Dr. Brown – PT 8390 What evaluation tools to use?

1. Dr. Brown – PT 8390What evaluation tools to use? • Patient Mary P. 88 year old women with history of hypertension, c/o of periodic dizziness • Other problems: arthritis of spine with marked height loss of 6 inches • Very limited household ambulator

2. What evaluation tools to use? • Patient: Almost 80 year old man who wants to celebrate his 80th birthday by hiking up to Mt. Everest base camp and then climbing to Camp I which is at ~21000 ft. • His goal: to be in the best shape possible. • Your goal: to put him in the best shape possible

3. What evaluative tools to use? • Your patient is 77 years old. Male widower • Dx: osteoporosis, CHF, PVD, Stage I kidney failure. • Living along in a 2-story house. Bedroom upstairs, does laundry in basement • Stooped posture, shuffling gait, slow movements…. • Goal: remain independent in the home

4. What evaluative tools to use? • Patient: 92 year old spry female who is incredibly thin, stooped • Dx: osteoporosis, a “touch” of “heart trouble” • Goal: less fatigue during volunteer jobs, more stable (fear of falling)

5. Summary • Pick evaluative tools that will provide objective data • Pick assessments that help with functional goal setting • Choose evaluation tools that are consistent with the problems or complains the patient has

6. Treatment approaches- Strength • Isokinetic • Advantages • Disadvantages • Isometric • Concentric • Advantages • disadvantages • Eccentric • Advantages • Disadvantages

7. Strength training cont’d • Open chain • Advantages • Disadvantages • Closed chain • Advantages • Disadvantages • Functional training • Advantages • Disadvantages

8. Strengthening Velocity training Power training 40% 1-RM vs 80% 1-RM Reps Hypertrophy vs. hyperplasia

9. Percent Weeks of Training

10. Percent gain in strength Weeks of Rx

11. What IS strength gain? • Hypertrophy • Increase in individual fiber size through addition of satellite cells, sarcomeres • Increase in contractile proteins: actin and myosin • Concomitant increase in connective tissue

12. Fiatarone et al • Strength trained 9 men and women that averaged 90 years of age. • Knee extension with free weights for 8 weeks • 270% increase in strength!!!!!!!!! • How??? What does this mean?

13. Treatment approaches- Gait • Important components • Stability (isometric mostly) • Flexibility (adequate ROM) • Speed of movement • Coordination (a component of balance) • Direction changes • Modulating fast and slow speeds

14. Exercises for Stability • Manual Resisted gait, resisted standing • Weighted gait belt, backpack, ankle weights • Resisted getting up from a chair, sitting down • Resisted turning at the head, trunk, pelvis • Reduced base of support, with resistance • Strength machines have some carry-over

15. Exercises for gait flexibility • “Mother may I”……. • Specific ROM exercises for deficits at hip, knee and ankle • Obstacle course…high objects to step over, large “streams” to step over etc. • Practicing larger than normal and smaller than normal steps in sagittal and frontal planes

16. Exercises for gait speed • Walking fast and slow- alternate quickly • Practice crossing the street • Use a treadmill and increase speed incrementally, but with time to adapt • Put a 50 ft walkway in the middle of the gym: time the participant repeatedly. Encourage to walk as quickly as possible (please use gait belt!) • Additional benefit: cardiovascular

17. Exercises for gait coordination • Side stepping • Crossing one foot over the other in sagittal plane • “Braiding” • “Put your left foot in, and put your left foot out….” • Dance steps • “lion hunt” • Nu-step device

18. Exercises for direction/speed • While walking have person “stop”! Repeat stop and start multiple times • Walk forwards and backwards, sideways, alternating speeds • For extra challenge and for balance, close eyes periodically • Others?

19. Treatment approaches- Balance • Start with what your evaluation says is deficient……… • One leg stand • Romberg postures • Turning whole body • Turning head and trunk • Reaching to floor • Others?

20. Balance exercises • Rocking side to side, forward and back • Balancing on unstable object • Stepping over objects • Stepping up to objects • distractions- conversation, counting • Obstacle courses • Eyes open and closed

21. Balance exercises • “Mine field” • Walk on toes and heels • Dance steps- waltz, tango, fox trot • Conga line • Avoid “cracks” in floor while walking • Look up instead of at floor • Others?

22. Treatment approaches- Cardiovascular endurance • Most effective: increase time of any exercise, particularly walking • Increase speed of any activity- TM, gait, cycle rpm • Fahrtlik approach- 10s on, 10s off…. • Increase difficulty of any exercise that is repetitive….walking with weighted vest or resistance, increase wattage on bike, increase uphill angle of treadmill

23. Cardiovascular endurance • Work on getting from point A to point B as quickly as possible • Teach people how to take their own heart rate……set target heart rate for each activity • Set up an inside or outside endurance program • In the mall…..Sears to Penny’s for example • PedNet, MKT….with markers.

24. Treatment approaches- ROM • Stretching exercises must be held at least 10s to be effective……….and repeated at least 4x! Continue to get additional benefit up to 7 stretches held for 10s. • Optimal stretch- hold 1 minute. • Functional approach • Bending, stooping, reaching…….

25. Treatment approaches- speed, coordination • Increasing the speed of any activity • Hand to nose • Foot to line • Walking • Throwing • Kicking • Turning • Fine motor tasks