working with the older client part 1 article 2016

7/26/2019 Working With the Older Client Part 1 Article 2016

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Working with the older client: Part 1By Chris Gellert, PT, MMusc & Sportsphysio, MPT,

CSCS, MS

!ntroductionAccording to the 2012 Census, people over the age of 65 make upalmost 14% of the U population! "hat means there are over 4#million seniors $adults 65 or older toda&, 'ith the num(ers continuingto gro', reaching )0 million (& 20#0! "his aging population creates auni*ue opportunit& for the +tness professional to 'ork 'ith! n thisarticle, 'e 'ill revie' the e-ects of aging on the musculoskeletals&stem, learn simple functional assessments and understand (ene+tsof strength strengthening! n part 2, strength training guidelines andprogramming for common aging conditions 'ill (e discussed!

"#ects o$ ging on the Musculoskeletal Syste%"he aging process involves changes to various structures andnumerous s&stems 'ithin the (od&! .esearch has sho'n that skeletalmuscles change 'ith age, speci+call& t&pe , 'here there is adecreased in these +(ers, that atroph& over time, and decrease in si/e$runner et al! 200)! .esearch has consistentl& sho'n that musclestrength decreases 'ith age$indle ., etter 3! 1)!h&siologicall& it has (een studied that maimal strength capacit&reaches a peak sometime around the second or third decade of life,and (& the +fth decade, (egins a gradual decline$eterson et al!

2010! "he strength of people in their 70s is a(out 40% less than thatof people in their 20s$Chiung89u iu, 2011! "he decline in musclestrength is associated 'ith an increased risk of falls and ph&sicaldisa(ilit& in older adults!

unctional assess%ents o$ older clientBalance testsAssessing an older client:s (alance needs to (e o(;ective and notguess'ork! "here are man& tests availa(le, (ut $eware o(;ective,measurea(le, and supported 'ith research as the timed up and go testand the sit to stand test!

1'Ti%ed (p and Go TestUse a standard armchair! lace the line ten feet from the chair! "hescore is the timetaken in seconds to complete the task! "he su(;ect is encouraged to'ear regularfoot'ear and to use an& customar& 'alking aid!


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Gi)e the $ollowing instructions:= .ise from the chair= >alk to the line on the ?oor $10feet

= "urn, return to the chair= it do'n again

igure 1* T(G testScoring:ersons 'ho take 10 seconds orless to complete this se*uence ofmaneuvers are atlo' risk of falling! ersons 'ho take @20 seconds to complete thisse*uence are at high risk of falling$ohannon, .>!, 2006!

+'Sit to stand testave the client sit 'ith their (ack against the (ack of the chair! Ask

the client to stand from the seatedpositing, counting each stand aloud sothat the client remains oriented! topthe test 'hen the patient achieves thestanding position on the 5threpetition!

Scoringge -or%s:

igure +* Sit to stand test

.' unctional s/uat"he s*uat is a classicfundamental primal movement someone t&picall& performa dail&(asis! >hether it is to perform to pick something up or move something! "he s*

amovement that re*uires proper ankle and hip mo(ilit&, 'hile sta(ilit& is re*uirethe kneeand lum(ar spine! Understanding the functional anatom& and muscle recruitmefundamental'hen prescri(ing this eercise 'ith an& client!

ge Ti%e0seconds'

6086 11!4)08) 12!67087 14!7

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igure .* S/uat picture igure * S/uat analysis

Mo)e%ent nalysis:As the (od& descends,the hip ?eors concentricall& contract 'ithslight lum(ar ?eion, 'hile the knees undergo ?eion, glute maimusand hamstrings eccentricall& contract! At the ankle, dorsi?eionoccurs, 'here the anterior ti(ialis$concentricall& contracts 'hile thegastrocnemius eccentricall& contracts!

.eturning to an upright position0)ertical),the opposite occurs! "hehip ?eors eccentricall& contract, there is slight lum(ar etension,'hile the knee transitions from ?eion to etension! ip etensionoccurs via the glute maimus, 'hile the hamstrings concentricall&contract!

Ankle plantar ?eion occurs 'ith the concentric contraction of thegastrocnemius 'hile there is eccentric contraction of anterior ti(ialis!

Bene2ts o$ Strength Training $or i%pro)ing $unctionin older adultsMuscles 3ehind the %o)e%ent"here are numerous (ene+ts of strength training for older adults!o'ever, it is important to understand the muscles (ehind ever&da&

movement! arge muscle groups, including shoulders, arms, trunk,hips and legs, are important to perform activities ofdail& living$ABs and are suscepti(le to the agingprocess, training should targets these muscle groups!"he latissimus dorsi muscle $assists 'ith sit to stand!lute maimus is a primar& hip etensor muscleinvolved in 'alking and clim(ing stairs! "he hamstringmuscles are important in ?eing the knee and etending the

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http://en.wikipedia.org/wiki/Flexionhttp://en.wikipedia.org/wiki/Flexion


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hip, 'hich are involved in ever&da& activities such as 'alking, sit tostand, and negotiating stairs! lute medius and minimus muscles arelateral sta(ili/ers that are important for getting in and out of (ed orcar or stepping into a (athtu(!

4esearch: Bene2ts o$

Strength Training and Balancetrength training ph&siologicall& improves strength of (ones andconnective tissue, si/e of fast and slo'8t'itch +(ers, reduces (loodpressure, improves (lood ?o' 'ith man& more (ene+ts! .esearch hassho'n speci+call& that strength training improves gait%echanics$ersch et al! 200, reduces the risk for $allsin theelderl& $Darlson, D et al! 201#, "rom(etti, A et al! 2011, herringtonet al! 2007 E Fhen8o, Cao, et al 2006!

alance de+ned is de+ned as the a(ilit& to maintain an uprightposture during (oth

static and d&namic tasks$en;u&a, el/er, E Daplanski, 2004!aintaining (alanceinvolves a comple interaction among the sensor&, vesti(ular andvisual s&stems!

Aging dampens reaction time and muscle strength impairing, in somepeople, the a(ilit& to control a fall! n older adults, possessing lateralsta(ilit& is a ke& contri(utor to maintaining (alance control! ateralsta(ilit& is controlled (& (oth the glute medius and glute minimusmuscles $Grr, .!, et al! 2007!

t has (een sho'n there are several contri(uting factors thatcontri(ute to a person 'ith falling! Gne ma;or factor is leg weakness,particularl& in hamstrings and glute maimus! >hich has (eencommonl& reported as an important fall8risk factor! ndividualsehi(iting this sign have 4! times the risk of falling than people 'ithnormal strength $ird, ! et al!, 200, E .u(enstein, 2006!

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igure 5*Glute %edius %uscle

igure 6*Glute%a7i%us%uscle


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tudies (& $


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American eriatrics ociet& and ritish eriatrics ociet&! 2011!Kummar& of the Updated American eriatrics ociet& ritisheriatrics ociet& Clinical ractice uidelines for reventions of Hallsin Glder ersons!:Journal of American Geriatric Society, vol! 5!,issue 1!, pp!147815)!

en;u&a, el/er, E Daplanski, 2004, KAging8induced shifts from areliance onsensor& input to muscle cocontraction during (alanced standing,: KTheJournals of Gerontology,

eries A, iological ciences and edical ciences, vol! 5, issue 2,166!

ird, ! et al!, 200, K3-ects of .esistance and Hlei(ilit& 3ercisenterventions on alanceand .elated easures in Glder Adults,:Journal of Aging and PhysicalActivity, vol! 1), pp! 4448454!

ohannon, .>!, 2006, .eference values for the timed up and go testIa descriptive meta8anal&sis!Journal of Geriatric Physical Therapy, vol!2, issue 2, pp!64867!

runner, H!, et al! 200), K3-ect of Aging on keletal uscles,:Journalof Aging and Physical Activity, vol! 15!, pp! ##68#47!

uatois, !, et al! 2010, A simple clinical scale to stratif& risk ofrecurrent falls in communit& d'elling adults aged 65 &ears and older!Journal of Physical Therapy0, vol! 4, pp! 5508556!

Cadore, 3!, 201#, K3-ects of Bi-erent 3ercise nterventions on .iskof Halls,ait A(ilit&, and alance in h&sicall& Hrail Glder AdultsI A &stematic.evie',:Rejuvenation Research,Jol! 16,


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Darlson, D et al! 201#, Krevention of falls in the elderl&I A .evie',:steoporosis !nternationalvol! 24! pp! )4)8)62"

en/, et al! 2005, KHoot and Ankle .isk Hactors for Halls in GldereopleI A rospective tud&,:Journal of Gerontology# $iologicalScience,vol! 61, issue 7, pp! 766%&'("

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+'41!

herrington, C!, et al! 2007, K3-ective 3ercise for the revention ofHallsI A &stematic .evie' and eta8Anal&sis,:Journal of theAmerican Geriatrics Society,vol! 56, ssue 12, pp! 22#48224#!

"rom(etti, A!, 2011, K3-ect of usic8ased ultitask "raining onait, alance, and Hall .isk in 3lderl& eople A .andomi/edControlled "rial,:Archive !nternal )edicine,vol! 6, pp! 52585##!

Fhen8o, Cao, et al 2006, K"he 3-ect of a 128'eek Com(ined 3ercisentervention rogram on h&sical erformance and ait Dinematics inCommunit&8B'elling 3lderl& >omen,:Journal of PhysiologyAnthropology,pp! #258##0!

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working with the older client part 1 article 2016

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