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Intro to PT > Intro to PT Chapter 14 > Flashcards

Intro to PT Chapter 14 Flashcards

1
Q

Life expectancy (2017)

A

Male at birth - 76.1
Male at 65 - 83.1
Female at birth - 81.1
Female at 65 - 85.6
Both at birth 78.6
Both at 65 - 84.5

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2
Q

2018 U.S. # of people over 65

A

51 million - 15.6 %

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3
Q

By 2060 U.S. over 65

A

94.7 million

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4
Q

groups have at least 1 disability:

65-74:

A

26.4%

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5
Q

groups have at least 1 disability:

75-84:

A

45%

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6
Q

groups have at least 1 disability:

85 and older:

A

72.5%

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7
Q

41.5% of people over 85 have

A

3 or more
disabilities

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8
Q

ADL examples

A
  • Eating
  • Dressing and undressing
  • Bathing and grooming
  • Bed and bathroom
  • Transfer and ambulatory activities
  • Other activities such as propel wheelchair, manage elevator, dial a telephone
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9
Q

IADL - instrumental activities of daily living - examples

A
  • Shopping
  • Laundry
  • Housekeeping
  • using public transportation
  • managing finances
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10
Q

Primary goal of PT for old old independent population:

A

achieve optimal physical function and prevent conditions that might limit ability to continue at independent level.

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11
Q

Older persons that impair daily function primary goal of PT:

A

may need PT to regain mobility skills

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12
Q

Settings Patients are seen

Hospital

A

acute conditions

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13
Q

Settings Patients are seen

Rehabilitation Center-

A

after medically stable and
need intensive rehabilitation

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14
Q

Settings Patients are seen

Long-Term Care

A

if require nursing care or
assistance with activities of daily living (ADLs)

 Skilled Nursing Facility (SNF)
 Assisted Living Facility (ALF)

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15
Q

Two types of services offered to pts in long term care

A
  1. rehabilitation to return to prior level of functioning (PLOF)
  2. functional maintenance programs to maintiain current skills and prevention of further disability.
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16
Q

Healthy Older People who want to maintain, regain or improve physical status

A

may attend aquatic exercise programs, tai chi, or yoga conducted or supervised by PTs

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17
Q

PTs provide…. To pts before limitations

A

Education, prevention, health, wellness, fitness to pts before they have limitations.

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18
Q

Consulting with an individual, PTs provide the knowledge necessary to acquire

A

appropriate Adaptive Equipment or Assistive Devices.

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19
Q

Example of Adaptive Equipment

A

Grab bars - transfer pole -

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20
Q

Assistive Devices

A

Provides assistance during periods of mobility.

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21
Q

Older patients

PT Other roles: administrator

A

Researcher, administrator manager of rehabilitation services, or supervisors of PTAs.

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22
Q

hypokinesis

A

decreased activity or movement

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23
Q

Physcical changes in bones, muscles and joints and decreased strength

A

often related to hypokinesis, or sarcopenia

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24
Q

Musculoskeletal deficiencies

A

 Decreased strength from hypokinesis (decreased
movement) and sarcopenia (decreased muscle mass)
 Decreased flexibility
 Decline in bone mass
 Weight bearing joint deteriorate

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25
Q

connective tissue changes with age

A

Becomes less hydrated and stiffer.

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26
Q

Without activity muscles

A

have fewer oportunities to lengthen and shorten.

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27
Q

CNS changes with age

A

Lower conduction velocity to make movements slower.

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28
Q

Sensory systems changes with age

A

 Vision (cataracts, macular degeneration)

 Hearing losses (presbycusis)

 Affect balance, mobility, ability to detect environmental hazards

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29
Q

Vision (cataracts, macular degeneration)

effective lighting and use of contrasting colors

A

importent for offerning the older person cues about objects or surfaces that might interfere with safe mobility.

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30
Q

Macular degeneration

A

affects the retina and loss of central vision.

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31
Q

Presbycusis

A

1/3 of adults over 65. 1/2 of adults over 75. - Loss of hearing high pitched sounds.

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32
Q

Vestibular aging

A

senses of head movement and degree and acceleration for coordination of posture and balance. - may become less sensitive.

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33
Q

Hypertension and aging

A

65.75% - age 65-74
73% of age 75 over

34
Q

Tactile loss

A

Age causes tactile loss which reduces touch, pressure, and pain recieved from the environmnet.

35
Q

Non-hispanic blacks

A

More likely to to be hypertensive than any other group.

36
Q

aging

Cardiovascular reserve

A

aging causes reduced ability to respond to increased workloads.

37
Q

death rates by falls for older adults

A

up 30% over 2007-2016

38
Q

Dynamic balance

A

complex interaction of multiple systems that are subject to age related changes.

39
Q

Balance questions

Three questions routinely asked older patients about falling

A
  1. Have you fallen in the last year
  2. Do you feel unsteady when standing and walking.
  3. Do you worry about falling?
40
Q

Myth about cognition and older people

A

cognitive funnction always significantly decreases with advanced age..

41
Q

Older adults

Alzheimers

A

age is a risk factor. 5.8 million americans.

42
Q

cognitive features of normal aging

A

slower processing speed and declines in certain memory, language, visuospatial and executive functions which are not significant enough to impair function.

43
Q

agiing

Psychosocial changes

A

 May face discrimination
 Adjustment to retirement
 Depression from functional deterioration and social isolation

The PT and PTA has a responsibility to bring signs of psychological problems to the attention of other members of the health care team.

44
Q

Common conditions of elder adults

Osteoarthritis

A

 Most common orthopaedic problem for older adults
 Typically occurs in hands, hips and knees

cartilage deteriorates to joint injury or overuse. (calcium deposits)

maintain at least a moderate activity level while protecting the joints.

22.7% adults

45
Q

aging

bariatric programs

A

therapists spcialize in treating excessively overweight individuals.

46
Q

aging

Rheumatoid Arthrits

A

 Autoimmune disease
 Inflammation of joints
 More common in women; peak at 40 to 60 years of age

PT goals:
pain relief - heat modalities.
Maintaining flexibility necessary to function

47
Q

aging common conditions

Osteoporosis

A

 Not part of normal aging process
 Decreased mineralization of bones
 More common in women
 Primary role of PT is prevention of injury (book says just prevention)

dual energy x-ray absoptiometry.

Need to be active and load bearing.

48
Q

aging common conditions

Hip Fracture

A

One of most imp health care issues.
20% mortality rate within 1 year
300,000 hip fractures a year.
95% from fall

 Significantly diminishes ability to perform ADLs and IADLs

 PT essential after surgery; focuses on early mobility, transfer training, gait training, weight-bearing precautions, use of assistive devices

49
Q

PT plays role in preventing both osteoporosis and hip fracturs

A

address activity level, weight bearing, flexibility, strengthening and education.

50
Q

aging

reasons for falls

A

related to both:
Interinsic factors and extrinsic factors.

51
Q

Aging

Intrisic factors for falling

A

Age
Previous history of falls
Cognitive changes
Sensory problems
Multiple medical condiitions
Muscle weakness
Orthostatic hypostension

52
Q

aging

Extrinsic factors for falling

A

Poor lighting
Uneven or slippery surfaces
Medications
Improper AD or improper use of device
Improper footwear
Throw rugs
Lack of handrails or grab bars.

53
Q

aging common conditions

Diabetes mellitus

A

21.4% over 65
12 million people over 65

 Insufficient insulin action (production or absorption) results in excessive glucose in blood

 Complications include renal failure, peripheral
neuropathies, poor circulation that causes skin
ulceration, coronary artery disease, and retinopathies

54
Q

Principles of Examination aging

Examination

A

musculoskeletal, neurolotic, cardiovascular, pulmonary and integumentary status.

skils and capabilities needed for maximum independence.

55
Q

Principles of Examination aging

History

A

 Review of medical chart provides information about other services the patient is receiving
 May include a family member
 Includes social history, and can include screening for cognitive status, depression, urinary incontinence, nutrition

establish raport. Information about evironment.

56
Q

Principles of Examination aging

Geriatric Self-Efficacy Index for Urinary Incontinace

A

Judge if further testing need to be done related to incontinance

57
Q

Principles of Examination aging

Braden Scale

A

determine if there is a risk for developing pressure sores.

58
Q

Principles of Examination aging

Systems Review

A

Cardiovascular and pulmonary, integumentary,
musculoskeletal, neuromuscular and communication ability

59
Q

Principles of Examination aging

Tests and measures

A

 Cardiovascular and pulmonary function
 Pain assessment
 Strength, range of motion, posture
 Sensation, coordination, vestibular
 Balance and Gait
* Dix-Hallpike Test to rule out Benign Paroxysmal Positional Vertigo
* Static and dynamic sitting and standing including outcome measures

60
Q

sterognosis

A

perception of form through touch.

61
Q

examination - aging

static balance in standing

A

unipedal stance test (UPST) - standing on one foot with eyes open and eyes closed.

62
Q

examination - aging

Romberg test

A

Stands with one foot directly in front of the other with their eyes open and closed.

63
Q

examination aging

Dix-Hallpike Tes

A
  1. pt sit upright with legs extended
  2. rotates pts head 45 degree twoard ear being tested
  3. pt lie back down with head hanging off the edge of the table
  4. holds pt’s neck extended for at least 30 seconds
  5. Watches the pt’s eyes for nystagmus, rapid rhyrthmic eye movement.
  6. return pt to upright.
64
Q

examination aging

Balance tests

A

30 second chair stand test
4-stage balance stest
STEADI toolkit - fall risk
Berg Balance scale
Balance Evaluation Systems Test (Bestest)
Mini-BESTest
Dynamic Gait Index
Functional Gait Assessment

65
Q

examination aging

Elderly Mobility Scale (EMS)

A

The EMS is a seven item, 20 point validated assessment tool for the assessment of frail
elderly subjects (Smith 1994). The EMS is measured on an ordinal scale.

66
Q

examination aging

Short Physical Performance Battery

A

an objective measurement instrument of balance, lower extremity strength, and functional capacity in older adults (>65 years of age). The test includes three different domains (walking, sit-to-stand and balance) to assess functional mobility.

67
Q

examination aging

Functional outcome measures

A
  • Elderly Mobility Scale
  • Short Physical Performance Battery
68
Q

examination aging

Minimal Detectable Change (MDC)

A

MDC- the smallest amount of change in a measurement that reflects a true change in the pt’s condition. For example in Timed Up and Go, MDC helps determine whether a change in performance is statistically significant.

69
Q

examination aging

Minimal Clinically Important Difference (MCID)

A

MDIC - smallest change in a measure that a pt or clinician would percieve as meangful. For instance, in 6-minute Walk Test, MCID helps determine whether the observed changes are clinically relevant.

70
Q

examination aging

Rehhabilitation Measures Database

A

Searchable database for outcome measures that includes MDC and MCID values if available.

71
Q

Evaluation, Diagnosis, and Prognosis

PT completes detailed evaluation

A

Assesses signs, symptoms, or syndromes resulting from the pathologic condition

72
Q

Evaluation, Diagnosis, and Prognosis

Develop a prognosis estimating maximum level of improvement the patient will experience

A

 Develop functional goals to enhance movement and function
 Develop plan of care to achieve goals

73
Q

Evaluation, Diagnosis, and Prognosis

approach and dischharge

A

 Interprofessional approach
 Discharge planning started at initial evaluation

74
Q

Intervention aging

examples

A

therapeutic exercise, functional training, physical agents, manual therapies, and pt instruction.

75
Q

Intervention aging

The American College of Sports Medicine and the American Heart Association Guidelines

A

 Aim for moderate-intensity aerobic activity 30
minutes, 5 days a week or vigorous-intensity for 20 minutes, 3 days a week.

 Muscle strengthening recommendations are 8-10 exercises with resistance for 10-15 repetitions performed on 2 or more nonconsecutive days/week

 Flexibility exercises performed 2 days a week for at least 10 minutes

 Balance exercises

76
Q

Intervention aging

Go4Life program

A

National Institute on Aging. individualize interventinos based on older adult’s endurance, strength, balance, and flexibility needs

77
Q

Intervention aging

Education and instruction essential

A

Include family members and caregivers

78
Q

Intervention aging

Consider setting

A

inpatient with lots of equipment or home in the environment the pt must function.

79
Q

Intervention aging

Other points about interventions

A

 Intervention focuses on improving daily function

 Consider medications that could impact rehab program

 Include information or instruction in health promotion, wellness, and prevention

80
Q

Ethical Considerations aging

A

 Must consider vulnerability to elder abuse

 Could occur in form of neglect, emotional,
psychological or physical, or financial
exploitation

Intro to PT (15 decks)

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