1. Physical Therapy Interventions with Elderly Patients
Dr/ Rehab F. Gwada

2. Physical Therapy Interventions with Elderly Patients
Physical therapists evaluate and develop specifically designed, therapeutic exercise programs.
Physical therapy intervention can prevent life-long disability and restore the person's level of functioning to its highest level.
Recent trials suggest healthy older women are capable of exercising and increasing the exercise intensity by exercise training (ET) similar to young women

3. General goals of physical therapy program
Functional independence is the ultimate goal of PT intervention. Short term goals include:-
Reduce pain
Improve sensation, joint proprioception
Increase overall fitness through exercise programs
Suggest assistive devices to promote independence
Recommend adaptations to make the person’s home accessible and safe

4. General goals of physical therapy programme
Prevent further decline in functional abilities through :
Education
energy conservation techniques
joint protection
Increase, restore or maintain range of motion, muscular strength, flexibility, coordination, balance and endurance
Teach positioning, transfers, and walking skills to promote:
maximum function
independence within the person’s capability
What are energy conservation techniques?
Energy conservation techniques are ways to modify activities to prevent exhaustion. Using these strategies to do the things you have to do may help you to have energy left over to do the things you want to do
What are some examples?
• Pace activities and spread them throughout the day/week.
• Plan the day in advance so that you won’t feel rushed.
• Break up tasks into small steps and rest in between.
• Sit down instead of standing for most any activity.
• Work with arms below the shoulders as overhead activities are more taxing.
• Avoid ironing by buying clothing made from wrinkle resistant fabrics

5. Forms of Geriatric Physical Therapy modalities
Exercise
Manual Therapy
Electrotherapy modalities
Education

6. Forms of Geriatric Physical Therapy modalities
Exercise
Manual Therapy
Electrotherapy modalities
Education
Exercise is defined as any form of physical activity that is beyond what the person does while performing their daily tasks.
Exercise is something that is designed to:
maintain and improve a person’s coordination, muscle strength, flexibility and physical endurance, as well as their balance. all contribute to functional activity improvement .
increase the mobility
lessen the chance of injury through falling.

7. Balance &Gait training
Exercise
Exercise
ROM
stretching,
Mobilizing ex.
Strengthen ex.
Aerobic ex.
Balance &Gait training
Exercise in relation to geriatric therapy might include activities that are geared towards a particular injury or limitation.
A physical therapist works with the person, teaching them to exercise on their own, so they may continue their exercise program at home.

8. Muscle strength
Limitation daily activities due to sarcopenia, loss in muscle strength can be partially or totally solved with the practice of strength training and weight-bearing
Generally strength training of antigravitational muscles is the most important measure to achieve better functional activity and carry out activities.
The most trained anti gravitational muscles act on knee, hip and trunk extension

9. Considerations of strength training for Elderly patients
Correct alignment: determine by direction & line of pull of muscle fibers.(e.g.Quadriceps strengthen from high sitting position)
Appropriate stabilization: to avoid trick movement.
Smooth movement (produce movement without shaking or jerking
Breathing guidelines( start with inspire before lifting and exhale during lifting , avoid holding breath.
Frequency: 2-3/week for 3 sets of 10 RM/ session.
Rest intervals(1-2 min between sets in same session)
NB: active recovery is more efficient than passive recovery for neutralizing the effect of muscle fatigue

10. Considerations of strength training for Elderly patients
Mode : both static & dynamic
Make sure  you warm up at least 10 minutes before exercise and cool down for at least 10 minutes after exercise.
stop the exercise if patient feel pain in joints.
Maintain a good upright posture during all exercises.
Instruct the patient to don’t grip the weights tightly
All movements should be done in a slow to moderate and deliberate manner.

11. Cont. Type of resistance:-
Body weight: for very frail elderly and fir initial training.
Manual resistance: for PT. who can tolerate body wt.
Mechanical resistance: simple( free weights, sand bags, elastic resistance) and complex compact, space –consuming and expansive equipment (a computerized isokinetic dynamometer)
NB: in case of old olds complex equipment should not be used , as it may result into muscle soreness or inhibition

12. Precautions of mobilization ex. for Elderly patients
They should not applied too vigorously, otherwise cause jt. Trauma or hypermobility in elderly
In elderly patients with weakened CT. , decrease circulation and osteoporosis ,used gentle mobilization techniques such as gliding and jt. Distraction within tolerance of tissue
Comfortable stabilization of a proximal bone to prevent undue stress
Joint distraction applied perpendicular to treatment plane and gliding technique applied parallel to it.

13. Electrotherapy modalities
Manual therapy
Manual therapy is applied with the goals of:
improving the person’s circulation
restoring mobility they may have lost due to an injury or lack of use.
reduce pain.
Manual therapy can include manipulation of the person’s joints and muscles, as well as massage. -
Exercise
Manual Therapy
Electrotherapy modalities
Education:

14. Electrotherapy modalities
Education
Education is important to the success and effectiveness of geriatric physical therapy.
Physical therapists teach elderly how to :
perform daily tasks safely.
use assistive devices
protect themselves from further injury.
Older adults can utilize physical therapy as a means for regaining their independence.
Physical therapy can help seniors to feel better, as well as to enjoy a higher quality of life
Exercise
Manual Therapy
Electrotherapy modalities
Education

15. Electro therapeutic modalities
Electro therapeutic modalities included cold & heat modalities , electrical stimulation currents, and laser therapy .
Their effect include:
Improve healing tissue by minimizing continuing damage & facilitating repair .
Reduce pain
Maintain tissue healthy during inactivity
In geriatric, should remember the principle & appropriate dose of electrotherapy modalities
At higher levels of stimulation the effect becomes inhibitory or progressively more damaging.

16. Considerations of using heat & cold modalities in geriatric patients
Firstly assess ability to tolerate the change in body temperature
Check patient history carefully for the presence of chronic disease which may alter the response to temperature changes e.g. diabetes
Factors contributing to increase risk of thermal injury in elderly :
Decrease reactivity of
Hypothalamic thermoregulatory system
Impaired of circulatory sysrem
Loss of sweat gland
Atrophy of skin with reduction in circulation
Decrease perception of thermal gradients .

17. Considerations of using electrical stimulation current in geriatric patients
Electrodes should be moist or adequately covered with transmission gel.
Electrodes should be secured in position , constrictive or moist strapping should be avoided.
Never allow the full weight of body or a heavy limb to rest in electrodes, to avoid burn
Treatment time minutes
Current intensity should be minimal
Visible contraction at patient tolerance better than maximum contraction
Thin &dry skin of elderly must be provide extra care to avoid irritation and burn
Avoid electrical stimulation in presence of pacemaker.

18. Any Q?