Transcription of STRENGTHENING THE Geriatric patient for function
1 1 STRENGTHENING THEG eriatric patientfor functionInstructor: Michelle green , MS, PTRehab Summit 2012 Friday, May July 27th4:15 6:16pmSESSION 307 STRENGTHENING the Geriatric patient for FunctionMichelle green , MS,PTCross Country EducationLeading the Way in Continuing Education and Professional Development. comply with professional boards/associations standards: I declare that I or my family (do, do not) have any financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation.
2 Additionally, all planners involved do not have any financial relationship. Requirements for successful completion are attendance for the full session along with a completed session evaluation form. Cross Country Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with CarolinaI live here2 CAPE FEAR HEALTH SYSTEM500 BED ACUTE CARE70 BED IN- patient REHAB FACILITYWHAT DO OUR patients SAY THEIR GOALS ARE?Getting to the bathroom3 WHAT DO OUR patients SAY THEIR GOALS ARE?Getting to the we give DO OUR patients SAY THEIR GOALS ARE?
3 Walk like beforeWHAT DO OUR patients SAY THEIR GOALS ARE?Walk like beforeSo, we give DO OUR patients SAY THEIR GOALS ARE?Walk like beforeSo, we give get INTO A INTO A LEARN A FREE THROW???5 WOULD MORE MORE LEARN BACH ON THE PIANO?WE EXPECT A COACH TO KNOW THE MECHANICS OF THE A THERAPISTSHOULD KNOW THE MECHANICS OF THEIR A THERAPISTSHOULD KNOW THE MECHANICS OF THEIR WOULDN T PAY A COACH IF THEY DIDN T KNOW THE BASIC MECHANICS OF THEIR from baseball skills coaching manual:They learn to focus on the task at hand and repeat each skill until the proper response is a habit when they are playing.
4 Each drill is designed to address a specific skill that is essential for the player to succeed in baseball COACH then sets up drills with similar demands, directional changes, muscle activation patterns and speeds of movements as the sport he is train differently then SENIORS NEED A COACH TO GET THEM BACK INTO DO SENIORSSTRENGTH TRAIN?To achieve aesthetically appealing musclesTo achieve bulk and power for competitionTo maximize efficiency and safety of movement in many activities of interestWHY DO SENIORSSTRENGTH TRAIN?8 WHY DO SENIORSSTRENGTH TRAIN?
5 To achieve aesthetically appealing musclesTo achieve bulk and power for competitionTo maximize efficiency and safety of movement in many activities of interestFUNCTION!!!OUR GOAL: function NOT FORMMODEL BASED ONTASK ANALYSISVERSUSREPS/SETS AND WEIGHT SELECTION(we restore function not personal train!)LET S LEARN TO MAKE OUR EXERCISES COUNT, TO BE COACHES OF HUMAN MOVEMENT9 PLAN OF ACTIONALIGNMENTTRUNK INITIATIONMUSCLE ACTIVATION HOW IS MUSCLE USEDRE-EDUCATEONE TASK AT A YOUR THOUGHT MODELW erner AS, Use of the ICF Model as A Clinical Problem-Solving Tool in Physical Therapy and Rehabilitation Medicine.
6 Phys Ther 2002: 82:11; 1098-110710 ACTIVITY(dressing, bathing, walking, steps, transfers)will improve ONLY when theidentified IMPAIRMENT is : Min assist for sit- s: Mod assist for dressing. Max assist for lower body information helps you come up with relevant, SKILLED treatment????ACTIVITY(dressing, bathing, walking, steps, transfers)will improve ONLY when theidentified IMPAIRMENT is : Laundry list of problemspoor balance, poor strength, poor ROMBETTER: Specific impairments for EACH assist sit- stand due to dec. ant pelvic tilt, poor closed chain push through hip extensors, unable to sustain quads once : Sit- stand min assist for ant pelvic tilt to come forwardADL s: Mod assist for dressing to attend to left side of will I work on for transfers?
7 What will I work on in ADL s?11 CHANGE YOUR THOUGHT of Mrs. Jones has poor posture. Let s do postural re-education. What about Mrs. Jones posture is limiting her in wheelchair propulsion? Instead of Mr. Owens has weak LE s, let s do ther ex to make them stronger What do we need to strengthen in Mr. Owen s legs to improve his sit to stand What do we need to strengthen in Mr. Owen s to make it eaasier to get his pants on? WHY ALIGNMENT?To Ensure Best Muscle Length for Best Activation PotentialMuscle is too short, not enough cross bridges can be formedMuscle too long, not enough cross bridges can be formedBOTH RESULT IN LIMITING TENSION/ACTIVATION POTENTIALAUGUST 22, 2008 SEPTEMBER 5, 2008 NOT DIAGNOSIS BASED!
8 !!A stroke. No, MS, no, incomplete SCI, no left THR with resp. failure in surgery. No, drug overdose with chest tube on left T MATTER!!!! Alignment 1st!!!!!!12 ALIGNMENTW hich task? PICK ONE TASK AT A we in best alignment? USE BASIC PLUM LINE Do we need to stop and do remedial work to get the body ready for alignment ROM joint mobs muscle lengthening soft tissue workSOMETIMES YOU HAVE TOGO BACK BEFORE YOU GOFORWARD WITH THER EX!ALIGNMENT consider THER EX to address these impairments:BEFORE the ther ex needed to improve the strength for the Won t get strong if not aligned!
9 PEC LENGTHENINGSCAP RETRACTIONSCAP DEPRESSION/LAT ENGAGEMENTTRUNK SYMMETRY (LENGTH AND ACTIVATION CORE ENGAGEMENTPELVIC ALIGNMENT ON ALL PLANESTRUNK INITIATIONW here does the trunk initiate the movement for that task?Is the patient able to get into that position? If not, then THERE S YOUR EXERCISE!If it does, then move MOVEMENT OF INITIATIONUPPER TRUNK OR LOWER TRUNKPLANESSAGITTAL, FRONTAL, TRANSVERSE, DIAGONALSTRUNK MOVEMENT PATTERNSUPPER TRUNK INITIATED MOVEMENTS SAGITTAL Flexion: bend down to pick up pen Extension: look at clouds above DIAGONAL Flexion: reach to opposite side foot.)
10 Sit- supine Extension: reach up and behind (seatbelt) FRONTAL Flexion: place glass on floor to side TRANSVERSE Rotation: look over shoulder behind youNORMAL TRUNK MOVEMENTUPPER TRUNK INITIATED MOVEMENTLESS ADL SBEGIN WITH THESE PATTERNS14 TRUNK MOVEMENT PATTERNSLOWER TRUNK INITIATED MOVEMENTS SAGITTAL Anterior Tile: sit stand Posterior: lifting foot to tie shoes DIAGONAL Anterior Tilt: Reach outside BOS at angle Posterior Tilt: crossing legs to put on shoes FRONTAL Lateral reach outside of base of support TRANSVERSE Rotation: scooting forward and back on mat in sittingNORMAL TRUNK MOVEMENTLOWER TRUNK INITIATED MOVEMENTBASE OF MOST ADL SWHERE IN THE TRUNK ARE THESE TASKS INITATED?
