Geriatric Physical Therapy

Outlines

Impaired Posture

Ambulation
Posture

Good posture
Bad posture

◦ Energy
◦ Efficient
◦ Stress

Static
posture
Dynamic posture

Active posture
Passive posture
Posture

The alignment and positioning of the body in relation to

◦ Gravity
◦ Center of mass
◦ Base of support.

Optimal
◦ Muscular & skeletal balance
◦ Protection

Less than optimal

◦ Faulty relationship or balance
◦ Strain
Easy posture
Fatigue posture
Rigid posture
Habitual posture
Overstretch of extensor & over contracted
of flexors

Forward head posture

Shortening of sub occipital muscles
(extensors)

Lengthening of pre vertebral muscles

(flexors)
Thoracic khyphosis

Till40 year constant

After 40 year …..Women

Hyper khyphosis

40 degree
Fall risk
Compression fracture
Respiratory complication
Lordosis

Excessivelordosis
 Low back pain

Age related changes

Bone
Disc
Height decrease 0.1% per year in women & 0.02% in
men
45 year of age
Ligamentous flavum
Role of posture in common spinal
condition

Osteoporosis
Osteopenia
Spinal Osteoarthritis
Spinal stenosis
  Osteoporosis is common
 Over 50% of women and 30-45% of men over age 50 have
osteopenia/osteoporosis

 Osteoporosis as a disease characterized by low bone mass and micro

architectural deterioration of bone tissue, leading to increased bone
fragility and a consequent increase in fracture risk.

 Osteopenia & osteoporosis

 T score
CorticalBone
Trabecular bone

 Bone cells

 Osteocytes -
◦ Osteoblasts
◦ Osteoclasts

Chemistry of bone
◦ Mineral
◦ Matrix (collagen I & IV )
Hormonal Influence
 Vitamin D ( activity of both cells &increase absortption of
calcium )

 Parathyroid Hormone (calcium removal from bone to blood)

 Calcitonin ….osteoclast

 Estrogen
◦ Increase bone remodeling

 Androgens
◦ Increase bone formation
Osteoporosis - types
 Postmenopausal osteoporosis (type I)

◦ Caused by lack of estrogen

◦ Causes PTH to overstimulate osteoclasts
◦ Excessive loss of trabecular bone

 Age-associated osteoporosis (type II)

◦ Bone loss due to increased bone turnover

◦ Malabsorption
◦ Mineral and vitamin deficiency

Secondary type
Osteoporosis treatment options

◦ Calcium and vitamin D

◦ Calcitonin
◦ Bisphosphonates
◦ Estrogen replacement
◦ Selective Estrogen Receptor Modulators
◦ Parathyroid Hormone
 For the purpose of these guidelines a pragmatic decision was made
to separate the target client groups into 3 broad categories:

 1 Those with normal bone mass concerned with reducing the

risk together with people with mild bone changes (osteopenia).

 2 People with a clinical diagnosis of osteoporosis without any

history of fracture (#).
 3 A frailer group with advanced bone changes usually having
sustained fractures (#).
Measurement

Alignment
Spinalcurve
Occipital to wall
Ranges of motion
Intervention

Exercises
Muscle imbalance
Principles of specificity

Axial (core) strengthening exercise

Low bone density

Flexion exercise
Extension exercise

Fracture& flexion exercise

Osteoporosis & flexion
Stretching
Three rules

Do not put structure at postural risk

Isolate & target movements
Duration
ADLs
Painful knee OA
Habitual greater demand on knee
extensors
Use hip knee ankle flexion strategy
Greater demand on hip extensors
Betz Prevent Fractures
Manual therapy
Mobilization
Mobilization with passive movement
Muscle energy techniques
Soft tissue mobilization
PNF

External support
Lumbar support
Strengthening exercise
Ambulation
Normal Gait

Four locomotors function

1. Shock absorption (eccentric)

2. Stance stability (GRF , static & dynamic)
3. Propulsion (Contralateral)
4. Energy conservation (hamstring eccentric
knee and hip)
Gait Assessment

Interventions
Gait training
Training speed
Obstacles
Dual tasking