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Falls are the ____ leading cause of death in people over 75 years
7th
____% of adults over 75 years ago have had injurious falls acquire a fear of falling
48%
____% begin avoiding situations that require refined balance skills
26%
Decreased balance control is a major factor affecting loss of independent ____
Mobility
____ factors affecting aging:
- changes in gene expression that result in changes in hormonal function, aging & death
Primary
____ factors affecting aging:
- experiential and include nutrition, exercise, stress level, and acquired pathologies
Secondary
_____ ____ is adults observed walking spontaneously in a natural setting
Naturalistic approach
Measures of gait variability are predictive of future ____
Falls
Gait variability measures significantly ____ in older adults who fell
Increase
____ ____ is the extent individuals performance varies from trial to trial in repeated task
Intraindividual variability
Older adults have ____ levels of muscle responses and different activation sequences among leg muscles than young adults during walking
Higher
___-___% of falls in older adults result from tripping over an object
35-47%
A ____ rate of development of muscle activation contributes to inadequate recovery from trips, leading to falls
Lower
How quickly restorative forces can be generated is critical to recovery of ___
Balance
Older adults are less _____ after slips than young adults
Stable
Older adults slip ____ & _____ and fall more often than younger
Longer & faster
Older adults have difficulty generating efficient reactive postural responses when they ___
Slip
Slips account for ____-___% of falls and subsequent injuries in older adults
27-32%
___ ___ strategies:
- modify gait in response to environmental challenges to walking
Visually activated
_____ strategies:
- modify gait parameters to minimize destabilizing effects associated with tasks
Predictive
Trips under ____ ____ are a major cause of falls in older adults
Obstacle crossing
Older adults need to begin making modifications to gait patterns ____ to a step requiring obstacle avoidance
Prior
Decreased ____ ____ is a contributor to locomotor changes in older adults
Muscle strength
______ conditions are underlying contributing factors to changes in gait pattern seen in older adults
Pathological
There is reduced _____ associated with peripheral neuropathy
Somatosensation
Peripheral nerve dysfunction is associated with _____ in walking speed
Slowing
Poor ____ is associated with poor walking performance in older adults
Vision
Older adults monitor terrain during walking ____ than younger adults do
More
Age related slowing in walking speed is in part a function of decreased magnitude of ____ repsonse (vestibular)
Saccule
Sensory/motor aspects of performance require more _____ control as individuals age because of frailty, sensory deficits, and problems in sensory integration
Cognitive
____ is critical to maintaining independence
Mobility
Impaired _____ is one of the earliest and most characteristic symptoms of neurologic disorders
Mobility
____/____:
- reduced ability to generate force (primary contributor to disordered gait)
- primary neuromuscular impairment affecting number, type, and discharge frequency of motor neurons
- affects neural and non neural components of force production
- significant reduction in muscle activity in both PF & TA
- weak quads (difficulty controlling knee flexion during loading and midstance)
- hip flexor weakness (affects swing phase of gait)
- hip extensor weakness (forward trunk lean —> threatens stability)
- weak hip ABD (drop of pelvis on side contralateral to weakness —> trendelenburg gait)
- loss of eccentric & concentric contractions
- effect on gait speed
Paresis/weakness
______:
- alters mechanical properties of a muscle producing increased stiffness
- inappropriate activation of a muscle during gait cycle when being rapidly lengthened
- frequent accompaniment of neuro disorders
- quad spasticity (excessive knee extension in stance phase of gait)
- hamstrings spasticity (excessive knee flexion; frequent problem in CP)
- hip ADD spasticity (contralateral drop in pelvis during stance)
Spasticity
_____ spasticity:
- common problem following neuro injury, stroke, CP, TBI
- contributes to pathologic gait patterns in stance and swing phases of gait
PF
Impaired ____ can manifest as:
- coactivation of agonist and antagonist muscles
- abnormal phasing of multi joint movement leading to poor intersegmental coordination
- increased activation of muscles unrelated to spasticity mediated stretch
Coordination
_____ impairments:
- change in alignment
- weakness
- loss of ROM & contractures
MSK
____ balance strategies integrated into gait cycle are necessary to recovery of stability following unexpected perturbation
Reactive
Performance of ____ walking tasks are predictors of adverse health outcomes in geriatric neurologic populations
Complex
____ diminishes the ability to modify gait in response to terrain changes
Stroke
Abnormal somatosensory inputs result in ____ ____
Gait ataxia
Ataxia is worse when ____ cues are reduced or inappropriate
Visual
____ inputs regulate gait on a local (step by step basis) level and global (route finding) level
Visual
____ ____ deficits:
- ipsilateral trunk lean toward stance leg resulting in loss of stabilty
Body image
Impaired ____ ____:
- inappropriate foot placement and difficulty in controlling COM
Body image
____ gait is a gait pattern that results from pain
Antalgic
____ _____ disorders affect the ability to navigate safely though environment, avoiding collisions with obstacles
Spatial relation
Not all patients who have had a ____ will have a gait disorder
Stroke
Posture, balance, and gait require ___ ____
Attentional resources
Attentional demands with postural control in stance and gait are ____ in individuals with impaired balance
Greater
It is important to evaluate walking function under more ______ conditions in people with neuro pathology
Complex
There is a great deal of ____ among patients even with the same diagnosis
Heterogeneity
Management of ____ problems is the key to return to functional independence in patients with neuro pathology
Mobility
Measuring ____ ____ is the single best measure of gait function
Gait velocity
____ evaluation:
- strength
- ROM
- tone
(In passive situations)
Static
____ evaluation:
- examines patient performing functional movements
Dynamic
______ measures:
- documents level of function and helps predict disability
Functional
____ examination:
- determines resources and constraints affecting gait and other aspects of mobility function
Static