Test 1 Flashcards
What is ageism?
A: Prejudice or discrimination against a particular age-group, especially the elderly.
Q: What is the difference between optimal aging and successful aging?
A: Successful aging refers to avoiding disease, maintaining high physical and cognitive function, and engaging in productive activities. Optimal aging refers to functioning well across domains despite medical conditions.
Q: What are the 5 most common causes of death among older adults?
A: Heart disease, cancer, COVID-19, cerebrovascular diseases, chronic lower respiratory diseases.
Q: What are the 6 most common chronic health conditions among older adults?
A: Hypertension, arthritis, heart disease, diabetes, kidney disease, osteoporosis.
Q: What is the life expectancy for men and women?
A: Men: 73.2 years, Women: 79.1 years.
Q: What percentage of work is needed to provide an overload when prescribing exercise?
A: 60-80% of 1-rep max for strength training.
Q: How would you describe the 4 different stages of the Slippery Slope of Aging?
A: Fun: Independent, Function: Some limitations, Frailty: Assistance required, Failure: Dependent for most tasks.
Q: What are the 5 criteria for measuring frailty?
A: Weight loss, exhaustion, weakness, slow walking speed, low physical activity.
Q: What are the absolute contraindications to aerobic exercise?
A: Unstable angina, acute heart failure, severe hypertension, uncontrolled arrhythmias.
Q: What are the good exercise prescription parameters for those with HTN, DM, OA?
A: HTN: Moderate aerobic exercise, 5-7 days/week. DM: 150 minutes of moderate exercise weekly. OA: Low-impact aerobic and strengthening exercises.
Q: What is the optimal exercise prescription for pre-frail and frail individuals?
A: Strength training 2-3 days a week, balance exercises, and moderate aerobic activity.
Q: Discuss the i-STRONGER program used in this study including who the program is for, the exercise parameters used, the results of the study, and the clinical significance.
A: For: Older adults at risk of frailty. Parameters: Progressive resistance and functional exercises. Results: Improved strength and mobility. Significance: Reduces frailty and improves functional capacity.
Q: What are the common characteristics of polypharmacy?
A: Use of 5 or more medications, increased risk of adverse reactions, and drug interactions.
Q: What is the impact of pharmacokinetic changes in older adults?
A: Slower metabolism and elimination of drugs, leading to prolonged effects and higher risk of toxicity.
Q: What are common adverse drug reactions (ADRs) experienced by older adults and which types of medications produce specific ADRs?
A: Sedation and dizziness (benzodiazepines), postural hypotension (antihypertensives), cognitive impairment (antidepressants).
Q: What are the normal age-related cellular immune changes that result in increased systemic inflammation?
A: Decline in T-cell function and increased pro-inflammatory markers.
Q: What is the proposed reason for these normal age-related changes?
A: Immunosenescence, where the immune system declines with age.
Q: What are the normal aging changes associated with the central nervous system?
A: Decreased brain volume, slower neural processing, and reduced neurotransmitter levels.
Q: How do the normal age-related changes of the central nervous system impact the function of an older adult?
A: Slower reaction times, reduced cognitive function, and impaired motor coordination.
Q: How do the normal age-related changes of the peripheral nervous system impact the function of an older adult?
A: Reduced motor control, slower reflexes, and higher fall risk.
Q: What is fiber (re)grouping?
A: Motor neurons reinnervate denervated muscle fibers, creating larger motor units.
Q: What are the normal aging changes associated with the peripheral nervous system?
A: Reduced nerve conduction velocity and loss of motor neurons.
Q: What are approaches to address total-body inflammation and what is the impact of exercise?
A: Anti-inflammatory diet, exercise reduces systemic inflammation and improves immune function.
Q: What are the typical first signs of illness in older adults?
A: Weakness, confusion, and loss of appetite.
Q: Describe the normal age-related sensory changes to vision in older adults.
A: Presbyopia, reduced contrast sensitivity, and narrower visual field.
Q: What are some compensatory measures that can be taken to address specific vision impairments?
A: Improved lighting, use of magnifiers, contrast enhancement.
Q: What are the common vision pathologies experienced by older adults and what is the impact on their vision/visual field?
A: Cataracts, glaucoma, macular degeneration; all result in reduced central or peripheral vision.
Q: Of the sensory impairments experienced by older adults, which one impacts balance the most?
A: Loss of proprioception.
Q: Does hearing decline with age?
A: Yes, presbycusis causes difficulty in hearing high-frequency sounds.
Q: What are some strategies a physical therapist can use when working with a patient with hearing impairment?
A: Use visual cues, face the patient while speaking, and reduce background noise.
Q: Which sensory changes have been linked to dementia?
A: Decline in both vision and hearing.
Q: What is sarcopenia and why does it occur?
A: Sarcopenia is the loss of muscle mass and strength, caused by aging, hormonal changes, and reduced physical activity.
Q: What physiologic changes contribute to the normal aging of muscle tissue?
A: Decrease in muscle fibers, reduced protein synthesis, and loss of motor units.
Q: What metabolic changes affect our musculature as we age?
A: Decreased mitochondrial efficiency, reduced insulin sensitivity, and slower energy metabolism.
Q: What physiologic changes contribute to the normal aging of the skeletal system?
A: Decreased bone density, slower bone remodeling, and reduced calcium absorption.
Q: What physiologic changes contribute to normal joint aging?
A: Thinning cartilage, reduced synovial fluid, and joint stiffness.
Q: What physiologic changes contribute to the normal aging of tendons?
A: Tendons become less elastic, heal slower, and have reduced collagen production.
Q: What physiologic changes contribute to the normal aging of cartilage?
A: Loss of water content, thinning, and increased brittleness of the cartilage.
Q: What physiologic changes contribute to the normal aging of the intervertebral discs?
A: Loss of water content, reduced disc height, and increased degeneration.
Q: What trends in joint range of motion are noted within the aging adult?
A: Decreased flexibility in most joints, particularly in the spine and hips.
Q: Which joints are not typically limited in range?
A: Shoulder flexion and extension tend to be less affected.
Q: What are the two most common fractures associated with osteoporosis?
A: Hip fractures and vertebral compression fractures.
Q: What are the key components of the history specific to the aging adult population?
A: Functional status, fall history, medications, and comorbid conditions.
Q: What movement or loading precautions exist for a patient with spinal stenosis? Why?
A: Avoid excessive extension and high-impact exercises to prevent nerve compression.
Q: When would you use the wall to occiput distance or plumb line assessment and what can it tell us as practitioners?
A: Used to assess thoracic kyphosis; a positive test may indicate vertebral fractures or postural changes.
Q: What movement or loading precautions exist for a patient with a medical diagnosis of osteoporosis? Why?
A: Avoid high-impact activities and excessive spinal flexion to reduce fracture risk.
Q: What is spinal stenosis and how is it classified?
A: Narrowing of the spinal canal, classified as either lumbar or cervical stenosis.
Q: What are the key findings associated with spinal stenosis?
A: Pain, numbness, and weakness in the legs or arms, relieved by flexion.
Q: What is neurogenic claudication?
A: Leg pain and weakness caused by spinal stenosis, worsened by walking or standing.
Q: Is physical therapy indicated for those with spinal stenosis?
A: Yes, it can help improve function and reduce symptoms through exercises and posture correction.
Q: What is the difference between symptomatic and radiographic osteoarthritis?
A: Symptomatic OA: Pain and physical symptoms present. Radiographic OA: Visible joint degeneration on imaging but may not have symptoms.
Q: Differentiate between the modifiable and non-modifiable factors contributing to the development of knee osteoarthritis.
A: Modifiable: Obesity, joint injury, physical activity. Non-modifiable: Age, gender, genetics.
Q: What are the clinical diagnostic criteria as set forth by the American College of Rheumatology for knee osteoarthritis?
A: Pain in the knee, radiographic osteophytes, and morning stiffness lasting less than 30 minutes.
Q: What questions are most appropriate within the history to differentiate knee osteoarthritis and assist mobility?
A: Ask about the location and onset of pain, stiffness, and any difficulty with walking or stairs.
Q: Can you identify the risk and protective factors associated with knee OA?
A: Risk: Obesity, joint injury, repetitive stress. Protective: Regular low-impact exercise, healthy weight, balanced diet.
Q: Is there a direct correlation between radiographic appearance and pain with knee OA?
A: No, radiographic severity does not always correlate with pain intensity.
Q: How would you design your treatment intervention and progression based on the evidence presented for knee OA?
A: Focus on strengthening exercises, weight management, and joint mobility activities, progressing as tolerance improves.
Q: What medications are most effective within this subpopulation of patients with knee OA?
A: NSAIDs, acetaminophen, and corticosteroid injections.
Q: What are platelet-rich plasma injections?
A: A treatment where a concentration of a patient’s own platelets is injected into the knee to promote healing and reduce inflammation.
Q: What type of exercise program is best based on evidence for preventing bone density loss in postmenopausal women?
A: Weight-bearing exercises such as walking, jogging, and resistance training.
Q: What type of exercise program is best based on evidence for preventing bone density loss in premenopausal women?
A: Regular weight-bearing and resistance training exercises focusing on the hips, spine, and legs.
Q: How would you design an evidence-informed intervention as a physical therapist?
A: Incorporate weight-bearing and resistance exercises 3-5 days a week, focusing on spine, hip, and lower limb strength.
Q: How would you design an evidence-informed intervention as a physical therapist?
A: Similar to postmenopausal, with added emphasis on intensity and progression to maintain bone health.
Q: What type of exercise is best based on evidence for preventing bone mineral density loss in men?
A: High-impact and resistance training exercises targeting spine and hip health.
Q: How is osteoporosis operationally defined and what imaging test is performed diagnostically?
A: Defined as low bone mineral density; diagnosed using a DXA scan (dual-energy X-ray absorptiometry).
Q: Identify and name the psychological factors contributing to gait alterations.
A: Fear of falling, depression, anxiety, and cognitive decline.
Q: What are each of the phases of the Ranchos Los Amigos gait cycle during the stance and swing phase?
A: Stance phase: Initial contact, loading response, mid-stance, terminal stance, preswing. Swing phase: Initial swing, mid-swing, terminal swing.
Q: What normal age-related gait changes may contribute to falls?
A: Slower gait speed, shorter stride, decreased balance, and variability in step patterns.
Q: Can you identify additional pathologic gait change variables which significantly increase the risk of falling?
A: Foot drop, muscle weakness, and poor coordination.
Q: What performance measures and markers indicate the functional category of aging?
A: Gait speed, Timed Up and Go (TUG), and 6-minute walk test.
Q: What is the cut-off gait speed often cited for functional walking speed in the community?
A: 0.8 m/s.
Q: What is the typically quoted community distance ambulation goal on measures such as the Functional Independence Measure (FIM) and is this sufficient? Why or why not?
A: 150 feet is typically quoted, but this may not be sufficient for full community ambulation due to longer distances required.
Q: What is the cut-off gait speed indicating a greater likelihood of frailty and very limited community ambulation?
A: Less than 0.6 m/s.
Q: Can you name each of the primary gait assistive devices and their indications?
A: Canes (mild balance issues), walkers (moderate balance or mobility problems), crutches (temporary support post-injury).
Q: What performance measures and markers indicate frailty?
A: Slow gait speed, weakness, unintentional weight loss, and exhaustion.
Q: What is specificity of training and how might a PT tailor an intervention for the patient?
A: Training should focus on tasks relevant to the patient’s goals, such as strength for climbing stairs if stair mobility is needed.
Q: What does it mean to apply task-oriented motor learning? Why is impairment-based training not enough?
A: Task-oriented motor learning involves practicing real-world tasks to improve functional outcomes, while impairment-based training doesn’t always translate to improved daily function.
Q: Where is the center of gravity normally located within an individual?
A: Around the second sacral vertebra (S2).
Q: What is dual-tasking and how could a PT incorporate these principles into their treatment plan?
A: Dual-tasking is performing a physical and cognitive task simultaneously; a PT can incorporate it by adding tasks like counting while walking.
Q: What are the six determinants of gait?
A: Pelvic rotation, pelvic tilt, knee flexion in stance, foot and ankle interaction, knee motion, and lateral displacement of the pelvis.
Q: How does fear of falling affect gait patterns?
A: Leads to slower walking speed, shorter stride length, and a wider base of support, which increases instability.
Q: What are the contextual factors that impact patient outcomes after primary TJA for OA?
A: Age, BMI, comorbidities, psychological factors, and preoperative functional status.
Q: When should physical therapy start for those s/p TJA and what are the benefits?
A: Physical therapy should start immediately post-op to reduce swelling, increase mobility, and prevent complications.
Q: Compare and contrast the effectiveness of Pre-op PT and Pre-op educational classes.
A: Pre-op PT improves strength and mobility, reducing recovery time. Pre-op education helps manage expectations and reduces anxiety.
Q: Describe the differences between an anatomic TSA and a reverse TSA.
A: Anatomic TSA: Replicates normal shoulder anatomy, used when rotator cuff is intact. Reverse TSA: Ball and socket are reversed, used when rotator cuff is irreparable.
Q: What are typical impairments or activity limitations that a physical therapist can address right after a TSA?
A: Limited range of motion, weakness, pain, and difficulty with overhead movements.
Q: What are the key components of the history when interviewing a patient after a total hip arthroplasty?
A: Surgical approach, weight-bearing status, pain levels, range of motion limitations, and pre-op function.
Q: What early post-operative complications are important to be aware of and screen for within the history and tests/measures?
A: Infection, blood clots, dislocation, and prosthetic failure.
Q: Describe the most common hip precautions based on the surgical approach (Anterior or Posterior).
A: Anterior: Avoid hip extension and external rotation. Posterior: Avoid hip flexion beyond 90 degrees, adduction, and internal rotation.
Q: Consider how a physical therapist may construct a post-operative treatment plan keeping weightbearing status and hip precautions in mind.
A: Focus on non-weight-bearing exercises initially, gradually progressing to weight-bearing as tolerated, while avoiding movements that violate hip precautions.
Q: Describe the strong to moderate recommendations for those undergoing TKA.
A: Emphasize early mobilization, strengthening exercises, and continuous passive motion therapy, with a focus on pain management and restoring range of motion.
Q: What are the best practice recommendations for outcome measures to use with those who have undergone a TKA?
A: Use of the Knee Society Score (KSS), Visual Analog Scale (VAS), and the 6-minute walk test.
Q: What physical agents are recommended for use after TKA and why?
A: Cryotherapy to reduce swelling and pain, and electrical stimulation to improve muscle strength and reduce pain.
Q: What are the impacts of a hip fracture on mortality?
A: Hip fractures significantly increase the risk of mortality, especially within the first year post-injury.
Q: Describe the types of hip fractures and the associated repairs typically completed.
A: Femoral neck fractures: Often require a total hip replacement or pinning. Intertrochanteric fractures: Typically treated with a rod or screw fixation.
Q: Which outcome measures have the strongest recommendation based on evidence for use with patients s/p hip fracture?
A: Timed Up and Go (TUG), 30-second sit-to-stand test, and gait speed.
Q: What type of hip surgical procedures typically have hip precautions?
A: Total hip replacements, particularly with the posterior approach.
Q: Which interventions have strong to moderate support for people s/p hip fracture in the inpatient setting?
A: Early mobilization, strength training, and balance exercises.
Q: What is the difference between a fall and a near fall?
A: Fall: Unintentional landing on the ground. Near fall: A stumble or loss of balance that does not result in hitting the ground.
Q: What types of exercise are highly recommended for patients s/p hip fracture?
A: Weight-bearing and resistance exercises focusing on strength and balance.
Q: Can you describe and differentiate the intrinsic and extrinsic risk factors for falls?
A: Intrinsic: Age, balance deficits, muscle weakness, sensory impairments. Extrinsic: Slippery floors, poor lighting, loose rugs, improper footwear.
Q: How does fear affect fall risk?
A: Fear of falling leads to decreased activity, muscle weakness, and worsened balance, which increases fall risk.
Q: Define the population in which PTs should be screening for fall risk.
A: Adults over 65, those with a history of falls, balance deficits, or gait impairments.
Q: How can PTs screen for fall risk?
A: Use tools like the Timed Up and Go (TUG), 30-Second Sit-to-Stand, and 4-Stage Balance Test.
Q: Describe the key components of a focused examination for fall assessment.
A: Gait analysis, balance tests, strength assessment, and sensory testing.
Q: Name the four key components of a patient-focused history in fall assessment.
A: Fall history, medications, functional status, and comorbidities.
Q: What outcome tool can PTs use to best assess sensory integration?
A: The Sensory Organization Test (SOT) or Clinical Test of Sensory Interaction on Balance (CTSIB).
Q: Which three outcome assessment tools aid in the prediction of falls?
A: Timed Up and Go (TUG), 30-Second Sit-to-Stand, and 4-Stage Balance Test.
Q: Identify the key modifications to enhance safety and reduce fall risk within the home.
A: Remove rugs, improve lighting, install grab bars, and clear walking paths.
Q: What type of motor learning is important to enhance an individual’s feed-forward mechanisms to reduce their risk of falls?
A: Repetitive task-specific practice that improves anticipatory postural adjustments.
Q: What is the difference between reactive and anticipatory postural responses? Can you think of an intervention which would address each?
A: Reactive: Responses to unexpected perturbations (balance recovery training). Anticipatory: Preparation for expected movements (task-specific balance exercises).
Q: What is the intensity required to truly change an individual’s balance?
A: High-intensity balance exercises that challenge the limits of stability.
Q: Is an assistive device enough to reduce falls? Why or why not?
A: No, while helpful, assistive devices must be paired with strength and balance training to reduce fall risk effectively.
Q: How can community intervention and programming decrease fall risk and provide useful referral sources for physical therapists? Please list the most prevalent community programs.
A: Community exercise programs like Tai Chi, fall prevention classes, and home safety evaluations can reduce fall risk.
Q: What are Safe Fall Landing Strategies?
A: Techniques to reduce injury during a fall by controlling how and where the body lands.
Q: What is the purpose of guiding a patient through a carefully designed safe fall landing strategies program?
A: To reduce the risk of injury during a fall by improving body control and landing mechanics.
Q: What is one of the best outcome assessment tools to assess reactive postural control?
A: The Balance Evaluation Systems Test (BESTest).
Q: Identify and discuss two primary intervention strategies to address righting and stepping strategies and reaction time during the near fall phase.
A: Step training for faster foot placement and balance exercises for quicker recovery reactions.
Q: Identify and discuss two primary intervention strategies to prepare older adults for safe landing strategies.
A: Controlled descent exercises (like squats) and training to land safely on hands or hips during a fall.
Q: What are the four distinct phases of falling?
Pre fall, near fall, fall landing, completed fall.
