Week 2 module 3 Flashcards
(131 cards)
1
Q
On the slippery slope of aging, what is fun?
A
What you want, when you want, for as long as you want
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
3
Q
On the slippery slope of aging, what is frailty?
A
Require help with ADLs and IADLs
4
Q
On the slippery slope of aging, what is failure?
A
Completely dependent
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
6
Q
What is considered the entryway to frailty?
A
Muscular system
7
Q
What is the most important factor in the subsequent institutionalization in regards to frailty?
A
Leg strength
8
Q
What is the role of physical therapy in frailty?
A
Must apply appropriate
principles of exercise prescription
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
10
Q
According to the physical stress theory, what happens when we apply sufficient load (60-100% of max) to a body?
A
Strengthening
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
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
13
Q
How do we provide functional training for our patients?
A
Overload the activity of interest to challenge the entire neuromuscular system
14
Q
How long does true strengthening take?
A
6 to 8 weeks
15
Q
What is the appropriate dosing of aerobic exercise for the aging adult?
A
60-90% of HR max
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
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
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
19
Q
What is the appropriate dosing of strength exercise for the aging adult?
A
60-80% of 1 rep max for strength gains
20
Q
___ is the cornerstone for preventing frailty or for reversing frailty
A
Strengthening is the cornerstone for preventing frailty or for reversing frailty
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
22
Q
How many reps should result in momentary fatigue when doing strength exercises with an aging adult?
A
8-12 reps
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
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
25
What are the strengthening exercise considerations for the aging adult?
* Underutilized and undermanaged
* Proper form
* Watch for breath holding
26
What are the parameters for flexibility exercise in the aging adult?
• 60 seconds needed for those 65 years an older to achieve
long term muscle lengthening
• 4 reps
• 5-7 days a week
27
What are the muscles we want to consider for flexibility exercise in the aging adult?
```
• Suboccipital muscles
• Pec minor
• Downward rotators
• Protractors
• Lumbar extensors
• Hip flexors and external
rotators
• Ankle plantar flexors
```
28
What is a fall?
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
29
A fall is as a result of what factors?
Environment, age related changes in functioning, and disease processes
30
What is a near fall?
Slip, trip, stumble, or loss of balance with recovery and remaining upright
31
What are some facts about falls?
• 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
32
What are physical consequences of a fall?
• Injury and/or death
- Hip, wrist, compression fractures
- Head trauma, TBI
- Bruises, contusions, lacerations
33
What are psychosocial consequences of a fall?
* Fear of Falling
* Anxiety
* Isolation
* Depression
34
What is included int he cycle of fear of falling?
- 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)
35
What are the intrinsic risk factors of a fall?
- Medical and neuropsychiatric conditions
- Impaired vision and hearing
- Age realted changes in neuromuscular function, gait, and postural reflexes
36
What are the extrinsic risk factors of a fall?
- Medications
- Improper prescription and or use of assistive devices for ambulation
- Environmental hazards
37
What are the age related risk factors of a fall?
- Medical conditions
- Medication use
- Sensory changes
- Balance and gait impairments
- Muscle weakness
- Problems with mobility
- Cognitive/psychological health
38
What are the environmental risk factors of a fall?
- 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
39
What are the behavioral and cognitive risk factors of a fall?
- Cognitive (focus and distraction- divided attention)
- Cognitive impairment
- Lack of exercise
- Unsafe footwear
- Alcohol use
- Nutrition, hydration
- Taking risks
40
What are the community policy risk factors of a fall?
- Buildings: safe public access, sidewalks in front of buildings
- Handrails, grab bars
- Laws
- Social policies
- Referral system and resource networks
41
Who do we screen for falls?
- 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
42
What are we doing when we screen a person for a fall?
Determine if the person is a low, moderate, or high risk for falls.
43
What are the ways to screen a person for a fall?
• 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?
44
When should a person receive a full assessment for a fall?
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
45
What is included in the multifactorial fall risk assessment?
* Focused History
* Physical Exam
* Functional Assessment
* Environmental Assessment
46
What is included in the focused history portion of the multifactorial fall risk assessment?
```
• 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
```
47
What are the sensory components of the physical exam and functional assessment portion of the multifactorial fall risk assessment?
* Vision: acuity, contrast, depth, visual field
* Vestibular
* Somatosensory: Vibration, proprioception, cutaneous
* Sensory integration: Interaction between the above 3- mCTSIB and CTSIB
48
What are the neuromuscular components of the physical exam and functional assessment portion of the multifactorial fall risk assessment?
* Strength: MMT, 5 times sit to stand, 30 second chair stand
| * ROM and flexibility: ankle, knee, hip, trunk, cervical spine
49
What are the aerobic endurance components of the physical exam and functional assessment portion of the multifactorial fall risk assessment?
* 6 minute walk test
* 2 minute walk test
* 2 minute step test
50
What are the movement analysis components of the physical exam and functional assessment portion of the multifactorial fall risk assessment?
Bed mobility, transfers, use of assistive devices and adaptive equipment
• The Barthel Index
51
What are the functional balance and gait components of the physical exam and functional assessment portion of the multifactorial fall risk assessment?
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
52
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?
Falls Efficacy Scale, Activity Specific Balance Scale, Fear of Falling Avoidance Behavior Questionnaire
53
What are the footwear components of the physical exam and functional assessment portion of the multifactorial fall risk assessment?
Arch support, heel support, soles with grip
54
What are the best predictors of falls in the aging adult?
1. Activities-specific Balance Confidence (ABC) Scale
2. Fear of Falling Avoidance Behavior Questionnaire
3. Timed Up and Go
55
What are the characteristics of the environmental (Home) assessment in regards to falls?
• 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
What are the considerations to take for every space in regards to falls?
• 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
What are the spaces to assess for falls?
• 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
What are the modifications that we can make to the environment to reduce the risk of falls?
* 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
What are the goals of the management interventions of falls?
* Maximize Independence and Functioning
* Prevent Falls
* Reduce Risk
60
How are reactive postural control (ankle, hip, knee, stepping strategies) trained to reduce the risk of falls?
* Weight shifts
| * Perturbations
61
How are anticipatory postural control (expected changes and learned experience) trained to reduce the risk of falls?
* Functional activities
| * Dynamic activities
62
How are stability limits trained to reduce the risk of falls?
* Reaching activities
| * Functional activities
63
How is sensory orientation trained to reduce the risk of falls?
* Surface changes
* Functional activities
* Eyes open/closed
64
What is the typical progression of balance exercises/activities to reduce the risk of falls?
* Static to dynamic
* Incorporate head, arm, leg movements
* Change/advance environment
* Single task to dual task
* Surface changes
* Add resistance
* Change speed
65
What is the intensity that balance exercises should be done in order to reduce the risk of falls?
50 hours of training over a 3-6 month period
66
What are the other PT interventions that can be done to reduce the risk of falls in the aging adult?
```
• Strengthening/Resistance Exercise
- Remember to avoid under dosing
• ROM and Flexibility Exercise
- Hip, ankle, spine
• Endurance
• Home Modifications
```
67
What are the characteristics of ADs as a form of PT intervention to reduce the risk of falls in the aging adult?
```
• 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
What are the referrals and other interventions that can be done to help a patient reduce the risk of falls in the aging adult?
* 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
What are the parameters of the Otago Exercise Program, community program used to reduce the risk of falls in the aging adult?
* 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
What are the parameters of the Matter of Balance, community program used to reduce the risk of falls in the aging adult?
* 2 hours/week for 8 weeks
| * Coping strategies to reduce fear of falling, prevention strategies, and exercise
71
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?
* Exercises for strength, balance, and fitness
| * 3x per week for 1 hour
72
What are the parameters of the Moving for Better Balance, community program used to reduce the risk of falls in the aging adult?
* 2 hours/class, 1x/week, 12 weeks
| * Slow, therapeutic Tai Chi movements
73
What are the characteristics of the systems review that is part of the examination of the cardiopulmonary exam for the aging adult?
* Further screening for other cardiopulmonary conditions as well as other system issues
* Vital signs
74
What are the tests and measures more specific to pulmonary and cardiac aging adult patients?
• 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
What are the parameters of the seated step test?
* 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
What causes bradycardia at rest in the aging adult?
Medications, dysrhythmia
77
What causes tachycardia at rest in the aging adult?
Hypotension, a-fib/flutter, cardiac autonomic disruption,
| ventricular tachycardia
78
What causes systolic HTN at rest in the aging adult?
Uncontrolled essential HTN
79
What causes systolic hypotension at rest in the aging adult?
Orthostatic, a-fib/flutter, heart failure, dehydration
80
What causes oxygen desaturation at rest in the aging adult?
Pulmonary conditions, supplemental O2
| dependence
81
What are the CVP benefits of exercise for the aging adult?
* ↓ 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
What are the CVP considerations in treatment of the older adult?
• 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
What are the characteristics of the presence of supplemental oxygen during exercise of the aging adult?
• 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
What are the characteristics of the presence of pacemakers during exercise of the aging adult?
• 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
What are the characteristics of the presence of defibrillators (implantable cardiac defibrillator) during exercise of the aging adult?
• 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
What are the absolute exercise contraindications to aerobic exercise in the aging adult?
• 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
What are the relative exercise contraindications to aerobic exercise in the aging adult?
* 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
What are the absolute indications for stopping aerobic exercise in the aging adult?
* 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
What are the relative indications for stopping aerobic exercise in the aging adult?
* 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
What are the components of the gait exam used for aging adults?
```
• 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
What are the functional measures used to asses gait speed?
* TUG
| * Gait speed
92
What are the functional measures used to asses gait endurance?
* 6-minute walk test
| * 2-minute walk test
93
What are the functional measures used to asses gait balance?
* Tinetti
* Berg
* 4 square step test
94
What are the functional measures used to asses gait dual task?
* TUG cognitive
| * TUG manual
95
What are the functional measures used to asses gait multiple task?
* DGI
| * FGA
96
What is the minimum on the gait speed outcome to be placed in the fun category?
Over 1.5 secs
97
What is the minimum on the gait speed outcome to be placed in the function category?
0.9-1.4 m/secs
98
What is the minimum on the gait speed outcome to be placed in the frail category?
0.3-0.8m/ secs
99
What is the minimum on the gait speed outcome to be placed in the failure category?
Under 0.3 m/secs
100
What is the minimum on the 6MW outcome to be placed in the fun category?
Over 500m
101
What is the minimum on the 6MW outcome to be placed in the function category?
300-500 m
102
What is the minimum on the 6MW outcome to be placed in the frail category?
200-299 m
103
What is the minimum on the 6MW outcome to be placed in the failure category?
Under 200 m
104
What is the minimum on the chair rise: 30 secs no hands outcome to be placed in the fun category?
Over 15 reps
105
What is the minimum on the chair rise: 30 secs no hands outcome to be placed in the function category?
8-14 reps
106
What is the minimum on the chair rise: 30 secs no hands outcome to be placed in the frail category?
Under 8 reps
107
What is the minimum on the chair rise: 30 secs no hands outcome to be placed in the failure category?
Unable
108
What is the minimum on the climb ten stairs outcome to be placed in the fun category?
Under 10 secs, no rails
109
What is the minimum on the climb ten stairs outcome to be placed in the function category?
9-30 secs with or without rails
110
What is the minimum on the climb ten stairs outcome to be placed in the frail category?
31-50 secs with rails
111
What is the minimum on the climb ten stairs outcome to be placed in the failure category?
Unable
112
What is the minimum on the floor-stand outcome to be placed in the fun category?
Under 10 secs, no assistance
113
What is the minimum on the floor-stand outcome to be placed in the function category?
11-30 secs with or without assistance
114
What is the minimum on the floor-stand outcome to be placed in the frail category?
Over 30 secs with assistance
115
What is the minimum on the floor-stand outcome to be placed in the failure category?
Unable
116
What are the characteristics of ADs in reference to gait of the aging adult?
```
• 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
What are the considerations for prescribing a cane for an aging adult?
* 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
What is the objective for prescribing a cane for the aging adult?
Enhances stability through
| wt redistribution; compensates for losses in vision and proprioception
119
What is the objective for prescribing crutches for the aging adult?
Permits significant WB shift from legs to arms
120
What are the considerations for prescribing crutches for an aging adult?
* 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
What is the objective for prescribing a walker for the aging adult?
Offers greater stability and
| significant WB shift from legs to arms
122
What are the considerations for prescribing a walker for an aging adult?
• 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
What are the motor dual task training interventions used for gait training in the aging adult?
```
• 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
What are the cognitive dual task training interventions used for gait training in the aging adult?
```
• Listening to music
• Listening to talk-radio
• Verbal fluency
• Answer autobiographical
questions
• Subtraction by 3
• Visuospatial task of pattern matching
```
125
Multi-factorial impairment based interventions for gait training focuses on...?
* Reducing deviations
* Improving gait efficiency
* Improving gait safety
* Increasing endurance
126
Multi-factorial impairment based interventions for gait training incorporates...?
* Specificity of training
* Task-oriented training
* Dual-tasking
* Task and environmental constraints
* Rehab of ALL the components
127
What are the characteristics of flexibility training as seen in multi-factorial impairment based interventions for gait training?
* Change what you can, adapt/compensate for what you can’t
| * Address obvious structural limitations caused by pathology or surgical procedures
128
What are the characteristics of strength, power, and agility training as seen in multi-factorial impairment based interventions for gait training?
• 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
What are the characteristics of cardiovascular training as seen in multi-factorial impairment based interventions for gait training?
* 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
What is dual task training?
The concurrent performance of two tasks that can be performed
independently and have distinct and separate goals
131
What are the characteristics of dual task training?
* 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
