Whta re the typical GAIT PATTERNS CHANGES associated with aging?

5

Decreased Speed

Decreases Step Length

Decreased excursion

Increased Stance time & Double limb support

Increased Variability (step, velocity, width, frequency)

What activities would be included when training patient to resume community ambulation?

7

Posture

Gait training

Mobility training

Stair Negotiation

Enviornemental adjustments

Assistive device training

Education

How do muscles work going up the stairs?

Concentrically

How do muscles work going down the stairs?

Eccentrically

What typr of training would you provide for these impairments?

Limited ROM

Decreased Strength

Decreased agility

Decreased Endurance

Flexibility training

Resistance training w/ task specific activity

agility training (obstacle courses)

Aerobic training

What would be your Exercise Rx for gait training and their limitations?

Mode

Frequency

Intensity

Duration

Mode: Stretching program, Aerobic, Resistance, and Agility training

Frequency: Aerobic: 4 days a week, Resistance 2 days a week, Stretching daily, Agility training: 2-3 days a week

Intensity: moderate

Duration: can build up to 45-60 min a day, start at 5-10 min and build to 60

What are specific interventions for gait training

Specificity of Training

Training Speed

Do PT's provide intervention for Assisted Ambulation?

NO

What are the neurological Interventions in gait training?

  Upright posture

Balannce

 Emphasize stability and symmetry

Weight shifting

 Provide sensory feedback

Does dual task affect gait, if so why?

What do patients tend to do when walking and needing to talk?

Yes, decreases complete attention from walking making it difficult on them.

They stop walking

What sensory systems are related to postural control?

Vision

Vestibular 
Somatosensory / Proprioception 

What are the strategies used by an older adult during loss of balance?

Ankle Strategy – distal-to-proximal direction (ankles à proximally).

Hip Strategy – proximal-to-distal direction (hips à distally)

Step Strategy – BOS changes in the form of stepping in order to keep COM within BOS, 

Reaching Strategy – BOS is enlarged by reaching/grasping with one’s hands. 

Suspensory Strategy – This strategy involves lowering one’s COM in order to improve stability. 

Which strategies are are cause by a large pertubation?

2

Stepping anf Reaching

When can you observe these strategies amongst the elderly during intervention

puuting on shoes, sock, or cloths

stepping in or out of tub

What are behavioral risk factors?

What part of the ICF model does it fall under?

Fear

Risk taking

Compliance with MEds

Participation Factors

What are Socio-Economic risk facotrs?

What part of ICF model?

Social Isolation

Low Income

Literacy

Lack of transporation

Personal Factos

What are Environmental risk?

What part of ICF?

Home hazards (stairs)

Community hazards (ex: potholes)

 Institutional hazards (hospitals; nursing homes; change in environment & routine)

Extrinsic Factors

What examinations can assess for falls risk?

4

Berg Balance

Tinetti

Functional Reach

TUG

What are the score ranges for Berg Balance?

0-56 scoring

41-56 = low fall risk

21-40 = medium fall risk

0 –20 = high fall risk

What is the scoring for Tinetti

0-24

18 high fall risk

19-24 moderate fall risk

  >24 low fall risk

WHat is the scoring for the Functional Reach Test?

score (inches) and how many more times likely to fall?

0-10

Greater than 10 inches              Not likely to fall

6 to 10 inches                           2 times more likely to fall

1 to 6 inches                              4 times more likely to fall

 Subject unwilling to reach        28 times more likely to fall

TUG Scores?

Most adults

Frail adults

Indicatinve of impaired functional mobility

0-30

Most adults can complete the test in 10 seconds. 

Scores of 11 to 20 seconds are considered within normal limits for frail elderly or individuals with a disability. 

Scores of over 30 seconds are indicative of impaired functional mobility.

What is tested in each test?

Berg Balance

Tinetti

Functional Reach

TUG

Static & Dynamic standing

Sit to stand,Balance, & Gait

Reaching

Gait /Functional Mobility

What are the strategies to help prevent falls in elderly?

3

Medical Strategies - meds, vision, hearing

Rehabilitative - gait, mobility training

Environmental Strategies - education

What are the best fall recovery strategies?

Medical Alert

Telephone near the floor

Practices assising onself, scooting to nearest stable surface/ furniture, and how to get up

How does fear of falling impact fall risk behavior?

• will already be apprehensive
• will probably remain inside and be reluctant to move or move as little as possible diminishing their strength and ROM, which will increase their fall risk.
• will begin to walk very slowly and
• nervously
• will not be prepared for fall recovery or know how to use their ankle, hip, and stepping strategies since they haven’t practiced them.

Whata re the joint changes associated with aging?

DJD / OA

RA

What are the Joint changes with DJD

  is it caused from over use?
Could it be an injury that never healed?

When do the pt's complain of pain?

What joints are usually affected?5

What happens to cartilage?

NO

Yes, need to treat properly when injured

Pain during WB activities, relieved w/ rest

Hands, Knees, Hips, Lumbar, Cervical

Erodes, new bone growth stimiulating causing osteophystes

What is the medical management of DJD/OA?

What is the surgical management?

NSAIDs (Anit-inflammatories)

Joint replacement

DJD /OA PT Intervention

Modalities used? 

What can relieve body wieght during exercise?

What should be strengthened?

What may affect joints?

Other? 3

Cold, US, E-stim

Aquatic therapy

Strengthen muscles around the joints

Weight/ if overwirght, educate and refer

Flexibility / Functional/ Addaptive Equipment training

What is Rheumatoid Arthritis

 WHat happens to the tendons and cartilage?

WHat kind of disease is RA?

What are other S&S?

What kind of drift can occur?

What age group does it affect?

What can happen from time to time?

Where is the inflammation occuring?

Tendons can rupture, and destruction of cartilge

Autoimmune disease / Systemic Disease

Fever / fatigue / nutritional deficiency / Anemia

Ulnar Drift

20-90

Flare ups

inflammation of synovial membrane

Rheumatoid Arthritis

What occurs in RA?

what are the common comlaints?

Swelling, Erythma, & PAin

joint pain, fatigue, weakness, weight loss

What is the PT Intervention

Should you tx during flare ups?

ROM, strengthening, joint protection, same as OA

NO

What occurs in cartilage during aging?

 In the extracellular matrix, modified and degraded matrix components accumulate.

·       The matrix changes appear to decrease the capacity of aging connective tissues to resist tensile forces and to reduce resiliency. 

Loss of Tissue eleaticity

The changes seen in cartilage do what to the tissue

?

Make them suseptible to injury

less capable of repairing damaged tisuue

Increasing associated conditions

What are skeletal changes in aging?

Osteoporosis

Osteopenia

Osteomalasia

Paget's Disease

Which is deterioration of bone density?

Which is the softening of Bone?

Osteoporosis& Osteopenia

Osteomalacia/Pagets 

Which is the bone disorder is characterized by increased bone re-absorption and increased formation?

What is deposited into bone?

Does this make the bone strong?

Paget's Disease

Collagen

NO

What is the medical tx for BOne Loss?

Hormone replacement Therapy ( Breast cancer risk)

Fasomax - builds bone (side effects such as osteo necrosis of the jaw, teeth ot jaw pain)

If someone taking fasomax has Jaw Pain, What should you do?

Call / Report to Doctor Immediately

What disorder is characterized

Death of cellular component of bone in the absent of infection 

Avascular Necrosis

In Avascular Necrosis

What arteries are affected

Which joint is most commonly affected

is it an infection

Circumflex Arteries

Hip

No

S & S of Avascular Necrosis?

What type pf gait pattern is nirmally seen?

TX?

Groin pain into medial thigh to knee, exacerbated by movement, WB is Painful

Antalgic Gait Pattern

THR

What is Sarcopenia?

age related wasting of muscle

Can sarcopenia be related to nutitional deficiency?

What may contribute to sarcopenia (nutritionally)?

Yes

Inadequate protein

Exercise Rx for someone with Impaired Muscle Performance?

What principle should be used?

Mode: Resistance traing

Intensity & Frequency -

> 50 2 -3 x a week

>60% 1-2 x week

70-80% 1 x week (better for 80 yo)

Duration

20-30 min

Overload Principle

Intervention to Address Postural Impairments?

6

Show your Pearl

Wall sits (Yoav's)

Sitting on stability ball

Pectoral stretch

Stregthening Back muscle (TB)

Any movements that take themout of their bad posture

Postural Intervention based on individual needs?

ADL Training

Education on Body mechanics

Core Strengthening

Specific stretching for trunk and extremities

Conditioning & Endurance Exercises

Manual Therpay

Exrternal Support

Whata re the 3 rules to stretching?

1. Do not place structures under riak of injury

2. Assure movement isolate the target tissue stretched

3. Stretch time 30 sec or greater

How can poor posture affect Osteoporosis?

can cause Additiong fractures perforing ADL's

How can poor posture affect Spinal Stenosis?

What posture do the assume & why?

decreasing in joint space, osteophyte development, protrusion of disc, leg & neck pain in extended posture

Flexion to increase joint space

How can poor posture affect Spinal Osteoarthritis?

Compromises diameter of spinal canal

What rheumatic condition is associated with Temporal Arteristis?

What is Temporal Arteristis?

Polymyalgia Rheumatica

Inflammation of the steries derived from aortic arch giving rise to Giant Cell Arteristis

Whata re characteristics of Polymyalgia Rheumatica?

Neck & hip Girdle Pain

Elevated Sedimentation Rate, Globulins

Low grade fever & Anemia

Weight Loss

Rapid response to steroids

What would you do if you suspected temoral Arterisits?

What could Polymyalgia Rheumatica lead to?

Call doctor immediately if patient c/o vision problems

Sudden monocular blindness

What are the neuropathies associated with Diabetes?

third nerve palsy

diabetic amyotrophy

mononeuropathy multiplex

polyneuropathy

autonomic neuropathy

thoracoabdominal neuropathy

What does Hospice provide?

What is the PT role is hospice care?

Medical, Emothional & Supportive, Family Services

keeping the pt comfortable and functional as long as possible, help with AD's, transfers, home assessment

Why are older adults more suseptible to thermoregulation?

Metabolic Rate

Tissue Changes

Sensory Changes

Aterial Sys Changes

Risk for Hypothermia

Increased exposure & impaired ability to precieve COLD

Decreased Metabolism

Decreased bod fat

Less efficient peripheral vascular sys

Poor nutrition

Don;t Shiver (muscle activity)

Risk for Hyperthemia

Will not run AC

Time of day they exercise

Meds

Alcoholism (dehdration)

Cognitive decline

MEdical condition

Loss of effective sweating

What DECREASES with age in th e Cardiopulmonary system?

 3

Aerobic Capacity

Max Cardiac Output

Max HR

What INCREASES with age in th e Cardiopulmonary system?

BP

Peripheral Vascular Resistance

chance of CAD & Ischemic disease

What is sick Sinus Syndrome

Low HR during Maximal exercise

What is an Exercise RX for an Older Adult?

Mode: Aerobic, resistance, stretching, Agility

Intensity: Moderate to High

Duration: at least 30 min

Frequancy: 3 x week 

What are some special Considerations in Exercise Rx

Pacemake

CHF

Ischmeic Hear disease (angina)

MI

Arrhythmias

Diabetes

Medication

How long should you take HR in someone with Arrhythmias?

60 sec

How do physiological changes associated with exercise impact the older adult?

Can positively effect physiological state: Vascular system, Nervous Sys, Integumentary, and Musculoskeltal

Pathological manifestations can cause exercise to negatively afftect function of certain systems during exercise

What are some of the positive aspects of physical activity in the older adult?

8

maintain function

look & feel younger

Sleep better

Helps bowel movements

Help Incontinence

Reduce fatigue

Improve SEX life

Improve bone health, coordination, strength and Endurance