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4 acute care > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

what are some clinical practice guidelines for the neurological population

A

Transfers:

Walking speed:

Walking distance:

Static and Dynamic Sitting and Standing Balance:

Balance while walking:

Balance confidence:

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2
Q

what happens to net center of pressure with both feet are in contact with the ground

A

When both feet are in contact there are separate COPs under each foot.

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3
Q

what is strength with aging

A

Decreased # and size of muscle fibers

Decreased rapid muscle force exertion

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4
Q

what is quiet standing use to stay up

A

inverted pendulum model of balance in A/P direction

slide 15 == look at equation

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5
Q

what are some clinical presentation for TBI

A

Both impaired Cognition & Physical Motor Function

Changes in Behavior and Emotional Control
*****Agitation, Aggression, Impulsivity

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6
Q

how doyou manage patient with depression

A
  • Exercise helps-resistance training, group exercise
  • Referral! Worsening depression needs to be treated as soon as possible.
  • Part of the team: Be aware of the treatment plans and goal.
  • Help patient focus less on the depression and more on other situation.
  • Motivation! – emphasizing strength, positive feedback
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7
Q

what are connective tissue contractures

A

: skin, subcutaneous fibrosis(burn), aponeurosis, tendon.

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8
Q

what is the mini mental state examination

A

The examination has been validated in a number of populations. Lopez et al, 2005

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9
Q

what are some bone density issue

A
  • osteopenia
  • osteoporosis
  • severe osteoporosis
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10
Q

what are some limitations for yoga hot yoga

A

Pre-existing conditions, such as cardiovascular disease, back pain, asthma, low/high blood pressure, diabetes, ect. should consult a doctor prior to starting hot yoga.

Should not be done in pregnant women.

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11
Q

look at slide in the psychosocial aspects of aging

A

13

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12
Q

how does dementia develop

A

Develops over a number of years and slowly worsens

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13
Q

what is the hallmark of TBI

A

decreased response to activity

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14
Q

what is the theoretical limits of stability

A

Theoretical limits of stability (LOS)
in stance are traditionally considered to
depend on the area of BOS

Valid in static standing tasks
Insufficient in dynamic situations

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15
Q

what are the normative date of the Fullerton Advanced Balance Scale

A

Score of 0-4 for each task
Higher = Better

40 Total Points (Full Form)
16 Total Points (Short Form)

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16
Q

what are the other types of dementia

A
  • vitamin B12 deficiency
  • over- or under-active thyroid gland
  • excessive alcohol
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17
Q

dynamic equilibrium motor systmes

A

Initiate Automatic and Voultary Movements
Select and Adjust Muscle contractile patterns

Ankle Muscles
Legs/ Thighs
Trunk Muscles

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18
Q

what is the take home message for yoga

A

Yoga will help improve balance.

If you need a modification, don’t be afraid to ask the instructor.

The best intervention will be one that is individualized.

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19
Q

what does it mean to be homebound

A

Leaving your home isn’t recommended because of your condition.

Your condition keeps you from leaving home without help (such as using a wheelchair or walker, needing special transportation, or getting help from another person).

Leaving home takes a considerable and taxing effort.

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20
Q

what is the order of balance strategies

A

-ankle strategy
-hip
step

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21
Q

how do we find contractures out

A

AROM vs. PROM

Manipulation

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22
Q

what are the perceived exertion scales

A

Borg
Borg Modified
Visual Analog

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23
Q

what are some optic symptoms of MS

A

Optic neuritis – first manifestation
Visual blurring
Diplopia
Loss of vision in one eye

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24
Q

Balance assessment powerpoint

A

slide 7 and 8

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25
Q

why count velocity into consideration

A

The projected location of COM to be situated outside of the base of support at the instant of takeoff from the chair while the horizontal momentum of the COM is directed towards the base of support.

Standing will not be maintained when a sufficiently large horizontal velocity exists, even though the horizontal COM is currently located inside the BOS

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26
Q

what is the sensory envrionment

A

The condition which exist or are perceived to exist in the real world around us that impact balance

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27
Q

what must be achieved to have gait

A

balance must be maintained to achieve gait

humans are dynamic

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28
Q

how odes tai chi enhance mindfulness

A

Decreases stress / increases relaxation

Improves overall quality of life

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29
Q

what is hospice

A

Hospice is an alternative to the traditional hospital based care for the dying. Hospice is a philosophy of care that provides palliative rather than curative care

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30
Q

what is the somatosensory system

A

surface chances, irregularities,

base of support changes

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31
Q

why do we have an outcome measure selection

A

Identify an impact of the disorder on an individual

Establish baseline measurement to monitor change

Evaluate an impact of an intervention

Evaluate the needs of the individual

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32
Q

what are the different types of contractures

A

muscular
arthrogenic contractures
ct contractures

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33
Q

what are some causes for cognitive changes in later life

A

Mental processing speed decline (time to process sensory input and motor output)

Sensory-perceptual changes (ex. Sensitivity to visual contrast, sound)

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34
Q

what is hypokinesis with aging

A

sedentary – sitting in flexed posture in recliner

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35
Q

what is Transfer of outcome measures

A

Transfers: Five Time Sit to Stand (5TSTS)

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36
Q

how do medication affect falls

A

4+ prescription drugs

increase risk for falls compared to fewer

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37
Q

what is the SN and Sp of the Functional Reach

A

Specificity: 0.67 (R/I)
Sensitivity: 0.75 - 0.97 (R/O)

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38
Q

what are some essential exercises for osteoporosis

A
  • posture alignment
  • therapeutic exercises for straighten
  • the stronger the muscle the stronger the bone
  • exercises involving weight bearing retain more bone mineral than non weightbearing
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39
Q

what are some predictor and risk for institutionalization

A 
Physical function
Restricted mobility: mobility outside of the home
Social resources and support
Health perception
Socioeconomic status
Health-care system
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40
Q

what is the scoring for the DGI

A

3: no gait dysfunction
2: minimal impairment
1: moderate impairment
0: severe impairment

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41
Q

what is are the goal of Fullerton Advanced Balance Scale

A

Produce a functional assessment tool to identify balance issues in functionally independent older adults

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42
Q

what protects against further loss

A

walking

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43
Q

what is the secondary injury

A

Secondary Injury: changes compromising brain function relative to the trauma (increased ICP pressure, infection, seizures)

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44
Q

what are some characteristics for delirium

A

Confusion, changes level of consciousness, difficult concentrating,

sun downing

Difficulty with immediate recall, short term memory, maintaining attention.

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45
Q

what is cerebellum

A

coordinates and regulates posture, movement and balance

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46
Q

what is hormone replacement

A

(Estrogen) – can cause some side effects in some women/increase the risk of breast or uterine cancer

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47
Q

what is the protocol of the dual task

A 
Cued walking 
Cognitive tasks paired with gait 
Balance
Strength training
Virtual reality
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48
Q

what are the steps for gait initiation

A
  • standing goal
  • gait initiation
  • gait acceleration
  • gait goal
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49
Q

Functional balance grades

A

slide 29

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50
Q

dynamic equilibrium- sensory systems section

A

Determine our body position
Compare, Select and Combine Senses
with response to environmental interactions

Visual System
Vestibular System
Somatosensation System

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51
Q

what is the berg balance scale

A

Objective measure that assesses static balance and fall risk in adults

History: Developed in 1989 by Berg et al

Key descriptions
=Static and dynamic activities of varying difficulty
=Scores range from 0-4, determined by ability to perform activity
==Item scores are then summed
Maximum score = 56

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52
Q

what is gait termination

A

The COP and COM trajectories during termination were virtually mirror images of that reported for the initiation trials.

During termination of gait
the COG must return
within the base of support.

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53
Q

what is the earliest finding of yoga

A

Earliest findings of yoga can be traced back to 5,000-10,000 years ago

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54
Q

what is the effect of age on daul task

A

Aging increases difficulty to perform dual-task activities due to:

Decreased walking speed
Change in postural stability
Gait deviations
Cadence discrepancies
Stride length difference
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55
Q

what are some limitations for yoga geriatric

A

crunches and sit-ups
Rounded back motions
End range sidebending and twisting
Forced rotation of the femur

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56
Q

what does the DGI involve

A 
Walking on level surface
Walking with change in gait speed
Walking with horizontal head turns
Walking with vertical head turns
Walking with pivot turn
Stepping over an obstacle
Stepping around obstacles
Walking up steps
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57
Q

what is severe osteoporosis

A

BMD more than 2.5 standard deviation below adult peak mean with history of one or more fracture

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58
Q

what is functional definition

A

Lose the ability to perform activities of daily living and need assistance (institutionalized, Dependent on others for ADL care, Debilitated and could not survive without substantial help, Need long-term help with basic ADLs)

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59
Q

what is the hallmark of PD

A

Pathologic hallmark:
degeneration of the substantia nigra in association with production of Lewy bodies

Progressive loss of dop

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60
Q

what do we do with acute care phase in pt

A

Pain management with modalities
Bed rest
Therapeutic exercise
—Addressing postural awareness

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61
Q

how does independent mobility outside the home associate with

A

Independent mobility outside of the home has been found to be associated with lower risk of institutionalization

In nursing home, 66% difficulty transferring from bed to chair, 66% have difficulty with ambulation.

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62
Q

what are some problems associated with institutionalization of latrogenic illness

A

Adverse drug reaction
Fluid and electrolyte imbalance
Falls or other accident
Nosocomial infection(UTI, bacterial infection, pneumonia and wound infection)

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63
Q

what is the max score for the berg

A

14 items with 4 being the highest score for each item

Max score is 56

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64
Q

what is vestibular

A

equilibrium
spatial awareness
rotation
linear movement

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65
Q

DGI ability to predict fall in older adults

A

Older Adults (mean age 73)
Specificity: 86%
Sensitivity: 67%

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66
Q

what are the normal bestest socres

A

60 – 69 yr old
86.5 ± 15.6

70-79 yr old
82.6 ± 14.5

80 – 89 yr old
72.6 ± 15

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67
Q

what is center of gravity

A

The vertical projection of the Center of Mass (COM) onto the ground

Point of origin about which all particles of body are equal distributed

Refers only to vertical direction in which gravity acts

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68
Q

what are the sensory orientation (bestest)

A

15 points

Sensory Integration for Balance (EO, EC, Firm, and Foam)
Incline – Eyes Closed

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69
Q

what is cerebral cortex

A

contributes higher level thinking and memory

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70
Q

what is release phase

A

the COP moves posteriorly and towards the swing limb

This will accelerating the COM forward and towards the stance limb.

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71
Q

how long does it take for the DGI to administer

A

10-15 minutes
<10 minutes if experienced

No prior training required to perform the test
Just need to know how each task is scored

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72
Q

what is the importance of the physical function in the elderly in relation to ADL

A

An individual’s dependence on others for ADLs.

It is estimated that 60% of people older than 65 years who are dependent in 5-7ADLs reside in nursing homes

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73
Q

what is their gait and balance impairments in someone with PD

A

Characteristic Gait Patterns

Balance Impairments: Retropulsion, Freezing Episode’s

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74
Q

what is visual

A

sight

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75
Q

what are the ability to predict fall risk of the Tinetti

A

Sensitivity of 68% - true positives

Specificity of 78% - true negatives

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76
Q

what is Crystallized intelligence:

A

knowledge that must be learned or memorized.

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77
Q

what are some problems associated with institutionalization hostile physical environment

A
  • raised beds
  • shiny floors
  • restraints
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78
Q

what is Fluid intelligence:

A

the ability to process new general information that requires no specific knowledge.

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79
Q

what is the stability in gait (bestest)

A

21

Gait – Level Surface
Change in gait speed
Walk with Head turns – horizontal
Walk with Pivot Turns
Step over Obstacles
Timed ”Get up and Go”
Timed “Get up and Go” with dual task
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80
Q

what has no impact on bone mineral density

A

swimming

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81
Q

what are some pathologic changes the contribute to posture changes

A 
Neurologic Disease
Pain and joint limitation  cause by arthritis
Cardiopulmonary complications
Postural hypotension
Hypokinesis
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82
Q

what are the different type of yoga

A

-pre classical
classical
post classical
modern

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83
Q

what are some fear of falling interventions

A

Home-based exercise and fall-related multifactorial programs and community-based tai chi delivered in group format.

Balance training reduces fear of falling

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84
Q

what do you do with sub acute phase in pt

A

Walking program
Therapeutic exercise
Strengthen abdominals, back extensors, —scapular retractors
—-Avoid lifting >10 #, avoid flexion

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85
Q

why count velocity into consideration PART 2

A

Conversely, it is possible for the COM to be initially located outside the BOS, and still be able to achieve upright standing, provided that sufficient horizontal COM velocity is directed toward the BOS.

Balance may be impossible
if COM velocity is directed outward.

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86
Q

look at slide in the psychosocial aspects of aging

A

15

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87
Q

what is the visual system

A

lighting, movement, self

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88
Q

what is the motor output

A
  • vestibuloocular reflex
  • motor impulse
  • motor impulses
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89
Q

how would you decrease decline in the intelligence

A

Healthy remained mentally active demonstrated less decline.

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90
Q

what is another impairments that affects balance

A

-posture

-

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91
Q

what is the reliability of the TUG

A

Inter-rater: ICC 0.992 - 0.91

Intra-rater: ICC 0.0.749 - 0.99 (decreases as time between tests increases)

Test-retest standard of error: 1 second (2-7 days)

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92
Q

what is the target population for dance

A 
Parkinson’s Disease!!!
Stroke
Multiple Sclerosis
Spinal Cord Injury
Huntington’s Disease
Elderly (>60)

Basically, older people with neurological conditions would respond well to dance interventions!

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93
Q

what is the cognitive factor of influencing frailty

A

high levels of education are reported to have favorable effects on the health of aging people. Cognitive impairment is an independent risk factor for admission to an institution.

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94
Q

what are some clinical presentation of cognition impairment in someone with stroke

A

impaired orientation, problem solving, impulsivity, decreased insight into deficits, cautious

Language Deficits: aphasia, dysarthria

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95
Q

what are the aspects of the transitions- anticipatory postural adj. (bestest)

A

18 points

Sit to Stand
Rise to Toes
Stand on One Leg
Alt Stair Touching
Standing Arm Raise
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96
Q

what are the normative scores of the Functional Reach

A

< 6-7 in. indicates limited functional balance

> 10 in. indicates functional balance

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97
Q

Look at pp of aging

A

slides 29-31

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98
Q

what is the history of the Fullerton Advanced Balance Scale

A

California State University, Fullerton Center for Successful Aging
—– Debra Rose
Established in 2006
Revised in 2008

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99
Q

what is the TUG

A
  • 10 ft measured from the start position/front of chair
  • ensure the subject is sitting all of the way back in a standard arm chair
  • “On the word GO you will stand up from the chair, walk to the line on the floor, turn around, and walk back to the chair and sit down.”
  • timing begins on the signal go and ends when the buttock returns to the chair
  • patient should be given 1 practice trial that is not included in the score
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100
Q

what is the prevalence of fear of falling

A

The prevalence of fear increased with age and women.

Associated with decreased satisfaction with life
Increased frailty and depressed mood and recent falls.
Decreased mobility and social activities.

Decline in physical and mental performance, an increased risk of falling and progressive loss of health-related quality of life.

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101
Q

how long does the berg take to administer

A

15-20 min and the time goes down with experience

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102
Q

how does the SES affect the elderly

A

Poor and near-poor elderly people are more likely to be experiencing health problems for which they require medical services than elderly people who are economically better off.

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103
Q

what is the affective symptoms of depression

A 
Sadness
Anxiety
Irritability
Fear
Anger
Depersonalization
Feelings of isolation
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104
Q

what is the Recap of the DGI

A

8 items with 3 being the highest score for each item
Max score is 24

A score of <19 is an indication of increased risk for falls

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105
Q

what is the reliability of Functional Reach

A

Inter-rater: ICC 0.54 - 0.98
Intra-rater: ICC 0.83
Test- retest: 0.75 - 0.89

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106
Q

what does the DGI assess

A

Assesses individual’s ability to modify balance while walking in the presence of external demands

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107
Q

what are the types of dementia

A
  • alzheimers
  • vascular
  • other
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108
Q

what is mobility in relation to motor control

A

Dynamic Sitting and Standing

Gait (initiation and termination )

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109
Q

Motor output- vestibular system function info

A

Head position in space
Linear movements of the head
Rotational movements of the head
Linear and angular accelerometer

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110
Q

what is the outcome measure selection: evidence

A

Population of interest

Is the measure reliable?

Is the measure valid?

Is the measure responsive the change?

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111
Q

what are some common causes of TBI

A 
Motor Vehicle Accidents 
Falls
Sports Related Injuries 
Drugs/ETOH Abuse 
Human Error
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112
Q

what is neuromuscular jx

A

contact inefficiency

–exercise has been shown to improve nerve conduction velocity, reaction times and strength.

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113
Q

what is skilled nursing facility

A

SNF differ from other senior housing facilities in that they also provide a high level of medical care

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114
Q

what is center of pressure (COP)

A

A vertical line projecting downward from the actual center of gravity onto the force plate a representation( indirect measure) of center of gravity

The point location of the vertical ground reaction force vector.

It represents a weighted average of all the pressures over the surface of the area in contact with the ground.

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115
Q

what does the scoring process mean of the Tinetti

A

Scored 0-1 or 0-2 (max: 28)
Minimum (0) = most impaired
Maximum (1 or 2) = least impaired, independent

16 items
9 balance (16 points)
7 gait (12 points)
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116
Q

what are some limitations of tai chi

A

muscle soreness

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117
Q

what is base of support (BOS)

A

The area of the object that is in contact with the support surface (anteroposterior length of the foot and the mediolateral width of stance

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118
Q

what is osteoporosis

A

BMD at least 2.5 standard deviation below adult peak mean without evidence of fractures

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119
Q

what is brainstem

A

integrates and sorts sensory information

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120
Q

what are some problems associated with institutionalization of latrogenic illness

A

Unintended and harmful condition resulting from a diagnostic or therapeutic intervention

Or an accidental injury occurring in an institutional setting.

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121
Q

how do you manage patient with dementia

A 
Simplify—keep it simple! 
Explain
Reorient
Slow down
Avoid change
One step at a time
Take care of yourself
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122
Q

what is MCID

A

Minimal clinical important difference (MCID)

Clinical Bottom Line: The MCID is a published value of change in an instrument that indicates the minimum amount of change required for your patient to feel a difference in the variable you are measuring.

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123
Q

what is WU

A

characterized by softness and emphasis on redirecting incoming force

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124
Q

what si the protocol for PD for late disease for yoga

A 
Chair Cat Pose
Chair Cow Pose
Chair Gate Post
Chair Spinal Twist
Chair Pigeon Pose
Modified Low Lunge
Chair
Without chair
Modified Extended Angle Pose
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125
Q

what is Parkinson disease

A

A disorder of the subcortical gray matter in the basal ganglia

Basal ganglia Function: provide a feedback mechanism to the cortex for the initiation and control of motor responses

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126
Q

what is hyperactive deliruim

A

agitated, with mood swings, at times angry, belligerent, and aggressive towards caregivers.

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127
Q

what is some info about homehealth

A

The home health agency caring for you must be approved by Medicare (Medicare-certified).

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128
Q

what is system definition

A

Take into account various interlocking physical, psychological and social complexes. (Diminished ability to carry out practical and social activities of daily living, Have poor functioning in physical, cognitive, emotional, sensory and social functions. )

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129
Q

what is swelling joint distention

A

modalities and anti-inflammatory medication.

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130
Q

what is kyphosis causes

A

Respiration

Scapular resting position

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131
Q

what is tai chi

A

A traditional martial art that embraces the mind, body, and spirit

Movements are conducted slowly, deliberately, and gracefully with continuous movements

Principles are based on philosophy of Taoism, which stresses the natural balance in all things

Things perfectly balanced in harmony are at peace, leading to longevity

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132
Q

how is more affected by lower social relationships

A

Women less affected than men

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133
Q

how do you score the Bestest

A

Score each category 0-3

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134
Q

what is the time to administer the Functional Reach

A

5 min

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135
Q

what are the aspects fo the biomechanical (bestest)

A 
15 points 
Base of Support
CoM Alignment 
Ankle Strength &amp; range
Hip/Trunk Lateral Strength
Sit on Floor and Stand up
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136
Q

what is the normative data of the Tinetti

A

slide 6 + 7

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137
Q

what are some limitations for yoga decreased balance

A

Chair yoga
Single leg stance
Avoid many body position changes
Always practice with others.

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138
Q

what are the 3 systems that have sensory input into balance

A
  • vestibular
  • visual
  • proprioception
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139
Q

what is Hao

A

Characterized by slow and internally loose movements

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140
Q

how much does it cause to treat injuries from fall

A

costs more than $19 billion each year to treat injuries from falls

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141
Q

what is the target population for dual tasking traing

A 
Stroke
TBI
Alzheimer 
Parkinson’s Disease
older population
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142
Q

what is the task description of the Functional Reach

A
  • stand close to the wall, but not touching
  • yardstick is affixed to the wall at the level of the patient’s acromion
  • lift arm closest to the wall to 90 deg of shoulder flexion w/ a closed fist- start position recorded on yardstick at 3rd metacarpal head
  • instruct subject to “reach as far as you can forward without taking a step”
  • location of the third metacarpal is recorded in inches
  • 5 trials → two practice trials followed by three test trials that are averaged to provide the final score
143
Q

what is the ability to predict fall risk and cut off of the Fullerton Advanced Balance Scale

A

“The probability of falling increased by 8% with each 1-point decrease in total FAB scale score … a cut-off score of 25 out of 40 on the FAB scale produced the highest sensitivity (74.6%) and specificity (52.6%) in predicting faller status.”

144
Q

what is the take home message for dance

A

encourage your patients to stay active and get moving. If they enjoy dance, they can get the added benefit of improving their balance!

145
Q

what is forward head cause

A

Cervical pain

146
Q

what are some self reports (outcome measures)

A

The Activities-Specific Balance Confidence Scale (ABC Scale)

The Tinetti Falls Efficacy Scale

147
Q

what is intermediate care facility

A

facilitating the transition from hospital to home. Other aims include avoidance of admission and improvement of pre-acute and post-acute care.

148
Q

what is postural stability

A

The ability to maintain the body’s center of gravity (COG) over the base of support (BOS) in a given sensory environment

149
Q

what is the education for pain

A

Purpose of pain mgmt, scheduling in consideration of therapy sessions (when patient receives prn)

Importance of communicating with healthcare team about pain

Importance of activity in pain mgmt

150
Q

what are the reliability and validity of the bestest test

A

ICC = .91
Excellent

Validity: r=.636, P

151
Q

what are arthrogenic contractures

A

capsular tightness, collagen of joint capsule will shrink, cartilage loss.

152
Q

what is somatic symptoms of depression

A 
Fatigue
Altered sleep patterns
Weight gain or loss
Tearfulness
Agitation
Heart palpitations
Overall weakness
153
Q

what are some age related changes related to posutrue

A
  • disc impairment
  • flexibiliy t
  • modification
  • education
  • strength
  • pain
  • hypokinesis
154
Q

what causes a greater likelihood of being institutionalized

A

Time in hospital—greater likelihood of being institutionalized in a nursing home.

155
Q

how do we determine the quality of instruments

A

Sensitivity

Specificity

Reliability

Validity

Likelihood ratios
- slide 26

156
Q

what are some physical impairments of tai chi that it addresses

A 
Range of motion
Flexibility
Strength
Postural stability
Bone density
CV system
157
Q

what are way to lower your risk of having a low social relationship in the elderly

A

People who had spouses or pets and belonged to social support groups had a lower risk

158
Q

what are some functional balance assessments (outcome measures)

A 
Berg Balance Test
Dynamic Gait Index 
Functional Gait Assessment
Timed Up and Go (TUG)
Tinetti Performance Oriented Mobility Assessment (POMA)
Fullerton Advanced Balance (FAB) Scale 
The Balance Evaluation Systems Test (BESTest)
High Mat
159
Q

what is a flexibility with aging

A

Decrease in elastin and increase in collagen.

Collagen – main supportive protein in skin, tendon, bone, cartilage, connective tissue

Tendons and ligaments become more rigid and less resilient to length changes

Hypokinesis (decreased activity)****

160
Q

what is disc impairments with aging

A

Decreased water in nucleus

Increased fibrosus of annulus

flatter less resilient disc

161
Q

what is the DGI for reliability/ validity

A

some things are excellent

slide 13

162
Q

what does a low score mean for Tinetti

A

higher risk of falling in the next year

163
Q

how do you manage patient with delirium

A

Hydration!
Calm and quiet environment
Low level of lighting without shadows, natural lighting
Simple clear explanations.
Familiar objects, individuals
Visual hearing aids
Avoid restraining agitated patient with delirium.

164
Q

what can dementia cause

A

May also cause personality changes

165
Q

what is unloading

A

is achieved by a rapid activation of the stance limb.

166
Q

what increase with falls

A

Reduced gait speed, stride velocity, Increase gait variability.

Significantly longer postural anticipatory adjustment phase during gait initiation

Difficulty with dual task

167
Q

what is standing goal

A

keep the body com sately within the base of support

168
Q

what is the indication of the Tinetti

A

Geriatric fall risk*
Neurologic Rehabilitation
–Parkinson’s Disease
–Stroke recovery

169
Q

what is the validity and reliability of the Fullerton Advanced Balance Scale

A

Test/Retest Reliability - total score
Excellent
r = 0.96

Test/Retest Reliability - single items
Adequate to Excellent
r = 0.52 - 0.82

Interrater Reliability
Excellent
ICC = 0.955 - 0.999

Concurrent Validity
Excellent Correlation w/ BBS scores
r = .75

170
Q

what are some abnormal balance due to specific pathologies

A

-stork

171
Q

what is the validity of the TUG

A

High correlations to ambulatory mobility, disability status, mod: balance confidence

172
Q

what is the history of the Tinetti

A

AKA Tinetti Mobility Test (TMT) or Performance-Oriented Mobility Assessment (POMA)

Created by Mary Tinetti (Yale University) in 1986

Used to predict patients that will fall at least once in the next year

173
Q

what is stability in relation to motor control

A

Maintain our Center of Mass over our base of support
Minimize motions of our center of mass
Restore our Center of Mass in changing Environments

174
Q

what are the symptoms of depression

A
  • cognitive
  • somatic
  • affective
175
Q

what are some functioan limitations that tai chi helps with

A

Balance and coordination

Gait improvements

176
Q

what are some limitations of dual task

A

They are already a fall risk!
Fear/apprehension during training
Difficult to measure progress

177
Q

look at slide of balance assessment

A

33 + 34 +35 +36 == this is all talking about the equipment in the new lab

178
Q

what is the psychological factor of influencing frailty

A

Self-rated health

179
Q

what is the osteoprosis NIH definition

A

“a systemic, skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with a constant increase in bone fragility and susceptibility to fracture”

180
Q

what are thsome training effects of Tai chi

A 
Fear of falling 
Single leg stance 
Rate of falling 
Flexibility 
Walking velocity*
Berg Balance Scale 
TUG
Functional reach 
Ankle and knee joint strength and ROM 
Decrease stress
Enhance sleep quality 
Enhance immune system 
Improve joint pain 
Improve symptoms of congestive heart failure
Increase aerobic activity
181
Q

what are the risk factors for osteoporosis

A 
Sex
Age
Race
Family History
Tobacco
Lifetime exposure to estrogen (amenorrhea)
Medications (steroids, thyroid hormones, heparin..)
Calcium 
Sedentary lifestyle 
Alcoholism 
Depression
182
Q

what is proprioceptive

A

touch

183
Q

what are some treatment of osteoporisis through drugs

A
  • hormone replacement
  • selective estrogen receptor modulators
  • bisphosphonates
  • calcitonin
184
Q

what is the physical factor of influencing frailty

A

Physical ability appears to be an important asset and impaired ability an important deficit in establishing frailty.

185
Q

what is dynamic conditions

A

COM can be outside of BOS as long as the COM velocity is large enough = balance can be maintained

186
Q

what is the Sn and SP of the TUG

A

Specificity: 0.31 - 0.56
Sensitivity: 0.74 - 0.8

187
Q

what is the vestibular system

A

Gravity, linear, angular, head/eye movements

188
Q

DGI ability to predict falls in elderly

A

Elderly (>65)
Specificity: 64%
Sensitivity: 59%

189
Q

what is classical yoga

A

Organized to contain the eight-limbed path which contained steps toward obtaining enlightenment

190
Q

what are some ways to help with pain

A
  • modification

- education

191
Q

Falls and the elderly

A

Falls
are the leading cause of
injury-related deaths
among people age 65 and older

192
Q

what are considered basic ADLs

A

Basic ADL: in nursing home bathing> dressing > toileting > eating

193
Q

what is gait goal

A

move the body outside the base of support and prevent falling.

194
Q

what is chen

A
  • Developed by Chen Wangtingin
  • Characterized by emphasis on spiral force
  • Movements are slow and soft combined with fast and hard
  • Explosive power and low stances
195
Q

what are some other clinical presentations for someone with MS

A

Sensory changes
Heat Sensitivity

Spasticity
Fatigue

Balance Impairments: secondary consequence of immobility

196
Q

what is gait initiation

A

Move body over the ground just one step the criterion of balance are drastically altered.

197
Q

what task are in the berg

A 
Sitting unsupported
Change of position: sitting to standing
Change of position: standing to sitting
Transfers
Standing unsupported
Standing with eyes closed
Standing with feet together
Tandem standing
Standing on one leg
Turning trunk with feet fixed
Retrieving objects from floor
Turning 360 degrees
Stool stepping
Reaching forward while standing
198
Q

what is a positive test for fudkda

A

> 30 degrees

199
Q

what could causes delirium

A

Medication, life-threatening illness

200
Q

what is hypoacive delirium

A

extreme drowsiness, fatigue, and indifference.

201
Q

what are the balance impairment of TBI clinical presentation

A

Altered sequencing of muscle activation

Lack of awareness to balance deficits

202
Q

what is calcitonin

A

– hormone that regulates bone metabolism; reduces bone resorption and may slow bone loss

203
Q

what are some types of delirium

A
  • hyperactive deliruim

- hypoacive delirium

204
Q

what is osteopenia

A

BMD between 1 and 2.5 standard deviation below adult peak mean without evidence of fractures

205
Q

what is the validity and reliabiltiy of the Tinetti

A

Excellent test-retest reliability ICC 0.96

Good interrater reliability ICC 0.84

Criterion validity - excellent correlation r=0.81

Better test-retest, discriminative, and predictive validities than TUG, one-leg stand, and functional reach tests

206
Q

what sit he financial factor of influencing frailty

A

socioeconomic factors

207
Q

what are the integration of input

A
  • cerebellum
  • cerebral cortex
  • brainstem
208
Q

what is during this single support time

A

the COM now accelerates forward and away from the stance limb.

209
Q

what are some modification with aging

A

Slow, prolonged stretching

Focus on FUNCTIONAL range not normal

210
Q

how does the memory change in later life

A

No definitive conclusions

Difficulty with multi-memory tasks

Frontal lobe shrink–working memory decline

Generally, long term memory less affected than short term memory.

211
Q

what does the time to administer the Tinetti

A

10-15

212
Q

what is the protocol for dancing

A

Could include ballroom, swing, pop, folk, even “traditional Greek!”

Partnered dancing vs. non-partnered dancing showed equal improvement, but “partnered dancing patients expressed more enjoyment and interest in continuing” (Hackney et al)

Dynamic movement with flow!

213
Q

what is motor control in relation to balance

A
  • stability
  • mobility
  • controlled mobility
  • skill
214
Q

what is the normal limits of stability for medial to lateral

A

ML total 16 degrees (8 both right and left)

215
Q

what is the take home message for the aging population for non injured .

A

Figure out the causes to an abnormal posture.

Extension, Extension, Extension!!!

Weight bearing aerobic exercise is beneficial for preventing osteoporosis.

216
Q

Motor output- vestibular system function impact of the system

A

Gaze Stability
Balance and Postural Stability
Orientation in Space

217
Q

what is post classical yoga

A

Rejuvenate the body and prolong life

Embraced the physical body as the way to obtain enlightenment

218
Q

what is postural alignment for osteoporosis

A

Extension! Extension exercise reduce the incidence of spine fracture reoccurrence.

219
Q

what are the types of intelligence

A
  • fluid intelligenece

- crystallized intelligence

220
Q

bergs ability to predict falls

A

Older Adults (mean age 75)
Specificity: 82%
Sensitivity: 91%

221
Q

balance PP

A

slide 36

222
Q

what is the history of the TUG

A
  • initially established in 1986 as the “Get Up and Go Test” by Mathias et al
  • modified to integrate time in 1991 by D Podsiadlo and S Richardson
  • is used to assess mobility, balance, walking ability, and fall risk
223
Q

what is after unloading

A

of the right limb the COP under the stance moves forwards.

224
Q

what is walking distance of outcome measures

A

Walking distance: 6 minute walk test (6MWT)

225
Q

what are some results form a stroke

A

Compensatory patterns of recovery
Abnormal motor patterns – flexor and extensor
Impaired balance and functional mobility

226
Q

what are the 4 cardinal signs of PD

A

Rigidity
Bradykinesia
Tremor
Postural Instability

227
Q

what is alzheimers disease

A

The most common type of dementia.

It is more likely to affect women or those who have a parent, brother, or sister with dementia

228
Q

what is therapeutic exercises for strengthening

A

High impact activities are better at increasing BMD than low impact activities.

229
Q

what is adult day care

A

Adult Day Care Centers are designed to provide care and companionship for seniors who need assistance or supervision during the day.

230
Q

how does health perception affect the elderly

A

A person’s subjective assessment of his or her personal health condition

Good health perception has been found to be an asset even when ADLs are impaired.

Level of independence and social support affect health perception

231
Q

what is dual task training

A

Ability to perform two or more cognitive and motor activities simultaneously while maintaining postural control (Shin, An, 2014)

“The ability to divide one’s attention between two or more concurrent tasks is an important aspect of functional movement during ADL (Shin, An, 2014)”

232
Q

what are some limitation of dnace

A
  • safety - guarding
  • environment
  • suboptimal compliance
  • —classes offered through community centers
  • –encourage participation
  • aging effect
  • -cognitive impairments
  • –moving impairments
233
Q

what is the Bestest

A

Developed by Dr. Fay Horak in 2008

Balance Evaluations Systems Test

Breaks down balance into 6 sub-categories

234
Q

what are some surgery

A
  • cement injected (vertebroplasty)

- kyphoplasty

235
Q

what is home health

A

Highly technological services, Skilled services, Pharmaceutical and infusion services, Home medical equipment services, Custodial care service

236
Q

what is COM (center of mass)

A

An imaginary point in space that is at the center of the total body mass

unique point where body forces sums to zero

All particles of body are equally distributed

Does not depend on vertical orientation

The point where if a force is applied it moves in the direction of the force without rotating

237
Q

what are some physical therapy intervention of post fractures

A
  • acute phase

- subacute phase

238
Q

what are the mean score for the ages for the berg

A 
60's= 55
70's= m 54 f53
80's= m 53  f50
239
Q

what is gait acceleration

A

move COG in a forward direction and voluntarily initiate the start of a forward fall to accelerate the COG ahead of the base of support

240
Q

what is the training effect of dance

A

Improvements in BERG and TUG outcome measures

Increased:

  • **Postural stability, proprioceptive control, and core activation
  • **Ambulatory velocity and cadence rate (assessed by 6 minute walk test)

Helps maintain and improve mineral bone density

Enhanced cardiovascular functioning

Develops static and dynamic balance

241
Q

look up virtual reality

A

slides

242
Q

what is the scoring of the berg balance

A

Scoring specific to each task, with 4 meaning patient can independently perform activity meeting time/distance criteria and 0 meaning patient is unable to perform activity

243
Q

what is pre classical yoga

A

Collection of texts containing songs, mantras, and rituals

244
Q

what is the berg cut off score

A

A score of <45 is an indication of increased fall risk

245
Q

how can we prevent falls

A

In order to prevent falls, it is important to identify the causes of falls, especially the modifiable risk factors for falling.

It was hypothesized that muscle weakness and balance performance were modifiable risk factors for falls in the elderly [Tinetti M.E. et al. 1994, Buchner D.M. 1997].

246
Q

At what age is there a restricted mobility

A

> 80 years old

247
Q

what is dementia

A

Enlarge ventricles, shrinkage cortex and hippocampus

Loss of memory

Lose daily living skills

248
Q

what are the take home messages

A
  • addresses physical impairment s
  • addresses functional limitations
  • enhances mindfulness
249
Q

what are the cut off of the Tinetti

A

≤18 High
19-23 Moderate
≥24 Low

250
Q

what are things that need to evaluated with balance issues

A 
Vitals 
Cognition 
Motor
Sensory 
Balance 
Function
251
Q

what is static conditions

A

an object is considered stable when the center of mass (COM) is maintained over its base of support (BOS).

252
Q

what is balance confidence of outcome measures

A

Balance confidence: Activities Specific Balance Confidence Scale (ABC)

253
Q

what is Sun

A

Created by Sun Lu-Tang

Youngest of all the styles

Characterized by agile steps, movements are smooth

High stances, easier for older people

Compact, doesn’t require large space

Holds learners’ interest

254
Q

what is the activity pyramind for seniors

A
  • sit as little as possible
  • do yard work or house cleaning (2-3)

everyday walk more at home take stairs park further from store

255
Q

what is the healthcare interdisciplinary team role =

A

Must address
balance and vestibular dysfunction
In the neurological population

Decrease Risk For Falls
Decrease Risk for Injury
Improve functional mobility
Improve Quality of Life

256
Q

what is the age of the Bestest

A

65+

257
Q

what are the 6 areas of the bestest

A 
biomechanical constrains
stability limits/ vertically 
anticipatory postural adjustments
postural responses 
sensory orientation 
stability in gait
258
Q

what is bisphosphonates

A
  • inhibit bone breakdown/bind permanently to bone surfaces and limit osteoclast activity
259
Q

what are the scores of the mini mental state examination

A

Scores of 25-30: normal
21-24 : mild,
11-20 : moderate
<10 : severe impairment.

Elderly patients with college education who present with complaints of cognitive decline and score < 27 on the MMSE are at greater risk of being diagnosed with dementia.

260
Q

by 2020 what is the annual cost of falls

A

By 2020, the annual costs
for fall-related injuries are expected
to reach $54.9 billion

261
Q

what are some key description for DGI

A

Can be performed with a marked distance of 20 feet
Can be performed with or without an assistive device
Scores based on a 4-point scale
Maximum score = 24 points

262
Q

what is vascular dementia

A

It is more likely to affect men.

High blood pressure, high blood fat (cholesterol), diabetes, and smoking all increase the chances of having vascular dementia.

263
Q

what is limits of stability

A

The furthest distance in any direction a person can lean away from midline (upright vertical) without altering the base of support (BOS), reaching or falling

264
Q

how does learning change in later life

A

Slower but once something is learned the rate of forgetting is no faster than young ones

Sensory deficits affect learning.

265
Q

what is the balance and posture in human gait

A

Total body center of gravity and the center of pressure under the support feet during level walking.

The COG moves forward along the medial border of each support foot and during single support it is accelerated away from the support foot towards the future position of the swing foot.

266
Q

what si modern yoga

A

Yoga masters traveled to the West and it became more modernized

267
Q

look at slide of balance assessment

A

32 - basically is saying that the slower we walk the more likely you will fall and the faster you walk the less likely you will fall

268
Q

how does the TUG have the ability ot predict falls

A

Related to many factors: age, footwear, cognition, AAD

TUG = shouldn’t be used alone to determine fall risk

269
Q

what is the ultimate goal for yoga

A

Ultimate goal of Yoga is to attain balance between mind and body for a joyous and healthy lifestyle

*******Meditation, yoga postures, and breathing

Research has shown that Yoga has many benefits, regardless of religion, race, age, and origin
****Including balance

270
Q

what are some strengthening considerations

A
  • cardiovascular
  • neuromuscular jx
  • swelling joint distention
  • other= Pathology, such as Parkinson’s and stroke(muscle tone)
271
Q

what is delirium

A

Acute brain syndrome

272
Q

what are some clinical presentation of asymmetry in someone with a stroke

A

Sensation Impairments:

Motor: Weakness, Spasticity/Tone

273
Q

what does a low quanity of social relationship relate to in the elderly

A

Increased risk of death and institutionalization among persons with a low quantity of social relationships.

274
Q

what is cognitive symptoms of depression

A 
Poor concentration
Low self-esteem
Indecisiveness
Guilt
Hopelessness
Inability to concentrate
Suicidal ideations
275
Q

what is the cutt off score of the TUG

A

> /= 12 sec in older adults is indicative of being at risk for falls

Community Dwelling Frail Older Adults > 14 sec associated with high fall risk
Post-op hip fracture patients at time of discharge > 24 sec predictive of falls within 6 months after hip fracture
Frail older adults > 30 sec predictive of requiring assistive device for ambulation and being dependent in ADLs

276
Q

how do we achieve posture stability

A
  • maintain - COM and BOS
  • minimize- motions of the com and cop
  • restoring- com or cop to an optimal location
277
Q

what is the modification for pain

A

Rate pain

Point to exact location of pain

Effective pain mgmt – TENS, visual imagery, relaxation, coordination with MD re: medications

278
Q

what are the clinical presentation of PD hallmark

A

motor disorder

279
Q

what is walking speed of outcome measures

A

Walking speed: 10 meter walk test (10mWT)

280
Q

what are some clinical presentation of balance impairments with a stroke

A

New center of mass

Delayed Motor Response

Frequent losses of balance towards the involved side

281
Q

what does stability limits depend on

A

Stability limits depend on
interaction between
position and velocity of the COM.

282
Q

what are the validity of Functional Reach

A

Adequate correlation with Berg, TUG

Other factors play into balance besides limits of stability

283
Q

what are the normal scores for hte TUG

A

60-69: 8.1 sec
70-79: 9.2 sec
80-89: 11.3 sec

284
Q

What is MDC

A

Minimal detectable change (MDC)

Clinical Bottom Line: The MDC is the minimum amount of change in a patient’s score that ensures the change isn’t the result of measurement error

285
Q

what is the Normal limits of stability for anterior to post.

A

AP total 12.5 degrees (8 forward, 4.5 backward)

286
Q

how many people fall

A

Every 18 seconds, an older adult is treated in an emergency room for a fall, and every 35 minutes a senior dies following a fall.

One out of every three people aged 65 and older falls each year, despite the fact, that research shows most falls are preventable.

287
Q

what is motor impulses

A

to control the eye movements
and
to make postural adjustments

288
Q

what are some education with aging

A

Effects of sedentary lifestyle

Encourage FREQUENT activity

289
Q

what is the living arrangement factor of influencing frailty

A

prolonged stays in hospital, admission to an institution

290
Q

what is assisted living

A

Assisted living is designed for individuals who require assistance with everyday activities such as meals, medication management, or physical assistance with bathing, dressing, and transportation.

291
Q

what are some spinal compression for osteoporosis

A
  • pain
  • orthosis– lumbosacral
  • transitional movements within a safe environment
292
Q

what is the bestest test used for

A

MS, PD, Stroke, Cerebral Palsy, and other neurological disorders

293
Q

what is Wu/Hao

A
  • Rich with hand techniques, emphasis on internal force
  • Tends to have a slightly forward leaning posture
  • Uses a higher, more narrow stance, so it may be easier for beginners and ideal for improving balance
294
Q

berg reliability/ valididty

A

this a excellent stats

slide 6

295
Q

what is the training effect of dual task

A

Improves gait velocity and stride length

May improve balance and cognition

Improves balanced weight distribution, BOS

296
Q

what is normative data for the DGI

A 
30= 24
40= 24
50= 23.9
60= 23.9
70= 23.9
80= 22
297
Q

when does delirium start and how long does it last

A

Abrupt onset (typically hours to weeks)

298
Q

Look at slide

A

24 of the clinical assessment of blance

299
Q

what are the aspects of the stability limits (bestest)

A

21 points

Sitting Vertically and Lateral Lean
Functional Reach Forward
Functional Reach Lateral

300
Q

what is selective estrogen receptor modulators

A

(SERMs; Raloxifene [Evista]) – synthetic drugs mimic estrogen’s beneficial effects on bone density; block the effect of estrogen on breast and uterine tissues

301
Q

what are the time to administer the Fullerton Advanced Balance Scale

A

10 functional test items

10-12 minutes to administer the test depending on the functional level of the patient

Test is designed for higher functioning, active elderly patients

302
Q

what are the most common fractures

A

hip
spine compression
wrist

303
Q

was is the average cost from a fall

A

Average hospitalization for a fall

costing $17,500.

304
Q

what are some problems associated with institutionalization: undernutrition

A 
Failure to thrive
Impaired physical function
Weight loss
Depression
Cognitive impairment

Dehydration—Check hydration!

305
Q

what are some limitations for yoga pregnant

A

No poses on the back after the first trimester.

Avoid stretching the abdominals too much.

Ensure enough balance or use chairs/walls for stability.

306
Q

what are are the phases of gait initiation

A
  • releasee phase
  • unloading
  • after unloading
  • during this single support time
307
Q

what are the reactive postural response (bestest)

A

18 points

In Place Response (Forward, Backward)
Compensatory Stepping Correction (Forward, Backward, Lateral)

308
Q

what is the history of Functional Reach

A

established in 1990 by PW Duncan et al to measure limits of stability

309
Q

what is static and dynamic sitting and standing balance of outcome meausres

A

Static and Dynamic Sitting and Standing Balance: Berg Balance Scale (BBS)

310
Q

what are some exericese for posture correction

A

extension and prevention

311
Q

what is the balance while walking of outcome measures

A

Balance while walking: Functional Gait Assessment (FGA)

312
Q

what is target population of tai chi

A

Anybody

Older Adults
***Especially for those suffering from complicated conditions with disruptions in their visual and somatosensory systems.

***More beneficial for the less frail older adults

313
Q

what happens with age and anterior posterior motion

A

Significant age differences did exist for antero-posterior motion of the COM and it’s relationship with the COP

314
Q

what is a primary injury of TBI

A

Primary Injury: Direct Consequence of the Mechanical trauma at the time of injury

315
Q

what is the interpersonal factor of influencing frailty

A

Social resources are important to frail elderly people

316
Q

who is eligible

A

under the care of a doctor, and getting services under a plan of care established and reviewed regularly by a doctor.

a doctor must certify that you need, one or more of the following: Intermittent skilled nursing care , Physical therapy , Speech-language pathology services, occupational therapy

317
Q

what is biomedical definition

A

Disease and illness oriented descriptions of the frail population (Multiple diseases, Numerous chronic conditions, Require long-term hospital care)

318
Q

what is balance both made of

A

intergrated

interactive

319
Q

what are some biological changes the contribute to posture changes

A 
Discs
Ligaments
Joint capsule
Articular cartilage
Muscle 
Bone density
320
Q

what is the target population for yoga

A 
Arthritis 
TKA
Chronic Low Back Pain
Parkinsons
Multiple Sclerosis
321
Q

slide ageing of m.

A

3 plum lines

322
Q

how long does it take to administer

A

less than 3 min

323
Q

when does intelligence decline

A

Decline does not actually occur until the sixties or seventies.

324
Q

what is ability to predict falls for the Functional Reach

A

Considers limits of stability, but balance is a more complex task;

Component of balance assessment but not used alone

325
Q

What conditions must be fulfilled for balance to be maintained?

A 
Static Sitting 
Dynamic Sitting 
Static Standing 
Dynamic Standing 
Translation
326
Q

what is cardiovascular

A

inefficiency leading to poor nutrient exchange

–increase activity level—increase blood flow to the muscle

327
Q

Look at Dance why dance slide

A

2

328
Q

what are some institutionalization

A
  • acute care facility
  • inpatient rehabilitation facility
  • skilled nursing facility
  • intermediate care facility
  • adult day care
  • assisted living
  • home health
  • hospice
329
Q

what is a stroke

A 
A stroke produces a sudden change in an individual’s neurological functions  
#1 cause: HTN

Mismatch of sensation and motor functions that interferes with normal movement patterns

330
Q

how long does it take to administer the Bestest

A

Time to Administer 20-30 minutes

331
Q

what would increase BMD

A

weight training or running

332
Q

what is the training effect for yoga

A 
Improved breathing control
****Increase oxygen supply to fight fatigue
Increased body awareness
Increased mobility
Decreased pain
Decreased joint stiffness
Improved self reported function
******Regional Interdependence 
1.4 second decrease in TUG - Knee OA population
***MCID= decrease of .8-1.4 seconds
333
Q

what equipment do you need for Tinetti

A

Hard, armless chair
Stopwatch
15 foot walkway

334
Q

what is standard error of measureement (sem)

A

Standard Error of Measurement (SEM)

Clinical Bottom Line: The SEM is the amount of error that you can consider as measurement error

335
Q

what are the task description of Fullerton Advanced Balance Scale

A 
Stand with feet together and eyes closed
Reach forward to retrieve an object held at shoulder height w/ outstretched arm
Turn 360 degrees to left and right
Step onto and over a 6 inch bench
Tandem walk
Single Leg balance
Stand on foam with eyes closed
Two footed Jump
Walk with head turns
Reactive postural control
336
Q

what is MS

A

Autoimmune chronic Inflammatory demyelinating disorder

Destruction of myelin sheaths & oligodendrocytes

Repair produces scars or plaques

Axonal Loss (white matter) destruction early
Cell Death (gray matter) over time

Patchy demyelination

337
Q

what is net center of pressure

A

If both feet are in contact with the ground the net center of pressure (COPnet) lies somewhere between the two feet, depending on the relative weight taken by each foot.

338
Q

how does the fall prediction work with the bestest

A

Sn = 0.86
Sp = 0.95
Cut off = 69%

Adequate ability to detect falls

339
Q

what is Yang

A

Created by Yang Lu-Chan in early 19th century
Most popular form
Characterized by gentle, graceful, and slow movements
Easiest to learn

340
Q

what is pain with aging

A

Decreased ability to localize pain
Decreased production/use of enkephalin
Decreased report of pain due to social pressures

341
Q

what are some abnormal postures

A
  • forward head
  • kyphosis
  • decreased lumbar lordosis
  • increased lumbar lordosis
  • loss of height

other
=Hip flexion contractures
=Knee flexion contractures
=Valgus/varus changes

342
Q

what is the clinical assessment of balance

A

Observation

Sensorimotor
Assess Lower Extremity sensation
Proprioception

Static and Dynamic Sitting Balance

Static and Dynamic Standing Balance
Narrow Base of support
Eyes open and Eyes closed
Functional Reach

Assess Ambulation

Vestibular System (if indicated)

343
Q

what is factors that influencing frailty

A
  • financial
  • cognitive
  • interpersonal
  • physical
  • psychological
  • living arrangement
344
Q

what is the generic protocol of yoga

A

Instructor biased
Key elements
Breathing exercises, postures, and meditation
Do not hold body tightly, or jerk the body at any point of time
Perform the practices according to your own capacity
Persistent and regular practice is essential
Each session should end with meditation/deep silence

345
Q

what are the protocol for PD for early/midl disease for yoga

A 
Cat Pose
Cow Pose
Cobra Pose
Downward Facing Dog
Low Lunge
Warrior II Pose
346
Q

what is a TBI

A

Altered brain function as a result of a external physical force or trauma

347
Q

what are the cut off scores of the Functional Reach

A

Community Dwelling Elderly < 7 in. indicated dependant on others to leave neighborhood, limited mobility skills, and most restricted in ADL’s

Frail Elderly: < 7.3 in. indicates fall risk

348
Q

what is inpatient rehabilitation facility

A

Minimal 3 hours therapy

349
Q

what are the interaction of com and bos

A
  • static conditions

- dynamic condditions

350
Q

what is gaze stability

A

The ability to maintain gaze or visual focus on an external target during movement

351
Q

what does a high score mean for Tinetti

A

better performance

352
Q

What are some contributing factors

A
  • sensory impairments
  • cognitive deficits
  • pathologies
  • medication
  • environment - hoarding
  • external factors (lead to slipping, tripping, bumping)
  • faulty footwear
353
Q

what is balance like in elderly

A

Reduced A-P motion of COM (limited mobility)

Reduced COM-COP separation

Reduced Anterior COM velocities

354
Q

what are some strengthening types

A

Warm Up and Cool Down Periods

Repetition of functional activities

Circuit training

Strength program
Emphasis on spinal alignment

4 acute care (4 decks)

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