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Fall-related deaths are more common among men (particularly white) than women ... and 'speed' to examine your muscle response, coordination, and energy output. ... – PowerPoint PPT presentation

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Title: MoBility:

  • Walking Your Way Into Forces and Motion

Linda Pruski MaryAnne Toepperwein Cheryl
Blalock Olivia Lemelle National Science Teachers
Association March 31 to April 3, 2005
Positively Aging/M.O.R.E.Choices and Changes
Michael J. Lichtenstein, Principle
Investigator Carolyn Marshall, Project
Director Linda Pruski, Education
Specialist MaryAnne Toepperwein, Education
Specialist Cheryl Blalock, Research Associate Yan
Liu, Programmer Analyst Olivia Lemelle, Graphics
Designer Kathleen Boehme, Administrator Steve
Owen, Statistician Kacy Vandewalle, Research
Intern Michelle Wang, Teacher Intern
SEPA MKITS funding from National Institutes of
Health National Center for Research Resources,
National Institute on Aging, National Heart,
Lung, Blood Institute
Positively Aging/M.O.R.E.
Positively Aging/M.O.R.E.Goals
  • To help teachers . . .
  • prepare and implement research-based curricular
    materials that explore interdisciplinary
    opportunities in health science, physiology, and
  • prepare students to make critical health
    decisions for extending and enhancing their lives

Positively Aging/M.O.R.E.Goals
  • To help teachers . . .
  • develop sensitivity to the needs and concerns of
    the aging population
  • foster an enduring interest in health science
    research and medical careers

National Institutes of Health
  • National Center for Research Resources Science
    Education Partnership Award
  • National Institute on Aging
  • National Heart Lung and Blood Institute
  • National Institute of Dental and Craniofacial

  • Much of the study of walking has its roots in the
    early 1800s and in early cinematography
  • Walking was once defined as a movement of
    falling forward, arrested by the weight of the
    body thrown on the limb as it is advanced
    forward. Weber brothers, 1836

Walking Benefits
  • Strengthen the heart and lungs
  • Control weight
  • Prevent osteoporosis
  • Increase stamina
  • Improve sleep
  • Strengthen/Loosen joints/connective tissue
  • Tone/Strengthen muscles
  • Relieve stress improve mood
  • Lower blood pressure, blood lipids

Walking Prescription
  • 30 to 45 minutes 3 to 5 times a week
  • May take months to work up to maximum minutes and
    days per week
  • Swing arms forcefully
  • Comfortable rate and consistent rhythm
  • 3 to 4 mph 140 strides/minute
  • Can talk with companion while walking
  • Do not fatigue
  • Can be repeated the next day without pain
  • Take pulse mind target heart rate

To Begin Walking
  • Consider personal fitness level and goals
  • Get a good pair of walking shoes
  • Learn to take pulse determine target heart rate
  • Plan what you are going to do
  • How far, where, keep a record (time/miles)
  • Progress at steady pace with specific goal in
  • Gradually introduce wrist/ankle weights, gentle
    inclines or hills
  • Warm up and cool down!
  • Talk with physician (need medical exam before
    starting walking program?)

Target Heart Rate
  • The rate at which exercise is the safest yet most
    beneficial for you
  • Between 70 and 85 of your maximum heart rate

Warm Up Cool Down
  • Warm Up
  • 5 to 10 minutes
  • Slow walk and simple stretches
  • Get heart ready for exercise
  • Limber up muscles, ligaments, tendons
  • Cool Down
  • 5 to 10 minutes
  • Easy, slow, relaxed stroll and stretching
  • Body adjusts back to resting state

Balance, Mobility, and Gait
  • Why?
  • Components of walking - an excellent exercise
    promoting CV fitness
  • Lower limb function related to health,
    disability, and mortality
  • Look for causes of gait change and impaired
  • Determine proneness to falls
  • Determine specific treatments, exercises,
    precautions, or interventions to improve gait and

Balance, Mobility, and Gait
  • Why?
  • Lower limb function related to health,
    disability, and mortality
  • Under reporting of illness due to age
  • Non-specific presentation of illness confusion,
    anorexia, falls
  • Masking by co-morbidity
  • arthritis may mask angina
  • back pain may mask kidney disease
  • Polypharmacology
  • too many meds, interactions unclear

Informal Assessment Tools from Everyday Materials?
  • Difficult for seniors to come in for regular
  • Uncomfortable in exam room
  • Need quiet and adequate furnishings
  • Need adequate TIME to talk with provider
  • Cost
  • Mobility
  • Location
  • Fearful White Coat Syndrome

Informal Assessment Tools from Everyday Materials?
  • Informal geriatric assessments conducted by
    caregivers, friends, and family facilitate early
    intervention in elder care and in maintaining a
    good quality of life
  • Medication control
  • Environmental adaptations
  • Promoting interaction/Reducing isolation
  • Preventing falls
  • Comfort dignity

Falls Among Older Adults
  • Falls are the most common cause of injuries
  • 1 out of 3 adults 65 fall each year
  • Falls are most common reason for traumatic
    hospital admissions among older adults
  • 1 in 20 requiring emergency treatment
  • Falls translate into fractures, spinal cord and
    brain injury

Falls and Fractures
  • About 3 of all falls cause fractures
  • pelvis
  • femur
  • vertebrae
  • humerus
  • hand/wrist
  • forearm
  • ankle
  • hip joint

Impact of Hip Fractures
  • Half of all older adults with hip fractures
    cannot return to normal life or live
  • Hip fractures in an aging population will
    increase over next four decades
  • By 2040, hip fractures may exceed 500,000
  • Lead to severe health problems and cause the
    greatest number of deaths

Falls and Deaths
  • Falls are leading cause of injury deaths among
    people 65 years
  • Fall-related deaths are more common among men
    (particularly white) than women

Where do people fall?
  • For adults 65 years
  • 10 occur in health care institutions
  • 30 occur in public places
  • 60 of fatal falls occur at home

What Examine Elderly
  • You can observe a lot just by watching.
  • Yogi Berra

Activities of Daily Living
  • Physical (BASIC) ADLs (ex. bathing,
    dressing, toileting, mobility)
  • Instrumental ADLs (ex.
    telephone, shopping, food prep, housekeeping,
    taking medications, transportation, finances)
  • Discretionary ADLs (ex.
    hobbies, social functions, golf)

Assessing Mobility
  • Get Up and Go Test
  • Hands Behind Head
  • Pick up Coin
  • Gait
  • feet touching each other?
  • wider base between feet to compensate for balance
  • Waddle
  • weakness in muscles
  • need protein, good nutrition, and regular exercise

Balance Gait Stations
  • Mobile Marvin
  • Gauge Your Gait
  • A Well-Turned Ankle
  • Could You Please Stand Still?
  • Gymnastic Joints

  • Describe determine
  • Stance
  • Posture
  • Stride
  • Pace
  • Gait
  • Balance
  • Strike
  • Cadence

Station 1 A Well-Turned Ankle
  • See-saws, fee-faws! Walking is just losing and
    regaining the center of gravity over your feet!
  • Use a homemade balance board test endurance and
    see how quickly your center of gravity shifts.
  • Role assignments PT (Timer), Test Subject,
    Technician (Referee)

Station 2Could You Please Stand Still?!
  • Feel out of balance? Then use your head get a
    bicycle helmet and homemade stabilometer to
    check your sway!
  • Estimate area from a stabilogrid to compare
    changes in balance sway
  • Role assignments Measurer, Balancer, Timekeeper,

Station 3 Get Up Go, Whoopee!
  • How fast can you get up and go from one
    place/position to another?
  • Use your height and speed to examine your
    muscle response, coordination, and energy output.
  • Role assignments PT (Timer), Test Subject,
    Technician (Recorder)

Station 4 Gymnastic Joints
  • ROM on you not a computer! Use your homemade
    goniometer (gonia angle metron measure) to
    assess flexibility of useful joints
  • Stationary Arm on part that doesnt move
  • Movable Arm on part that moves
  • Role assignments PT, Test Subject, Technician

Station 5 Carry My Books, Please
  • Overdoing? Muscles will punish you with pain if
    you exceed their limits!
  • Isokinetic strength force required to keep
    muscles and bones moving at a steady rate
  • Isometric strength force required to hold your
    muscles and bones in one place
  • Role assignments PT, Test Subject, Technician

Station 6 Gauge Your Gait
  • Tickle your toes with talcum then step out on the
    blue carpet to analyze your gait
  • Apply mathematical formulae to interpret gait
    information cadence, stride length, and
  • Possible application of Tenetti Rubric
  • Role assignments Walker, Reader, Measure Master,

Frailty Recognize Label It
  • Markers include
  • Extreme old age (85)
  • Disabilities (Interference w/ ADLS)
  • Multiple diseases (2)
  • Multiple medications
  • Geriatric symptoms dementia, incontinence, hip

Fighting Frailty as You Age
  • Nutrition
  • Wide variety of plant foods cereals/grains,
    vegetable fruit
  • Vitamins, minerals, fiber
  • Healthy snacks small meals

Fighting Frailty as You Age
  • Physical Activity
  • Begin gradually build up
  • Get going and enjoy doing!
  • Reduce risk of injury by lifting correctly!
  • Reduce osteoporosis to reduce risk of fractures
  • Stronger cardiovascular system

Fighting Frailty as You Age
  • Physical Activity for Mobility Challenged
  • Sit be Fit
  • Tai Chi
  • Yoga
  • Physical Therapy
  • Design of replacement limbs

Fighting Frailty as You Age
  • Vision/Hearing
  • Use ear plugs around loud noises to avoid damage
  • Wear protective lenses when in sunlight to avoid
    damage to eyes
  • Adaptive devices to compensate for vision or
    hearing loss

Fighting Frailty as You Age
  • Education across the early years can develop
    early intervention awareness and skills helping
    to improve the quality of life throughout the
    life span
  • The Positively Aging/M.O.R.E. Curricular
  • http//

How to Measure Cane Height
  • Research Dr. Margaret Wylde showed that 2/3s of
    regular cane users risk developing back pain due
    to incorrect cane height
  • At minimum height, a cane should reach the user's
    wrist when the arm is hanging to the side
  • The cane can be 2-3" higher than wrist to floor
    measurement and still be correct
  • The cane should usually be held on the side
    opposite the leg or foot that is injured or
  • A rubber tip is preferable to avoid skidding on
    waxed or slippery floors
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