Showing papers in "Topics in Geriatric Rehabilitation in 2012"
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TL;DR: Why and how physical therapist should incorporate walking speed data into functional screening, development of plans of care, and assessing efficacy of interventions are considered.
Abstract: Physical therapists expend a great deal of effort to assist older persons to regain the ability to walk independently. While we often use descriptors of gait patterns, assistive device use, level of assistance required, and distance traversed as part of our documentation, quantifying self-selected and fast walking speeds may be the most powerful measure to inform clinical decision making and to assess outcomes of intervention. In this article, we will consider why and how physical therapist should incorporate walking speed data into functional screening, development of plans of care (ie, setting appropriate goals), and assessing efficacy of interventions. We will explore the factors that determine an individual's self-selected walking speed and the importance of assessing if, and how much, an older person is able to increase walking speed for safe community function. We will then present current best evidence about how walking speed typically changes in the later years of life, highlight age- and gender-specific “norms” (ie, typical performance). We will review the converging evidence of key threshold values for walking speed, as they relate to community function, risk of frailty and morbidity, and risk of institutionalization and conclude with a discussion of how such information is used to determine physical therapy prognosis, setting measurable functional goals, documenting efficacy of intervention, and determining need for continued physical therapy care across delivery settings.
25 citations
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TL;DR: Brain and metabolic changes associated with plasticity were associated with neuropsychological test performance and nonpharmacologic interventions should continue to be developed and tested via clinical trials with mild cognitive impairment patients.
Abstract: Recent literature provides empirical evidence for nonpharmacologic interventions' potential to slow degeneration associated with mild cognitive impairment. Physical exercise and cognitive training interventions have showed trending toward slowing degenerative processes associated with dementia, specifically related to plasticity. A review of 6 clinical trials (2 physical exercise and 4 cognitive training) showing trending toward slowing degenerative processes in mild cognitive impairment is provided. Brain and metabolic changes associated with plasticity were associated with neuropsychological test performance. Several strengths, limitations, and suggestions for future empirical research were offered. Nonpharmacologic interventions should continue to be developed and tested via clinical trials with mild cognitive impairment patients.
14 citations
TL;DR: Improvements in TUG and FRT scores are shown, suggesting that Wii Fit balance games may be used as a clinical intervention to improve balance in community-dwelling adults aged 65 to 80 years.
Abstract: Computer-based active gaming has recently gained in popularity as an intervention in physical therapy clinics. However, little evidence exists supporting its effectiveness especially in the elderly population. The purpose of this pilot study was to determine whether a 4-week, computer-based balance intervention using the Wii Fit is effective as an intervention to improve balance in community-dwelling older adults. Community-dwelling adults aged 65 to 80 years were recruited from 2 local community centers. Sixteen older adults participated in a balance exercise program utilizing the Wii Fit 2 times a week for 4 weeks. Changes in balance were assessed by comparing preintervention and postintervention measures using the Timed Up and Go (TUG) and Functional Reach Test (FRT). The Activities-specific Balance Confidence Scale was used to determine the participants' perceived confidence in specific activities. Participants demonstrated improvements in balance as indicated by statistically significant changes in TUG and FRT (P < .05). The data from this pilot study showed improvements in TUG and FRT scores, suggesting that Wii Fit balance games may be used as a clinical intervention to improve balance in community-dwelling adults aged 65 to 80 years. The positive data outcomes warrant further investigation in using the Wii Fit as a balance intervention in a larger target population.
11 citations
TL;DR: The literature is reviewed and new surgical approaches such as microsurgical lymphaticovenous anastomosis are promising and recommended to reduce the incidence of breast cancer–related lymphedema (BCRL).
Abstract: Treatment of breast cancer has improved dramatically over the last 2 decades. Although these treatment options have significantly increased the 5-year survival rates, they are not without lasting adverse effects. As survival continues to improve for older women, the development of most feared long-term complication, breast cancer–related lymphedema (BCRL), will increase and can be more severe with increased age-related comorbidities. Since currently no definitive cure for BCRL exists, prevention by limiting and/or eliminating risk factors is of prime importance. Preventive exercise and education are recommended to reduce the incidence of BCRL and to enhance quality of life. There are new studies that mention mapping the axillary lymphatics before/during surgery to reduce the incidence of BCRL, as a mean to avoid extensive lymph node dissection; however its not definitely clarified. New surgical approaches such as microsurgical lymphaticovenous anastomosis are promising. In this article, we review the literature and discuss BCRL incidence, diagnosis, and treatment considering elderly patients.
11 citations
TL;DR: The intersect of the growing aging population and improvement in cancer detection and treatment provides focus on aging and rehabilitation outcomes in detection and management of secondary lymphedema.
Abstract: The leading cause of secondary lymphedema (LE) in developed countries is cancer treatment. It is estimated that more than 11.4 million cancer survivors in the United States are at risk for developing LE. The intersect of the growing aging population and improvement in cancer detection and treatment provides focus on aging and rehabilitation outcomes in detection and management of LE. The complexity of the problem of posttreatment LE and the predicted increase in the number of older cancer survivors led to the mandate for more attention to this multidisciplinary rehabilitation issue in gero-oncology.
10 citations
TL;DR: Elderly women divided on the basis of the presence or absence of a history of falls had a fall history not related to the quadriceps muscular function or to the anteroposterior displacement during sit to stand.
Abstract: To evaluate whether a history of falls is directly related to the quadriceps muscular function and body sway, 26 elderly women were divided on the basis of the presence or absence of a history of falls. Evaluation of muscular power and anteroposterior and mediolateral displacements of center of pressure during consecutive stand and sit 5 times were performed. Fallers exhibited higher mediolateral displacement than nonfallers. No differences were observed for quadriceps power and for sit-to-stand time between groups (P < .05). The fall history was not related to the quadriceps muscular function or to the anteroposterior displacement during sit to stand.
TL;DR: Falls did not lead to injury in the majority of elderly individuals in the study and therefore did not aggravate the adverse consequences of frailty, and the study found that functional capacity and spatial-temporal variables of gait differed significantly between the groups with different degrees ofFrailty.
Abstract: Objectives: To determine whether there are differences in functionality and gait between fallers and nonfallers in frailty groups. Methods: A cross-sectional study involving 125 community-dwelling elderly individuals. Frailty, falls, functional capacity, and gait were assessed. Results: Functional capacity and spatial-temporal variables of gait differed significantly between the groups with different degrees of frailty (P < .05). Significant differences were found in Dynamic Gait Index scores between the groups divided by degree of frailty and falls (P < .05). Discussion: Falls did not lead to injury in the majority of elderly individuals in the study and therefore did not aggravate the adverse consequences of frailty.
TL;DR: Preelderly women with unilateral secondary lymphedema exhibited a lower postural stability compared with health women, which lead to think us that asymmetric fluid distribution in the upper body parts increases postural sway and leaving them more vulnerable to falls.
Abstract: Aim: The aim of this study was to evaluate the static postural stability and fall risk of preelderly women with unilateral secondary lymphedema after breast cancer. Methods: This study was conducted on 46 preelderly women (24 with unilateral secondary lymphedema and 22 healthy) aged from 52 to 69 years. The Biodex Balance System was used to measure the parameters of postural stability and fall risk. The data acquisition involved 3 trials of 20 seconds to test the postural stability test. It was made in 3 directions (overall, anterior-posterior [AP], and mediolateral [ML]) and 2 conditions (once with open eyes, once with eyes closed). The fall-risk test was performed under the following conditions: (1) eyes open, firm surface; (2) eyes closed, firm surface; (3) eyes open, foam surface; and (4) eyes closed, foam surface. Results: For the postural stability, significant differences (P ⩽ .000) were observed in overall, AP, and ML displacement parameters in eyes closed condition between the lymphedema and healthy groups. There were no statistically significant differences in the fall-risk test results among the lymphedema and healthy group (P > 0.05). Conclusion: Preelderly women with unilateral lymphedema exhibited a lower postural stability compared with health women. These results lead to think us that asymmetric fluid distribution in the upper body parts increases postural sway and leaving them more vulnerable to falls.
TL;DR: It was found that 31% of women and 19% of men used an assistive device in their everyday life; there was no significant difference in device usage according to gender (P > .05); the most common device among men and women was a walking stick.
Abstract: This study examined assistive device usage and mobility level among elderly people. The inclusion criterion was age 65 years or older; all participants were volunteers. Participants were investigated in terms of their the sociodemographic characteristics and their levels of mobility device usage in everyday life, as assessed by the Rivermead Mobility Index and the Physical Mobility Scale. The study included 58 (35.6%) women (mean age = 73.18 ± 6.62) and 105 (64.4%) men (mean age = 73.31 ± 6.59). It was found that 31% of women and 19% of men used an assistive device in their everyday life; there was no significant difference in device usage according to gender (P > .05). The most common device among men and women was a walking stick. There were no significant differences between men and women in terms of Rivermead Mobility Index and Physical Mobility Scale scores; the mobility level of men was higher than women (P < .05). Assistive device usage is important for elderly people in maintaining indoor and outdoor mobility in everyday life. Our results should be taken into consideration in the rehabilitation of elderly people, especially elderly women. The use of mobility assistive devices reduces injury risk and becomes an important factor in increasing life quality in elderly people.
TL;DR: The results revealed that elderly people, especially those living in nursing homes, should be supported and educated to be aware of physical activity and quality of life.
Abstract: Objective: To compare level of mobility, quality of life, and functional independence of the elderly people living at home and in the nursing homes. Methods: The study comprised 130 voluntary elderly participants living in 2 nursing homes and 54 elderly participants living in their own homes, who met the inclusion criteria. Sociodemographic data and medical history of the participants were recorded, and the Elderly Mobility Scale, Barthel Index, and Nottingham Health Profile were administered. Results: The level of mobility of the elderly people living in nursing homes was found to be lower than that of those living at home (P < .05). Quality of life and all subdomains except sleep were better for elderly people at home (P < .05). Functional independence scores of the elderly people living at home were higher (P < .05). In both groups, a statistically significant relationship was found between the mobility assistive device, Barthel Index (P < .01), and Elderly Mobility Scale (P < .01). Conclusion: These results revealed that elderly people, especially those living in nursing homes, should be supported and educated to be aware of physical activity and quality of life.
TL;DR: The effectiveness of manual therapy and complex decongestive physiotherapy in elderly postoperative breast cancer patients was showed and the use of manuel therapy may help relieve the pain and increase the shoulder range of motion.
Abstract: The aim of this study was to evaluate the effect of manuel therapy and exercise treatment on shoulder function, pain, and lymphedema in elderly breast cancer patients. This study was carried out on 40 women older than 65 years with radical mastectomy (8–44 months after surgery), following breast cancer between years 2007 and 2011. All of the cases were treated with complex decongestive physiotherapy, manuel therapy, and exercises. Assessments included body composition (TANITA TBF-300, Japan), pain (visual analogue scale), shoulder range of motion (universal goniometer), muscle strength (Lovett muscle strength test), arm volume (circumferential measurement), function (DASH), and quality of life (SF-36). Subjects experienced significant decreases in pain and increases in function, range of motion at flexion, abduction and external rotation, muscle strength and physical functioning, role-physical, role-emotional and bodily pain subscales of quality of life (P < .05). Lymphoedema volume values were also decreased during the intervention period (P < .05). This study showed the effectiveness of manual therapy and complex decongestive physiotherapy in elderly postoperative breast cancer patients. The use of manuel therapy may help relieve the pain and increase the shoulder range of motion.
TL;DR: This case of a 70-year-old woman with shoulder impingement uses a conventional program and thoracic mobilizations with movement to facilitate correct posturing, improve segmental mobility, provide mechanoreceptor input to decrease pain, and improve shoulder range of motion.
Abstract: Shoulder impingement in the geriatric population can be disabling and costly. Currently, there are many techniques involving mobilizations for the cervicothoracic region that can be done in conjunction with modalities, exercises for the rotator cuff and scapular stabilizers, and mobilizations of the scapula and glenohumeral joint. This case of a 70-year-old woman with shoulder impingement uses a conventional program and thoracic mobilizations with movement to facilitate correct posturing, improve segmental mobility, provide mechanoreceptor input to decrease pain, and improve shoulder range of motion. After 7 sessions, the patient had improved range of motion, no pain with movement, and an improved outcome score on the Simple Shoulder Test.
TL;DR: The purposes of this article are to systematically identify the most commonly cited self-report measures of mobility in the literature and to discuss their clinimetric properties.
Abstract: Self-report measures of mobility provide important insight into patients' perception of difficulties that they have in performing mobility activities. The purposes of this article are to systematically identify the most commonly cited self-report measures of mobility in the literature and to discuss their clinimetric properties. The most common measures cited in the literature are the Medical Outcomes Study Short Form-36 (physical function subscale), the National Health and Nutrition Examination Survey (Physical Functioning Questionnaire), the Barthel Index (self-report), the Lower Extremity Functional Scale, and the Craig Handicap Assessment and Reporting Technique (mobility subscale). The clinimetric properties of these oft-cited self-report measures tend to be favorable, especially concerning issues of reliability and validity.
TL;DR: Body sway measurements as well as lower extremity muscle strength between elderly fallers and nonfallers were compared and muscle force asymmetry was found in the quadriceps muscle for both groups and ankle dorsiflexors only in fallers.
Abstract: Body sway measurements as well as lower extremity muscle strength between elderly fallers and nonfallers were compared. Nineteen subjects who reported falling at least twice in the last 6 months and 24 nonfallers participated in the study. Both fallers and nonfallers had significant increases in measurements of body sway while standing on foam when compared with baseline value of eyes open (P = .000). Left ankle dorsiflexors was the only muscle group that was significantly weaker in fallers than in nonfallers (P = .016). Muscle force asymmetry was found in the quadriceps muscle for both groups and ankle dorsiflexors only in fallers.
TL;DR: The current state of chronic lymphedema therapy is based on interdisciplinary care, and the vast majority of cases, the current therapy of choice is conservative complex decongestive therapy.
Abstract: The current state of chronic lymphedema therapy is based on interdisciplinary care. Various professional groups such as doctors, nurses, physiotherapists, nutritionists, sport therapists, bandaging specialists, and even the companies manufacturing compression garments are involved in the management of lymphedema. There are differences in the therapeutic forms applied for prophylaxis and acute medical and rehabilitative treatment, just as there are in other medical disciplines. In the vast majority of cases, the current therapy of choice is conservative complex decongestive therapy.
TL;DR: The measurement properties of the 6-minute walk test, shuttle walk, and 400-m walk are described and distance requirements for community ambulation and 3 measures for quantifying ambulatory endurance are reviewed.
Abstract: Ambulatory endurance is important for older adults interested in participating in life situations, particularly in the community. This article reviews distance requirements for community ambulation and 3 measures for quantifying ambulatory endurance. The measurement properties of the 6-minute walk test, shuttle walk, and 400-m walk are described.
TL;DR: It can be postulated that CDP could be preferred in the treatment of postamputation stump edema to shape the stump effectively, which is the basic cardinal requirement of prosthetic fitting after surgery.
Abstract: Objective: The aim of this study is to compare the effects of complex decongestive physiotherapy (CDP) and conventional bandaging (CB) on the postamputation edema of geriatric transtibial amputees. Material and Methods: Eleven geriatric transtibial amputees were included in the study. Randomized controlled study started on the first postoperative day with the amputees who are appropriate for CB and CDP. Before and after application, all the participants underwent circumferential assessments both amputated and intact side in each session. The period between the first session and the last session (transition to permanent prostheses) were recorded in days. The hospitalization period of the cases were also recorded. Results: There was not any significant difference between the groups when the duration of stay at the hospital was evaluated (P > 0.05). The period of transition to permanent prostheses was found to be shorter in CDP group (P < 0.05). When the first and last session values of both groups were analyzed, significant differences were determined (P < 0.05). The difference between the last circumferential measurements of the stump was observed to be more obvious in the CDP group than in the CB group (P < 0.05). Conclusion: To conclude, it can be postulated that CDP could be preferred in the treatment of postamputation stump edema to shape the stump effectively, which is the basic cardinal requirement of prosthetic fitting after surgery.
TL;DR: This article provided the first empirical, qualitative evidence on the relationship between the Nottingham Health Profile and VEINES-QOL instruments in elderly patients with chronic venous insufficiency.
Abstract: Chronic venous insufficiency is a common progressive disease. Although chronic venous insufficiency is common in general population, its incidence increases with aging and, as a result, the quality of life (QOL) is affected negatively. There are 2 ways to assess QOL in venous diseases: generic and disease-specific surveys. The 36-Item Short Form Health Survey and the Nottingham Health Profile are widely used generic surveys. Disease-specific surveys are popular for studying venous diseases and have a high sensitivity. The Chronic Venous Insufficiency Questionnaire, the Venous Insufficiency Epidemiological and Economic Study Quality of Life/Symptoms (VEINES-QOL/Sym), the Aberdeen Varicose Vein Questionnaire, and the Charing Cross Venous Ulceration Questionnaire are such tools. This study aimed to explore the correlation between the Nottingham Health Profile and VEINES-QOL scales in older adults. This article provided the first empirical, qualitative evidence on the relationship between the Nottingham Health Profile and VEINES-QOL instruments in elderly patients with chronic venous insufficiency.
TL;DR: Rehabilitation professionals who are equipped in differentiating mild cognitive impairment from normal aging will assist in early diagnosis and treatment and approach their patients in a more compassionate manner.
Abstract: Because normal aging includes changes in thinking and memory, it is challenging to differentiate between normal age-related changes and mild cognitive impairment, a pathological condition with risk for developing dementia. Cognitive changes associated with mild cognitive impairment may lead to physical impairments and dysfunction. Rehabilitation professionals who are equipped in differentiating mild cognitive impairment from normal aging will assist in early diagnosis and treatment and approach their patients in a more compassionate manner. Recommendations for physical exercise and cognitively engaging activities across the lifespan may attenuate cognitive decline with advancing years.
TL;DR: This article was to provide a resource of information about assessment tools for delirium, depression, MCI, and dementia, which therapists may effectively and efficiently apply in a clinical setting.
Abstract: Rehabilitation providers who provide services to older adults with movement dysfunction will likely encounter patients with delirium, depression, mild cognitive impairment (MCI), and dementia. Alterations in cognitive status and mood often interfere with the management of the patient's primary movement problem. Although physicians and mental health providers manage the primary diagnosis and treatment of these conditions, rehabilitation therapists must recognize signs and symptoms of these common geriatric conditions. However, health care workers are inconsistent in recognizing and differentiating delirium, MCI, dementia, and depression. Therefore, older adult patients should be assessed frequently using standardized tools to facilitate prompt identification and management of the underlying etiology. There are many valid and reliable screening tools that rehabilitation therapists may use to assess changes in mental status or mood in older adults. If delirium, depression, MCI, or dementia is confirmed by the screening results, referral to the primary physician and/or the neuropsychologist is optimal. The purpose of this article was to provide a resource of information about assessment tools for delirium, depression, MCI, and dementia, which therapists may effectively and efficiently apply in a clinical setting.
TL;DR: Measures of walking speed allow for a simple and reproducible clinical assessment of physical performance after TJA, which may prove to be a useful clinical tool for tracking performance and establishing prognosis.
Abstract: Total hip and total knee arthroplasties are common procedures, effective at improving self-reported function for patients with osteoarthritis. While self-report measures are commonly used to assess outcomes after total joint arthroplasty (TJA), they rarely accurately reflect the magnitude of physical performance deficits. Measures of walking speed allow for a simple and reproducible clinical assessment of physical performance after TJA, which may prove to be a useful clinical tool for tracking performance and establishing prognosis. Of the few studies examining walking speed after TJA, generally patients tend to improve after surgery, yet deficits of 17% to 20% persist when patients are compared with healthy controls.