EJ-H

Allen Cognitive Levels: An Introduction to Theory & Assessment: Summary

Allen Cognitive Levels: An Introduction to Theory & Assessment 6 Contact Hours

ACCESS THE FULL VIDEO PRESENTATION Scan the QR CODE ► to start video or visit https://uqr.to/Allen-Cognitive

Author Meredith Chandler OTR/L

Meredith has worked as an occupational therapist for almost 12 years, providing care for patients across the age span in a multitude of healthcare settings. She is a published writer, researcher, and educator for therapy practitioners. Her research experience includes neurodevelopmental treatment (NDT), autism spectrum disorder, dementia and other cognitive deficit conditions, sensory integration, and geriatric interventions. Meredith is married with four children and enjoys participating in her community, including fine arts, theater, and state OT association events. In her free time, Meredith loves to run, paint, binge-watch her favorite shows, and spend time with her family.

LEARNING OBJECTIVES Module 1 1. Predict the purpose and

Module 2

Module 3

1. Assess the validity and reliability of the ACL-5. 2. Analyze administration instructions for the ACL-5. 3. Categorize appropriate target populations for the ACL-5. 4. Analyze and implement tips for effective ACL-5 administration. 5. Compare ACL-5 results for the purpose of intervention planning. 6. Apply ACL-5 administration tips to case studies to produce valid, reliable results.

1. Analyze ACL-5 scores and categories. 2. Analyze ACL-5 results for the purpose of intervention. 3. Apply interventions based on each discipline’s scopes of practice: OT, PT, and SLP. 4. Organize ACL-5 results to create client-centered care plans. 5. Review case study examples reflecting ACL-5 results. 6. Apply therapy, client-centered care plans based on ACL-5 results.

intended applications of the ACL-5. 2. Analyze theoretical frameworks or constructs that lay the foundations for the ACL-5. 3. Differentiate evidence-based definitions and concepts supporting the ACL-5. 4. Analyze and discuss case studies reflecting cognitive deficits and impact on function. 5. Distinguish ACL-5 theoretical constructs utilizing provided case studies.

SELF-ASSESSMENT QUESTIONS

The four phases of the information processing model include encoding, retrieving, and storing information. a. Filtering

1. The integrated functioning of the brain’s cognitive processes that guide performance of everyday activities in varied environments is referred to as:

a. The Routine Task Inventory b. The Functional Cognition c. The Biopsychosocial Model d. The Information Processing Mode Scores utilizing the Allen Cognitive Level Modes of Performance are: a. Norm-referenced

b. Organizing c. Memorizing d. Processing

Therapists utilize both task analysis and activity demands in order to identify activities that are meaningful, realistic, match an individual’s functional cognitive capacity, and are: a. Relevant b. Challenging c. Safe d. Therapeutic

b. Standard-referenced c. Criterion-referenced d. Survey-based

ANSWERS: 1: b 2 : c 3 : a 4 : c

Allen Cognitive Levels: An Introduction to Theory & Assessment: Summary

• Information Processing Model : Aims to explain how information is encoded into memory. It is based on the idea that humans do not merely respond to stimuli from the environment. Instead, humans process the information they receive ○ Four phases: ■ Encoding ■ Filtering ■ Retrieving: pulling information into active consciousness ■ Storing information *Mental energy or processing speed influences all four phases of the IP model. • Biopsychosocial Model : Considers the whole person perspective and the view that biological, psychological, and social factors all play a significant role in understanding human functioning: ○ Can Do : What is biologically realistic for safe participation in everyday activities ○ Will Do : What is psychologically relevant to the person, such as motivation, values, and interests ○ May Do : What is socially and environmentally possible (i.e., family and caregiver support, financial resources, transportation, accessibility, legal factors, cultural beliefs and expectations) • Task Analysis and Equivalence : A method of breaking down a complex task into smaller, manageable steps (task analysis) while considering the different ways those steps can be performed to achieve the same outcome (equivalence). Therapists utilize both processes to identify activities that are: ○ Meaningful ○ Realistic ○ Matched to the individual's functional cognitive capacity ○ Safe • Hierarchy of Cognitive Complexity of Activity Demands: ○ The ACL-5 provides two purposes: an analysis of the cognitive complexity of: ■ The functional cognitive capacities of individuals ■ The activity demands of activities • Postural Actions : Small, automatic movements that help people maintain balance and body alignment (2.0-2.8): ○ Goal-directed Actions : Behaviors that are intentionally chosen and executed to achieve a specific outcome (4.0-4.8) • Evidence-based Concepts and Definitions : ○ Modes: An observable functional cognitive behavior characteristic ○ Cognitive Levels: Prominent, observable, voluntary motor action scored 1-6: ■ Modes X Cognitive Levels: 26 modes of performance

INTRODUCTION

MODULE 1 Allen Cognitive Levels Screen (5th ed)

A standardized assessment that provides a quick estimate of global functional cognitive capacity for individuals with suspected or diagnosed cognitive impairments . Scores are criterion-referenced using the Allen Cognitive Scale Levels and Modes of Performance. LEARNING TIP!

It takes approximately 15-30 minutes to be administered by an occupational therapist and other licensed practitioners (PT or SLP), who incorporate cognitive-based approaches within their scope of practice.

History and Development • 1985 : First version and instructions published in Occupational Therapy for Psychiatric Diseases: Measurement and Management of Cognitive Disabilities • 1992 : Large Allen Cognitive Level Screen (LACL) made available for individuals with visual and/or hand function impairments Developed within the Cognitive Disabilities Model (CDM) Framework • Focuses on understanding functional cognition , or “information processing capacity applied at the performance skill level” • Understanding abilities is accomplished through systematic, skilled observation of people as they perform activities. For example, the ACL-5 utilizes three visuospatial-motor stitching tasks of increasing complexity: ○ Running stitch ○ Whipstitch ○ Cordovan stitch • Target populations (appropriate for ages 6 years to elderly): ○ Dementia ○ Traumatic and/or acquired brain injuries ○ Substance use disorders, addiction ○ Psychiatric disorders (mood, schizophrenia) ACL-5 Theoretical Frameworks • Functional Cognition : How an individual utilizes and integrates his or her thinking and processing skills to accomplish everyday activities in clinical and community living environments. This is the primary concept rooted in the CDM

Allen Cognitive Levels: An Introduction to Theory & Assessment: Summary

MODULE 2 The ACLS-5, LACLS-5, and LACLS-5[D] provide an estimate of functional cognition (available cognitive mental functions) for engaging safely in valued everyday activities. These scores are established through observations of what individuals pay attention to in their external and internal or personal environments and their performance skills as they engage in activities, and from analysis of the cognitive complexity of activity demands, activity patterns, and contextual and environmental supports that appear to fit with the person's cognitive mental functions and desired activities and occupations they need and want to do. PSYCHOMETRIC PROPERTIES • Reliability : The interrater reliability evidence across all versions and forms of the ACLS that were developed between 1978 and 2007 has been high, with reported correlations ranging from r = 0.91 to 0.99 • Improvements from the ACL-3 : In the ACL-5, administrators are instructed to continue to next stitching task whether the person being tested completes three correct stitches or not in the preceding task (unless the individual refuses or appears sufficiently stressed) Testing Supplies • 1 standardized ACLS leather tool • 1 large eye steel needle • 2 permalok needles • 72" waxed linen thread for running stitch task and replacements • 60" of 3/32-inch-wide leather lace for the whipstitch and single cordovan stitch tasks *NOTE: Some testing supplies are latex-based. Difference Between ACL-5 and LACL-5 • LACL-5: Large Allen Cognitive Level Screen, 5th Edition • The primary difference is that the LACL-5 is the size of materials. It is a larger, adapted version of the ACLS designed specifically for individuals with vision or hand function impairments, allowing them to complete the cognitive assessment more easily • Disposable LACL-5- Kit comes with disposable tools for individuals who require infection control options • LACLS-5 is a valid performance-based measure for evaluating functional cognition Script *Deviating from the script can result in poor and inaccurate scoring, which means poorly matched interventions to improve functional performance.

• Initial task (running stitch) : ○ Instructions: “Please make a running stitch by threading the needle through the holes in this direction” ○ Observation points: Ability to follow basic instructions, hand-eye coordination, and consistent stitch pattern ○ Similar script is provided for whipstitch and cordovan stitch tasks ○ The administrator should continue to the next stitching task whether or not the person completes the previous task, unless they refuse or show significant stress • Minimal verbal prompts : ○ Only provide necessary cues to guide the individual, avoiding excessive prompting that could influence their performance • Observe behaviors : ○ Note any difficulties the individual shows: confusion, frustration, inability to follow instructions, or excessive need for visual cues • Scoring : based on test taker’s performance, points are assigned Error-Correcting Task Between the whipstitch task and the cordovan stitch task, the administrator will perform the cross-in-the-back error. The administrator then instructs the test taker to correct the error according to the standardized script. It is designed to assess problem-solving abilities and cognitive flexibility. Next, the administrator will perform a second error called the “twisted lace mistake.” The administrator will then ask the test-taker to correct the error according to the standardized script. Both error- correcting tasks are also calculated into the final scores. Administration Setup • Environmental considerations: ○ Good lighting ○ Minimal distractions ○ Can be done in sitting, bedside, and standing ○ Administrator must sit close enough for hearing efficiency and observing facial expressions • End administration or administering is contraindicated if: ○ Completion of all three stitching tasks ○ Refusal ○ Signs of excessive and unnecessary stress ○ Clients less than the age of 6 Calculating and Interpreting Scores • Scoring is based on two primary components: ○ The number of correct stitches ○ The difficulty of each stitch • Scoring ranges from 0 to 6, 0 being comatose • Scores are established by providing another standardized assessment within the cognitive disabilities model (CDM) to confirm the person’s cognitive level/mode

Allen Cognitive Levels: An Introduction to Theory & Assessment: Summary

Verifying Scores and Comparable Assessments • Allen Diagnostic Module 2 (ADM-2) : ○ 27 standardized craft-based activities ○ Each assessment is designed to introduce activity demands with an identified range of cognitive complexity within levels 3.0 and 6.0 on the ACL. ○ Administrators collaborate with individuals in selecting an assessment activity that is meaningful and within their expected functional cognitive capacities • Routine Task Inventory (RTI-E) : ○ 25 ADLs and IADLs are divided into four subscales: (1) Physical Scale-ADLs, (2) Community Scale-IADLs, (3) Communication Scale, and (4) Work Readiness Scale ○ Functional cognition is assessed based on therapists’ direct observation of performance in naturalistic contexts or on the perceptions of performance reported by the client or a caregiver MODULE 3 ACL-5: Scores and Interpretations Review • Converting results into therapeutic interventions: ○ Administer and interpret ACL-5 scores ○ Validate scores with additional assessments ○ Create client-centered goals ○ Tailor intervention plan based on results: ■ Mobility and fall risk ■ ADL/IADL performance ■ Swallowing/feeding ■ Safety and prevention ■ Cognitive retraining/skill development • ACL-5 results are scored on a total between 0 and 6 (incrementally on 2) *NOTE: No one scores a 6 (since the test does not measure a person's ability to plan for the future). • Interpretations are made for levels of impairment in global cognition and motor actions • Each level offers recommended assistance between 24-hour total dependent care and no assistance required ACL 0: Coma 0.8 • Generalized reflexive actions ACL 1: Awareness • Global cognition is profoundly impaired. The person responds to internal cues only ACL 2: Gross Body Movements • Global cognition is severely impaired. The person’s awareness is limited to their own postural actions (proprioceptive cues) to move their body in space or overcome the effects of gravity. There is a lack of awareness of the effects that actions have on objects or other people. Maximum assistance is needed when therapists demonstrate actions or use proprioceptive stimulation to elicit postural actions

ACL 3: Manual Actions • Global cognition is severely impaired. People perform spontaneous manual actions in response to tactile cues. Repetitive actions demonstrate an awareness of material objects but lack awareness of cause and effect, end-product, or goal. Their attention span is short (maximum 30 minutes) and actions are unpredictable. Moderate assistance is needed when therapists refocus attention to sustain or complete simple, repetitive actions safely. One-to- one assistance is required to halt perseverance and to prevent unsafe, erratic, or unpredictable actions that interfere with appropriate sequencing ACL 4: Familiar Activity • Global cognition is moderately impaired. A person is aware of tangible cues (see and touch) and understands visible cause-and-effect relationships. Goal-directed actions demonstrate an awareness of a familiar end product but fail to solve new problems, anticipate, or correct mistakes. There is no independent new learning, and they cannot invent new motor actions. They do not recognize errors unless clearly visible and may request help when mistakes are noticed. Their attention span is usually good for up to one hour. Minimum assistance is needed when therapists set up goal-directed activities with tangible results ACL 5: Learning a New Activity • Global cognition is mildly impaired. The person is able to learn new ways of doing things through trial- and-error problem solving. They may make hasty or impulsive decisions or make abrupt changes in their course of action. Standby assistance is needed when therapists adapt a new activity for safe and effective performance because errors and a need for safety precautions are not always anticipated ACL 6: Planning a New Activity • There is no global cognitive impairment. The person anticipates errors and plans actions to prevent errors. No supervision is required ACL-5 Relevance to Occupational Therapy • OTs are essential and equipped to measure functional cognition • OT practitioners utilize ADLs/IADLs and functional mobility to assess and develop interventions regarding functional cognition ACL-5 Relevance to Physical Therapy • Cognitive components of function and mobility are inevitably attached to physical activity • Roughly one in five older adults exhibit symptoms of at least mild cognitive impairment

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