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

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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

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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.

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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

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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

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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)

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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

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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

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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.

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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

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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.

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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.

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• 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.

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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
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PREVENTING FALLS RISK
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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.

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Ultrasound
Heat
Ice
Infrared heat
Electrical stimulations
Hot packs
TREATMENT OF PAIN AND INFLAMMATION
Hydrotherapy
Cervical tractions
Diathermy (short waves)
Massage
Microwave diathemy
Acupuncture
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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.

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• 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)

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