Geriatric Physiotherapy / Old Age Care Services

 Geriatric Physiotherapy

WHAT IS GERIATRIC PHYSIOTHERAPY/REHABILITATION

Geriatric Rehabilitation (GR) is defined as a multidimensional approach of “diagnostic and therapeutic interventions, the purpose of which is to optimize functional capacity, promote activity and preserve functional reserve and social participation “in older people with disabling impairments.”

Geriatric physical therapy is a form of physiotherapy specifically intended for older and their unique issues and challenges. Geriatric physiotherapy takes into account that older people tend to become less active over time, experience a decrease in muscle strength, muscle mass, less balance, coordination, and reaction timing, and have low ability for physical activity. When old age patients recover from any kind of illness, injury, or surgery, taking part in a senior rehabilitation program is very necessary to restoring functionality, reducing pain, and improving quality of life

WHAT GERIATRIC PHYSIOTHERAPY DOES

Orthopedic physical therapy, for instance, focuses on damage and injuries to musculoskeletal variety, as well as assists in recovery after orthopedic surgeries

Geriatric physiotherapy focuses more on building strength and endurance  such as-

• Keeping active through various exercise programs
• Preventing muscle atrophy, wasting of muscles mass, and overall weakness
• Decreasing the risk of falls and related injuries like fracture, sprain, strain, meniscus injury, dislocation
• Maintaining independence in performing daily activities by teaching easy ways and ergonomic advice

Geriatric physiotherapy is performed in a variety of settings, that include:

• Inpatient healthcare facilities rehabilitation as well as assisted living facilities
• At home, which is especially helpful for those who are very low  mobility  due to diseases or challenges who have difficulty getting out
• Very helpful in Daily living activity

Three major areas upon which physiotherapists focus on

• Deconditioning: A problem that occurs because the patient simply doesn’t use his limbs. This problem can be addressed by reconditioning the body through a range of movements and strengthening the exercise pattern.
• Cardio Vascular Diseases: For conditions like heart disease and stroke, exercise, aqua therapy, electrical stimulations, and more therapy can be used.

Today, when we’re witnessing a pandemic, we know how susceptible elderly people are, and how physiotherapy is helping them with breathing exercises to enable them to enhance their endurance, mobility, and physical functions. Physiotherapy is hence an important and integral part of the treatment for Covid-19.

NATURE OF TREATMENT

Geriatric physiotherapy generally consists of various types of exercises that improve strength, flexibility, endurance, and balance to aid in activities and movements and prevent overall deconditioning. Exercises typically include:

• Lower body stretches, lower back, hamstrings group, and hip flexors, to promote good mobility and joint alignment and to prevent tight muscles or stiff joints by Propper stretching technique
• Endurance training programs to keep the heart and lungs healthy and improve circulation using cardiovascular equipment like treadmills running, walking, stationary bikes
• Lower body strengthening exercises that target the glutes and quads to maintain strength, such as sit-to-stands, squats, half squats, step-ups, leg lifts, bridges, weight exercises program
• Balance exercises to maintain stability when standing, walking, and changing directions, including static balance exercises on flat and uneven surfaces, weight-shifting exercises, marching, and tandem walking heel to toe.
• Geriatric physical therapy includes bodyweight exercises to help improve your mobility. If equipment is used, usually only light weights or bands are provided to supply increased resistance without overloading joints.

WHAT ARE THE SIGNS THAT YOU NEED GERIATRIC PHYSICAL THERAPY-

• Trouble with balance
• Low endurance
• Joint stiffness or other discomforts
• A new injury or physical diagnosis
• Broken bones 
• Torn ligaments
• Strokes
• Arthritis 
• Osteoporosis 
• Cancer 
• Joint replacements 
• Balance disorders 
• Vertigo 
• Ankle sprains 
• Alzheimer’s
• Parkinson 

PRINCIPLES AND PRACTICE OF GERIATRIC REHABILITATION

Rehabilitation of an old age person includes a multifactorial physiotherapy treatment program all designed with the individual’s specific needs and abilities in mind.

The purpose of geriatric rehabilitation is to assist the aged in recovering, to make them more independent. Decrease in muscle strength and mass respiratory reserve and cardiovascular functioning, kyphotic postural changes, another change associated with inactivity and aging.

Health Awareness and Exercise programming: Exercises have the potential for improving physical fitness, agility, and speed of response. They also serve to improve muscle strength, flexibility, bone health, and cardiovascular response. Exercise has been shown to provide social and psychological benefits affecting the quality of life and social wellbeing.

Pain management: Pain management is a very important factor in geriatric rehabilitation. Pain is the human perception or recognition of a noxious stimulus. In geriatric 2 types of pain: acute & chronic. Treatment of acute pain may include medications to reduce inflammation, ice, heat, and gentle mobility exercises. Chronic pain is more frequently observed and difficult to control.

Principles of geriatric rehabilitation-

Three major principles

• Variability
• Hypokinetics
• Optimal health.

VARIABILITY

Variability of capabilities within an aged group is more pronounced than younger. Optimum health is directly related to optimum functional ability. In acute situations, rehabilitation must be directed toward: Stabilizing the primary problems, Preventing secondary complications such as bed sores & contractures Restoring lost functions

HYPOKINETICS

Hypokinetic is the physiology of inactivity, a common reason for losses in functional capabilities over age is inactivity or immobility. There are many reasons for immobilizing the aged. Over the period if it is ignored, hypokinetic leads to deconditioning. Deconditioning is defined as multiple changes in multiple organ system physiology that are induced by inactivity and reversed by exercise. The degree of deconditioning depends on the degree of inactivity and prior level of physical fitness.

Two major categories of inactivity or hypokinetic :

• The acute hypokinetic of bed rest
• Chronic inactivity induced by a sedentary lifestyle or chronic disease. Systemic complications of bed rest

Neurosensory- Decreased cognition, Decreased reaction time, Decreased balance, Decreased postural sway.

Cardiovascular – Decreased output, Increased heart rate, Decreased oxygen uptake, Decreased blood volume, Decreased aerobic capacity, Delayed post-activity recovery time

Respiratory– Atelectasis., Hypoxemia, Increased risk of pneumonia, Decreased intercoastal muscle strength, Decreased vital capacity, Impaired gas exchange

Musculoskeletal- Decreased muscle strength, Decreased aerobic capacity, Boneloss Joint contractures, OsteoarthritisDecreased glycoproteins

Other complications-  B- bladder and bowel incontinence retention, bed sores- emotional trauma- deconditioning of muscles& nerves, depression, demineralization of boneR- ROM loss & contractures, restlessness, renal dysfunction- energy depletion, EEG activity decreaseS- sensory deprivation,sleep disorders

OPTIMAL HEALTH

The last principle in geriatric rehabilitation is optimal health. WHO defines health as a state of complete physical, mental and social wellbeing. The existence of complete physical health refers to the absence of pathology, impairment, or disability. WHO, mental health includes cognitive and intellectual intactness as well as emotional wellbeing.

“Optimal health is a dynamic balance of physical, emotional, social, spiritual, and intellectual health…Lifestyle change can be facilitated through a combination of learning experiences that enhance awareness, increase motivation, and build skills and, most important, through the creation of opportunities that open access to environments that make positive health practices the easiest choice.”

GENERAL GOALS AND BENEFITS OF THE PHYSICAL THERAPY PROGRAMME

• Prevent further decline in functional abilities
• restore or maintain range of motion
• muscular strength
• flexibility
• coordination
• balance and endurance
• Teach positioning
• Reduce pain
• Improve sensation
• Joint proprioception increase

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 balance. all contribute to functional activity improvement and .increase the mobility lessen the chance of injury through falling.

Balance &Gait training
Exercise-ExerciseROMstretching, Mobilizingex.Strengthen.Aerobics.Balance&Gait training exercises about geriatric therapy might include activities that are geared toward 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.

 Muscle strength limitation in daily activities due to sarcopenia, and 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 the knee, hip, and trunk extension

Considerations of strength training for Elderly patients
Correct alignment: determine by direction & line of pull of muscle fibers. (e.g.Quadriceps strengthen from a high sitting position)Appropriate stabilization: to avoid trick movement.Smooth movement (produce movement without shaking or jerkingBreathing guidelines( start with inspiring 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 the same session)NB: active recovery is more efficient than passive recovery for neutralizing the effect of muscle fatigue.

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 the patient feels pain in the 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.

• Cont. Type of resistance:-
  Body weight: for very frail elderly and for initial training.Manual resistance: for PT. who can tolerate body wt.Mechanical resistance: simple( free weights, sandbags, 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 in muscle soreness or inhibition
• Precautions of mobilization ex. for Elderly patients
  They should not be applied too vigorously, otherwise, cause it. Trauma or hypermobility in elderly patients with weakened CT., decrease circulation, and osteoporosis, used gentle mobilization techniques such as gliding and jt. Distraction within a tolerance of tissueComfortable stabilization of a proximal bone to prevent undue stress joint distraction applied perpendicular to treatment plane and gliding technique applied parallel to it.
• Electrotherapy modalities
  Manual therapy is applied with the goals of the person’s circulation restoring g 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. -ExerciseManualTherapyElectrotherapymodalitiesEducation:
• Electrotherapy modalities
  EducationEducation is important to the success and effectiveness of geriatric physical therapy. Physical therapists teach the elderly how to: perform daily tasks safely.use assistive devices to protect themselves from further injury. Older adults can utilize physical therapy as a means of regaining their independence. Physical therapy can help seniors to feel better, as well as to enjoy a higher quality of lifeExerciseManualTherapyElectrotherapymodalitiesEducation
• Electrotherapeutic modalities
  Electrotherapeutic modalities included cold & heat modalities, electrical stimulation currents, and laser therapy. Their effect includes: Improving healing tissue by minimizing continuing damage & facilitating repair. Reduce painMaintain tissue healthy during inactivity geriatric, should remember the principle & appropriate dose of electrotherapy modalities higher levels of stimulation the effect becomes inhibitory or progressively more damaging.
• Considerations of using heat & cold modalities in geriatric patients
  Firstly assess the ability to tolerate the change in body temperature and check patient history carefully for the presence of chronic disease which may alter the response to temperature changes e.g. diabetes factors contributing to increased risk of thermal injury in elderly: Decrease reactivity of hypothalamic thermoregulatory system impaired of circulatory system loss of sweat gland atrophy of skin with reduction in circulation decrease perception of thermal gradients.
• 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, and constrictive or moist strapping should be avoided. Never allow the full weight of the 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 provided extra care to avoid irritation and burn to Avoid electrical stimulation in the presence of a pacemaker.

Exercise can bring about several benefits due to the following reasons:

• Increases the size and strength of muscle fibers
• Increases the strength of bones, tendons, and ligaments
• Promotes the healing process and breaks down scar tissue
• Increases the length of ligaments, tendons, and muscles
• Increases the blood supply delivered to your muscles
• Reduces pain
• Decreases swelling
• Promotes well-being
• Promotes normal movement
• Relaxes muscles

WHY CHOOSE US FOR GERIATRIC PHYSIOTHERAPY TREATMENT AT HOME?

1. Proven methodologies: Customized care plans, globally used care protocols, and evidence-based practices for an uneventful recovery.
2. Tools for measuring outcome: Internationally accepted tools for monitoring clinical outcomes against the benchmark to assure a desirable improvement.
3. Patient-centric approach: Building a therapeutic relationship with the patient and family via effective communication to facilitate patient participation and better outcomes.
4. Individualized care: We understand that each patient is different and so are their requirements. That’s why we provide you with a personalized care plan that caters to your needs.
5. Save money & time: Schedule your appointment as per your convenience with no stress of traveling and waiting