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Peds > Lecture 8: Older adult physical Fitness and Functional Assessment > Flashcards

Lecture 8: Older adult physical Fitness and Functional Assessment Flashcards

1
Q

Outcome measures:
* Good to write goals off of
* Reveals the willingness and ability to move, quality of movement, safety and judgement issues, and effort

A
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2
Q

ICF model

Health condition = the disorder or disease they come in with

Body functions and structures: What you’re developing your problem list off of
* What are they limited in (strength, rom, grip strength, balance etc…)

Acctvities: Now looking at how these body functions limit activities
* Balance - they’re unable to perform dynamic ambulation
* Decreased strength - they cant get off the toilet

Participation: What makes our work meaningful to the pt
* they live alone, but can’t get on and off toilet
* they don’t have dynamic balance during ambulation, so they can’t go to the grocery store = they can’t be a member of community w/o help - we help w/ this participation

this is a good way to write out our problem list

Environment factors / personal factors = help us guide our progrnosis
* No social support/family support = poor prognosis
* Personal factors = motiviation

A
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3
Q

Anatomical, physiological or cognitive abnormalities

A

Impairments

note: we can test for cognitiion as a PT, are they able to follow instructions / understand what I’m saying

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4
Q

Is there evidence to support functional improvement trhough interventions focused on impairments?

A

No

If were just focused on the ROM impairment were not going to get functional improvements
* We have to do something functional w/ them, not just work on ROM
* We need to link our interventions w/ function

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5
Q

This is essentially saying theres limitations w/ MMT
* Think pt being to strong
* Not being able to get into test position
* How much force they’re pushing with is subjective between therapists

A
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6
Q

What are self report outcome measures:

What are patient outcome measures?

A

Self report
* sheet the patient fills out in waiting room
* Subjective on part of the patient - but important because we need the pts perspective
* Less costly
* Gives us a sense of tehir pain in their own environment at home
* Good because it doesnt take away time from us

Patient outcomes measures
* Questionaires
* Think, DASH, LEFS
* Patients perception of the imact of a conditoin on specific activities and social roles

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7
Q

Name some patient reported outcome measures

A
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8
Q

name two common self-report measures

A

1) Activities specific balance confidence scale

2) Falls efficacy scale - international

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9
Q

Observer-Rated Measures
* ROM and MMT
* Quality of movement
* Ability to perform tasks
* Mostly subjective in nature - clinican is observing

Physiological measures:
* Cognitive ability
* rate of percieved exerction pain

A
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10
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A
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11
Q

Selection of functional performance measures

1) Safety - make sure the outcome measure is safe (stop if they’re unsafe)
* Be aware of the influenece of physical touch even inc lsoe guarding (aka don’t help them by holding them up / setting pace) - you want to guard them but not affect the outcome

2) Validity and reliability - does the outcome measure you’re using have this for the population you’re using

3) Diagnostic accuracy

4) Floor and ceiling effects

5) Relevance - are we measuring something that is of meaning to theraputic intervention

6) Sequence of tests - need to do outcome measure when they’re going to do best

A
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12
Q

The degree to which a test tests what it purports to test
* is actually testing what it should be

A

validity

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13
Q

Likelihood ratios

A
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14
Q

KNOW: few measures actually have the diagnostic accuracy to be used alone
* have to be used in clusters / clinical judgement

A
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15
Q

Most people do really well and get high scores on MMT when they shouldnt. Is that a floor or a ceiling effect?

A

Ceiling effect
* Test is not challenging enough

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16
Q

Many participants get the max score because the test is to easy

A

Ceiling effect

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17
Q

Most of the subjects tests at the lower end of the scale

A

Floor effect

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18
Q

Sequence of Tests:

less fatigue test first

Strength testing before endurance

If they fatigue easily do the test that gives you the most information first

Break up the testing if necessary - start w/ test rest, then do another one

A
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19
Q

Single test mobility measures
* Gait speed
* Sit to stand
* Floor transfers
* Stair climb test
* TUG
* Dual TUG - 9.8s
* Distance walking speeds (6MWT, 2MWT, 400M)

A
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20
Q

A walking speed of ____ is a predictor of poor clinical outcomes

A

If they are less than 0.8 m/s its a preidictor for poor clincal outcomes

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21
Q

KNOW: lower gait speeds are reported in clinical settings
* acute care = 0.46 m/s
* subacute care = 0.53 m/s (nursing home/ in patient)
* Ambulatory care = 0.74 m/s (outpatient)

KNOW: Higher gait speeds upone admission to a transitional care setting demonstrated better functional outcomes, shorter rehabiliation stay, and discharge to the community

A
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22
Q

Know: 30 second sit to stand is a transfer skill (can make a transfer goal here)
* more suited for a physically fit adult (because its how many you can do in 30 seconds)

A
23
Q

Why kind of test assesses multiple domains of physical function through observed task perforamnce of activities of daily living and mobility?
* What kind of score indicates better physical performance

A

Physical Performance Test

higher score = better physical performance

2 version - a long version and a shorter version

Some items:
* writing a sentence
* Put on and remove jacket
* Pick up coin from floor
* Chair rise
* 360 turn

24
Q

“Exercise is the single most efficacious intervention for older adults used by physical therapists”

Use their old interests to motiviate them - find something fucntional that they enjoy and can apply

A
25
Q

Physical exercise:
* Slows typical age related changes that impair exercise capacity
* Optimizing age-related changes in body composition (remember, you lose muscle fibers and they’re replaced by adipose)
* Promiting psychological and cognitive well-being (helps as they transition to another lifestyle, they’ve been used to one thing their entire life and now thats changing)
* Managing chronic disease - can helps prevent further decline / reverse
* Reducing the risks of physical disability (helps the be allowed to age at home)
* Increasing longevity - also helps improve quality of life, not just live longer

A
26
Q

ACSM older adult

How many minutes per week of moderate intensity EX

What about vigorous intensity EX

How many days per week should they be strengthening

What about balance

good for writing goals

A

150

75

2 strenghtening

3 balance

27
Q
A
28
Q

KNOW: pts over 80 in a skilled nursing factility = 87% adherence to group exercise
* were social and this is why so many do it
* however, its great if they arent in a skilled nursing facility, but we may want to connect them in some way to a fitness group (church / community)

older adults who particiapte in group based programs express a preference for expert guideance betcause of safety concerns

A
29
Q

strength decreases by % each decade

How much over 60?

A

10% each decade, then 15% after 60

CVD and resp systems decline

Hepatic and renal systems decline

Cognitive and sensory decline

30
Q

% of baseline strength is required to walk

A

24

31
Q

Single most important predictor of subsequent institutionalization?

A

leg strength

32
Q

When you have high function you have more strength

When you have decreased strength your function goes down and you become frail

A
33
Q

Common chronic conditions impacted by Pysical ianctivity
* We know it affects heart disease (think hypertnesion)
* cancer
* depression
* cognitive disease (altimers / demonxia)
*

A
34
Q

Fun gait speed

Functional fait speed

Frail gait speed

A

fun = > 1.5 m/s

function - 0.8-1.5 m/s

Frail = 0.3-0.8 m/s

35
Q

Probs know floor and fait speed

A
36
Q

Explain overload
* How do you start for someone that is completely sedintary?

A

stimulus should be 60-80% of max capacity for aerobic exercise

For someone who is sedentary gradually increase ebginning at 50% 1RM

37
Q

Matching exercise with type of muscle contraction, speed of contraction, and consideration of the functional movement

A

Specificity

38
Q

Functional training

1) Simple to move complex movements
2) Normal speed to quicker or slower
3) Stable to unstable surfaces
4) Eyes open to eyes closed

may ask the best sequence here

A
39
Q

In the physical stress thery explain what an appropariate overload is and what it does?
* what happens over 100%
* how do you remain stable / maintaience
* what happens with too little overload

A

switch appropate to 60-80% (not 60-100%)

40
Q

how much of gait is eccentric?

A

60%

41
Q

How many weeks to achieve a strengthening response in muscle tissue?

A

6

42
Q

KNOW: Random practice leads to skill acquistion compared to blocked practice

A
43
Q

Know: when exercise training you want to vary frequency and intensity (keep the body on its toes)

A
44
Q

KNOW: don’t always perscribe pts 3x10

1 set in first 3 months of training is beneficial in novice weightlifters and older avoids

Helps avoid boredom and injury

Devise several functional exercises that challenege muscle in different ways

Say maybe do many different exercise to target quads rather than 3x10 of the same exercise

A
45
Q

How long should you stretch

A

4x60s

but you can break up that 60’s as long as it still adds up to 60’s

46
Q

Duration of aerobic EX

A

30 minutes

47
Q

KNOW:

HR max = 220-age = good for general population

Karvonen mothod: 60-80% x (220=age=resting jeart rate + resting heart rate

Contraindications for aerobic EX are related to BP

A
48
Q

Aquatic exercise
* good for joint issues

Use RPE instead of HR in water because HR will decrease

A
49
Q
A
50
Q

Stretching
* there are age ased normas
* functional ranges
* modified sit and reach
* back scratch (apleys) test

Contraindications
* Joint instability
* precautions: pins and needles

A
51
Q

Plyometrics:

Measurement:
* timed functional test
* Rose’s Fullerton balance test

Application
* walk as quickly as you can
* get up from the floor - timed
* Jump in place
* Jump from foot to foot

A
52
Q

Tia Chi = improve burg balance scores

A
53
Q

Senior fitness test

all the below used together for a score

A
54
Q

STEDI = algorithm for fall risk screening

A

Peds (24 decks)

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