CHP 5 human development

is a developmental checklist reason enough to warrant OT services?

NO always perform your own assessments

prenatal period

• conception to birth; gestational period

• SENSORIMOTOR:

  • all neonatal reflexes are present at 29wks gestation (not fully developed)

  • innate tactile, prop, and vestibular rxn

  • response to tactile as early as 5.5 wks

  • response to sound at 24wks

early infancy

• birth to 3 mos

• SENSORIMOTOR:

  • tactile, prop, and vestibular begin to integrate and refine

  • visual continues to develop with response to stimuli 10in from face

  • auditory system develops to orient to typical voices

  • integration of primitive oral motor reflexes for feeding

  • integration of motor skills for head righting and turning head

  • changes in sensory input may overstimulate

middle infancy

• 4-6 mos

• general SENSORIMOTOR:

  • tactile and prop continue to refine = incr awareness and interest in world

  • vestibular, prop, and visual integrate for postural control and facilitating stable visual field

  • visual and tactile system become integrated for reaching and primitive grasp

  • play at midline

  • movement patterns progress from reflective to voluntary and goal directed

late infancy

• 7-9 mos

• general SENSORIMOTOR:

  • vestibular, visual and somatosensory responses incr in quality = more mobile and coordinated movements

  • tactile and prop become more refined allowing development of FM skills and motor planning

transitional infancy

• 10-12 mos

• general SENSORIMOTOR:

  • tactile and prop improve = development of midline skills and crossing midline

  • auditory, tactile, and prop heightened for development of sound and communication

  • tactile, prop, gustatory, and olfactory integrated for self-feed

infancy

• earliest period of post-natal life

• birth through 1 year

• divided into 4 periods

  • early infancy

  • middle

  • late

  • transitional

emerging toddler

• 13-24 mos

• general SENSORIMOTOR

  • tactile becomes more precise for localization and discrimination

  • balance and dynamic posture control stronger

  • further integration for complex motor planning > incr self-concept

  • symbolic gesturing and vocalization > ideation and ability to conceptualize

toddler

• 2-3 years

• general SENSORIMOTOR:

  • vestibular, prop, and visual further develop and refine for improved balance and postural control

  • tactile discrimination and localization skills > improved FM

  • motor planning and praxis ideation = incr planned actions and play

preschool/early childhood

• 3-5 years

• general SENSORIMOTOR:

  • PLAY based improvements

    • child challenges and develops sensorimotor competencies for roughhouse play, playground ax, games, sports, dancing, arts, and school tasks

  • social development and self esteem

  • refinement of sensory systems for independence in mobility and improved FM skills

rooting reflex

• stimulus, response, fxn sig, onset age, integration age

• stimulus: stroke corner of mouth, upper lip, and lower lip

• response: movement of tongue, mouth, and head during stimulus

• fxn sig: helps body locate feeding source

• onset age: 28 wks gestation

• integration: 3 mos

suck-swallow reflex

• stimulus: place index finger inside mouth with head in midline

• response: strong, rhythmical sucking

• fxn sig: facilitates nutritive sucking for ingestion of liquid

• onset age: 28 wks gestation

• integration: 2-5 mos

traction reflex

• stimulus: grasp infant forearms and pull-to-sit

• response: complete flexion of UE

• fxn sig: promote momentary grasp to enabled child to hold onto mother when being pulled

• onset age: 28 wks gestation

• integration: 2-5 mos

moro reflex

• stimulus: rapidly drop infants head backwards

• response:

  • first phase: arm extension/abduction, hand opening

  • second phase: arm flexion and adduction

• fxn sig: protective response to stress; helps develop extensor tone during period when flexor tone is dominant

• onset age: 28 wk gestation

• integration: 4-6 mos

plantar grasp reflex

• stimulus: apply pressure with thumb on infant ball of foot

• response: toe flexion

• fxn sig: incr input to sole of foot; integration associated with readiness for indp gait

• onset age: 28 wks gestation

• integration: 9 mos

galant reflex

• stimulus: hold infant in prone suspension, gently scratch or tap alongside spine with finger from shoulder to butt

• response: lateral trunk flexion and wrinkling of skin on stimulated side

• fxn sig: enhances trunk stabilization by facilitating lateral trunk movement

• onset age: 32 wk gestation

• integration: 2mos

Asymmetric tonic neck reflex (ATNR)

• stimulus: fully rotate infants head and hold for 5s

• response: extension of extremities on face side, flexion of extremities on skull side

• fxn sig: promotes visual attention to UE; decr incidence of rolling

• onset age: 37 wks gestation

• integration: 4-6 mos

palmar grasp reflex

• stimulus: place finger in infants palm

• response: finger flexion; reflexive grasp

• fxn sig:

  • incr palmar tactile input

  • prepares muscles for voluntary grasp

• onset age: 37 wks gestation

• integration: 4-6mos

tonic labyrinthine (supine) reflex

• stimulus: place infant in supine

• response: increased extensor tone

• fxn sig:

  • facilitates full body extensor tone

  • allows posture to adapt to that of head

• onset age: 37 wks gestation

• integration: 6ms

tonic labyrinthine (prone) reflex

• stimulus: place infant in prone

• response: increased flexor tone

• fxn sig:

  • facilitates full body flexor tone

  • allows posture to adapt to head

• onset age: 37 wks gestation

• integration: 6mos

landau reflex

• stimulus: hold infant in horizontal prone suspension

• response: complete extension of head, trunk, and extremities

• fxn sig:

  • regulates tone

  • promotes prone extension to manage flexor tone

• onset age: 3-4 mos

• integration: 12-24 mos

• real EX: lifting baby in air over head to play and they have extremities ext

symmetric tonic neck reflex (STNR)

• stimulus: place infant in crawling position and extend the head

• response: flexion of hips and knees

• fxn sig:

  • facilitates quadruped position in preparation for crawling

  • breaks up total-body extension

• onset age: 4-6mos

• integration: 8-12mos

neck righting on body (NOB)

• stimulus: place infant in supine and fully turn head to one side

• response: log rolling of entire body to maintain alignment with head

• fxn sig:

  • facilitates rolling

  • maintains body orientation in response to cervical position changes

• onset age: 4-6mos

• integration: 5yrs

body righting on body (BOB)

• stimulus: place infant in supine, flex one hip and knee toward the chest and hold briefly

• response: segmental rolling of upper trunk to maintain alignment

• fxn sig:

  • promotes trunk and spinal rotation to facilitate sitting and quadruped positions

• onset age: 4-6mos

• integration: 5yrs

reflexes that persist throughout life

• 3 main

• labyrinthine/optical righting

• protective extension:

  • downward parachute (protective extension downward)

  • forward parachute (protective extension forward)

  • sideward parachute (protective extension sideward)

  • backward parachute (protective extension backward)

• tilting:

  • prone, supine, sitting, quadruped, standing

labyrinthine/optical (head) righting

• stimulus: hold infant suspended vertically and tilt slowly (45deg) to side forward or backward

• response: upright positioning of head

• fxn sig:

  • basis for head management and postural stability

  • orients head in space vertically

• onset age: birth-2mos

downward parachute (protective extension down)

• stimulus: rapidly lower infant toward supporting surface while suspended vertically

• response: ext of LE

• fxn sig:

  • prepares LE for surface contact

  • breaks fall

• onset age: 4mos

forward parachute (prot. ext)

• stimulus: suddenly tip infant forward toward supporting surface while vertically suspended

• response: sudden ext of UE, hand opening, and neck ext

• fxn sig:

  • place UE in anticipation of surface to break fall

  • supports prop sitting

• onset age: 6-9ms

sideward parachute (prot. ext.)

• stimulus: quickly but firmly tip infant off balance to side while in sitting

• response: arm ext and abduction to side

• fxn sig:

  • unilateral support body for use of opposite arm

  • prevent fails

• onset age: 7mos

backward parachute

• stimulus: quickly but firmly tip infant off balance backward

• response: backward arm ext or arm ext to one side spinal rotation

• fxn sig: protect from backward fall

• onset age: 9-10mos

tilting reflexes

• what

• types & onset age

• stimulus: tilt baby while in appropriate position

• rxn: curve spine toward raised side, abduction/extension of arms and legs

• types:

  1. prone: 5mos

  2. supine & sitting: 7-8mos

  3. quadruped: 9-12mos

  4. standing: 12-21mos

• purpose: adjust center of gravity and preserve balance

general principles for motor development (5)

1. occurs in cephalocaudal/proximal to distal direction

   • EX: core strength and sitting balance before standing and walking

2. progresses from gross to fine movement

3. progresses from stability to controlled mobility

4. occurs in spiraling manner, with periods of equilibrium and disequilibrium

5. sensitive periods occur when child is affected by environmental input

STABILITY: 0-4 ms

• prone

• supine 0-3m & 3-4m & 4-5m

• sitting 0-3m

• PRONE

  • lifts head and sustains at midline

  • rotates head freely when supported

  • bear weight on forearms & can tuck chin and gaze at hands in forearm prop

  • attempt to shift weight on forearms > shoulders collapse

• SUPINE:

  • 0-3ms

    • holds head to one side

    • turn head from side to side

  • 3-4ms

    • hold head in midline

    • tuck chin and extend neck

    • bring legs together in midline

  • 4-5ms

    • no longer has head lag when pulled to sitting

    • begins to play with hands in midline away from body

• SITTING

  • 0-3ms

    • bobs head and moves side to side > steady

    • right head, rounded back, hips apart & turned out

    • tuck chin and gaze at floor

    • less support, hips bent and shoulders in front of hips (bad center gravity)

• STANDING

  • 0-3ms

    • some weight on legs when held

  • 3-4ms

    • hold head up at midline

    • aligns pelvis and hips; turns legs outward and apart (starfish)

STABILITY: 5-6ms

• prone

• supine 4-5ms & 5-6ms

• sitting

• standing

• PRONE

  • bear weight and shift weight on extended arms

  • shift weight on forearms and reach forward

  • lies prone with hips and legs extended

  • equilibrium rxns

• SUPINE:

  • 4-5ms

    • no longer has head lag when pulled to sitting

    • begins to play with hands in midline away from body

  • 5-6ms

    • lift head independently & actively kick legs

    • feet > mouth & hands to feet

    • reaches for toy uni or bilaterally

    • maintain thumb and finger ext with open palm (open hands)

• SITTING

  • sits alone momentarily

  • incr back ext, props forward on arms, wide base with legs bent

• STANDING:

  • incr bear weight, less support (hold by arms or hands); bounces

STABILITY: 6-8ms

• prone

• supine 7ms

• sitting 7-8ms & 8-10ms

• standing 6-9ms

• PRONE

  • lifts chest and thighs off surface

  • exhibits airplane posturing in prone

  • pivots in prone

  • moves from prone to sitting

• SUPINE (7ms)

  • equilibrium rxn

• SITTING

  • (7-8ms)

    • equilibrium rxn

    • rotate upper body with lower stationary

    • protective responses to side

  • 8-10ms

    • sits well w/o support; plays in sitting

    • legs closer together, full upright, knees straight

    • variety sitting positions (W and side)

    • sitting > prone indp

• STANDING

  • 6-9ms

    • pulls to stand

STABILITY: 9+ms

• prone 9ms

• sitting10-12ms

• standing:

• PRONE

  • begins to dislike prone

• SITTING:

  • 10-12ms

    • protective ext back

    • move in/out positions

    • fully developed trunk & equilibrium rxn

• STANDING:

  • 9-12ms

    • pull to stand with legs only

    • stands alone momentarily

    • equilibrium rxn

    • weight shift

rolling

• 3-4ms

• 5-6ms

• 6-14ms

• 3-4ms

  • accidental roll from prone

  • roll supine to side

  • 3ms belly to back

• 5-6ms

  • prone > supine

  • supine > side w/indp movements

  • supine > prone w/indp movements

  • 6mos back to belly

• 6-14ms

  • segmented rolls

crawling & creeping

• 7ms

  • crawls on belly

• 7-10ms

  • reciprocal creep

• 10-11ms

  • creeps on hands and feet

• 11-12ms

  • creeps well on variety surfaces and inclines

cruising and walking

• 5-6ms

  • high guard position (wide based gait & arms ext)

  • protective ext to front

• 8ms

  • cruises sideways

• 9-10ms

  • cruise around furniture with slight turn to intended direction

• 10-12ms

  • stoops and recovers

  • walks with mod support (hand held)

  • reaches for furniture out of reach when cruising; cruises in either direction no hesitation

• 12-15ms

  • walks with wide gait

• 15-18ms

  • frequent falls w/wide gait

  • runs stiffly with eyes on ground

climbing

• 15-18ms

  • climbs on and off surfaces

  • creeps up stairs

• 18-24ms

  • walks up&down stairs while holding on

  • creeps backwards down stairs

• 2-2.5yr

  • walks up&down w/o support w/time and no alternating of feet

• 2.5-3yr

  • walks UP stairs alternating feet

• 3-3.5yr

  • walks DOWN stairs alternating

jumping

• 2yr

  • jump down from step

• 3yr

  • jump off floor with both feet

• 3-4yr

  • gallops

• 4-5yr

  • jump over object

  • hops on one foot

• 5yr

  • hops straight line

• 5-6yr

  • skips alternating feet

reaching

• 0-2ms

  • visual regard & batting w/closed hands in supine

• 3-4ms

  • direct arm movement in supine

  • hands together at midline for bilateral reaching in supine

• 5ms

  • bilateral reaches > secures > holds object to body in supine

  • indirect reach in supine

  • weight shift in prone to reach w/closed fist (still tricky to grab)

• 6ms

  • unilateral reach incr, more open hand, more direct reach & success in supine

  • weight shift in prone to grab with more success

• 7ms

  • weight shift and grab while on hands and knees/ unilateral grab

• 9ms

  • reaching unilateral and bilateral all position more success

grasping a cube

• 0-1ms

  • visual attention & reflexive grasp

• 3ms

  • sustained voluntary grasp

  • uses ulnar side with no thumb involvement

• 4-5ms

  • primitive squeeze > ulnar palmar grasp w/fingers on top surface, object in center palm and thumb adducted

  • 4 MONTHS Primitive Squeeze Grasp

  • 5 MONTHS Palmar Grasp

• 6-7ms

  • 6 MONTHS Radial Palmar grasp

  • wrist straight (7ms)

• 8ms

  • 8 MONTHS radial digital grasp

Grasping Pellet

• 0-3ms

  • NO voluntary grasp or NO visual attention to pellet sized object

  • 3ms > visual attention w/out grasping attempts

• 6ms

  • swiping/raking

• 7ms

  • inferior-scissor grasp

  • raking with adducted, flexed thumb and flexed fingers

    • clawing with mittens

• 8ms

  • scissor grasp

  • thumb and side of index finger

• 9ms

  • inferior pincer grasp

• 10ms

  • pincer grasp

  • btw pads of fingers

• 12ms

  • fine pincer grasp

  • fingertips

power grasp

• when

• how

• ex

• WHEN: used to control tools or other objects & when hand strength is required

  • hook, spherical, and cylindrical are often considered types of power grasps

• HOW:

  • object held obliquely in hand w/ ulnar fingers flexed and radial fingers less flexed. thumb ext and add.

  • stabilize with ulnar and control with radial

• EX: using a hammer

hook grasp

• when

• how

• EX

• WHEN: to carry objects such as purse or briefcase

• HOW:

  • transverse metacarpals arch is flat, fingers adduct w/flex at IP; MCP flexed or ext

• EX: holding a purse or briefcase

spherical grasp

• when

• how

• WHEN: to hold small ball

• HOW:

  • wrist ext, fingers abduct w/flex at MCP and IPs; hypothenar eminence assists in cupping and control of objects

cylindrical grasp

• when

• how

• WHEN: hold glass, cup, or can with hand around object

• HOW:

  • transverse arch flat against object; fingers abduct; IP and MCP flex

disk grasp

• WHEN: hold disk such as jar lid

• HOW:

  • finger hold disk with ext of MCP and flex of IP; wrist flex and thumb ext with larger objects; only pads of fingers touch object

lateral pinch

• when

• how

• WHEN: to exert power on or with small object

• HOW:

  • index finger slightly flexed and thumb flexed and adduct'; pads of fingers on radial side of index finger near DIP

• EX: holding a key

pincer grasp

• WHEN: hold and handle small objects and precision tools

• HOW:

  • thumb opposed to index finger pad and object held in finger pads; ulnar fingers flexed (pad to pad)

• EX: holding a pencil, holding a coin, rolling a dough ball btw finger and thumb > using the PADS

three jaw chuck (tripod) grasp

• WHEN: hold and manipulate writing utensil or eating utensil

• HOW:

  • thumb simultaneously opposed to index and middle finger pads

tip pinch

• used to prehend and hold tiny objects

• HOW:

  • thumb opposed with thumb tip meeting index tip forming circle

object manipulation and release skill development

• 0-1ms:

  • no release

• 1-4ms

  • involuntary release

• 5-6ms

  • two stage transfer

    • taking hand grasps object before releasing hand lets go

• 6-7ms

  • one stage transfer

    • taking hand and releasing hand perform actions simultaneously

• 7-9ms

  • voluntary release

• 15ms-2yrs

  • finger-palm translation

• 2-2.5yr

  • palm-finger translation

  • simple rotation

    • unscrewing bottle cap (90deg or less)

• 3-6yrs

  • object shift

    • separating paper, turning page, shifting pencil or marker

• 6-7yrs

  • complex rotation

    • turning pencil over to eraser

bilateral hand use

• asymmetric movements until 3ms > symmetric movements until 10ms

  • by 12-18ms infant uses both hands for different functions

  • 18-24ms manipulation skills

  • 2.5yrs uses two different hands for different functions

development of prewriting and writing skills

• 8-12ms

  • mouths writing utensil & crinkles paper

• 12-18ms

  • scribbles; arm moves are unit

  • 12-16 MONTHS cylindrical grasp

  • 12-18 MONTHS palmar supinate grasp

• 2-3yrs

  • digital pronate grasp

• 3.5-4yrs

  • statis tripod

  • hand moves as unit

• 4.5-6yrs

  • dynamic tripod

  • 4-5yr: copies letters and numbers

  • 5-6yr: write name with upper and lowercase

scissor skills development

• 1-2yr

  • none

• 2-3yr

  • holds and snips; opens/closes in controlled fashion

• 3-4yr

  • cut with jagged snips

  • cut straight and curved lint with guide

  • cut simple circle using helper hand

• 4.5-5yr

  • cut simple shapes

• 5.5-7yr

  • cut complex shapes

development of drawing skills

• 1-2yrs

  • scribbles w/out intent

• 2-3yrs:

  • scribbles with intent

  • imitates vertical and horizontal lines and circles

• 3-4yrs

  • scribbles and draws more recognizable simple shapes

  • human figure with 1-3 features

• 4.5-5yr

  • intentional drawings

  • recognizable but maybe unrealistic features

• 5.5-7yr

  • detailed and thoughtful drawings

Piaget

• 4 stages

• sensorimotor

  • birth to 2yrs

  • child uses sensorimotor skills to develop understanding of world and progress from reflexive activity to cognitive function

• preoperational

  • 2-7yrs

  • progresses from dependence on perception and egocentric thoughts to logical and problem solving; engage in symbolic and verbal play

• concrete operations:

  • 7-11yrs

  • use logical thinking on observed or mentally represented objects; enjoy games with rules

• formal operations

  • 11-teens

  • logic to hypothesize problem solving and can draw from past and present experiences

early object use milestones

• 3-6 mos

  • banging and shaking

• 6-9mos

  • explores objects; pulling turning poking tearing

• 8-9mos

  • relational play; placing objects in containers

• 9-12mos

  • complex actions; opening doors, placing lids, pushing train, rolling ball

• 12-15mos

  • placing baby in carriage and pushing (simple schema combos)

• 24-36mos

  • multischema combo; put food in bowl, scoop food with spoon, and feed doll

• 36-42mos

  • complex scripts

exploratory play

• 0-2yrs

• child engages in play experiences to develop body schema

• sensory integrative and motor skills develop

• mostly with parent or caregiver

symbolic play development

• 12-18ms

  • basic make believe play, primarily involving self (sleeping, eating,)

  • imitates familiar activities

• 18-24mos

  • increases non-realistic objects in pretending (block for train)

  • inanimate objects perform familiar activities (doll washes herself)

• 2-4yrs

  • play experiences with refined ideas, emotions, and actions

creative play

• 4-7yrs

• sensory, motor, cognitive, and social play to refine skills

• explores combo of actions

• cooperative peer groups

game play

• 7-12yrs

• rules, competition, social interaction, and skill development

• cooperative peer groups

oral motor development

• 4-5mos

  • strong sucking, good lip closure, tongue moves up and down, munching

• 7-8mos

  • mastication of soft and mashed foods with diagonal jaw movements

• 9mos

  • lateral tongue mvt for effective mastication of mashed and soft foods; drink from cup but jaw not firm

• 12mos

  • jaw is firm, rotary chewing for good bite on hard cookie

• 24mos

  • able chew most foods, well-graded sustained bite, drink from cup with firm jaw

development of self-feeding

• 5-7mos

  • take cereal or poured baby food from spoon

• 6-8mos

  • attempts to hold bottle; needs to be monitored for safety

• 6-9mos

  • hold and tries to eat cracker but sucks more than bites

  • consumes soft foods that dissolve in mouth

  • grabs spoon but bangs or sucks on either end

• 9-13mos

  • finger-feeds self portion of soft table foods

• 12-14mos

  • dips spoon in food, brings spoonful to mouth but spills by inverting spoon

• 15-18mos

  • scoops with spoon and brings to mouth

• 24-30mos

  • interest in fork; stab at food; proficient in spoon

development of toileting skills

• 1-2yrs

  • knows & is distressed when wet, cooperates with changings, regular bowel movements

• 2-2.5yr:

  • POTTY TRAINING

  • regular urination, bowel accidents rare, interest in toileting, knows when they need to go, cooperates for limited time when placed on potty; may need help with clothing managment

• 3-4yrs

  • toilet on own, may need help with hygiene or clothes management (fasteners)

• 4-5yrs

  • daytime & nighttime control

  • indep on toilet but may need help for difficult clothes

• 5-6yrs

  • completely indp

development of self-dressing

• 1yr

  • cooperates with dressing, puts arms up for don/doff, extends legs, removes socks

• 1.5-2yr

  • DOFF > unfastened clothes & shoes, mittens

  • helps pull pants down, pushes arms through holes when shirt placed on head

• 2.5-3yr

  • assist & attempts to DON » easy shoes, socks

  • DONS pullover shirt, open front jacket

  • unbuttons, unsnaps, unzips (&zips when on track) easy fasteners

• 3.5-4yr

  • DON > easy shoes, elastic pants, pullover shirt, mittens

  • recognizes correct clothing orientation

  • buttons, zips, snaps, fastens, and unbuckles easy fasteners

    • large buttons, 3-4 button series

• 4.5-5yr

  • indp don/doff body clothes

  • indp with buckles

  • minimal assist for difficult fasteners & tying laces

• 5-6yrs

  • INDP > difficult fasteners & tying shoes

development of IADLs

• 2-3yrs

  • imitate chores, follow easy cleanup directions, wipes up spills, fills pet food dish

• 4-5yrs

  • prepare simple snacks, set table, empty dishwasher, sort laundry, make bed, water, feed pets, sort trash, etc.

• 6-7yrs

  • make & pack lunch, help meal prep, wash & dry unbreakable dishes, tidy up

• 8-9yrs

  • prepare hot meal, load dishwasher, wash/dry breakable dishes, walk pets, mop, fold & put away laundry

• 10-11yr

  • clean kitchen/bathroom, help with shopping, change bed

• 12+

  • meal prep, laundry & ironing, grocery shop, wash car, simple home repair, manage house machines (washer/dryer)

neonatal assessments (2)

• Assessment of Preterm Infants Behavior (APIB)

• Neurological Assessment of Preterm and FullTerm Newborn Infant (NAPFI)

Comprehensive developmental assessments (7)

1. Bayley Scale of Infant Development 3 (BSID-III)

2. Developmental Assessment of Young Children (DAY-C)

3. Denver Developmental Screening Test II

4. First STEP Screening Test for Evaluating Preschoolers

5. Goal-Oriented Assessment of Lifeskills (GOAL)

6. Hawaii Early Learning Profile (HELP)

7. PEDI

Motor development assessments

1. BOT 2

2. EDPA

3. M-FUN

4. PDMS-2

5. TIME

issues important for aging

• as you age, your body weakens and changes in every aspect; aging is complex and practice should consider an integration of theories

  • biological theory: focuses on cellular, molecular, and biological aspect of aging

  • psychological theories: address changes in cognitive, personality, and social development

  • sociological theories: considers context of aging

• older adults are likely to have less education, altered support systems (widowed, etc.), insecure income, and possess a disability

• heart disease is leading cause of death

• account for a lot of healthcare costs

age-related changes to body

• muscular system

  • muscle loss, endurance loss, balance loss > falls, sprains, tears

• skeletal system

  • degenerative joints, stiffer, loss bone mass & density, spinal weakness, posture changes > kyphosis, falls, fractures

• neurological system

  • atrophy nerves in brain, decr blood flow to brain, altered synaptic transmission, whole body nerve changes, tremors > decr speed, coordination, FM skills, cognition, homeostatic regulation

• sensory system

  • loss of fxn

    • vision loss!!!, hearing loss, tactile loss, vestibular loss

  • ALL can lead to deprivation, isolation, confusion, senility, depression, decr social, decr QoL

• cognitive system

  • Decr communication, memory, processing speed, perceptual skills

• cardiopulmonary!!!

  • inactivity, degen of heart muscle, decr blood flow, conduction changes, changes in blood vessels incr BP, decr resp capacity, unproductive resp > reduced exercise capacity, orthostatic HTN, fatigue, decr ejection, hypoxia, no cough, aspiration

    • important to assess prior to exercise

• integumentary (skin)

  • decr skin composition, decr sebaceous ax, brittle nails, loss protective barrier > skin tears & injury, dehydration, diminished touch and temperature sense

strategies to slow or reverse age-related muscular changes

• improve health

• increase physical activity

• strength training

• flexibility and ROM interventions

strategies for age-related skeletal system changes

• postural exercises

• weight-bearing

• nutritional, hormonal, and medical therapy

strategies for age-related neurological changes

• address medical problems (cerebral blood flow)

• improve health, nutrition, and smoking cessation

• incr physical activity

• motor learning and control strategies

  • incr time for rxn, limited complex sequences, allow incr cautionary behaviors, promote familiarity

    • adapt to new body

strategies for age-related vision loss

• max visual fxn (envir. mod)

• allow extra time for discrimination

• incr lighting, reduce glare

• large print, high contrast

• magnify

• eye path for diplopia

• safety education

signs & sx of elder abuse

• physical abuse

• sexual

• emotional

• financial

• physical abuse

  • individual reports abuse

  • bruises, black eyes, lacerations, fractures and dislocations

  • rope marks, restraint signs

  • broken eyeglasses, hearing aids

  • under or overdosing drugs

  • sudden change in behavior, caregiver refuses to leave them alone with visitor

• sexual abuse

  • individual reports

  • bruises around private areas

  • unexplained STI or genital bleeding

  • torn, stained, or bloody underwear

• emotional abuse

  • individual reports

  • emotionally upset, agitated, withdrawn, nonresponsive

  • unusual behavior (sucking, chewing, biting, rocking)

• financial or exploitation

  • sudden change in banking or account

  • inclusion of additional names on bank cards

  • unauthorized withdraw of money

  • abrupt changes in will or other documents

  • unpaid pills or substandard care despite funds