Geriatric Rehabilitation & Assessment & Treatment

TOPIC OUTLINE Performanced Based Measures Activity

(1) Evaluation 🡪 Quantification of actual tasks through performance based
(2) Diagnosis measures provide unique information
(3) Plan of Care Joint specific mobility test
(4) Impaired Joint Mobility 🡪 ROM testing
🡪Muscle tendon unit (MTU) extensibility
Joint Examination 🡪Segmental Mobility
● History Intervention
🡪 Activation & Participation 🡪 Patient/Client education
🡪 Symptoms 🡪 Therapeutic exercise
🡪 Occupation/Activity 🡪 Stretching exercise
🡪 Health Condition/Injury/Surgery 🡪Strengthening exercise
🡪 Family History 🡪 Combined exercise intervention
🡪 Living Environment 🡪 Other Forms:
● Test & Measures - stabilization
🡪 Observation Task Analysis - taichi
🡪 Self Reported measures of activity & participation - yoga
🡪 Performanced based measures of activity 🡪Adaptive/assistive device
🡪 Joint Specific Mobility Testing Aging associated changes in Endocrine function linked
Sarcopenia
Activity & Participation 🡪 Inc. Insulin Resistance
🡪 First Interview the activity of limitation & participation 🡪Dec. Growth Hormone
restriction 🡪Dec. Insulin like growth hormone
🡪 Clarifies the functional goal of the patient 🡪Dec. Estrogen & Testosterone
● Symptoms 🡪Vitamin D deficiency
🡪 Relate the chronic symptoms, compensatory movement 🡪Inc. Parathyroid Hormone
overtime One Repetition Maximum (1-RM) & Multiple repetition
🡪 Original Symptoms VS Symptoms progression maximum (RM) Test
🡪Timing & Duration Procedures For Measurement of Muscular Strength
🡪 Testing should be completed only after the subject has
Occupation/Activity participated in familiarization/practice sessions
🡪 Information on joint loading and movement history 🡪 The subject should warm up by completing a number of
🡪 Lacking activities/Sedentary Lifestyle submaximal repetitions of the specific exercise that will be
🡪 Threshold for joint injury & mobility impairment used to determine 1-RM
● Age associated changes 🡪Determine the 1-RM within four trials w/ rest periods of
● Activity Reduction 3-5 min between trials
● Contralateral stages 🡪 Select an initial weight that is within the subject’s
● On hand & knees perceived capacity of (50-70% of capacity)
● Walking pattern 🡪 Resistance is progressively increased by 5-10% for upper
Health Condition/Injury/Surgery body or 10-20% for lower body exercise from the previous
🡪 Presence of comorbidities successful attempt until the subject cannot completed the
🡪Endocrine,Neuromuscular,cardiovascular,pulmonary & selected repetitions
musculoskeletal pathology 🡪 All repetitions should be performed at the same speed of
movement & ROM to instill consistency between trials
Family History 🡪 The Final Weight lifted successfully is recorded as the
🡪 Increase Likelihood of joint specific diseases via genetic absolute 1-RM or multiple RM
predisposition
Living Environment Evidence Supported Suggestions for Resistance Training
🡪 Integral in gathering information in activity participation 🡪 Resistance Exercise against sufficient load can increase
🡪 Both home & community MM strength & power even in the very old
🡪 Stair Height, chair type,Flooring 🡪Effective exercise options:
Observation Task Analysis - Intensities > 50% of 1RM performed 2-3 times
🡪 Specific Functional task problematic w/ patient per week w/ 1-3 sets per exercise sessions
🡪 Observing & analyzing possible structure/motion affect to - Intensities > 60% of 1RM performed 1-2 times
guide PT to select a Specific Measure per week w/ 1-3 sets per exercise sessions
Self Reported Measures of activity & participation - For ind. Older than 80 years old, resistance 1 time
🡪 Patient Perspective of activity performance per week at high intensity (70-80% 1RM) may
🡪 Pain & psychological functioning of activity performance add benefit

Sean John Kyle Torralba/ BSPT-2YB-1

Geriatric Rehabilitation & Assessment & Treatment
- Eccentric resistance exercise at high intensity is 🡪 This time taken to complete five repetitions is the score
particularly beneficial for older adults
Evaluation
🡪 MMT Chair Stand: Norms
🡪 Anthropometric Measurement 🡪 For the 30 sec chair stand; seven repetitions may indicate
🡪 Testing functional Performance frailty in people w/ CAD
Motor Control 🡪 8 repetitions may be the threshold for physical disability
🡪 Ability to regulate or direct MovementMobility Stair Climb
🡪 Assesses the ability to climb a flight of stairs
Contemporary theories 🡪 Identify impairment that can contribute to stair climbing &
🡪 Dynamical system theories or dynamical action theory of indicate how quickly and/or safety the patient can
motor development accomplish the task
🡪 Movement & neutral control of Movement 🡪 The stair climb test is also used as a functional test of
Major Motor Control Body structure & Functional power
Impairment 🡪 Timing starts when the patient’s first foot is lifted from
🡪 Motor system impairment floor and is stopped when both feet are on the top stair
🡪Paresis 🡪 The therapist should score ascent and descent separately
🡪 Abnormal tone 🡪 The therapy should document the use of
🡪 Fractionated movement deficit handrails,Assistive Devices, Gait belts & number of stairs.
🡪 Ataxia Stair Climb: Scoring
🡪 Hypokinesia 🡪 Non-disabled individuals, 0-5 seconds/stair is typical
🡪 Sensory System Impairment 🡪 Decreases w/ age from 2.5 stairs/sec in 20-39 yr.olds to
🡪 Somatosensory Loss 1.2 stairs/second in 90+ years old
🡪 Perceptual Deficits Floor Rise
Paresis 🡪 Floor rise ability is necessary for a patient’s safety &
🡪 Reduced ability to voluntarily activate the spinal motor confidence
neurons 🡪 The floor rise test assesses the patient’s ability to descend
🡪 testing functional performance and rise the floor, thereby identifying impairments.
Functional Testing functional ability & informing clinical decision- making
🡪 An analysis of any functional task shows that movement Floor Raise
are multiplanar & asymmetrical,incorporate rotation and are 🡪 The therapist should demonstrate the lowering of the
speed & balance dependent. body to the floor, lying supine and rising again
🡪 Observation of the individual performing the functional 🡪 During the test, the patient should lie supine so that 75%
task is the only way to accurately test functional ability. of the body is in contact with the floor
🡪 Observation provides information about the quality of 🡪 The patient may choose to place the head & trunk flat on
performance the floor, bending the knees or lying flat with only the head
Chair Stand & shoulder raised
Purpose: 🡪 A chair should be nearby to be used by the patient if
🡪 The chair test is a test of mobility specifically targeting the needed.
force production of leg muscles 🡪 Document the type of assistance needed to rise,
🡪 Excessive bending forward of the trunk in order to stand appropriate
may indicate that the patient is weak quadriceps 🡪 When an individual has difficulty getting up from the floor,
🡪 Some patient may need to extend their arms forward to it often involves an inability to shift weight from the hips
help them stand and in side-setting to the knees.
🡪 If this occurs, it could indicate that the patient’s legs are 🡪 The PT should note the “cause” of any difficulty in rising
weak & that the trunk is being used aid in the standing such as pain,weakness or an inability of motor plan. These
Equipment: causes may form the basis of a treatment plan.
🡪 A standard, Armless Chair, 17 inches (42cm), high, and a
stopwatch
Testing Procedure:
🡪 The test is always done without the use of the patient’s
arms
30 seconds Version:
🡪 The patient rises from a sitting position and stands to a
fully erect position as many times as possible in 30 seconds
🡪 The number of repetition is the patient scores
Timed 5-repetitions Versions
🡪 The Patient comes to a full standing position five times as
quickly possible

Sean John Kyle Torralba/ BSPT-2YB-1

Geriatric Rehabilitation & Assessment & Treatment
Abnormal Tone 🡪 In extrapyramidal rigidity, there is a decreased in swing
Hypertonicity time, but usually no qualitative change in the response
🡪 UMNL (CVA,TBI,MS,PD,SCI,CP) 🡪 In spasticity, there may be little or no decrease in swing
🡪 Spasticity time, but the movements are jerky and irregular, the forward
🡪 Decerebrate & Decorticate Rigidity movement may be greater and more brisk than the
🡪 Opisthotonus backward,and the movement may assume a zigzag pattern
🡪 Cogwheel & lead pipe Rigidity 🡪 In hypotonia, the response is in increased in range and
🡪 Activation & Participation prolonged beyond the normal.
Hypotonicity Shoulder Shaking Test
🡪 Atonia/Flaccid/Floppy 🡪The examiner places her hands on the patient’s shoulders
🡪LMNL (May be seen on acute & early recovery stage of and shakes them briskly, back and forth, observing the
CVA, Peripheral Neuropathy) reciprocal motion of the arms
Tone Assessment 🡪 In extrapyramidal disease, there will be a decreased range
🡪 Position the pt. in relaxed comfortable position. of arm swing on the affected side.
🡪Perform the PROM test on a faster rate towards the 🡪 In hypotonia, Especially the associated with cerebellar dse.
opposite motion of the shortened/spastic muscle. the excursions of the arm swing will be greater than normal.
🡪 Flexor spasticity (catch & release in extension range) Arm Dropping Test
🡪 Extensor spasticity (catch & release in flexion range) 🡪 The pt’ arms are briskly raised to the shoulder level, and
🡪 Perform testing on (B) sides for comparison then dropped
🡪 In spasticity, there is a delay in the downward movement
of the affected arm, causing it to hang up briefly on the
affected side. (Bechterew’s or Bekhterew’s sign)
🡪 In hypotonicity, the dropping is more abrupt than normal
🡪 A similar maneuver may be carried out by lifting and then
dropping the extended legs of the recumbent pt.
Non-Equilibrium/Coordination
Dyssynergia
🡪 Lack of integration of the components of the act result in
decomposition of movement the act is broken down into its
component parts and carried out in a jerky,erratic,awkward,
disorganized manner
Babinski Tonus Test
Dysmetria
🡪Arms are abducted at the shoulders, are the forearms are
🡪 Errors in judging distance and gauging the distance,speed,
passively flexed at the elbows
power and direction of movement
🡪 Hypotonicity there is increased flexibility & mobility and
🡪 When reaching for an object 50cm away, the hand shoots
the elbows can be bent to an angle more acute than normal
out 55cm, overshooting the target (hypermetria) or fails to
🡪 Hypertonicity there is reduced flexibility and passive
reach the target (hypometria)
flexion cannot be carried out beyond an obtuse angle
🡪 Hypermetria is more common.
Head Dropping Test
Intentional Tremors
🡪 Pt lies supine without a pillow,completely relaxed, eyes
🡪 Active, kinetic or terminal tremor that is not present at rest
closed and attention diverted
but becomes evident on purposeful movement
🡪 The examiner places one hand under the Pt occiput and
🡪 When the patient reaches to touch an object there are
with the other hand briskly raises the hand, and then it
irregular, to and fro, jerky movements perpendicular to the
allows it to drop
path movement that increase in amplitude as the hand
🡪 Normally the head drops rapidly into the examiner’s
approaches the target
protecting hand, but in Pt w/ extrapyramidal rigidity there is
Dysdiadochokinesia
delayed, slow gentle, dropping of the head because of
🡪 One act cannot be immediately followed by its diametric
rigidity affecting the flexor muscles of the neck,
opposite; the contraction of one set of agonist and
Pendulousness of the legs
relaxation of the antagonists cannot be followed
🡪 Pt sits on the edge of a table, relaxed with legs hanging
immediately by relaxation of the agonist and contraction of
freely
the antagonists
🡪 The examiner either extends both legs to the same
🡪 Inability to perform alternate pronation & supination
horizontal level or then released them (Wartenburg’s
pendulum test) or gives both legs a brisk, equal backward
push.
🡪 If the Pt is completely relaxed & cooperative, there will
normally be a swinging of the legs that progressively
diminishes in range & usually disappears after 6-7
oscillations.

Sean John Kyle Torralba/ BSPT-2YB-1

Geriatric Rehabilitation & Assessment & Treatment

-One Repetition Maximum (1-RM) & Multiple repetition

maximum (RM) Test

Sean John Kyle Torralba/ BSPT-2YB-1