Impairments Flashcards
1
Q
Aerobic Capacity
A
- Aerobic Capacity is the amount of oxygen consumed by the body during intense exercise, in a given time frame. It is a function both of cardiorespiratory performance and the maximum ability to remove and utilize oxygen the from circulating blood
2
Q
Factors affecting aerobic capacity
A
- Deconditioning
- Age related physiological changes
- Specific pathologies
- Functional mobility deficits
3
Q
BENEFITS OF IMPROVING AEROBIC CAPACITY
A
- Lower risk of: early death, coronary artery disease, stroke, high blood pressure, adverse blood lipid profile, type two diabetes, metabolic syndrome, colon cancer, breast cancer.
- Weight management/weight loss, improve cardio-respiratory and muscular fitness, prevention of falls, decreased depression, improved cognitive function.
- Improved functional health, reduced abdominal obesity,
- Decreased risk of hip fracture, lung cancer, endometrial cancer…
- Weight maintenance following weight loss, increased bone density, and improved sleep quality
- 150 to 250 minutes per week (30-50”/day) of moderately vigorous physical activity will facilitate prevention of weight gain
4
Q
TESTS & MEASURES
A
- Heart rate, blood pressure, respiratory rate, oxygen saturation, Rate of Perceived Exertion (RPE), Self Reporting Measures of Activity.
- 6-Minute walk test: The primary outcome measured is distance.
- Incorporate a standardized path/walkway.
- Distance can be affected by the shape of the path.
- Rectangular or circular paths produce on average greater distance walking then do straight/linear paths.
- Path must be obstacle free
5
Q
TESTS & MEASURES: Graded exercise testing
A
- Graded exercise testing for: Assessment of Aerobic Capacity.
- Useful to: Diagnose cardiovascular and/or pulmonary disease, determine disease severity/risk stratification, evaluate functional ability, establish a baseline for exercise prescription or disease progress, evaluate intervention effectiveness.
- Modes may include: Treadmill walking, Leg & arm cycle ergometry, Stair stepping
6
Q
Nu-Step
A
- Practical clinical tool for both diagnostic and exercise intervention.
- Engages all 4 extremities
- Useful for very young/fit individuals, as well as the frail elderly
- Adaptable for multiple patient types.
7
Q
IMPAIRED JOINT MOBILITY FACTORS
A
- Connective tissue changes
- Joint structure changes
- Negative influence of excess loading on Articular Cartilage leads to increased incidence of osteoarthritis
- Histological changes specific to the articular cartilage results in increased calcification
- Intervertebral disc’s become less fluid in the nucleus and more fibrous in the annulus.
- Increased stiffness and decreased elasticity are characteristic of the fibrous structures as a result of the aging process.
- Age related kinematic changes occurring at the:
- Segmental level - OSTEOKINEMATICS
- Joint level - ARTHROKINEMATICS
8
Q
AGING & ROM: Spine/LE
A
- Decreases with advancing age and variable based on body segment.
- Cervical : Gradual decline beyond 30 years of age. Greatest decline in both extension and lateral flexion
- Thoracic and Lumbar Spine: Declines with age in linear fashion (16-90 years) Greatest lost found in: Extension 77%,, Flexion 50% , Lateral Flexion 44%
- Lower Extremities: A decline in joint motion occurs to the greatest extent in the hip, then the ankle/foot joint complexes.
- Generally, knee range of motion remains constant throughout life barring any specific joint pathology.
- HIP: Greatest decline seen in hip extension.
- ANKLE: Greatest decline seen in dorsiflexion
9
Q
AGING & ROM: UE
A
- The influence of age is relatively less for upper extremity range of motion.
- SHOULDER COMPLEX: How many muscles attach to the scapula?
- Most notable in shoulder dysfunction is that of flexion and external rotation
- The influence of a kyphotic spine is substantial on shoulder kinematics.
- For the elbow and wrist there are no specific age related deficits in the absence of specific pathologies
10
Q
HAMSTRING RESTRICTIONS
A
- One of the single most significant influence on ankle, knee, hip, lumbo-sacral-pelvic junction, spine, and shoulder dysfunction is:
- HAMSTRING RESTRICTIONS!!!
11
Q
MEASUREMENT/STRETCHING of HAMSTRINGS
A
- 90/90 Test Position
- Activate quads to facilitate Reciprocal Inhibition
- 20 SECOND HOLD
- Minimum of 3 repetitions each leg
- Perform HS Stretching in both supine & standing
- Stretch HS a MINIMUM of 3 x/day
*
12
Q
IMPAIRED MUSCLE PERFORMANCE
A
- SARCOPENIA = The degenerative loss of skeletal muscle mass (0.5-1.0 % loss per year after the age of 50), Quality, and strength associated with aging. The term is derived from Greek and literally means “flesh poverty”.
- Sarcopenia progresses at a rate of 1% to 3% per year after the age of 50.
- Multiple compounding factors associated with Sarcopenia including:
- Aging
- Comorbidities
- Sedentary lifestyle
13
Q
CONSEQUENCES OF SARCOPENIA
A
- Contributes to deficits in: Mobility, functional capacity, and decreased skeletal muscle oxidative capacity.
- Muscular impairments combined with increased fat mass results in: elevated fall risk, frailty, & comorbid pathologies including type 2 diabetes.
- Sarcopenia results in the decreased capacity for effective protein synthesis due to diminished protein reserves in skeletal muscle.
14
Q
MUSCLE FUNCTION & STRUCTURE CHANGES
A
- Lean muscle mass accounts for 50% of body weight in young adults.
- By the age of 75 to 80 years lean muscle mass decreases to 25%.
- Type IIa fast twitch muscle fibers undergo significantly greater atrophy than the Type I slow twitch muscle fibers.
*****Increasing the volume of Fast Twitch muscle fibers via strength training programs focusing on said fibers can have positive consequences in improving rapid muscle recruitment thereby decreasing reaction time and reducing overall fall risk****
15
Q
Other Components of Impaired Muscle Performance Include:
A
- Denervation/Re-innervation Process as a result of a 50% decline in available Motor neurons, and diminished number and availability of satellite cells.
- Deficits in absolute and specific force generation, wherein muscle becomes weaker even when atrophy is avoided and force production, separate from muscle atrophy, is compromised with aging.
- Muscle activation deficits: Reduction in force production abilities with aging occurs more rapidly than the decline in muscle mass alone.
- Deteriorating muscle quality and metabolism: Muscle quality and contractile capacity decreases secondary to infiltration of fat and other non-contractile tissues (connective tissue)
- Metabolic function changes with aging: Altered endocrine function (See Box 14-2, page 265)
- Cytokines & Adiposity: chronic inflammation and obesity play a significant role in contributing to sarcopenia.
