Here we, Dr. Kiran (PT), and I, present a detailed overview of geriatric rehabilitation along with the dosage. Age related changes in posture its associated neurophysiology and compensations adapted by the elderly are also decribed in easy to learn way. The pathomechanics of fractures have been illustarted in easy to learn method too.

1. GERIATRIC REHABILITATION

2. OBJECTIVES
 Definition and aims of geriatric rehabilitation
 Geriatric assessment
 Principles of geriatric rehabilitation
 Common conditions associated with aging
 Geriatric rehabilitation post fall

3. WHAT IS GERIATRIC REHABILITATION?
 Defined as “Diagnostic and therapeutic
interventions whose purpose it is to restore
functional ability or enhance residual functional
capacity in older people with disabling
impairments”

4. AIMS OF GERIATRIC REHABILITATION
 Educate the patient- prognosis, healthy movement
choices
 Regain independence in ADLs and IADLs.
 Facilitate the patient's adaptation by modifying the
environment.
 Aid in Secondary Prevention.

5. GERIATRIC REHABILITATION PRINCIPLES
1) Ascertain existing level of function

6. CONTINUUM OF PHYSICAL FUNCTIONING IN
OLDER ADULTS

7. 2) Perform a comprehensive assessment
 be aware of multiple interacting impairments
associated physiological aging
 Emphasis on CVS, RS and Neurological systems

8. GERIATRIC ASSESSMENT
 Geriatric rehabilitation starts with a Comprehensive
Geriatric Assessment -
 Current impairment – MSK, Neuro evaluation
 Functional exam - TUG, endurance, disease
specific scale, FIM
 Systemic review – HMF, RS, CVS, Integumentry
 Environmental examination- home and
community assessment

9. 3) Patient and family centered goal setting
4) Emphasis on functional achievements
5) Realize impossibility and convey it positively to
the family and the elderly.
 Understand that improvements occurs slowly
6) Individualized and task specific programs
7) Avoid immobilization
 Hastens the muscle loss and reduces confidence in
movement

10. 8) Encourage social stimulants
 Helps heighten motivation level
 Increases active participation
9) Minimize medications
 Comorbidites that can be managed by physical
therapy should be closely monitered and necessary
medicinal adjustments to be made.
10)Achieve family and social reintegration

11. COMMON PROBLEMS
 Decreased Endurance
 Reduced Joint mobility
 Impaired Strength
 Impaired Posture
 Reduced Postural control and falls
 Motor control associated problems following CVA,
or neurodegenerative conditions

12. GERIATRIC REHABILITATION AFTER FALLS

13.  A fall is defined as an event which results in a
person coming to rest accidently on the ground/
floor / other lower level.
Causes
of falls
Intrinsic- Motor, sensory, cognitive
systems
Extrinsic-environment low light,
slippery mat, cluttered environment

14. INTRINSIC CAUSES:
MOTOR
 Strength- Reduced MVC of proximal lower limb muscles
– sarcopenia and gastrosoleus
 Flexibility – ankle , spine
 Delayed onset activation of postural synergy during
perturbation and anticipatory movts.
 Usage of hip and inefficient stepping strategies – forward,
lateral stepping

15. SENSORY
 Decreased somatosensory inputs from ankle
 Increases reliance on vision
 More time and attention required for sensory reweighing
 Increased time for visual processing
 Increased reaction time
COGNITION
 Reduced attentional resources and processing speed.
 Resources and difficulty to allocate attention during dual
tasking.
 Fear of fall

16. GERIATRIC REHABILITATION
POST FALL
 Acute care
 Functional mx.
 Preventive mx.

17. ACUTE CARE-
 Patient education
 Pain management
 Bed mobility and sit to stand
 Restoration of ROM, strength
 Early ambulation

18.  Pain management
Electrotherapy, rest, hot packs gentle isometrics
Low tens
F- 3 Hz - 5Hz
I- 30mA or more
D- 400 μs
T- 20 mins
Rationale: Elderly has reduced perception of fast pain
compared to dull pain so low TENS helps control dull
pain but activating descending pain control systems.
 Bed mobility and sit to stand
Sit to stand
Start with force control stratergy progress to
momentum control stratergy for efficiany

19.  Restoration of ROM, strength
Regain range
Precautions-
 Avoid aggressive joint mobilisations
 Presence of attendant during self stretching
 Strengthening
F- 3 /week
I- 50- 70% MVC
T- function specific, circuit training
D- 30-40mins
Precautions-
 Avoid end range compression and rotation movts, forceful
spinal fexion
 Prefer therabands over free weights
 Review dietery and fluid intake

20. Examples of strenghthening:

21. Functional mx.
I. Task specific balance training
ARTICLE
Balance training with Multi-task exercises improves fall-
related self efficacy, gait and balance physical function in
older adults with osteoporosis: RCT
Halvarsson, etal. 2014
 Inclusion criteria :
 age ≥65 years
 with diagnosed osteoporosis,
 afraid of falling / had a fall at least once in the last 12
months and independence in ambulation.

22. Outcome measures-
 Falls Efficacy Scale
 GAITRite® system
 one-leg stance and the modified figure-of-eight
test.
 Late-Life Function and
Disability Instrument (LLFDI)

23. METHODOLOGY
 2 groups: Training, and Control group
45 minutes/session, 3/week for 12 weeks + 30 mins of
community ambulation 3/week 30 mins
 Exercises challenging:
 Stability limits (changing BOS during sitting and standing
, reach outs),
 Sensory orientation (walking/standing/sitting on uneven
surfaces, eyes open/closed, compliant, slippery and
hard surfaces walking over a ramp with varying textures)
 Gait (walking at different pace , performing dual- and
multi- cognitive or/and motor task,like walking and
talking carrying and walking obstacle crossing )

24. RESULTS
 Significant improvements in all the outcome
measures were present in the intervention group
compared to the control.
 Points to remember-
 Task specificity provides the best carryover effects.

25. II. Environmental adaptations – well light room,
switches near doorway, keeping floor dry, grab
bars in toilets, bed closer to the wall, non slippery
mats

26. Preventive mx-
HEP
 Strength -
2 Days/week 60%–70% 1 RM
 Flexibility-
Everyday self stretching or flexibility yoga
 Endurance-
F - 5 days /week for moderate intensity.
I - 70% to 85% of their maximum heart rate
5–6 on Modified Borg’s Scale
D- 150–300 min/week.
T- low impact rhythmic exercise involving large
muscle group.

27.  Cognitive preventive measures-
Hobby inculcation, reentry to community group
activities
 Fatigue and stress management-
Activity pacing- prioritize and plan the day
Yoga and meditation

28. REFERENCES
 Andrew a. Guccione, Rita a. Wong, Dale avers, Geriatric
physical therapy. 3rd ed. Elsevier
 Anne Shumway-Cook. Motor Control: Translating Research
into Clinical Practice. 4th ed.
 George. Prevention of cognitive decline: lifestyle and other
issues. [Cited 2021 may 11]
 Cringuta paraschiv et. Al, General principles of geriatric
rehabilitation vol. 7, no. 1, january - march 2015

29. THANKYOU