623 3.3 Musculoskeletal Considerations for the Elderly

discs, ligaments, joint capsules, articular cartilage, muscle, bone density

biological changes occur in these structures in elderly populations, leading to lack of ROM and inability to complete functional tasks

decreased water in nucleus, increased fibrosis of annulus

stiff disc impairments likely occur due to what two main factors?

neurologic disease, arthritis, cardiopulm complications, postural hypotension

4 general pathologic changes that occur in the elderly, which lead to stiffness and reduced function

sensory deficits

in neurologic diseases, what symptoms occur first?

CoG moves beyond BoS

How can impairments in posture contribute to balance issues in the elderly population?

Assistive devices

good remedy for people with poor posture, provides a larger BoS

forward head, increased thoracic kyphosis, hip flexion contractures, knee flexion contractures, varus/valgus, decreased/increased lumbar lordosis, loss of height

abnormal postures commonly observed in the elderly

difficult respiration, rounded and lateral scapular resting position

consequences of increased thoracic kyphosis

lack of abdominal strength

common cause of increased lumbar lordosis in elderly

arthritis

common cause of decreased lumbar lordosis in elderly

extension

- back bends, cervical retraction, chest puffing, scapular retraction, prone on elbows

intervention to treat the postural changes seen in the elderly

decreased # and size of muscle fibers, decreased rapid muscle force exertion

strength age related changes

Type 2

muscles fibers that a reduced in elderly

decreased ability to localize pain, production/use of enkephalin, report of pain d/t social pressures.

age related changes of pain in the elderly

hypokinesis

Decreased motor response especially to a specific stimulus

sedentary lifestyle (sitting in flexed posture in recliner)

what causes hypokinesis much of the time?

Insufficiency (like PVD) can lead to poor nutrient exchange and return → reduced ability for aerobic exercise

how can the cardiovascular system lead to strength impairments in the elderly?

inefficient contractions

how can the NMJ lead to strength impairments in the elderly?

increase swelling → reduced strength

how can the joints lead to strength impairments in the elderly?

PD, stroke

other pathologies that can lead to strength impairments in the elderly

↑ activity level (↑ BF to muscles), walking

interventions to improve strength in the elderly

nerve conduction, velocity, reaction times, strength

exercise has been shown to improve what three things in the elderly?

modalities, anti-inflammatory medication

warm up and cool down

repetition of functional activities

circuit training

strength programs w/ emphasis on spinal alignment

interventions that may help the elderly participate in strength training

F (looking for FUNCTIONAL)

T/F. We are looking for normal movement in the elderly populations.

near max effort

6-10s hold

5-10 reps (quality over quantity)

10s rest

3x/day, 5 weeks max

recs for isometric strengthening

Effort:

Hold:

Reps:

Rest:

Freq:

Determine 1 RM

60-80% 1RM

3 sets, 8-10 reps

1-2 min rest

3x/week, 8 weeks min

recs for isotonic strengthening

Intensity:

Sets and Reps:

Rest:

Freq:

↓ elastin and ↑ collagen

tendons + ligaments = more rigid

↓ responsive to length changes

Hypokinesis (↓ activity)

flexibility impairments in the elderly

slow, prolonged stretching

Functional ROM, not normal

encourage FREQUENT activity

flexibility interventions for the elderly

TENS, visual imagery, relaxation (yoga, tai chi), coordination w/ MD for medications

effective management techniques for the elderly

osteoporosis

a systemic, skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with a constant increase in bone fragility and susceptibility to fracture

1 - 2.5 SD

BMD between these two standard deviations below adult peak mean without evidence of fractures would be considered osteopenia

2.5

BMD at at least what standard deviations below adult peak mean without evidence of fractures would be considered osteoporosis

2.5

BMD greater than what standard deviation below adult peak mean with history of one or more fractures would be considered severe osteoporosis

men

which gender has the highest bone density

menopause

when do women experience a dramatic drop in bone density?

Sex, age, race, family history, tobacco, lifetime exposure to estrogen, meds, calcium deficiency, sedentary lifestyle, alcoholism, depression

RFs for osteoporosis

hormone replacement therapy

selective estrogen receptor modulators

bisphosphonates

calcitonin

4 txments for osteoporosis

estrogen

side effect, increased risk of breast or uterine cancer

risks and examples of hormone replacement therapy

Raloxifene (Evista)

mimis estrogens effects on bone density and blocks effect of estrogen on breast and uterine tissue

effects and examples of selective estrogen receptor modulators

Fosamax, Didronel, Actonel

Inhibits bone breakdown/binds permanently to bone surfaces and limits osteoclast activity

effects and examples of bisphosphonates

hormone that regulates bone metabolism

reduces bone resorption and may slow bone loss

effects of Calcitonin

postural alignment (extension)

high impact strengthening

WB exercises

essential exercise fo osteoporosis

protects from further loss

how will walking affect bone mineral density?

increase

how will weight training or running affect bone mineral density?

none

how will swimming affect bone mineral density?

pain management, transitional movements in safe range, orthosis (jewett)

Treatments of compression fractures which may result from osteoporosis

Kyphoplasty, Vertebroplasty

pain control options for compression fractures

kyphoplasty

Use of a balloon in the vertebral body to contain bone cement, which is typically performed in the thoracic spine

t

t/f. kyphoplasty and vertebroplasty DO NOT alter stability of the spine, but only help with pain

vertebroplasty

surgical repair of a vertebra (usually performed for compression fractures due to osteoporosis), which inserts cement into the bone; typically performed in the lumbar spine

pain management w/ modalities

bedrest possibility

therapeutic exercise addressing postural awareness

acute phase of PT intervention post compression fracture

walking program

therapeutic exercise (strengthen abdominals, back extensors, scapular retractors)

Avoid lifting >10#

Avoid flexion

sub-acute phase of PT intervention post compression fracture

MD guidelines

exercise tolerance via RPE or VAS

precautions to take in PT intervention post compression fracture

sitting >30 min at a time

The activity pyramid for people over 60 recommends "cutting down" on what?

flexibility and balance

aerobic and recreational activities

Muscle strengthening

The activity pyramid for people over 60 recommends what activities "throughout the week"?

walking or some light household chore

The activity pyramid for people over 60 recommends what activities "every day"?

2-3x

how often should we recommend doing yard work or house cleaning & strengthening a week?

3-5x

how often should we recommend doing aerobic activity and swim/golf/tennis a week?

every day

How often should we recommend walking at home, taking the stairs, or parking further from the store?