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Aging adult > Week 2 module 3 > Flashcards

Week 2 module 3 Flashcards

1
Q

On the slippery slope of aging, what is fun?

A

What you want, when you want, for as long as you want

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2
Q

On the slippery slope of aging, what is function?

A

Choices made based on decreased physical capacity

• Have mobility disability or at risk for

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3
Q

On the slippery slope of aging, what is frailty?

A

Require help with ADLs and IADLs

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4
Q

On the slippery slope of aging, what is failure?

A

Completely dependent

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5
Q

What are the characteristics found in a person that is considered frail?

A

• Unintentional weight loss of >/ 10 lbs in past year
• Self-reported exhaustion 3 or more days/week
• Muscle weakness
- Grip strength < 23 women, < 32 men
• Walking speed < 0.8 m/sec
• Low level of activity
- Sitting quietly or lying down majority of the day

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6
Q

What is considered the entryway to frailty?

A

Muscular system

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7
Q

What is the most important factor in the subsequent institutionalization in regards to frailty?

A

Leg strength

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8
Q

What is the role of physical therapy in frailty?

A

Must apply appropriate

principles of exercise prescription

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9
Q

According to the physical stress theory, what happens when we apply too much stress (>100% of max) to a body?

A

Injury or tissue death

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10
Q

According to the physical stress theory, what happens when we apply sufficient load (60-100% of max) to a body?

A

Strengthening

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11
Q

According to the physical stress theory, what happens when we apply the usual stress (40-60% of max) to a body?

A

No change in tissues

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12
Q

According to the physical stress theory, what happens when we apply too little or no stress (0-40% of max) to a body?

A

Atrophy and loss of ability to adapt

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13
Q

How do we provide functional training for our patients?

A

Overload the activity of interest to challenge the entire neuromuscular system

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14
Q

How long does true strengthening take?

A

6 to 8 weeks

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15
Q

What is the appropriate dosing of aerobic exercise for the aging adult?

A

60-90% of HR max

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16
Q

How do we measure the dose of the aerobic exercise we provide for the aging adult?

A

• Target Heart Rate: (220-Age) x 60% to 90%
• Karvonen Method: ([60% to 90% x (220 – Age – Resting Heart Rate)] + Resting Heart Rate)
OR
• Rating of Perceived Exertion
- 12-16 = 60-90% on a 6-20 scale
- 5-8 = on a 10 point scale
- Good for those with blunted heart rate response
• Talk Test

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17
Q

What are some of the things that may limit the abilities of an aging adult to participate in aerobic exercise?

A
  • Joint pain

- Muscle weakness

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18
Q

How can we manage the limits of an aging adult participating in aerobic exercise?

A
  • May need strengthening exercise first

* Aquatics may also be an option

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19
Q

What is the appropriate dosing of strength exercise for the aging adult?

A

60-80% of 1 rep max for strength gains

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20
Q

___ is the cornerstone for preventing frailty or for reversing frailty

A

Strengthening is the cornerstone for preventing frailty or for reversing frailty

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21
Q

How do we determine how to figure out the 60-80% of 1 rep max for the aging adult, since they can’t be 1 rep maxxed?

A

• Select weight thought to have patient experiencing muscle fatigue at around 10 reps
• Have them perform 1-2 reps and assess RPE
- 11-15 on 6-20 point scale
- “somewhat hard to hard” = 70-80% of 1 rep max

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22
Q

How many reps should result in momentary fatigue when doing strength exercises with an aging adult?

A

8-12 reps

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23
Q

How do do we know that our patient is experiencing momentary fatigue when doing strength exercises with an aging adult?

A

Observe for: look of concentration, slight tremor, mild increase in respiration

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24
Q

According to research, how many sets of strengthening exercises is sufficient for the older adult?

A

1 set has shown to have the same effect as 3 sets, so 1 set is sufficient, unless they really enjoy it

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25
Q

What are the strengthening exercise considerations for the aging adult?

A
  • Underutilized and undermanaged
  • Proper form
  • Watch for breath holding
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26
Q

What are the parameters for flexibility exercise in the aging adult?

A

• 60 seconds needed for those 65 years an older to achieve
long term muscle lengthening
• 4 reps
• 5-7 days a week

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27
Q

What are the muscles we want to consider for flexibility exercise in the aging adult?

A 
• Suboccipital muscles
• Pec minor
• Downward rotators
• Protractors
• Lumbar extensors
• Hip flexors and external
rotators
• Ankle plantar flexors
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28
Q

What is a fall?

A

Inadvertently coming to rest on the ground, floor or other lower level, excluding intentional change in position, to rest on furniture, wall, or other objects

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29
Q

A fall is as a result of what factors?

A

Environment, age related changes in functioning, and disease processes

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30
Q

What is a near fall?

A

Slip, trip, stumble, or loss of balance with recovery and remaining upright

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31
Q

What are some facts about falls?

A

• 25% (1 in every 4) of American’s age 65 and older fall each year
- Less than ½ tell their doctor
• 1 in every 5 falls causes significant injury (broken bone, head injury)
• Falls are the most common cause of TBI
• Falls are the leading cause of fatal injury among older adults
• 300,000+ people a year are hospitalized for hip fractures
- Greater than 95% are caused by falling, usually sideways
- The chances of breaking a hip increase with age

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32
Q

What are physical consequences of a fall?

A

• Injury and/or death

  • Hip, wrist, compression fractures
  • Head trauma, TBI
  • Bruises, contusions, lacerations
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33
Q

What are psychosocial consequences of a fall?

A
  • Fear of Falling
  • Anxiety
  • Isolation
  • Depression
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34
Q

What is included int he cycle of fear of falling?

A
  • Fear of falling –>
  • Restricts activity –>
  • Physical capabilities reduced (moves slower, avoids movement) –>
  • Restricts more activities –>
  • More impaired physical capabilities (becomes de-conditioned, decreased strength and endurance)
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35
Q

What are the intrinsic risk factors of a fall?

A
  • Medical and neuropsychiatric conditions
  • Impaired vision and hearing
  • Age realted changes in neuromuscular function, gait, and postural reflexes
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36
Q

What are the extrinsic risk factors of a fall?

A
  • Medications
  • Improper prescription and or use of assistive devices for ambulation
  • Environmental hazards
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37
Q

What are the age related risk factors of a fall?

A
  • Medical conditions
  • Medication use
  • Sensory changes
  • Balance and gait impairments
  • Muscle weakness
  • Problems with mobility
  • Cognitive/psychological health
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38
Q

What are the environmental risk factors of a fall?

A
  • Clutter
  • Poor lighting
  • Lack of handrails, grab bars
  • Floors: wet, slick, throw rugs, or uneven surfaces
  • Stairs: lack of adequate handrail, light switch
  • Lack of handrails, grab bars
  • Items that are hard to reach
  • Obstacles in paths… carelessness
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39
Q

What are the behavioral and cognitive risk factors of a fall?

A
  • Cognitive (focus and distraction- divided attention)
  • Cognitive impairment
  • Lack of exercise
  • Unsafe footwear
  • Alcohol use
  • Nutrition, hydration
  • Taking risks
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40
Q

What are the community policy risk factors of a fall?

A
  • Buildings: safe public access, sidewalks in front of buildings
  • Handrails, grab bars
  • Laws
  • Social policies
  • Referral system and resource networks
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41
Q

Who do we screen for falls?

A
  • At minimum every older adult (over 65)

- A person with early aging changes or certain disease processes that puts them at a risk for falls

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42
Q

What are we doing when we screen a person for a fall?

A

Determine if the person is a low, moderate, or high risk for falls.

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43
Q

What are the ways to screen a person for a fall?

A

• Stay Independent brochure
OR
• 3 key questions
1. Have you fallen in the past 12 months?
2. Do you feel unsteady when standing or walking?
3. Do you worry about falling?

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44
Q

When should a person receive a full assessment for a fall?

A

If the person scores >4 on the Stay Independent brochure or if
they answer yes to any of the 3 questions used to screen for a fall

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45
Q

What is included in the multifactorial fall risk assessment?

A
  • Focused History
  • Physical Exam
  • Functional Assessment
  • Environmental Assessment
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46
Q

What is included in the focused history portion of the multifactorial fall risk assessment?

A 
• History of falls- Need details!
• Medication review
• Review of risk factors for falls
  - Current and past medical history
• Living environment
  - Gather information from patient/family/caregiver
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47
Q

What are the sensory components of the physical exam and functional assessment portion of the multifactorial fall risk assessment?

A
  • Vision: acuity, contrast, depth, visual field
  • Vestibular
  • Somatosensory: Vibration, proprioception, cutaneous
  • Sensory integration: Interaction between the above 3- mCTSIB and CTSIB
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48
Q

What are the neuromuscular components of the physical exam and functional assessment portion of the multifactorial fall risk assessment?

A
  • Strength: MMT, 5 times sit to stand, 30 second chair stand

* ROM and flexibility: ankle, knee, hip, trunk, cervical spine

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49
Q

What are the aerobic endurance components of the physical exam and functional assessment portion of the multifactorial fall risk assessment?

A
  • 6 minute walk test
  • 2 minute walk test
  • 2 minute step test
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50
Q

What are the movement analysis components of the physical exam and functional assessment portion of the multifactorial fall risk assessment?

A

Bed mobility, transfers, use of assistive devices and adaptive equipment
• The Barthel Index

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51
Q

What are the functional balance and gait components of the physical exam and functional assessment portion of the multifactorial fall risk assessment?

A

Lots of measures
• The skill is in selecting the correct measures for the patient
• Gait speed, TUG, Tinetti-POMA, MiniBEST, Functional Reach Test, Functional Gait assessment, Four Step Square Test, Berg Balance Scale, Dynamic Gait Index, Short Physical Performance Battery

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52
Q

What are the perceived functional ability and fear of falling components of the physical exam and functional assessment portion of the multifactorial fall risk assessment?

A

Falls Efficacy Scale, Activity Specific Balance Scale, Fear of Falling Avoidance Behavior Questionnaire

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53
Q

What are the footwear components of the physical exam and functional assessment portion of the multifactorial fall risk assessment?

A

Arch support, heel support, soles with grip

54
Q

What are the best predictors of falls in the aging adult?

A
  1. Activities-specific Balance Confidence (ABC) Scale
  2. Fear of Falling Avoidance Behavior Questionnaire
  3. Timed Up and Go
55
Q

What are the characteristics of the environmental (Home) assessment in regards to falls?

A

• Often overlooked
• Key for safety and prevention of falls at home!
• Consider all areas of the person’s living environment
- Physical environment, level of assistance, support,
adaptations using and needed
• Include, if any, other family members living in the house and caretakers that will be present in the home with the individual.

56
Q

What are the considerations to take for every space in regards to falls?

A

• Surface: concrete, wood, tile, carpet, gravel, grass, dirt,
rugs, throw rugs, runners, etc.
• Lighting: Adequate, dim, bright, glare, etc.
• Steps/Stairs: hand rails, number, height, condition
• Door widths, direction of door opening/closing
• Thresholds
• Objects: clutter, cords, toys, papers, furniture, etc.
• Phone: accessible

57
Q

What are the spaces to assess for falls?

A

• Entrances/Exits
- Approach included
• Hallways
• Stairs/Steps
• Living Room/Family Room
- Furniture accessibility, layout
• Kitchen
- Height of cabinets, knobs/buttons on stove, height of counters and sink, pantry
accessibility, item accessibility, layout
• Bathroom
- Unsecure bath mats, grab bars, tub/shower/combo, bath bench/seat, toilet seat height, shower head, surface in tub/shower, layout, space for assistive device
• Bedrooms
- Light switch location, lamps, night light, bed height, width,
and firmness, layout, closet accessibility, night stands
• Laundry Room
- Front/Top load, cabinets, accessible with assistive device
• Porches
• Back yard/leisure areas

58
Q

What are the modifications that we can make to the environment to reduce the risk of falls?

A
  • Enhance lighting
  • Remove throw rugs or secure them
  • Add hand rails
  • Change layout of room, furniture in room, change patient’s room
  • Remove clutter, cords, toys, papers, trip hazards, etc.
  • Change accessibility of food, utensils, products, clothing, etc.
  • Widen doors
  • Obtain elevated commode, shower chair or bench, non-slip surfaces
59
Q

What are the goals of the management interventions of falls?

A
  • Maximize Independence and Functioning
  • Prevent Falls
  • Reduce Risk
60
Q

How are reactive postural control (ankle, hip, knee, stepping strategies) trained to reduce the risk of falls?

A
  • Weight shifts

* Perturbations

61
Q

How are anticipatory postural control (expected changes and learned experience) trained to reduce the risk of falls?

A
  • Functional activities

* Dynamic activities

62
Q

How are stability limits trained to reduce the risk of falls?

A
  • Reaching activities

* Functional activities

63
Q

How is sensory orientation trained to reduce the risk of falls?

A
  • Surface changes
  • Functional activities
  • Eyes open/closed
64
Q

What is the typical progression of balance exercises/activities to reduce the risk of falls?

A
  • Static to dynamic
  • Incorporate head, arm, leg movements
  • Change/advance environment
  • Single task to dual task
  • Surface changes
  • Add resistance
  • Change speed
65
Q

What is the intensity that balance exercises should be done in order to reduce the risk of falls?

A

50 hours of training over a 3-6 month period

66
Q

What are the other PT interventions that can be done to reduce the risk of falls in the aging adult?

A 
• Strengthening/Resistance Exercise
  - Remember to avoid under dosing
• ROM and Flexibility Exercise
  - Hip, ankle, spine
• Endurance
• Home Modifications
67
Q

What are the characteristics of ADs as a form of PT intervention to reduce the risk of falls in the aging adult?

A 
• Do not reduce the number of falls or fallers
  - No adverse effects though
• Increase base of support
• Provide tactile cues about the ground
• Can provide support
68
Q

What are the referrals and other interventions that can be done to help a patient reduce the risk of falls in the aging adult?

A
  • Refer to MD or dietician for vitamin D supplementation
  • PT reviews medications, refers to MD for management of polypharmacy or medications linked to falls
  • PT assesses vision, refer to ophthalmologist for corrective eyewear or possible surgery
  • PT reviews footwear and foot abnormalities, work with or refer to orthotist as needed
69
Q

What are the parameters of the Otago Exercise Program, community program used to reduce the risk of falls in the aging adult?

A
  • 17 strength and balance exercises, 30 min/day, 3 x/week
  • Walking program 30 min/day, 3x/week
  • Great for preparing to enter a community program or as a starter community program
70
Q

What are the parameters of the Matter of Balance, community program used to reduce the risk of falls in the aging adult?

A
  • 2 hours/week for 8 weeks

* Coping strategies to reduce fear of falling, prevention strategies, and exercise

71
Q

What are the parameters of the Stay Active and Independent for Life (SAIL), community program used to reduce the risk of falls in the aging adult?

A
  • Exercises for strength, balance, and fitness

* 3x per week for 1 hour

72
Q

What are the parameters of the Moving for Better Balance, community program used to reduce the risk of falls in the aging adult?

A
  • 2 hours/class, 1x/week, 12 weeks

* Slow, therapeutic Tai Chi movements

73
Q

What are the characteristics of the systems review that is part of the examination of the cardiopulmonary exam for the aging adult?

A
  • Further screening for other cardiopulmonary conditions as well as other system issues
  • Vital signs
74
Q

What are the tests and measures more specific to pulmonary and cardiac aging adult patients?

A

• Vital signs during testing
• Walk and step tests (6MW, 2MW, 2MST & seated step tests validated in this population)
• Graded exercise testing (treadmill walking, leg/arm cycle ergometry, total body recumbent exercise test)
• Self-report measures (SF-36, Physical Function Subscale of RAND Health Survey, disease
specific, Duke Activity Status Index, PASE)
• Use of Angina, Dyspnea, Claudication Scales; RPE

75
Q

What are the parameters of the seated step test?

A
  • Stage 1: alternate placement of feet onto step or bar at 6 in., rate = 1/sec
  • Stage 2: 12 inches
  • Stage 3: 18 inches
  • Stage 4: 18 inch step and add alternating arms
  • HR, BP monitored, at 2 minutes below 75% max HR continued for 5 min.
  • After 5 min, if under 75% then progress to next stage
76
Q

What causes bradycardia at rest in the aging adult?

A

Medications, dysrhythmia

77
Q

What causes tachycardia at rest in the aging adult?

A

Hypotension, a-fib/flutter, cardiac autonomic disruption,

ventricular tachycardia

78
Q

What causes systolic HTN at rest in the aging adult?

A

Uncontrolled essential HTN

79
Q

What causes systolic hypotension at rest in the aging adult?

A

Orthostatic, a-fib/flutter, heart failure, dehydration

80
Q

What causes oxygen desaturation at rest in the aging adult?

A

Pulmonary conditions, supplemental O2

dependence

81
Q

What are the CVP benefits of exercise for the aging adult?

A
  • ↓ HTN
  • ↑ HDL
  • ↓ incidence CAD
  • ↓ platelet aggregability
  • ↓angina/ischemia
  • ↓ O2 requirement
  • ↓ respiratory s/s
  • ↓ hospitalizations
  • ADLs performed below anginal threshold
  • ↑ glucose utilization
  • ↑ weight mgmt.
  • ↑ exercise tolerance
  • ↑ ability to do ADLs
  • Improved psychological state
  • ↑ quality of life
  • Productivity in work and play
82
Q

What are the CVP considerations in treatment of the older adult?

A

• Same exercise parameters for normal aging adult
• May need to use other scales for exertion and exercise response due to normal
aging changes and/or pathological CVP conditions
• May or may not be treating an older adult for the primary CVP pathology, but may
likely need to compensate for a CVP co-morbidity
• Be specific in training, especially those with compromised CVP systems
• May need to modify exercise in order to meet your goals or adapt to patient needs
• Gauge progress by questioning ease of performing normal activities

83
Q

What are the characteristics of the presence of supplemental oxygen during exercise of the aging adult?

A

• May be required during exercise in patients with disease processes
preventing adequate oxygenation
• Make sure pt. brings own source or clinic is equipped
• Assess oxygen saturation during activities and titrate to maintain levels > 90% (make sure you have clearance from MD to titrate)
• Oxygen delivery device may require modification of mobility
activities

84
Q

What are the characteristics of the presence of pacemakers during exercise of the aging adult?

A

• Mode of pacing programmed into the device affects the patient’s cardiovascular tolerance to exercise
• Exercise tolerance dependent on underlying disease, type of pacemaker, and degree to which pt. dependent upon pacer to maintain cardiac output
- Fixed rate pacemakers cannot elevate HR to accommodate higher demand
- Pacemaker set on dual mode can allow HR to vary according to demand
• Patient c/o lightheadedness, syncope, low BP, and decreased activity tolerance
should trigger referral back to cardiologist to check pacemaker function

85
Q

What are the characteristics of the presence of defibrillators (implantable cardiac defibrillator) during exercise of the aging adult?

A

• Monitor HR and rhythm for abnormalities and activates when needed to convert to normal rhythm using electric shock
• Can be combined with pacemaker functions
• Therapist needs to know rate at which generator becomes activated
• Goals of therapy to determine safe activities and proper resistance/workload for exercise to allow high enough HR for health benefit but not too high to
activate ICD
- If HR rises above present rate, pt. should be sit down and be instructed to cough or perform Valsalva to cause vagal stim & decrease HR/prevent ICD shock
- Inform physician if defibrillator delivers shock during session
• Significant psychological effects in 90% of patients w/ICD in form of depression and anxiety

86
Q

What are the absolute exercise contraindications to aerobic exercise in the aging adult?

A

• Unstable angina
• Uncontrolled cardiac dysrhythmias causing symptoms of hemodynamic compromise
• Uncontrolled symptomatic heart failure
• Acute or suspected major cardiovascular event (inc. severe aortic stenosis, pulmonary embolus or
infarction, myocarditis, pericarditis, or dissecting aneurysm)
• Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands

87
Q

What are the relative exercise contraindications to aerobic exercise in the aging adult?

A
  • Known significant cardiac disease (inc. left main coronary stenosis, moderate stenotic valvular disease, hypertrophic cardiomyopathy, high-degree atrioventricular block, ventricular aneurysm)
  • Severe arterial hypertension (systolic BP > 200 mmHg or a diastolic BP of >110 mmHg) at rest
  • Tachydysrhythmia or bradydysrhythmia
  • Electrolyte abnormalities
  • Uncontrolled metabolic disease
  • Chronic infectious disease
  • Mental or physical impairment leading to inability to exercise safely
88
Q

What are the absolute indications for stopping aerobic exercise in the aging adult?

A
  • Drop in systolic BP of >10 mmHg from baseline despite an increase in workload when accompanied by other evidence of ischemia
  • Moderately severe angina (>2/4 on angina scale)
  • Increasing nervous system symptoms
  • Signs of poor perfusion
  • Subject’s desire to stop
  • Technical difficulty with monitoring equipment
  • Sustained ventricular tachycardia
  • ST elevation (+1.0 mm) in leads without diagnostic Q waves
89
Q

What are the relative indications for stopping aerobic exercise in the aging adult?

A
  • Drop in systolic BP of >10 mmHg from baseline despite an increase in workload in the absence of other evidence of ischemia
  • Increasing chest pain
  • Hypertensive response (systolic BP of >250 mmHg or diastolic BP of >115 mmHg)
  • Fatigue, shortness of breath/wheezing, leg cramps, or claudication
  • ST or QRS changes such as excessive ST depression (>2 mm ST-segment depression)
  • Arrhythmias other than sustained ventricular tachycardia (inc. multifocal PVCs, triplets of PVCs, supraventricular tachycardia, heart blocks, or bradyarrhythmias)
  • Development of bundle-branch block or intraventricular conduction delay that cannot be distinguished from ventricular tachycardia
90
Q

What are the components of the gait exam used for aging adults?

A 
• Survey or interview of patient’s perception of walking
• Prior level of function and duration of that level are key in goals setting
• Observational gait analysis
• Supported by objective measures
• Ideal combination of measures:
  - Speed
  - Endurance
  - Balance
  - Postural stability
• Use all measures to document progress
91
Q

What are the functional measures used to asses gait speed?

A
  • TUG

* Gait speed

92
Q

What are the functional measures used to asses gait endurance?

A
  • 6-minute walk test

* 2-minute walk test

93
Q

What are the functional measures used to asses gait balance?

A
  • Tinetti
  • Berg
  • 4 square step test
94
Q

What are the functional measures used to asses gait dual task?

A
  • TUG cognitive

* TUG manual

95
Q

What are the functional measures used to asses gait multiple task?

A
  • DGI

* FGA

96
Q

What is the minimum on the gait speed outcome to be placed in the fun category?

A

Over 1.5 secs

97
Q

What is the minimum on the gait speed outcome to be placed in the function category?

A

0.9-1.4 m/secs

98
Q

What is the minimum on the gait speed outcome to be placed in the frail category?

A

0.3-0.8m/ secs

99
Q

What is the minimum on the gait speed outcome to be placed in the failure category?

A

Under 0.3 m/secs

100
Q

What is the minimum on the 6MW outcome to be placed in the fun category?

A

Over 500m

101
Q

What is the minimum on the 6MW outcome to be placed in the function category?

A

300-500 m

102
Q

What is the minimum on the 6MW outcome to be placed in the frail category?

A

200-299 m

103
Q

What is the minimum on the 6MW outcome to be placed in the failure category?

A

Under 200 m

104
Q

What is the minimum on the chair rise: 30 secs no hands outcome to be placed in the fun category?

A

Over 15 reps

105
Q

What is the minimum on the chair rise: 30 secs no hands outcome to be placed in the function category?

A

8-14 reps

106
Q

What is the minimum on the chair rise: 30 secs no hands outcome to be placed in the frail category?

A

Under 8 reps

107
Q

What is the minimum on the chair rise: 30 secs no hands outcome to be placed in the failure category?

A

Unable

108
Q

What is the minimum on the climb ten stairs outcome to be placed in the fun category?

A

Under 10 secs, no rails

109
Q

What is the minimum on the climb ten stairs outcome to be placed in the function category?

A

9-30 secs with or without rails

110
Q

What is the minimum on the climb ten stairs outcome to be placed in the frail category?

A

31-50 secs with rails

111
Q

What is the minimum on the climb ten stairs outcome to be placed in the failure category?

A

Unable

112
Q

What is the minimum on the floor-stand outcome to be placed in the fun category?

A

Under 10 secs, no assistance

113
Q

What is the minimum on the floor-stand outcome to be placed in the function category?

A

11-30 secs with or without assistance

114
Q

What is the minimum on the floor-stand outcome to be placed in the frail category?

A

Over 30 secs with assistance

115
Q

What is the minimum on the floor-stand outcome to be placed in the failure category?

A

Unable

116
Q

What are the characteristics of ADs in reference to gait of the aging adult?

A 
• Can improve posture or make it worse
• Can provide support and confidence
• Can improve activity and participation
• Type prescribed depends on goals for/restrictions
in mobility
• Goal to provide least restrictive device with optimal degree of stability and support
• Need instruction and practice
• Must have patient buy-in
117
Q

What are the considerations for prescribing a cane for an aging adult?

A
  • Appropriate for pts who need balance & stability assist w/minimal WB shirt (up to 25%)
  • Coordination needed to use effectively; may not be appropriate for older pt w/cognitive or coordination impairments
118
Q

What is the objective for prescribing a cane for the aging adult?

A

Enhances stability through

wt redistribution; compensates for losses in vision and proprioception

119
Q

What is the objective for prescribing crutches for the aging adult?

A

Permits significant WB shift from legs to arms

120
Q

What are the considerations for prescribing crutches for an aging adult?

A
  • Permits more WB shift (50% or >) than a cane (up to complete NWB on one LE)
  • Less stable than walker
  • Req. good balance & upper body strength
  • Inappropriate use of axillary crutches can lead brachial plexus injuries
  • Loftstrand crutches permit hand use & reaching
121
Q

What is the objective for prescribing a walker for the aging adult?

A

Offers greater stability and

significant WB shift from legs to arms

122
Q

What are the considerations for prescribing a walker for an aging adult?

A

• Provides > WB shift (50% or >) than a cane but w/more stability than crutches; difficult
to maneuver on stairs
• Standard offers greatest stability but can be difficult for older adult to maneuver; req.
more attentional demand & has greatest destabilizing effects compared to RW
• RW is less stable than std but is easier to propel for those w/upper body weakness; ↓s
energy costs by 5% compared to std walker
• Rollators have adv. of RW with brakes/seat
• Hemi-walker allows lrg BOS for pts w/one functional arm
• Platform walkers heavy & ↑ energy expend., but permit WB thru humerus

123
Q

What are the motor dual task training interventions used for gait training in the aging adult?

A 
• Multidirectional (fwd/bwd,
side-stepping, turning, obstacles)
• Balancing (dynamic wt shifts
perturbations)
• External cueing (speed, stride
length, timing/metronome)
• Carrying/picking up/reaching
for objects
124
Q

What are the cognitive dual task training interventions used for gait training in the aging adult?

A 
• Listening to music
• Listening to talk-radio
• Verbal fluency
• Answer autobiographical
questions
• Subtraction by 3
• Visuospatial task of pattern matching
125
Q

Multi-factorial impairment based interventions for gait training focuses on…?

A
  • Reducing deviations
  • Improving gait efficiency
  • Improving gait safety
  • Increasing endurance
126
Q

Multi-factorial impairment based interventions for gait training incorporates…?

A
  • Specificity of training
  • Task-oriented training
  • Dual-tasking
  • Task and environmental constraints
  • Rehab of ALL the components
127
Q

What are the characteristics of flexibility training as seen in multi-factorial impairment based interventions for gait training?

A
  • Change what you can, adapt/compensate for what you can’t

* Address obvious structural limitations caused by pathology or surgical procedures

128
Q

What are the characteristics of strength, power, and agility training as seen in multi-factorial impairment based interventions for gait training?

A

• Achieve mobility with stability prior to emphasizing increased velocity
• Target PF, DF, quads, abductors, and extensors; UE strength in lats and triceps
when patient using AD
• Pre-gait activities can be done to focus on strength and control

129
Q

What are the characteristics of cardiovascular training as seen in multi-factorial impairment based interventions for gait training?

A
  • Continue to assess vitals to determine response to training
  • Remember that while an AD can increase stability, they can also add to energy demands
130
Q

What is dual task training?

A

The concurrent performance of two tasks that can be performed
independently and have distinct and separate goals

131
Q

What are the characteristics of dual task training?

A
  • Walking not just a rhythmic and automated process but demands attention
  • Attention demands increase w/age and w/task complexity
  • Results in increased gait variability, instability, and increases fall risk
  • “Stops walking when talking” test

Aging adult (5 decks)

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