Exam 1 (wks 1-4)

Question 1

What is ageism

Answer 1

Prejudice or discrimination against a particular age-group and especially the elderly

Question 2

What is the difference between optimal aging and successful aging?

Answer 2

Successful aging = avoiding disease and disability, maintaining high physical and cognitive function, and sustained engagement in social and productive activities.
Optimal aging = the capacity to function across many domains in spite of medical conditions.

Question 3

What are the 5 most common causes of death among older adults?

Answer 3

Heart disease
Cancer
Covid
Cerebrovascular diseases
chronic lower respiratory diseases
Alzheimer disease

Question 4

What are the 6 most common chronic health conditions among older adults?

Answer 4

Hypertension
High cholesterol
Arthritis
Heart disease
Diabetes
Kidney disease

Question 5

What is the life expectancy for men and women?

Answer 5

In 2021
73.2 for males
79.1 for females

Question 6

What percentage of work is needed to provide an overload when prescribing exercise?

Answer 6

60%

Question 7

How would you describe the 4 different stages of the Slippery Slope of Aging?

Answer 7

• Fun: What you want, when you want, for as long as you want
• Function: Choices made based on decreased physical capacity, Have mobility disability or at risk for
• Frailty: Require help with ADLs and IADLs
• Failure: Completely dependent

Question 8

What are the 5 criteria for measuring frailty?

Answer 8

• 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

Question 9

What is the difference between a fall and a near fall?

Answer 9

Fall = inadvertently coming to rest on the ground (excludes change in position, resting on furniture wall or other objects)
Near fall = slip, trip, stumble or loss of balance with recovery and remaining upright

Question 10

How does fear affect fall risk?

Answer 10

Fear of falling leads to restricted activities which leads to reduced physical capabilities more restricted activity/ ability and greater fear of falling.

Question 11

Can you describe and differentiate the intrinsic and extrinsic risk factors for falls?

Answer 11

Intrinsic ex.: medical conditions, impaired vision/hearing, age related changes in neuromuscular function, gait, and postural reflexes
Extrinsic ex.: medications, improper prescription, use of assistive devices, environmental hazards

Question 12

How can PTs screen for fall risk?

Answer 12

Stay independent brochure
OR
3 key questions:
- Have you fallen in the past 12 months?
- Do you feel unsteady when standing or walking?
- Do you worry about falling?
*If pt scores >4 on the stay independent or if they answer yes to any of the 3 questions

Question 13

Name the four key components of a focused exam for fall assessment.

Answer 13

Focused history
Physical exam
-sensory
-neuromuscular
-aerobic endurance
Functional assessment
Environmental assessment

Question 14

What outcome tool can PTs use to best assess sensory integration?

Question 15

What are the 3 outcome measures that best predict falls?

Answer 15

Activities-specific Balance Confidence (ABC) Scale
Fear of Falling Avoidance Behavior Questionnaire
Timed Up and Go

Question 16

What type of motor learning is important to enhance an individuals feed-forward mechanisms to reduce their risk of falls?

Answer 16

Practice
Mistakes

Question 17

What is the intensity required to change a pts balance?

Answer 17

2-3 hrs/wk for a minimum of 12 wks

Question 18

Is an assistive device enough to reduce falls?

Answer 18

No. not as a single intervention

Question 19

Name some community intervention programs to decrease fall risk.

Answer 19

Otago Exercise Program
Master of Balance
Stay Active and Independent for Life
Moving for Better Balance

Question 20

The three health conditions which should be identified as part of every fall assessment.

Answer 20

Osteoporosis
Depression
Polypharmacy

Question 21

What interventions have Grade A & B evidence supporting their use in addressing fall-related risk factors?

Answer 21

Strength training
Balance training
Gait training
Correction of environmental hazards
Correction of footwear

Question 22

What are the 4 distinct phases of falling?

Answer 22

Pre-fall
Near-fall
Fall-landing
Completed fall

Question 23

What is one of the best outcome assessment tools to assess reactive postural control?

Answer 23

MiniBest test

Question 24

3 primary intervention strategies to address righting and stepping during near fall phase

Answer 24

Power training
Perturbation training
Step training

Question 25

Two primary intervention strategies to prepare older adults for safe landing strategies.

Answer 25

Knee and elbow flexion More points of contact

Question 26

Highest risk meds for falls

Answer 26

Benzodiazepines Cardiac meds Anti-depressants Antipsychotics Antiepileptics Antihypertensives

Question 27

What does the Barthel index assess?

Answer 27

Bed mobility, transfers, use of assistive devices and adaptive equipment

Question 28

Name 3 tests you could use to assess aerobic endurance

Answer 28

6-min walk test 2-min walk test 2-min step test

Question 29

Perceived functional ability and fear of falling assessment tools

Answer 29

Falls efficacy scale Activity specific balance scale Fear of falling avoidance behavior questionnaire

Question 30

Identify and name the psychological factors contributing to gait alterations

Answer 30

Depression Self efficacy Appearance Perception of mobility Anxiety and fear Perceived risks Fear of harm from others Worries about access/barriers

Question 31

What is dual-tasking and how could a PT incorporate these principles into their treatment plan?

Answer 31

Assess using the TUG cognitive or TUG manual

Question 32

What are normal age related changes to gait?

Answer 32

Decreased walking speed with ability to increase speed voluntarily Smaller steps/stride length but symmetrical Step width avg. 1-4 inches Smaller toe clearance

Question 33

What performance measures and markers indicate the functional category of aging?

Answer 33

Gait speed = .9-1.4 6 min walk = 300-500 30 sec sit to stand = 8-14 10 stairs = 9-30 sec Floor to stand = 11-30 sec no assistance

Question 34

What are the six determinants of gait?

Answer 34

Pelvis rot. Pelvic tilt Knee flexion in stance phase Foot mechanism Knee mechanism Lateral displacement of the pelvis

Question 35

What are the contextual factors that impact patient outcomes after primary TJA for OA?

Answer 35

Behavioral/ psychosocial Support and attitudes Biological/ intrinsic Provider and systems factors

Question 36

Compare and contrast the effectiveness of Pre-op PT and Pre-op educational classes.

Answer 36

Pre op PT - training with walking devices, managaing expectations, planning for recovory (debatable) Pre op edu = good evidence, more benefit

Question 37

When should physical therapy start for those s/p TJA and what are the benefits?

Answer 37

Immediately

Question 38

Describe the differences between an anatomic TSA and a reverse TSA.

Answer 38

Anotomic - must have intact rotator cuff Reverse - no rotator cuff but need deltoid

Question 39

What are typical impairments or activity limitations that a physical therapist can address right after a TSA?

Answer 39

Bed mobility Single Arm ADLs Core strengthening Functional reach

Question 40

What are the key components of the history when interviewing a patient after a total hip arthroplasty?

Question 41

What early post-operative complications are important to be aware of and screen for within the history and tests/measures?

Question 42

Describe the most common hip precautions based on the surgical approach (Anterior or Posterior)

Question 43

Consider how a physical therapist may construct a post-operative treatment plan keeping weightbearing status and hip precautions in mind.

Question 44

Describe the strong to moderate recommendations for those undergoing TKA. How are these the same and how are they different from what you learned in the asynchronous lecture?

Question 45

What are the best practice recommendations for outcome measures to use with those who have undergone a TKA?

Question 46

What physical agents are recommended for use after TKA and why?

Question 47

What are the impacts of a hip fracture on mortality?

Question 48

Describe the types of hip fractures and the associated repairs typically completed.

Question 49

What type of hip surgical procedures typically have hip precautions?

Question 50

Which outcome measures have the strongest recommendation based on evidence for use with patients s/p hip fracture?

Question 51

What types of exercise are highly recommended for patients s/p hip fracture?

Question 52

Which interventions have strong to moderate support for people s/p hip fracture in the inpatient setting?