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PHYSICAL THERAPY IN GERIATRIC PATHOLOGY University Lecturer

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PHYSICAL THERAPY IN GERIATRIC PATHOLOGY University Lecturer, Dr. Mirela Dan, Academic Foundation for Physical Therapy - Oradea CONTENTS 1. INTRODUCTION 2. – PowerPoint PPT presentation

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Title: PHYSICAL THERAPY IN GERIATRIC PATHOLOGY University Lecturer


1
PHYSICAL THERAPY IN GERIATRIC PATHOLOGY
  • University Lecturer, Dr. Mirela Dan,
  • Academic Foundation for Physical Therapy - Oradea

2
CONTENTS
  • 1. INTRODUCTION
  • 2. GENERAL ISSUES OF GERONTOLOGY
  • 2.1. Ages of Involution
  • 2.2. Biology of
  • 2.2.1. Theories of Senescence
  • 2.2.2. Physiological Alterations in Senescence
  • 3. GENERAL AND SPECIFIC ISSUES OF GERIATRICS
  • 3.1. Cardiovascular System
  • 3.2. Respiratory System
  • 3.3. Skeletal System
  • 4. FUNCTIONAL REHABILITATION AT 3-RD AGE
  • 4.1. Basic Rules and Principles for Physical
    Therapy at 3-rd Age
  • 4.2. Kinetic Rehabilitation at 3-rd Age by
    Affections
  • 5. PHYSICAL EXERCISE CHEAPEST WONDER MEDICINE
  • 5.1. Effect of Physical Exercise with Elders
  • 6. LONG LIFE THROUGH EXERCISE
  • 6.1. Effort Tests for the Motric Capacity of
    Elders
  • 7. TESTS ON THE CONTENT OF THE COURSE
  • 8. BIBLIOGRAPHY

3
GENERAL ISSUES OF GERONTOLOGY
  • There are a few social aspects of old age
  • increasing real and potential longevity and its
    social protection
  • social utilization of the professional and
    social expertise of elders
  • prophylaxis of old age and fight against the
    drastic degenerescent diseases
  • The involution ages have a step by step
    evolution which we will describe, taking into
    account the fundamental type of activities and
    the characteristic type of relations.

4
GERONTOLOGIC STEPS
  • Step 1. Adaptation period or getting old 65-75
    years
  • Step 2. Medium old age 75-85 years
  • Step 3. Great old age or longevity over 85 years
  • Terminal Step

5
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6
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7
MOST AFFECTED SYSTEMS AT 3-RD AGE
  • CARDIOVASCULAR
  • SYSTEM
  • - Ischemic Cardiopathy
  • Cardiac Insufficiency
  • Arterial Hypertension
  • Arterial Hypotension
  • Troubles of Peripheral
  • Arteriovenous Circulation
  • RESPIRATOR
  • SISTEM
  • - Bronchial Asthma
  • Chronic Bronchites and
  • Emphysema
  • - Pulmonary Tuberculosis
  • - Broncho-pulmonary
  • Neoplasm
  • Extrapulmonary
  • Respiratory Troubles
  • SKELETAL
  • SYSTEM
  • - Rheumatismal Shoulder
  • Scapulohumeral
  • Periarthritis
  • - Coxarthrosis
  • - Gonarthrosis
  • - Spine
  • - Rheumatoid Periathritis
  • - Ankylopoietic Spondilitis

8
CARDIOVASCULAR AFFECTIONS

  • OBJECTIVES
  • Ameliorate clinical state.
  • 2. Ameliorate metabolic and neuroendocrine
    parameters
  • 3. Obtain hemodynamic effects
  • 4. Fight sedentarism
  • 5. Maintain/optimize physical condition through
  • a) increase of aerobe functional power or of
    maximum oxygen consumption
  • b) more economical work of heart and vessels
  • c) decrease of energetic costs for the same
    effort done
  • 6. Improve life quality
  • MEANS
  • Various types de dynamic activities beginning
    with ergometric bike, gymnastics programs, walks
    or bike rides (prescribed distances), light runs
    in open air, swims, stair climbs, various sports
    accessible to the physical condition (tennis,
    volley, bowling)

9
RESPIRATORY SYSTEM AFFECTIONS
  • OBJECTIVES
  • 1. Ameliorate rheologic quality of bronchic
    secretion and of mucociliary functions
  • 2. Maintain/increase thoracic expansion in low
    mobility zones
  • 3. Decrease ventilatory travail through thoracic
    vertebral limbering up and increase contribution
    of diaphragm ventilation, of abdominal
    respiration
  • 4. Increase efficiency of muscular respiratory
    pump
  • 5. Ameliorate intrapulmonary and intracapillary
    air distribution
  • 6. Tonify abdominal and respiratory muscles
  • 7. Accommodation to effort, very useful to
    maintain general physical condition and
    respiration control during movement and effort
  • MEANS
  • Postural drainage and education of cough reflex -
    defficitary at old age associated with
    secretolithics
  • Respiratory education/reeducation on all
    quadrants with conscientisation and self-
    conscientisation
  • 3. Respiratory displacement exercises towards the
    reserve volume with preinspiration fiber
    stretching, respiratory muscles tonifying
    exercises
  • Learning and using various types of relaxation or
    phases
  • Effort training

10
SKELETAL AFFECTIONS
  • OBJECTIVES
  • 1. Regain normal mobility of join, working in all
    three functional plans
  • 2. Tonify muscles that motorly involve joint
    segments
  • 3. Correct vicious postures
  • 4. Increase joint mobility
  • 5. Conserve motricity and stability function
  • 6. Coordinate movements
  • 7. Reeducate walk

  • MEANS
  • Exercises are selected depending on the
    evolution stage of the disease, functional
    deficit degree and age of the patient
  • During exercises the affected segment must be
    released from the body weight and the amplitude
    of the movements is established depending on the
    pain turn-up, on the nonpain rule
  • Exercises are executed actively, with normal
    resistance, then mechanotherapy is applied
  • In case of immobilization, isometric exercises
    are done
  • Dosage of exercises is made depending on the
    possibilities of the patient
  • Execution positions are dorsal, ventral, lateral
    decubitus, and hands and knees

11
PHYSICAL EXERCISE EFFECTS ON CARDIOVASCULAR SYSTEM
  • Decrease of adrenergic stimulation of the
    myocardium contractility
  • Increase of vascular rigidity and peripheral
    vascular resistance
  • Increase of systolic pressure
  • Moderate hypertrophy of left ventricle
  • Prolongement of myocardial contraction.

12
EFFECTS OF AEROBIC EXERCISE
  • Modification of energetic needs, increasing the
    total daily energy consumption
  • Decrease of body weight, especially of visceral
    adipose deposits
  • Amelioration of muscular force
  • Increase of oxidative capacity of muscles and
    glycogen deposits, increase of mitochondrial
    enzymes level and capillary density
  • Increase of bone density
  • Normalizing glicemy and insulin level
  • Increase of enzymes that intervene in glucose
    phosphorilation, oxidation and depositing
  • Increase of HDL cholesterol and decrease of LDL
    cholesterol and of triglycerides concentration
    in plasma
  • Decrease of tendency to obesity, of
    cardiovascular risk and of the evolution towards
    sugar diabetes

13
OBJECTIVES OF PHYSICAL THERAPY IN OSTEOPOROSIS IN
3-RD AGE
  • Learn the correct body posture and movements to
    prevent osteoporosis effects.
  • Increase muscular force through resistive and
    weights exercises programs, very attentively
    conceived, to become routine.
  • Learn the correct way of weight lifting to
    protect the spine.
  • Improve balance to prevent falls.
  • Prevent fractures by decreasing falling risk due
    to bad coordination, weak sight, muscular
    hypotonia, confusion and medicine consumption
    which have as a side effect arterial hypotension
    or alteration of sensorial feeling.
  • Educate patients regarding fall and fracture
    risk, through establishing personalized programs
    for increasing stability, including exercises to
    increase muscular force.
  • Pain reduction acute back pains, due to
    vertebral compression, must be treated using
    orthopedic corsets, analgesics, heat and massage.
    Exercises programs must focus on increasing the
    force of paravertebral muscles.
  • Reduce periods of inefficient rest.

14
KINETIC INDICATIONS IN CASE OF SPINE COMPRESSION
POSTFRACTURES
  • Body alignment is one of the main concepts of
    correct posture and byomechanics. A correct body
    alignment decreases the spine level stress and
    ensures a correct posture.
  • Unsure movements are to be avoided, that is
    any exercise or activity that implies spine swirl
    or bending beneath waist level, with streched
    lower limbs, as standing up, bundlings given by
    stomach aches, toe-tips rising.
  • Correct posture and alignment in orthostatism,
    sitting or walking straight head, forward look,
    back-driven shoulders, light contraction of
    abdominal muscles, a slight lumbar curve.
  • Prolonged orthostatism feet tips directed
    forward, knees not locked in hyperextension, one
    leg rests on a stool or stair, weight will be
    periodically transferred on the other lower
    limb.
  • Seated a rolled towel or a pillow will be
    positioned at the back, the trunk stays upright,
    feet rest on the floor or on a stool.
  • Standing up from seated position hips will move
    forward, weight moves on the legs, chest is
    lifted, standing up by pushing, using muscles,
    arms can support the movement by pushing forwards
    on the chair-arms, the knees will not be blocked.

15
  • Bending feet apart at shoulder level,
    straight back, knees and hips will bend (not the
    waist), combination of twist and bend will be
    avoided, one hand will be used for support.
  • Lifting objects first kneel on one knee and
    keep the object next to the body small bags will
    be used and will be carried with both hands
    (after acute spine fractures do not carry more
    than 2-3 kg).
  • Laces tying - sitting, the leg will be put
    over the opposite knee or on a stool.
  • Pushing and pulling objects straight
    posture, correctly aligned, avoid twists, use
    legs and not back to do it.
  • Getting in and off the bed sitting on the
    bed edge, bend laterally the trunk to the head of
    the bed, lower limbs stay at the bed edge when
    the trunk lies in bed, the legs are lifted too,
    back roll with bent knees backwards for rising
    to sit on the bed edge.
  • To reach a shelf use both hands at once, use
    only safe ladders, with handels.
  • Coughing and sneezing lightly contract
    abdominal muscles to protect the back, and (A) a
    hand will be put at the back, or (B) lightly bend
    the knees, or (C) press the back against the
    chair or the wall, for support.

16
REHABILITATION OF POSTFRACTURE AT HAND LEVEL
Preventing loss of complex function of hand
improvement of precision and fine movements

KINETIC OBJECTIVEs
Reducing stiffness and ankylose of wrist
Increasing muscular force
Recovery of muscular tonus
17
PREVENTING FALLS RISK
18
REHABILITATION IN FEMOR POSTFRACTURE
OBJECTIVES 1. Prevent pulmonar
embolia through respiration exercises 2.
Progressively increase mobility, without pain 3.
Increase muscular force around hip joint and
knee 4. Increase stability 5. Improve balance 6.
Learn transfers 7. Reeducate walk with various
helping devices
  • MEANS
  • Exercises to increase mobility, resistive
    exercises, elasticity, learning transfers,
    balance exercises, bed mobilizations and walk.
  • Patients are taught transfer and daily hygiene
    techniques in the first weeks of rehabilitation.
  • Using helping devices under physical therapist
    supervision.
  • Exercises to continually increase force in
    rehabilitation period, including isometric and
    isotonic exercises for hip and knee.

19

Ultrasound
Heat
Ice
Infrared heat
Electrical stimulations
Hot packs
TREATMENT OF PAIN AND INFLAMMATION
Hydrotherapy
Cervical tractions
Diathermy (short waves)
Massage
Microwave diathemy
Acupuncture
20
EFFORT EVALUATION TESTS
  • Classic determination of CF (cardiac frequency)
    and of AT (arterial tension) in clinostatism
    orthostatism during physical effort after end
    of effort and ECG recording at rest at effort
  • Assessing the degree of dyspnea at effort
  • 1-st degree dyspnea shows out when
    climbing slopes and stairs (over 15-20 stairs)
  • 2-nd degree dyspnea shows out even at walk on
    flat surface at the pace of a healthy person
  • 3-rd degree dyspnea shows out even at walk on
    flat surface at personal pace
  • 4-th degree dyspnea shows out even at usual
    activities dressing, washing, speaking
  • 5-th degree dyspnea is present at rest too.

21
  • Candle test
  • Apnea test
  • Assessment/test of respiratory function
  • Vital capacity
  • Maximal expiratory volume per second
  • Progressive effort test - on cicloergometer.
  • Pain is estimated on Kattus scale
  • Physical tiredness and exhaustion estimation
    on Borg scale
  • Effort tests by walking
  • Imposed pace tests (Test of the pendulum)
  • 6 minutes walk - test
  • Claudication period (effort test for peripheral
    ischemia)
  • Samuels posture test (effort test for peripheral
    ischemia)

22
BIBLIOGRAPHY
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    Paris.Masson.
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    Principles and Practice, J.B. Lippincot,
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    De l'évaluation en kinésithérapie respiratoire au
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23
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24
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