Final Exam Flashcards
Adolescence stages of development
11 yrs - 18 yrs
Adolescence (erikson)
12-19 yrs / identity vs, role confusion
Pre-adolescence
rapid physical growth and secondary sex characteristcs
Girls: 8-10
Boys: 9-11
End of Puberty
Females: menses at 12-13
Males: production of sperm
Characteristics of Puberty
- Primary sex characteristics
- secondary sec characteristics
- Rapid physical growth
- Change in body proportions
Sex Characteristics
Primary: testes and ovaries
Secondary: physical appearance
Adolescence Factors Affecting Timing of Puberty
Genetics, stress, socioeconomic status, environment, nutrition, fat on body, chronic illness
Puberty in female athletes
-delayed
-ovulation occurs after period
-pubertal maturation issues
-ovulatory cycles don’t occur for months to years
Pubertal maturation
establishment of cyclic ovarian function
Puberty is second to ______ as most rapid growth
Prenatal period
Adolescence Growth spurt order
Feet, legs, trunk
Puberty Height increase
Male: 4-12 inches
Female: 2-8 inches
Puberty Weight Increase
Male: 15-65lbs
Female: 15-65lbs
Adolescence Height Increases
Girls: 13-15
Boys: 15-17
Adolescence BMI Index for age
Underweight: <5%
Healthy: 5-85%
Overweight: 85-95&
Obese: 95%
Puberty Changes in body proportions
-Nose reaches adult size first
-Hands and feet before arms and legs
-LE become longer than trunk
Bone growth stops when?
Males: 21
Girls: 18
Adolescence Bones
-Immature, porous with unstable growth plates
Adolescence Muscles
-adult muscle diameter reached at 12
-strength increases related to age
-Girls: strength levels off at 15
-Boys: strength levels off 13-20
Adolescence Cardiopulmonary System
-60-90bpm
-16-24 breaths per min
-increase in size of organs
-higher HR during exercise
-lower stroke volume
-higher cardiac output
-BP lower at rest
Adolescence temperature regulation
-greater surface area to body mass
-produce more heat
-lower sweating capacity
-increased risk for temperature related injuries
Adolescence Psychosocial development
-social antagonism: need for privacy and hate supervision, wish for independence
-self consciousness
-Search for identity
-emotion issues
Psychosocial Development Young Teens
-13-14
-most self centered
-value peer’s opinions
Psychosocial Development Middle Teens
-15-16
-better at compromising
-think more independently
-risk taking behaviors
Psychosocial Development Late Teens
-17-18
-develop seriousness
Cognitive development
-11-14
-increasingly capable of thinking hypothetically
-abstract concepts
-self relective
Adolescence Self Esteem
-small gains in second decade of life
Determined by:
attractiveness, peer acceptance, intelligence, athletics, support from peers and family
Adolescence Depression/Suicide
-3rd leading cause of death 15-24
-Masked by anxiety, ED, drugs, hyperactivity
Adolescence Destructive Behaviors
-Disordered eating (bulimia, anorexia, obesity
-Self harm
-substance abuse
Adolescence Sexuality
-48% of high schoolers have sex
-condom use is 57%
Adolescence Sport Injury Risks
-growth spurts
-increased training
-sport specialization
Relative energy deficiency in sport (RED-S)
-insufficient caloric intake or excessive expenditure
-decreased muscle strength
-chronic fatigue
-bone loss
-stress
female athlete triad
-low bone mass
-menstral disturbance
-energy deficient
Adolescence ACL injury
-can occur with growth plate fracture
-increased risk for osteoarthritis
Most common type of scoliosis
-right thoracic and left lumbar
Idiopathic adolescent scoliosis (AIS)
-most common spinal deformity with 3d rotation
AIS screening age
Girls: 10-12
Boys: 13-14
What bony landmarks are looked at for scoliosis?
-scapula (uneven), iliac crest (elevated), spinous process (body shift), arm gapping
Refferal for scoliosis
10+ degrees
Diagnosis of scoliosis
20+ degrees
Naming convention for scoliosis
Convex side and left or right
Orthotic intervention for scoliosis
25-45 degree curves
Surgical intervention for scoliosis
45-50 degree curves
ATNR Diminishing Age
3-9th months
STNR
-neck is flexed, UE flex nad LE extend
-neck is extended, UE extend and LE flex
-Emerges 6-9m
-Diminishes 9-11months
Middle age stages of development?
40-65 yrs
Middle adulthood (Erikson)
26-64yrs / generavity vs. Stagnation
Midlife crisis
-period of transition where you struggle with identity and self-confidence
-40-60s
Middle Adulthood Considerations
-role in society and functional needs
Middle Adulthood Vision
-Presbyopia: loss of accommodative ability of the lens
-reduced dim light vision
-increased glare sensitivity
-diminished color sensitivity
-increased risk of glaucoma
Middle Adulthood Hearing
-Presbycusis: age related hearing loss, begins with loss of high frequencies
-ability of to to distinguish sounds becomes harder
Middle Adulthood Muscle
-strength declines at 30
-each decade declines 5%
-increased occurrence of muscle strains
-LE strength reduced by 40% btwn 30-80
-increased fat deposits
Middle Adulthood Bone
-Osteoporosis=10% of adults over 50, risk increases 5 fold (7-35%) in women, risk increases 3 fold in men (3-11%)
Middle Adulthood Balance
-coordination declines in 30
Middle Adulthood Vestibular System
-begins to decline in 40s
-decreased sensory cells and nerve fibers 40%
-dizziness and vertigo past 50
-Increased threshold of excitation
Menopause
-absence of menses for 12 months
-average age 51
-ovaries begin to atrophy and decline of estrogen and progesterone
Perimenopause
-3-5 years before menopause
-estrogen and progesterone fluctuate
Post-menopause
-end of females reproductive years
-end of ovulation, produce small levels of estrogen and progesterone
-increased risk of heart disease and osteoporosis due to estrogen decrease
-symptoms galore
Andropause
-symptoms men have during decreased testosterone production (hypogonadism)
-increases risk of metabolic syndrome
-decrease erections, slowed ejaculation, decreased muscle mass, erectile dysfunction, hair loss, insomnia, bone loss
Middle Adulthood Cardiopulmonary Changes
-heart disease, 2nd most common cause of death 45-64
-25% of american deaths
-atherosclerosis: build up of plaque in arteries
-silent killers
-74-76bpm, BP 140/85, 10-20 respiratory rate
Middle Adulthood Cancer
-leading cause of death 45-64
-breast, prostate, lung, colon
Geriatrics Stages of Development
65+
Geriatrics Erikson
65+Ego integrity vs. dispair
For every 100 woman over 65-74 there are_____
86 men
15% of people 85+ live_____
in long term care facilites
Theories of Programmed Aging
-Hayflick Limit
-Neuroendocrine and Hormonal theory
-Caloric restriction theory
Neuroendocrine and Hormonal Therory
-aging decreases the promotion of hormones
Caloric restriction theory
-caloric restriction extends lifespan and slows aging
-reduces metabolic rate and oxidative stress
Theories of aging Stochastic
-Free radical
-error/catastrophe theory
-somatic mutation theory
-cross linking theory
Free Radical Theory
-free radicals damage cells
Error/catastrophe theory
-errors ini DNA accumulate and kill the cells
Somatic Mutation Theory
-genetic damage or mutation results from radiation
Cross linking theory
-cross-linking of proteins that slow normal cell processes
Successful Aging
-capacity to function across all domains
-physical, cognitive, active engagement, low risk of disease
Primary Aging
-inevitable and happens in all systems
Secondary Aging
-lifestyle, environment, disease
Typical aging
-gradual decline in function of most systems
Atypical Aging
-aging due to disease
-cognitive decline
Geriatric Musculoskeletal
-5-10% of muscle loss 20-50
-12-15 muscle loss each decade after 50
-peak bone density at 30
Geriatric Neuromuscular
-Decrease in brain, vascular supply
-increase risk for neuro diseases
Geriatric Neuro red flags
-loss of consciousness
-confusion
-seizures
-sudden incontinence
-sudden gait abnormalities
Geriatric Cardiopulmonary
-heart disease #1
-VO2 max decreases 10% every decade past 20
-decrease pacemaker cells
-heart cells thicken
Geriatric Visual
-Presbyopia: loss of accommodative ability of the lens
-reduced dim light vision
-diminished color sensitivity from yellowing of lens
-glaucoma, cataracts, macular degeneration, retinopathy
Cataracts
clouding of lens due to protein buildup
-70% of adults at 75
Glaucoma
-loss of peripheral vision
Macular degeneration
loss of central clarity
Retinopathy
damaged BV in eyes
Geriatric Integumentary
-largest organ, 15%
-less thick, less nerves/BV
-less thermoregulation
-less cell turnover
-longer healing
-less mast cells
-infection risk
-less collagen and elastic
Pressure Injuries
-can develop in 2 hours
-skin tears
Geriatric Cognition
-decreases everywhere
-long term memory and procedural are stable
-retention of new info stable but needs more cues
-visual recognition of objects are stable
Atypical Cognition Aging
-mood changes
-visual-spacial changes
-memory changes
-difficulty communicating
Mild cognitive impairment
-do not interfere with ADLS (unlike dementia and Alzheimer’s)
-19% 65-75, 38% 85+
-gradual, opposite of learning
Dementia
-umbrella term for disorders of the brain
-affects thinking, behavior , and ADLs
2 or more to meet criteria
-memory
-reasoning and judgment
-communication
-focus issues
-visual perception
Delirium
-sudden change in mental function
-slurred speech, hallucination, agitation
Causes
-UTI, dehydration, hospitalization, drug interactions
Geriatric Depression
-most common mental health condition 65+ (11-16%), (30-44% in living communities)
-can mimic dementia
Geriatric Common conditions
-Hypertension, arthritis, heart disease, diabetes, frailty, cancer, stroke, UTIs, pneumonia
Geriatric Mortality conditions
-Heart diseases
-cancer
-Covid
Geriatric Cancer
-Breast, prostate, lung, colorectal
-spinal metastasis
Signs
-constant pain at night that doesnt change with movement
-weight loss
-back pain
-fatigue
Geriatric Diabetes Complications
-diabetic neuropathy
-retinopathy
-wound healing
-increased stroke risk and cancer risk
Frailty
-decreased physiologic reserve across multiple systems
-affects physical, cognitive, and psychological
-underweight, low energy, slowness, inactivity
Predictive of:
-falls
-hospitalization
-death
-disability
Fit (not frail)
-conditions well controlled or absent
-physically active
-gait of >1.2 m/s
-TUG <10s
Mild frailty (prefrail)
-slowing, may need help with IADLs
-beginning to restrict life
-gait of 0.8-1.2 m/s
-TUG 10-15s
Moderate frailty
-difficult outdoor mobility
-may need help with ADLS
-Restricted life
-gait of 0.5-0.8 m/s
-TUG 15-20s
Severe Frailty (end stage)
-dependent with ADLs
-dying (6-12m)
-gait of <0.5 m/s
-TUG >20s
Geriatric Stroke
-leading cause of long term disability
-reduce mobility
-FAST
Risk factors
-age
-high BP
-diabetes
Geriatric UTIs
-most common hospitalization for infection
-10% of women over 65
Signs
-change in mental function (mimics dementia)
-flank pain
-hematuria
Geriatric Pneumonia
-4x more likely in older adults, 5x more likely to be hospitalized
-decreased ability to clear airway (diaphragm and intercostals)
-2nd leading cause of hospital acquired infection (8-10% of admissions, 50% of sepsis, 33% mortality rate)
Ageism
-earlier death by 7.5 years
Polypharmacy
-excessive or inappropriate use of meds
-65+ purchase 30% of meds
-more likely to have adverse reactions, 50% take 1 unneeded drug
-average older adults take 5 meds, average nursing home 7 meds
Signs
-no reason, duplicate, interacting, contraindicated, dosage, treatment of reactions
Polypharmacy Pharmacokinetics: Absorption
Decreased
-gastric acid
-stomach emptying
-motility
Polypharmacy Pharmacokinetics: Distribution
Decreased
-h20
-plasma proteins
-lean body mass
Increased
-fat
Polypharmacy Pharmacokinetics: Metabolism
Decrease
-liver mass
-blood flow to liver
-enzyme activity
Polypharmacy Pharmacokinetics: Excretion
Decreased
-kidney mass
-blood flow to kidneys
-nephron function
Geriatric common meds
Laxatives, BP meds, diuretics, DM meds
NSAIDS: GI stress
Opioids: sedation
Antidepressants: confusion
Barbiturates/antihypertensives: depression
Antihypertensives: orthostatic hypotension
Diuretics/glucocorticoids: fatigue and weakness
Geriatric Falls
-29% of people 65+
-50 bil per year
-Gait speed 6th risk factor
-Cutoff for community @ 0.8m/s gait
-TUG: 13.5s (8.5s for falls)
-Sit to stand: 11.4s
-BERG: 45/56
Work on balance, somatosensory, vestibular, AD training, environment mods, CV endurance
Balance Outcome measure for Geriatric Patients
-Berg Balance
-Sharpened romberg: feet together, tandem, semi tandem witih eyes open and closed
-4 square step
-functional reach
-MiniBEST
Self-Report Outcome measure for Geriatric Patients
-MFES: modified falls
-Efficacy scale
-Fear of falling avoidance Q
Functional Outcome measure for Geriatric Patients
-Sit to stand
-TUG
-WT?
Endurance Outcome measure for Geriatric Patients
-6 min walk test
-step test
Disability
-4% visible
Types
-ambulation
-cognitive
-visual
-hearing
-medical
Medicare
-65+ or disability
Part A: IP, SNF, HH, Hospice
Part B: OP, DME
Medicaid
-low income, pregnant, responsible for minor, disabilities
Discharge Planning: Independent Living
-walk 400m (different terrains, obstacles)
-1.2 m/s gait
-carry 1 gallon/8lbs
Discharge Planning: Inpatient
-3 hrs per day of therapy
-high level of prior function
-not safe to go home
Discharge Planning: Skilled nursing facility (SNF)
-unable to do 3 hrs a day
-variable prior function
-moderate progress
Discharge Planning: Outpatient
-high level of function
-stable needs
-community travel
Discharge Planning: Home health
-limited ambulation
-safe at home
-good functional prognosis
Discharge Planning: Long term acute care
-high complexity
-poor prognosis
-less need for skilled therapy
Discharge Planning: palliative care
-chronic illness
-treat pain and suffering
-fix things other than physical
Discharge Planning: Hospice
-end of life care
-6 months or less
-manage pain and symptoms
Discharge Planning: Advanced Care Directives
-identify preferences for care
Living wills, DNR, medical orders for life sustaining care, power of attorney
Geriatric PT intervensions
-group exercise
-resistance exercise
-aquatic exercise
-balance training
-power training
-Home training/modifications
Sensory loss
-bright colors
-large print
-less background noise
-strong smells
-avoid temperature extremes
Leading Causes of Death in men
-heart disease
-cancer
-unintentional injuries
Heart Disease in Men
-50% of deaths 65+
-1/4 have CHD (CAD most common blood vessel disease 47%)
Coronary Artery Disease
-#1 killer of men
-plaque buildup
Symptoms
-chest pain
-arrhythmia
-heart attack
Risk Factors for Heart Disease in Men
-hypertension
-high cholesterol
-tobacco use
Coronary Angioplasty
-catheter and balloon in artery
Coronary Bypass Surgery
-take vein from other part of body and move it to heart
Cancer risk factors in Men
-smoking
-obesity
-inactivity
-genetic predisposition
Most common Cancers in Men
-Prostate (10m)
-Lung (7m)
-Colorectal (4.4)
Prostate
-produces fluid to make semen and controls urethral output
-grows 21x compared to birth weight (1.5g - 31g) due to decreasing testosterone
Benign Prostatic Hyperplasia
-enlargement of the prostate
-20% 50s, 60% 60s, 70% 70s
Lower Urinary tract Symptoms (LUTS)
-frequency, urgency, urge Incont., nocturia
Treatments for BPH
-lifestyle mods
-Surgery
-Medications
Alpha blockers: relax prostate and bladder neck
Alpha reductase inhibitors: reduce size
Prostate Cancer RF
-age
-family history
-Race
Prostate Cancer Symptoms
-pain with urination
-blood in urine
-back, hip or pelvic pain
-painful ejaculation
Prostate Cancer Screening
-Digital Rectal Exam
-Prostate Specific Antigen test
Prostate Cancer Treatment
-Surgery
-radiation
-hormone
-Chemo
St. Louis ADAM questionnarie
-Androgen Deficiency in Ageing Males
-depression can increase score
Causes of Andropause
-alcohol
-obesity
-smoking
-hight BP
-diet
-sedentary
Osteoporosis in Men
-25% of 50+
-testosterone deficiency
Primary Osteoporosis
-age
Secondary Osteoporosis
-lifestyle behaviors
Risk Factors
-alcohol
-caffeine
-immobilization
-meds (glucocorticoids)
Metabolic Syndrome
-25% of population
-need 3 or +
-deadly quartet
1.Diabetes
2. Obesity
3. Hypertension
4. Dylipidemia
Common Male injuries
-back injuries
-shoulder injuries (overuse and rotator cuff)
-fractures
4x more likely to drown, 50% alcohol
Male Depression
-6 million men
-more successful with suicide
Common Male Pelvic Floor Disorders
-Chronic Prostatitis: non infectious
-Neuralgias
-Anismus: spasm of anal region
-ED
Endometriosis
-endometrial tissue grows outside of uterus
-11% of women 15-44
-Most common 30-40
RF
-Nulliparous
-long periods and short cycles
-family hx
Interstitial Cystitis
-Painful bladder syndrome
-chronic pain of bladder, pelvis and genitals
-3-8mil women
Sym
-Pain, urinary frequency, pressure, dysuria, UTI
Primary Dysmenorrhea
-most common
-pain from contractions of uterus
RF
-early period (<11)
-bad periods
-smoking
-stress
Secondary Dysmenorrhea
-caused by associated medical conditions: endometriosis, fibroids, cysts
Anorexia
-restriction of calories and over exercising
Can cause:
-heart issues
-anemia
-osteoporosis
-kidney issues
-amenorrhea
Bulimia
-binging and purging to lose weight
-2% of women (15-29)
Sym
-tooth decay
-broken blood vessels
-dehydration
Binge Eating
-once a week for 3 months
-3% of women (early to mid 30s)
-dieting increasing risk 12x
Mental Health conditions that affect Women more than men
-Anxiety 2x
-depression 2x
-PTSD 2x
-BPD
-body dysmorphia
-Postpartum depression
Pregnancy MSK changes
-forward chin, eyes down
-shoulders forward and slouched
-anterior pelvic tilt, strained abs, butt out
-hyper extension of knees
-weight on inner borders of feet
Diastasis Recti
-stretching of linea aspera 2> inches
-33% at 21 weeks, 60% at 6 weeks post, 45% at 6 months post, 32% at 12 months postpartum
Pregnancy Related Pelvic Pain
-20% of pregnancies
-low back pain
Signs
-waddle gait, grinding in pubis area
Autoimmune Conditions
-75% women
-3x more than men
Heart Attack signs in Women
-pain in jaw, neck, throat
-nausea/vom
-indigestion
-heartburn
-tiredness
-dyspnea
Stroke in Women
-after 85, more likely than man
-2x more likely than 20-39yrs
-repeat strokes in 5 years
Breast Cancer
-peaks around 75-80
-very few before 45
Ovarian Cancer
-most common reproductive cancer
-1/78 chances
-older than 63
RF
-family hx
-genetic mutation BRCA or lynch syndrome
-other cancers (breast, uterine, colon)
-jewish
-endometriosis
-never given birth
Cervical Cancer
-hpv virus
-hispanic women have higher rates, black women die more
RF
-HIV
-smoking
-parity
-birth control
Osteoporosis
-1/4 women 65+
RF
-small frame
-post-menopausal
-family hx
Pelvic Floor Dysfunction
-PF disorders, weakening of the support structures
Ex
-prolapse
-incontinence
RF
-pregnancy/childbirth
-aging
-obesity
Pelvic Organ Prolapse
-1/3 women
Stress Incontinence
-1/3
-urethra support structures
Overactive bladder
-urge incontinence
-15% of women
-urge followed by leaking from triggers
Bowel Leakage
-6-15%
RF
-perineal tear
-forceps
-diabetes
-radiation
-constipation
Constipation
-slow transit, obstructed, dyssynergic
-women (19.7%) more than men (10%)
-1-8% of Americans
What age makes up the infancy stage of development?
0-1 year
Neonatal stage of development?
O - 2 weeks
Infant Stage of development
3 weeks - 1 year
Toddlerhood Stage of development
13m - 2y 11 M
Early childhood Stage of development
3 years - 10 years, 11 M
Preschool stages development Stage of development
3yrs - 5 yrs
Elementary school stages of development
5 yrs - 10yr, 11 m
Adolescence stages of development
11 yrs - 18 yrs
Young adulthood stages of development
18 - 22/25
Adulthood stages of development?
22-40yrs
Middle age stages of development?
40-65 yrs
Late adulthood pages of development?
65+ yrs
Infancy (erikson)
0-l yr / trust vs. Mistrust
Early childhood (erikson)
1-3 yrs / autonomy vs. shame
Preschool (erikson)
3-6 yrs/ Initiative vs. Guilt
School age (erikson)
6-12 yrs /industry vs. Inferiority
Adolescence (erikson)
12-19 yrs / identity vs, role confusion
Young adult (erikson)
20-25 yrs / intimacy vs. Isolation
Middle adulthood (Erikson)
26-64yrs / generavity vs. Stagnation
Maturity (erikson)
65+/ego integrity vs. Despair
Vertical line of body alignment
Mastoid process, anterior to shoulders, hip joints, anterior to knee joints, anterior to ankle joints
Newborn developmental changes
Large head, c curve of spine, flexion predominates
First 3 months developmental changes
Flexed posture, limb symmetry, increased spine extension, midline orientation, lift head
4 to 6 months developmental changes
Lumbar extension, head held up, hands knees position, sitting at 6 months
7 to 9 months developmental changes
Quadraped positions, creeping, sitting
10 to 12 month developmental changes
Vertical posture, pull to stand, walking
2 to 6 years developmental changes
Loss of body fat, gain more balance and flexibility
7 to 12 years developmental changes
Improved symmetry, adult skills refined, growth spurt, puberty
Adolescence developmental changes : posture control
11 years to 18 years. Ideal posture
Adulthood developmental changes: posture control
18 to 40 years. Reduced symmetry, ideal posture
Older Adulthood developmental changes
40 plus. Flexed posture, kyphosis, internal shoulder rot, cervical extension, issues with transition movements, less balance and strength
ACSM School-aged children Activity Recommendations
-60 min/day vigorous; aerobic: running, biking
-3x/week; strengthening: gymnastics, climbing, monkey bars, yoga
-3x/week; bone loading: jump rope, hopscotch, tennis, basketball
ACSM Healthy Adults Activity Recommendations
-30min/5 day moderate intensity (can talk) or 20min/3 day vigorous intensity (can’t talk); aerobic
-Resistance 2x/wk
-Flexibility 2x/wk
