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physio Flashcards

1
Q

Understand this model
(We’ve taken this before many times)

A

Understood👍🏻

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2
Q

What is homeostasis

A

Physiological process that maintain a stable internal state of the body

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3
Q

What will influence vulnerability to illness and injury ?

A

Extent to which the body can:
- adapt to physiological stressors
- maintain homeostasis

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4
Q

As we age, what happens to our ability to tolerate stressors ?

Can it be modified ? And how?

A

DECREASE

Yes it can be modified with lifestyle adaptations

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5
Q

The SUCCESSFUL aging older adult has a __________ capacity to tolerate physiological stressors.

The UNSUCCESSFUL aging older adult has a __________ capacity to tolerate physiological stressors.

A

HIGH

LOW

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6
Q

What increases tolerance to physiological stressors?

A

Exercise
Healthy diet
Emotional health
Sleep pattern
Regular physical check ups at doctor

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7
Q

What decreases tolerance to physiological stressors?

A

Smoking
Sedentary lifestyle
Bad eating habits
Co-morbidities (presence of 2 or more chronic illnesses in patient)

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8
Q

At which point in life does the decline in bone mineral begin?

A

3rd decade (30 yrs old)

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9
Q

Which gender has a FASTER rate of bone mass loss and when?

A

Women during menopause

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10
Q

Skeletal tissue can change depending on what?

A

Day-to-day nutrient intake
Inactivity
Weight bearing
Hormones
Medications

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11
Q

True or false
All risk factors for bone loss are NON-modifiable

A

False

There are modifiable AND non-modifiable risk factors for bone loss

(NOTE:
Modifiable : CAN be changed by lifestyle
Non-modifiable: CANNOT be changed by lifestyle)

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12
Q

What are some non-modifiable risk factors for bone loss (hint: 7)

A

Genetics : women with small frame

Age: female > 50 years

Family history of osteoporosis

Premature at birth

LOW estrogen: menopause

Childhood malabsorption dx

Age-related loss of muscle mass

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13
Q

What are some modifiable risk factors for bone loss (hint: 9)

A

Calcium intake : ≥ 1200 mg/day is required

Alcohol intake

Smoking

Low BMI ( <18.5 ) - may lose skeletal tissue faster

Low estrogen (may take hormonal therapy)

Inactivated, immobilization

Insufficient protein at all ages

Inadequate vitamin D

Hyperthyroidism

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14
Q

What is estrogen

A

Critical hormone for the maintenance of bone mass in BOTH men and women

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15
Q

True or false
Estrogen is responsible for the maintenance of bone mass in only women

A

False

Both men and women

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16
Q

Why is exercise crucial for skeletal tissues ?

What jobs involve a lot of inactivity ?

A

Because inactivity ( ⬇️ muscle contractions ) removes stimulus for osteoblastic activity (bone formation)

Desk/office jobs

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17
Q

What has research concluded about exercise AND hormonal replacement

A

That either alone or in combination, they can ADD bone mineral density to the osteopenic framework of older men and women.

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18
Q

What is body composition

A

Body composition is a term used often by doctors and health professionals. It refers to the percentage of fat, bone, and muscle in your body.

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19
Q

What gradual shift in body composition occurs with aging ?

Provide example

A

⬆️ INCREASE in fat mass

⬇️ DECREASE in lean mass

Example:
- 20 year old man with lean body mass/fat mass ratio of 85/15

  • 70 year old man with the SAME WEIGHT as the 20 yr old has a ratio of 70/30
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20
Q

Relationship between intra-abdominal fat and risk for serious illnesses?

A

The MORE the intra-abdominal fat = the GREATER the risk for heart disease, diabetes, and cancer

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21
Q

Active men and women have LESS:

A
  • fat
  • whole-body inflammation
  • disease
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22
Q

Does the number on the scale necessarily dictate a person’s health ?

A

No

Both pictures are of the same weight , however the one on the right has more muscle mass contributing to a good portion of the body weight, while the picture on the right has more fat mass.

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23
Q

What are some changes in cardiovascular tissue that occur as a result of aging ?

(Hint: 3 major changes + examples)

A
  1. Decline in maximum HR = lower aerobic capacity
    ( ex: even though a 90 year old can still run a marathon, he takes a longer time )
  2. Decline in VO2 max = lower aerobic capacity
    ( ex: a 70 year old female with VO2 max value of 18 mL O2/kg/min is UNABLE to climb a flight of stairs without resting OR is unable to walk half a kilometer)
  3. The heart and peripheral vessels are stiffer and less compliant = high blood pressure (⬆️BP) and reduced cardiac output (⬇️CO)
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24
Q

For exercise safety, what should you take into consideration when dealing with older patients with cardiovascular changes resulting in high BP and low CO ?

A
  • Physical therapist must watch for unacceptable increase in BP
  • Patient must perform WARM-UPS before aerobic exercise
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25
Q

Why must an older patient with cardiovascular changes due to age perform warm ups BEFORE aerobic exercises ?

A

To accommodate for :
- slower arteriovenous oxygen exchange
- stiffer vascular tissues
- reduction in sympathetic nervous system output
- lower aerobic capacity

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26
Q

How to enhance cardiovascular endurance in older patients?

A

Exercise programs must CHALLENGE older adults, they must NOT be treated like fragile objects !!

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27
Q

The heart, like any muscle, must be ___________ to grow stronger .

A

Trained

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28
Q

True or false
Walking a patient in the hallway constitutes an acceptable aerobic workload for most people

A

FALSE

Can be acceptable for UNCONDITIONED patients.
BUT it does NOT constitute as an acceptable workload for most people.

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29
Q

What is required for “training” to occur ?

A

Elevated HRs that are sustained for 20 minutes or more

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30
Q

5 minute of bike exercise followed by rest and then 5 minutes of alternating normal/brisk gait is an example of :

A

Accumulating aerobic exercise

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31
Q

Changes in the nervous system (NS) that occur due to aging

A
  1. Slowing of NS which causes :
    - LESS nerve conduction velocity
    - HIGH movement time
    - HIGH reaction time
    - HIGH risk of falling
  2. Loss of neurons = LESS muscle mass (loss of innervation)
  3. Altered balance of SNS and PNS which causes:
    - LESS gastric mobility
    - bladder control issues
    - hypertension or hypotension
    - inadequate response to heat or cold
  4. LESS deep sensation (joint position sense and vibratory sense)
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32
Q

How can reaction time in older adults be measured

A

Induced fall
External perturbation
Simulated driving

(NOTE: external perturbation forces the patient to react to the external force and maintain postural stability to not fall)

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33
Q

True or false
Exercise has LITTLE effect on improving reaction time

A

True

( even if it improved, it has little impact on function !)

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34
Q

How is nerve conduction velocity basically measured?

A

They stimulate the nerve and record the latency response of the muscle

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35
Q

What are some visual changes that can occur due to aging

What is a consequence of these changes?

A

LOW contrast sensitivity
NO depth perception

Consequence: falling

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36
Q

Common visual problems in the elderly

A
37
Q

Changes in postural alignment that occur with aging

A

Malalignment of joint

Center of mass is shifted ANTERIORLY

38
Q

True or false
Center of mass shifts POSTERIORLY with aging

A

False

Shifts ANTERIORLY

39
Q

What is sarcopnia ?

A

Loss of muscle mass

40
Q

Loss of muscle mass in older adults can lead to:

A
  • LESS muscle strength and power
  • LESS function
  • Frailty and risk of falling ( when combined with LOW balance and endurance )
  • increased intramuscular fat
  • larger subcutaneous fat
  • decreased cortical bone mass
41
Q

Loss of muscle mass in older adults may be exacerbated by ______________________.

A

Sedentary lifestyle

42
Q

Application of Nagi Model regarding the loss of muscle mass in older adults

A
43
Q

Muscle mass can be measured by :

A

Manual muscle testing MMT

Isokinetic and hand-held dynamometers

44
Q

Many articles addressed the value of grip strength as a predictor of important outcomes. Due to its predictive validation and simplicity, grip strength should be considered as a VITAL SIGN useful for screening in adults.

What is LOW grip strength associated with:

A
  • Functional limitations
  • Disability
  • Premature death
  • An increased risk of complications/prolonged stay after hospitalization or surgery
45
Q

Treatment of loss of muscle mass

A
  • nutrition
  • strength-training exercises
46
Q

What is the minimum time required to achieve a true strengthening response in muscle tissue ?

A

6 weeks minimum

47
Q

Is power training better than regular resistance training ?

A

A study concluded that power training is feasible for older adults AND has a small advantage over strength training for functional outcomes

48
Q

What is Cachexia ?

  • can it be treated the same way as regular loss of muscle mass?
  • what is it associated with ?
  • when is it typically seen?
A

Severe weakness and wasting of the body due to severe chronic illness (loss of muscle mass due to severe illness)

  • CANNOT be treated with nutrition and strength training ❌
  • Associated with :
    - End-stage cancer
    - AIDS
    - Tuberculosis
  • cachexia of old age typical precedes DEATH and is the FINAL STAGE of COPD and chronic HF
49
Q

What is joint mobility?

A

The capacity of a joint to move PASSIVELY taking into account the surrounding tissues

50
Q

Joint mobility is DIRECTLY influenced by:

A

Changes in muscles, bones, tendons, ligaments, cartilage, and capsules

51
Q

________________________ tissues hold us together while still permitting freedom of movement in all directions

A

Collagenous

52
Q

Characteristics of impaired joint mobility

A
53
Q

Impaired joint mobility: what does the decrease in water content in intervertebral discs cause?

A

Body shrinking or Height loss

54
Q

Impaired joint mobility: what does the decrease in water content in articular cartilage cause?

A

Osteoarthritis

(More prone to breakdown)

55
Q

Clinically, loss of water content in joints can be seen as :

A
56
Q

How to treat impaired joint mobility ?

A
57
Q

What is the influence of impaired joint mobility on activity and participation?

A
58
Q

Joint mobility is assessed by:

A
59
Q

Joint mobility is treated by:

A
60
Q

True or false

Physically active older adults will not go through age-related changes in joint function .

A

False

They will also go through these changes

61
Q

Joint mobility is treated by remediation, compensation, and prevention. What do physically active older adults require more?

A

Compensation & prevention > remediation

62
Q

Impaired joint mobility can be treated by remediation, which involves:

A
63
Q

Remediation: what is the benefit of therapeutic exercises?

A

Can reverse age-related decline in joint mobility

64
Q

Remediation: what is the primary mode of exercise targeting impaired joint mobility

A

Stretching exercises

65
Q

Remediation: what does muscle strengthening exercises contribute to?

A

Joint loading and control of motion

66
Q

Remediation: manual joint mobilization for impaired joint mobility should be done with _________________.

A

Caution

67
Q

What is the optimal stretching time and number of a petition for an adult > 65 years?

A
68
Q

According to a study, what are the SLR stretch durations that were found most effective when increasing hip flexion and knee extension in older adults?

A

15 , 30 , or 60 seconds

69
Q

Relationship between stretch duration and ROM benefit

A

The longer the hold of the stretch (60 sec) = the greater the ROM benefit

70
Q

Young adults VS older adults in static standing.

Does swaying increase or decrease as we age ?

A

Swaying increases as we age

71
Q

What factors increase swaying with age?

A

Muscle weakness
Proprioception
Vertigo
Diabetes ( sensation )
Impaired vision
Etc.

72
Q

Older adults rely on _____________ to balance themselves

A

Vision

73
Q

Older adults have longer reaction time, which can lead to:

A
  1. Longer reaction time

⬇️

  1. Longer time to activate muscles

⬇️

  1. Increase possibility of falling

⬇️

  1. Longer time to recover from fall
74
Q

Functional mobility may include:

A

Sit to stand
Transfer from bed to chair
Walking
Stair climbing

75
Q

What is one definition of “mobility disability” ?

A

Inability to walk 1/4 mile or climb a flight of stairs without assistance

76
Q

____________ is a unique human skill that requires multiple systems to work in a correct manner.

A

Walking

77
Q

What systems are involved in walking?

A

Neurologic
Musculoskeletal
Cardiopulmonary
Cognition

78
Q

Age-related changes of gait?

A
79
Q

True or false

Older adult gait is simply a slower version of younger adults gait.

A

False

Older adults display a more conservative gait pattern in an effort to be safer and stable.

80
Q

Does the base of support increase or decrease as we get older?

A

Increase BOS

81
Q

How to assess functional mobility?

A
82
Q

____________________ is a reliable, valid, sensitive, and specific measure of functional ability.

A

Gait speed

83
Q

Gait speed is the _______ vital sign

A

6th

84
Q

Importance of gait speed.

A
85
Q

Just get a good understanding of this diagram that basically shows how gait speed can predict an individual’s health status etc.

A

Ok 👍🏻

86
Q

Gait speed rule of thumb

A
87
Q

Impaired functional mobility is treated by?

What is our goal?

A

Our goal is to ensure that the patient is able to ambulate safely and independently in different environments

88
Q

You can read this, but she said don’t worry about it

A

Ok 👍🏻

89
Q

List some low impact exercises to try at home

A

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