7 - EXERCISE PRESCRIPTION FOR OLDER ADULTS Flashcards
PREVENTION
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Strategies
Tableau
Assessment frailty: name + description + what to assess
Fried’s criteria
1) Physical inactivity: less than 150 min of moderate activity per week
2) Low muscle strength: can be measured by grip strength - < 21 kg in men & < 14 kg in women
3) Slow walking speed
1) Less than 0,8 m/s with or without walking aids
2) Predictor of mortality
4) Exhaustion / fatigue: self reported
5) Weight loss: loss of 4,5 kg or more (5% of weight) in 1y
=> Scoring as follows: 0-1: not frail, 1-2: pre-frail, 3+: frail (mild, moderate & severe)
What to assess
1) Muscle function
1) Grip strength
2) Chair lift
2) Balance & walk function
1) Timed up & go
2) 6MWT
3) Tinetti
4) Unipolar balance
3) Cognitive functions
1) Mini mental state
2) CODEX (dementia)
3) Geriatric depression scale
4) Nutritional status
1) Nutritional screening initiative
5) Dependency
1) KATZ: activity of daily living
2) IADL: instrumental activity of daily living
Fall management: rehab plan reasoning
- Uni-factorial interventions, with physical exercises (balance & muscle strengthening): effective in reducing number of falls & number of fallers in people living at home
- For frail subjects and/or those at high risk of falling, multifactorial approach appropriate
- Muscle strengthening = improvement of functional capacities but does not bring any improvement in balance function if used alone
—> Key muscles: dorsal flexors of foot, triceps surae, quads, hamstrings - Balance training = key to any falls prevention exercise program
- Physical activity, in particular balance rehabilitation, muscular reinforcement & improvement of endurance helps to maintain autonomy of elderly person
- Can should preferably be individual: targeted & adapted to each person
Fall management in elderly: balance
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Fall management: strengthening
- Take into account fatigue: DOMS
- Key muscles: ankle dorsiflexors, triceps, quadriceps & hamstrings
- 60-80% of RM
- Closed chain
- Eccentric with lower energy cost
- Functional gestures
Fall management: foot
- Important sensory input
- Gait
- ROM: ankle & foot
- Muscle length: triceps surae
- External sensory stimulation
- Weight-bearing proprioceptive exercises
Fall management: optimizing sensory afferents
- Exercises on foam cushions or mats
- Seated exercises (ball, chair + dynair cushion)
- Exercise or unstable trays
- Progression in difficulty:
- Decrease polygon sustentation
- Add head oscillations
- Closing eyes
- Exercises with balls
- Optokinetic rehab
Optokinetic examples
- Cx spine ROM
- Eye-head exercise
- Egocentric & exocentric targets
- Walking + eye-head dissociation
Exocentric: description
- Involve motor tasks requiring individual to focus on external objects or targets in environment, rather than own body movements
- Exercises necessitate integration of visual & spatial information to interact with external world accurately & efficiently
- Exocentric exercises rely on individual’s ability to process & integrate visual information with motor planning & execution to achieve desired outcome
1) Ball sports: throwing, catching or kicking call, which requires accurate perception of ball’s position, velocity & trajectory
2) Target-based activities: Archery or darts, where goal is to hit specific target at distance
3) Interactive activities: dance or martial arts routines that involve interacting with partner or opponent &
responding to movements
Egocentric: description
- Egocentric exercises: motor tasks requiring individual to focus on own body movements, positioning & spatial orientation
- In these exercises, individual’s perception of body & its movements is central to task
- Egocentric exercises rely on person’s ability to process & integrate proprioceptive & kinesthetic information to maintain balance, control movement & coordinate body segments
1) Balance exercises: Single-leg stands, tandem walking or balance board training
2) Flexibility exercises: stretching routines that focus on individual muscle groups & joints
3) Body awareness exercises: yoga or Pilates, which emphasize body positioning, alignment & controlled
movements
Fall management: walking rehab
- Footwear & adapted technical aids
- Gait symmetry (height & length of step)
- Solicitations of speed changes during walking
- Phases of walking
- Higher activities of walking
- Walking on unstable surfaces
- Catching up on balance in standing position
- Passing obstacles
- Sit-stand transfer exercises
- Walking with variations in speed, direction , changes in position
- Double-tasking
- Walking outdoors if possible
Fall management up after falling
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Fall management: roles of PT
To work within interdisciplinary team & investigate possible causes of falls through detailed subjective history
Goals
- Prevent future falls by ensuring living environment is safe
- Prevent future falls by working on mobility, balance & strength
- Restoring confidence to improve quality of life & reduce fear of falling
- Training patients to cope with future falls & minimize complications
Fall management: addressing fear
Progressive exposure to circumstances that patient apprehends
- Desensitization process
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