Immobility and rehabilitation

Question 1

What happens to the prevelance of immobility/disability as age increases ?

Answer 1

It increases

Question 2

What is the commonest type of disability ?

Answer 2

Problems with locomotion

Question 3

What is the commonest cause of disability ?

Answer 3

MSK conditions

Question 4

Appreciate this pic of some of the causes of functional limitations

Question 5

Define what sarcopenia is

Answer 5

It is age related loss of muscle mass and function

Question 6

What is the criteria for defining sarcopenia ?

Answer 6

You need to have criteria 1 + 2 or 3 or both:

1. Low muscle mass
2. Low muscle strength
3. Low physical performance

Question 7

when does muscle mass start to usually decline ?

Answer 7

Around 30yrs old and then accelarates at 60yrs old

Question 8

Define what is meant by sarcopenic obesity ?

Answer 8

A condition defined as the presence of sarcopenia and obesity i.e. loss of muscle mass accompanied with increased fat

Question 9

What does sarcopenic obesity increase the risk of?

Answer 9

Cardiometabolic disorders – insulin resistance, metabolic syndrome, cardiovascular disease

Question 10

What are some of the consequences of sarcopenia ?

Answer 10

Muscle wasting causes decreased exercise capacity ==> decreased activity ==> increased risk of diabetes and increased bone loss ==> dependance on others

Increased bone loss ==> increased risk of fractures

Decreased energy used ==> increased fat deposition/obesity

Muscle weakness causes increased risk of falls

Question 11

Appreicate the viscious cycle of immobility

Answer 11

Question 12

What are some of the causes for the development of sarcopenia ?

Answer 12

Note cachexia = weakness and wasting of the body due to severe chronic illness

Question 13

Define primary sarcopenia ?

Answer 13

Sarcopenia purley due to age

Question 14

Define seconday sarcopenia

Answer 14

Sarcopenia due to one or more causes

Question 15

What are the proven immobility treatments to reduce chances of sarcopenia development? (imagine these are are good for treating it too)

Answer 15

Excerise:

• Progressive resistance training to increase strength and endurance and functional measures e.g. gait speed, chair stands
• Aerobic training to increase endurance

Reduce sedentary time

Question 16

What are the recommended physical activity levels for older people (>65) ?

Answer 16

Its the same as for other adults (18-64 years).

• 150 minutes a week of moderate intensity activity in bouts of 10 minutes or more. OR
• 30 minutes of brisk walking or equivalent activity 5x week OR
• 75 minutes of vigorous activity spread across the week or a combination of moderate and vigorous activity.
• Strength and balance work should also be carried out at least 2x week.

Question 17

What are some of the other interventions which have some degree of evidence behind their use ?

Answer 17

1. Nutrition – Calcium & Vitamin D, Protein supplementation
2. Creatine
3. ACE inhibitors

Question 18

How can the effectiveness of immobility intervetions be measured ?

Answer 18

Physical activity monitors e.g. activPAL, stepwatch 3 etc

Question 19

Define rehabilitation

Answer 19

A personalised, interactive and collaborative process, reflecting the whole person. It enables an individual to maximise their potential to live a full and active life within their family, social networks, education/training and the workplace where appropriate.

Question 20

What may rehabilitation include (note this is not just for old people rehabilitation can occur at any point in someones life)

Answer 20

habilitation, reablement and recovery

Question 21

What are the aims of rehabilitation ?

Answer 21

• Maximise the participation of the patient in his or her social setting;
• Minimise the pain and distress experienced by the patient;
• Minimise the distress of, and stress on, the patient’s family and carers.

Question 22

Define reablement/recovery

Answer 22

The active process of an individual regaining the skills, confidence and independence to enable them to do the things for themselves, rather than having things done for them.

Question 23

Define habilitation

Answer 23

The process of assisting an individual with achieving developmental skills when impairments have caused a delay or blocking of initial acquisition of these skills,

e.g. congitive, emotional/social, fine motor, gross motor or other skills that contribute to mobility, communication, socialisation, performance of activities of daily living and quality of life

Question 24

Who may need rehabilitation ?

Answer 24

People with long-term conditions, illness, ageing people with general deterioration

Question 25

What are the principles of rehabilitation/reablemnet ?

Answer 25

• Person centred e.g. find out what matters to them most
• Goal –directed
• Co-ordinated
• Improve outcomes

Question 26

What are the principles of goals used in rehabilitation ?

Answer 26

• Used to Measure progress
• Evaluate intervention
• Realistic to motivate individual
• Adaptable

Question 27

How is rehabilitation often measured?

Answer 27

• Impairment / activity specific assessments
• Activities of Daily Living (ADL) Scales