MoBility:

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Mo-Bility

• 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
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Positively Aging/M.O.R.E.Choices and Changes
Project
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
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Positively Aging/M.O.R.E.
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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
  gerontology
• prepare students to make critical health
  decisions for extending and enhancing their lives

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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

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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
  Research

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Walking

• 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

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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

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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

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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
  mind
• Gradually introduce wrist/ankle weights, gentle
  inclines or hills
• Warm up and cool down!
• Talk with physician (need medical exam before
  starting walking program?)

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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

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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

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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
  balance
• Determine proneness to falls
• Determine specific treatments, exercises,
  precautions, or interventions to improve gait and
  balance

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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

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Informal Assessment Tools from Everyday Materials?

• Difficult for seniors to come in for regular
  assessments
• Uncomfortable in exam room
• Need quiet and adequate furnishings
• Need adequate TIME to talk with provider
• Cost
• Mobility
• Location
• Fearful White Coat Syndrome

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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

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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

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Falls and Fractures

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

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Impact of Hip Fractures

• Half of all older adults with hip fractures
  cannot return to normal life or live
  independently
• 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

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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

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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

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What Examine Elderly

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

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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)

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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
  compromises?
• Waddle
• weakness in muscles
• need protein, good nutrition, and regular exercise

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Balance Gait Stations

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

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Locomotion

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

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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)

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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,
  Reader

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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)

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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

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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

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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
  velocity
• Possible application of Tenetti Rubric
• Role assignments Walker, Reader, Measure Master,
  Timekeeper

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Frailty Recognize Label It

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

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Fighting Frailty as You Age

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

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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

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Fighting Frailty as You Age

• Physical Activity for Mobility Challenged
• Sit be Fit
• Tai Chi
• Yoga
• Physical Therapy
• Design of replacement limbs

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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

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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
  Projects
  
• http//teachhealthk-12.uthscsa.edu

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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
  weakened
• A rubber tip is preferable to avoid skidding on
  waxed or slippery floors