Lifespans Flashcards

(85 cards)

1
Q

IDEA (Individuals with Disabilities Education Act Parts*

A

Part C - Early Intervention
 Provides services for children under 3 years of age
 Provides for family directed services

Part B- Early Childhood Special Education
 Provides services for children 3 years old through 21 years of age & provides:
- Free, appropriate, public education in the least restrictive environment

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2
Q

Family Centered Care - S M A R T

A

S – Support
 Families with information, education, understanding , and resources
M – Measure
 The effectiveness of programs through qualitative and quantitative outcome measures
A- Ask
 The right questions. Determine the individual needs of the patient and family. This will decrease the tendency to make biasing generalizations
R – Respect
 That individual differences between the child, family and therapist do occur and that they may be different from our own.
T – Train
 Early on in the health care profession, and recognize that the training is lifelong and ongoing

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3
Q

6 Stages of Adjustment for Disability

A

1) Shock
2) Denial
3) Depression
4) Anger
5) Acknowledgement
6) Adjustment

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4
Q

Types of Teams

A

Multidisciplinary Team
 Discipline specific roles are well defined
 Professionals work independently but recognize and value contributions of other disciplines
 Little or no interaction or ongoing communication
occurs among professionals
 Treatment occurs in isolation for remediation of
weaknesses
 Fragmentation of reporting occurs
 Overlap and gaps in services may occur and child may not be visualized as a whole

Interdisciplinary Team
 Discipline specific roles are well defined (role
definitions are relaxed)
 Emphasis on teamwork
 Therapy services may occur in isolation; however,
team discusses at regular intervals during team
meetings
 Individuals from different disciplines work together cooperatively to:
- Plan
- Implement
- And evaluate services

Transdisciplinary Team
 Decreases the number of professionals that families must encounter on a regular basis while meeting the needs of the child
 Professionals committed to teaching, learning, and working with others across traditional disciplinary
boundaries
 Role release
 Transference of information and skills specific to one discipline to other team members of different disciplines
 Team members work together to conduct assessments, program plan, develop goals and implement treatment plans

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5
Q

Dynamic Systems Theory

A

explains how complex, self-organizing systems—ranging from motor development to ecological interactions—change over time through interconnected, nonlinear components rather than linear, predetermined steps. It focuses on how new behavioral patterns (attractors) emerge from the interaction of multiple subsystems (e.g., infant walking, motor skills in autism) and adapt to environmental influences.

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6
Q

3 important elements of motor control

A
  1. Neural circuit—underlies the processing of input/output
  2. Motor plan—effector of output of the neural circuit
  3. The environment in which movement occurs—shapes the play between the neural circuit & the motor plan
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7
Q

Motor Control Strategies

A

 Motor program – a set of pre- structured muscle commands that end up producing coordinated movement / learned task / carried out without influence of peripheral feedback
 Motor plan - overall strategy for movement
 Feedback – afferent information sent by sensory receptors to control centers with constant updates that allow for corrections shaping the ongoing movement & allows motor responses to be adapted to the demands of the environment
 Motor-skill acquisition – behavior is organized to achieve a goal directed task with active problem solving needed for the development of the motor program, plan, and learning & is adaptive to the specific demands of the environment
 CNS recovery - reorganization is dependent on experience - practice is required to regain lost skills, & ability to retain & generalize re-learned skill to other similar tasks or to apply in other environmental contexts
 Feed-forward - prepares the system in anticipation of responses required for movement and adjusts the system for incoming sensory feedback for future movements
 Anticipatory (feed-forward) postural adjustments used by children with cerebral palsy and typically developing children to counteract self-generated motions that disturb balance.

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8
Q

Neonatal Prematurity: Prematurity

A

Birth at less than 37 weeks
Fetus considered viable at 22 to 23 weeks of gestation

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9
Q

Principles of Motor Development: Directional Concepts

A

 Cephalic to Caudal (Head to Tail)
 Proximal to Distal
 Gross to Fine
 Undifferentiated to Specific

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10
Q

Physiologic Flexion

A

Full term babies are born in physiologic flexion due to confinement & position in the womb
 Hip, knee & ankle flexion contractures

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11
Q

Antigravity Extension

A

Voluntary, active movement against gravity first seen at the neck then the trunk
 In prone, begins with lifting of the head
 In prone, extensors strengthen & flexion contractures decrease

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12
Q

Antigravity Flexion

A

Develops in supine first
 Foot-play, head lifting
 Progression from supine to sit

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13
Q

Lateral Flexion & Rotation

A

Lateral flexion activity leads to crawling
 Rotation leads to rolling

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14
Q

Reflexes/Automatic Movements

A

Reflexes
 Basic unit of movement in the
hierarchical theory of motor control
 Involve the combination of a sensory
stimulus & a motor response

Primitive Reflexes
 Typically present at birth
 Normal for young infants
 Usually integrated in the first 9
months of life

Abnormal Reflexes
 Persistent, abnormal, or
asymmetrical usually indicate early
brain damage and will affect future
normal development

Occur in response to a stimuli & often involuntarily
 Significance:
- Initial appearance demonstrates functioning subcortical primitive centers
- These early reflexes eventually
diminish reflecting maturation of the
nervous system with increased
control of the cortex

Include:
 Permanent Reflexes
 Primitive (Neonatal) Reflexes
 Postural Reflexes

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15
Q

Primitive Reflexes

A

 Are succeeded by the postural reflexes (inhibited by the frontal lobes) which enable the maturing child to interact effectively with his environment (Goddard, 1996)
 If present beyond 6 to 12 months of life, they are termed aberrant & may result in immature patterns of behavior
 Despite the acquisition of later skills, may cause immature systems to remain

Primitive Reflexes:

Rooting
Suck / Swallow
Moro
Startle
Palmer Grasp
Plantar Grasp
Positive Support
Stepping
Asymmetrical Tonic Neck Reflex (ATNR)
Symmetrical Tonic Neck Reflex (STNR)
Tonic labyrinth Reflex (TLR)
Galant Reflex

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16
Q

Postural Reaction vs Postural Reflex

A

While often used
interchangeably, “postural reaction” and
“postural reflex” are technically not
exactly the same, with “postural reaction”
sometimes considered a broader term
encompassing the complex motor
response to a balance disturbance, while
“postural reflex” refers specifically to the
automatic, involuntary muscle activation
triggered by sensory information to
maintain posture; essentially, a postural
reaction is the full response involving
multiple reflexes and muscle actions to
maintain balance.

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17
Q

Postural Reactions

A
  1. Righting Reactions
     Orient the head & body in space
     Involve head & trunk movements
  2. Protective Responses
     Used in response to rapid displacement of the body as a result of an outside
    force
     Involve the movement of the extremities in the direction of the displacement
  3. Equilibrium Responses(aka Labyrinthine Reactions)
     Used when there are slow changes occurring between the center of gravity and
    the base of support
     Degree of displacement determines the response used
    - Beginning with the head
    - Then the trunk
    - Then the shoulder & or hip abduction if the displacement is great enough
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18
Q

Postural
Reactions:
Righting &
Equilibrium
Reactions

A

 Emerge as primitive reflexes
 Emerge to help the infant or child
cope with demands of a gravity-
based environment
 Provide the basis for the control of
automatic balance, posture and
voluntary movement
 Are complex postural responses that
continue to be present throughout
adulthood

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19
Q

Righting Reactions

A

 Thought to be mediated at midbrain level in
response to signaling from several different
sensory receptors including:
- Proprioceptors, cutaneous receptors, eyes and
labyrinth of the ears
 Realigns the head or trunk with each other or
with an outside stimulus

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20
Q

Landau Reflex ***(almost always on boards)

A

 Not a primitive reflex because it is not present
at birth (age of onset3-4 months) and it is not a true postural reflex because it should not persist beyond the age of 12-24 months
 When the baby is held in prone suspension,
supported under the tummy, the head, spine
and legs will extend

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21
Q

Pediatric Gait

A

 3 yrs. of age is when a child’s gait pattern
begins to resemble that of an adult. Initially there is a wide-based stance with rapid cadence and short steps.
 Toddlers have a broad-based gait for support,
and appear to be high-stepped and flat-footed, with arms outstretched for balance. Legs are externally rotated, with a degree of bowing.
 Heel strike develops at around 15-18 months
with reciprocal arm swing.
 After the age of 2, running and change of direction occur.
 School-aged children, demonstrate a step
length increase and step frequency slows.
 Adult gait and posture occur around the age of
7- 8 years.

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22
Q

Gross Motor Milestones (for Boards)

A

Measured by months within the first 2 years & are significant:
* 2 months - head steady in sitting
* 6-7 months – supported sitting (ex. siting with arms behind or at sides supporting oneself)
* 8-9 months – sits without support
* 8-9 months - cruising (ex. using the couch to move around)
* 12-15 months - walking
* 24 months – runs & changes direction

Refer to Developmental Milestones Handout

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23
Q

Milestones forFlexibility / Posture / Alignment

A

Spine:
0-12 months
* Changes from the physiologic flexed & rounded posture with the emergence of cervical and lumbar curves (lordosis)
- Development of head control in prone leads to development of cervical lordosis
- Development of head control in sitting & standing contributes to lumbar lordosis
* Provides increased stability of the back and neck

1-6 years
* Curves continue to increase
* 1-2 years – standing and walking

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24
Q

Milestones for Pediatric Gait

A

Walking
* Walks without support (12-15 months)
Early Walking (12-18 Months):
* LE’s: Toddlers walk with a wide stance for stability. They often land flat-footed, rather than heel-toe. May have a “high-stepping” gait as they lift their feet higher to clear the ground
* UE’s: Arms are held up (high guard position) for balance. Arm swing is minimal or absent.

Developing Gait (18 Months - 3 Years):
* Narrowing base: The base of support gradually narrows as balance improves.
* Heel strike: Heel-to-toe gait starts to develop
* Reciprocal arm swing: Arm swing becomes more coordinated with opposite arm and leg movements.
* Increased step length: Step length increases as leg strength and coordination improve.
* Improved balance: Balance becomes more refined, allowing for running and changes in direction (2 years

Mature Gait (3 Years and Beyond):
Adult-like gait:
* .By around 3 years old, gait pattern becomes more similar to adults, with heel-toe contact, reciprocal arm swing, and a narrower base of support.
Gait maturation:
* .Gait continues to refine and mature, with increased velocity, step length, and coordination, reaching near-adult patterns by 7- 8 years old

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25
Apgar Developmental Screening Test
0, 1, or 2 points 5 Categories: Activity (Muscle tone) - [Absent/Arms & Legs flexed/Active movement] Pulse - [Absent/Below 100 bpm/Over 100 bpm] Grimace (reflex irritability) - [Flaccid/Some flexion of extremities/Active motion(sneeze, cough, pull away)] Appearance (skin color) - [Blue, pale/Body pink, extremities blue/Completely pink] Respiration - [Absent/Slow, irregular/Vigorous cry] Total Points: Severely depressed 0-3 Moderately depressed 4-6 Excellent condition 7-10
26
Rooting Reflex
Position: Supine Stimulus: Open mouth and turn head in direction of touch Normal age or response: 28 weeks of gestation to 3 months Lack of Integration Interferes with: - Oral-motor development - Development of midline control of head - Optical right, visual tracking, & social interaction
27
Suck/Swallow Reflex
Position: Supine Stimulus: Light touch in oral cavity Positive Response: Close mouth, suck, and swallow Normal age of response: 28 weeks of gestation to 2-5 months Lack of Integration Interferes with: - Development of coordination of sucking, swallowing, and breathing
28
Moro Reflex
Position: Supine, head at midline Stimulus: Head dropping into extension suddenly (more than 30 degrees extended) Positive Response: Arms abduct with fingers open, then cross trunk into adduction; infant usually cries Normal age of response: 28 weeks of gestation to 4-6 months Lack of integration interferes with: - Balance reactions in sitting - Protective responses in sitting - Eye-hand coordination, visual tracking
29
Startle Reflex
30
Ankle Foot Deformities: Classifications
Classifications * Metatarsus adductus * Talipes Equinovarus(Clubfoot) (plantarflexion with varus & supination) * Calcaneovalgus (dorsiflexion with eversion or valgus of hind- foot) Signs & Symptoms  Obvious deformities  Gait abnormalities  Delay is gross motor and mobility skills Treatment  Serial Casting  Surgery  Stretching - To supplement splinting or bracing for minor deformities - To counter the deformity - CAUTION – it is important to stretch the gastrocnemius/soleus while avoiding the mid-foot ligaments Mobility training (play activities) * To promote normal developmental skills - Rolling - Creeping - Pull to stand - Standing - Cruising - Walking  Sensory stimulation (when out of cast) * To promote normal sensory sensitivity and proprioception awareness *Promotes motor output *Types of sensory input - Rubbing with textured material - Water play - Sand play - Massage - Weight-bearing
31
Arthrogryposis (Multiplex Congenita)
- Picture with the infant hella contorted * Non-progressive neuromuscular disorder Presents with:  Multiple contractures (distally > proximally) due to decreased fetal movement  Dislocation at hips or knees  Deformities of joints (fusiform or cylindrical shape)  Joint fusion (in some cases)  Thinning of subcutaneous tissue  Absence or decreased size of muscle groups  Absent skin creases
32
Attention Deficit Hyperactivity Disorder (ADHD)
“Attention Deficit Hyperactivity Disorder or ADHD is a common childhood illness that can be treated. It is a health condition involving biologically active substances in the brain. Studies show that ADHD may affect certain areas of the brain that allow us to solve problems, plan ahead, understand others’ actions, and control our impulses.” Hallmark common symptoms  inattention—easily distractible, careless, forgetful, difficulty completing tasks  hyperactivity—constantly in motion, restless  impulsivity—impatient, lack of restraint Many situations and conditions may trigger symptoms that mimic ADHD but are not ADHD * Examples:  Death, divorce, learning disability, ear infections, anxiety, depression, undetected seizures, sudden change in lifestyle ***To have a definitive diagnosis of ADHD, the behaviors must appear before age 7 and continue for at least six months. * The symptoms must also create a real handicap in at least two areas of the child’s life—in the classroom, on the playground, at home, in the community, or in social settings.
33
Autism Spectrum Disorder (ASD)
* A developmental disability resulting in social, communication, and behavioral challenges. * Symptoms begin in early childhood and continue throughout the lifespan. * A variety of disorders fall under 1 umbrella categorized as ASD. * Causes are unknown, can be environmental , genetic, or biological. * Motor skills are impaired. * Motor coordination, postural control and imitation skills are limited. * Planning and completing new motor tasks is challenging. * Delayed social skills * Not a definitive way to diagnosis ASD * A child’s behavior and specific development must meet certain criteria to receive an ASD diagnosis
34
Autism Spectrum Disorder: 2 major signs that indicate a child may have ASD
1. Difficulties in social communication and interaction  Avoiding eye contact  Enjoys playing alone  Lack of social interaction with peers  Lack of understanding boundaries and personal space  Repetitive speech on a preferred topic or speaks words repetitively 2. A tendency to engage in restricted, repetitive patterns of behavior  Performs self-stimulating behaviors (flap hands, spinning, rocking, etc.)  Irritated by minor changes or upset due to change in normal routine  Short attention span  Decreased safety awareness  Unusual reaction to touch, smell sound, movement or taste  Difficulty imitating movements or controlling posture  Decreased coordination and balance
35
Brachial Plexus Injuries: Erb’s Palsy
Paralysis or weakness of the muscles of the arm that is caused by damage to the brachial plexus  Upper arm paralysis involving C-5 & C-6 Causes * Excessive stretching of the fetal head and neck in opposite directions during delivery * Pulling on the infant’s shoulders during the delivery or excessive pressure on the baby’s raised arms during a breech (feet first) delivery * Two potentially harmful forces during labor:  Natural expulsive force of the uterus  Traction force applied by obstetrician * Labor is typically long and difficult. The infant is usually…  High birth weight  Sedated  Hypotonic  Separation of bony segments  Overstretching  Soft tissue injuries Clinical Manifestation* * Adduction * Internal rotation * Elbow extension * Forearm pronation * Wrist flexion
36
Cerebral Palsy (CP)
 Group of non-progressive motor disorders caused by cerebral damage during gestation, time of birth, or early childhood  Most common physical disability of childhood  Affects tone, posture, and movement Classified by muscle tone Pathology -> Tone Quality: Hypertonic - High Tone Hypotonic - Low Tone Mixed Programing - Low to High Tone Fluctuating Programing - Athetoid Regulatory Inconsistencies - Ataxic Signs & Symptoms * Characteristics vary from mild and undetectable to severe loss of control accompanies by profound mental retardation * All types of CP demonstrate:  Abnormal muscle tone  Impaired mobility & movement  Abnormal reflexes  Developmental delays  "W" position sitting* Etiology (Not an all inclusive list -basically know that if something happened prenatal, perinatal, or postnatal.) * Prenatal  Genetic  Viral Infections  Bacterial infections  Drug/alcohol exposure * Perinatal  Prematurity  Low-birth weight  Severe jaundice  Intra-ventricular hemorrhage  Poor nutrition (of mother)  Asphyxia * Postnatal  Infection  Asphyxia  TBI from trauma (MVA, fall, shaken baby syndrome, child abuse)  CVA  Near drowning  Brain tumor
37
NDT Principles*
Uses handling and positioning techniques Uses techniques to facilitate normal movement patterns and inhibit abnormal patterns or substitutions Uses sensory input to impact motor output Substitutions or compensation is not allowed during treatment Addresses postural & reflex responses to affect functional motor skills Addresses abnormal tone & movement patterns Promotes the use of affected parts or segments of the body Uses the principles of repetition and practice
38
Sensorimotor Integration
 Main premise is based on belief that problems with learning, attention, behavior & visual perception is due to faulty integration of sensory input  Treatment focuses on providing systematic sensory input to help organize a child’s motor output - So a child can have normal muscle function and strength, but their sensation is a problem.
39
Signs of Sensorimotor Integration Processing Deficits
 Overly sensitive or under-reactive to touch, movement, sights and/or sounds.  Easily distracted, impulsive, or lacking self control.  Activity level is unusually high or low. Inability to relax or calm self.  Difficulty transitioning from one situation to another.  Poor self concept.  Social, emotional and/or behavioral problems.  Physical clumsiness or carelessness.  Delays in academics, motor skills, and/or speech and language skills
40
Motor Control Approach
 Uses a variety of techniques to gain motor control  Group activities / obstacle courses / aquatics / team sports etc.
41
Pediatric Movement Development Sequence
 Babies have cephal-caudal sequence development pattern. Because of this, you should start at the head and move to the neck and trunk; then the arms and legs to deliver sensory stimulation. This helps the brain form networks to work together for developmental motor skills. As the primitive reflexes become more and more integrated into the background, the higher development functions are refined and accomplished.
42
Categories of Assistive Technology
PPT #8, Slides 43-48
43
Benefits of Seating and Positioning*
 Facilitation of developmental skills  Maintenance or improvement of ROM  Prevention of or minimization of contractures  Maintenance or improvement of strength  To promote social interaction with peers  To promote functional skills  Reduction of postural deformities by maintaining alignment of trunk & limbs  Minimize abnormal postural reflexes  Promotes balance / righting and equilibrium reactions  Prevents development of pressure sores
44
Pediatrics Orthoses
 TYPES:  AFO – ankle foot orthosis  KAFO – knee ankle foot orthosis  HKAFO – hip knee ankle foot orthosis  RGO – reciprocating gait orthosis  TLSO – thoracic lumbar sacral orthosis  SMO – supramalleolar orthoses
45
2 Main Seizure groups
1. Focal seizures, also called partial seizures, happen in just one part of the brain. 2. Generalized (Grand Mal) seizures are a result of abnormal activity on both sides of the brain.  Signs:  Loss of consciousness, falling down, loss of bowel or bladder control, and rhythmic convulsions  Muscle contractions and rigidity  Falls, rapid pulse, pallor, dilated pupils  Biting the tongue, frothing at the mouth  Eyes rolling back in the head  Most seizures last from 30 seconds to 2 minutes and do not cause lasting harm. It is a medical emergency if seizures last longer than 5 minutes or if a person has many seizures and does not wake up between them.  Seizures can have many causes, including medicines, high fevers, head injuries and certain diseases. People who have recurring seizures due to a brain disorder have epilepsy.  Immediate Recovery - Gradual awakening to consciousness - Confusion - Long sleep (after a brief awakening)  Full Recovery - Fully awake, normal mental stage (in some people) - Tiredness, depressed mood What to do:  Protect the person from injury  Cushion their head  Aid breathing by gently placing them in the recovery position one the seizure has finished.  Be calmly reassuring  Stay with the person until recovery is complete DON’T  Restrain the person  Put anything in the person’s mouth  Try to move the person unless they are in danger  Give the person anything to eat or drink until they are fully recovered  Attempt to bring them round Call an AMBULANCE if…  You know it is the person’s first seizure  The seizure continues for more than 5 minutes  One seizure follows another without the person regaining consciousness between  The person is injured during the seizure  You believe the person needs urgent medical attention Details to Record  Date and time  How long the seizure lasted  What body parts are affected  Type of movement and other symptoms  Possible causes  Behavior after the seizure  Vital signs when stabilized
46
46
Child Abuse - Common Signs
 Unexplained injuries  Change in behaviors (i.e. withdrawal from school and friends/family)  Changes in eating and sleeping pattern  Child prefers to be alone  Changes in school attendance & performance  Displays risk taking behaviors  Inappropriate sexual behaviors  Lack of personal care or hygiene  Lack of desire to participate in activities that child previously enjoyed (i.e. sports, therapy)
47
Communication and Aging Article https://pmc.ncbi.nlm.nih.gov/articles/PMC3074568/
48
Presbyopia
The lens becomes less flexible as you age making it more difficult to read without glasses. This is known as presbyopia and part of aging.
49
Presbycusis
age related hearing loss
50
Questionnaires in Older Adult
Barthel Scale/Index (BI) - is an ordinal scale used to measure performance in activities of daily living (ADL). Ten variables describing ADL and mobility are scored, a higher number being a reflection of greater ability to function independently following hospital discharge. Time taken and physical assistance required to perform each item are used in determining the assigned value of each item. The Barthel Index measures the degree of assistance required by an individual on 10 items of mobility and self care ADL. Geriatric Depression Scale (GDS) - is a screening test originally developed by J.A. Yesavage and colleagues in 1982 that is used to identify symptoms of depression in older adults. The scale is a 30-item, self-report instrument that uses a "Yes/No" format. mini mental state examination (MMSE) - is a commonly used set of questions for screening cognitive function. This examination is not suitable for making a diagnosis but can be used to indicate the presence of cognitive impairment, such as in a person with suspected dementia or following a head injury.
51
*Interdisciplinary Collaboration
1. Registered Nurse (RN) ◦ Works independently; provides advanced care methods to patient & coordinates with MD about treatment ◦ In a nursing home, Federal law mandates that one RN be on staff 8 hours/day, 7 days/week ◦ RNs have 2-6 years of education 2. Licensed Vocational Nurse (LVN)/Licensed Practical Nurse (LPN) ◦ Works under supervision of MD or RN ◦ In a nursing home, Federal law mandates a LPN/LVN be on staff 24 hours/day ◦ LPN has 1 year of education 3. Certified Nursing Assistant (CNA) ◦ Works under supervision of RN or LVN; provides majority of patient care ◦ Approximately 8 weeks of education State laws may mandate higher staffing needs. Implications: PTAs should take full responsibility for recognition of change of status of the patient and notify nursing. Daily communication with these individuals to coordinate needs for the patient is indicated. The PTA will also work with nursing staff in fall prevention and quality improvement initiatives.
52
Geriatric Mental Health
2 Big things: - Depression in the elderly - Mental Health-Anxiety * Fears of the Elderly
53
Medicare Parts A, B, C, & D
(Like a PPO) Part A - covers impatient hospital stays, home health visits, and hospice care. Part B - covers physician visits, outpatient services, preventive services, and some home health visits. ______________________ (Like a HMO) Part C - refers to the Medicare Advantage program through which beneficiaries can enroll in a private health plan. Part D [D for drugs] - covers outpatient prescription drugs through private plans that contract with Medicare. Medicaid - for those with particularly low income
54
Medicare Supplemental Insurance
Medigap, is private insurance designed to pay for out-of-pocket costs not covered by Original Medicare (Parts A & B), such as deductibles, copayments, and coinsurance. It helps lower your personal healthcare expenses and provides freedom to choose any doctor who accepts Medicare.
55
Long-term Care Insurance
Long-term care refers to a host of services that aren’t covered by regular health insurance. This includes assistance with routine daily activities, like bathing, dressing or getting in and out of bed. A long-term care insurance policy helps cover the costs of that care when you have a chronic medical condition, a disability or a disorder/disease. Most policies will reimburse you for care given in a variety of places, such as: - Your home. - A nursing home. - An assisted living facility. - An adult day care center.
56
In-Patient Rehabilitation Facility
Must admit 75% of patients with 1 of specific diagnoses such as stroke (in order to be designated as an IRF). Individuals admitted are required to have 3 hours of therapy/day for 5 days a week, as part of admission criteria. Uses the FIM(Functional Independence Measure) for documentation and billing
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Skilled Nursing Facilities (Short Term Care)
Skilled Nursing Facilities may be part of a hospital (transitional care unit), a free-standing entity, or part of a nursing home. Skilled Nursing Care is covered under Medicare Part A if a patient has had a qualifying stay in a hospital: the patient entered the SNF within 30 days of a 3 day hospital stay In 2013, the first 20 days were covered completely; the next 80 days were covered but required a co- payment of $148/day. Benefits are limited to 100 days per benefit period. After the 100 day limit, the individual must pay for by private funds, LTC insurance or becoming eligible for Medicaid.
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Restraints
Physical: cuffs, jackets/vests, mitts, beds with side rails, chairs with lapboards Chemical: Medication Hospital bed upper body guard rails are not considered restraints (cause they may be necessary to prevent the patient from falling). Having upper rails with foot rails all up are considered as a restraint. History - Restraints frequently were used in the past with the mistaken belief they were preventing the patient from injuring themselves and were sometimes used because it was easier for the staff if the patient were physically or chemically restrained. Patients often sustained more injuries while restrained such as being at increased risk for pressure ulcers, UTIs, atrophy, etc. In addition, individuals have also been strangled by various restraints. The standard of care now is to provide the least restrictive, safe environment.
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Hospice and Respite Care
Hospice Care is provided for those that are terminally ill and can be provided in the home or at special facilities Palliative Care is specialized medical care for people with serious illnesses, focusing on relieving symptoms, pain, and stress to improve quality of life for patients and families. Respite Care is short term assistance that provided the care giver needed rest
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Stages of Death and Dying
Elizabeth Kubler Ross discussed stages of grief and dying many years ago. While these may not be universal, they are presented here for consideration of proper support during different stages. 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance
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Signs of Impending Death
1. Loss of appetite 2. Excess fatigue and increased sleeping 3. Increased weakness 4. Confusion 5. Labored breathing 6. Withdrawal 7. Kidneys shutting down 8. Swelling in the legs 9. Coolness in the tips of fingers 10. Mottled veins 11. Terminal Lucidity 12. Seems like they're suddenly getting better within a couple days of passing
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Laws Regarding Elder Abuse
Physical therapy professionals are mandated reporters of suspected elder abuse. - Report to Ombudsman within 48 hours Elder abuse can take the form of physical abuse, or neglect. Failure to report suspected abuse or neglect may be punishable as a misdemeanor. The physical therapist assistant should talk with the physical therapist about suspected abuse.
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Aging Overview
TYPES OF AGING - Chronologic - Biologic - Psychologic Theories of Aging - Programmed longevity - Hormonal theory - Immunological theory-immune system programmed to decline over time results in disease and death Error or Damage Theory 1. Wear and tear theory 2. Rate of living theory: greater the oxygen basal metabolism the shorter the lifespan 3. Cross linking theory-cross linked proteins cause damage 4. Free radicals theory-atoms or molecules with an unpaired electron can react with other molecules causing dysfunction. Free radicals can be found in environment. Anti-oxidants such as beta-carotene, Vitamin C and Vitamin E can donate electrons to free radicals Read this article: https://pmc.ncbi.nlm.nih.gov/articles/PMC2995895/
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Age changes - Cardiovascular System: Blood Vessels
1. Arteriosclerosis-hardening of the arteries. 2. Atherosclerosis-plaque development on the arterial walls, narrowing lumen of arteries and capillary walls thicken 3. Baroreceptors that monitor blood pressure become less sensitive. EFFECT 1. Blood pressure becomes elevated 2. Decreased blood flow to peripheral tissue, heart, and brain 3. When changing position, blood pressure may drop: orthostatic hypotension
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Peripheral Arterial Disease
Peripheral arterial disease is narrowing of the peripheral arteries due to atherosclerosis of the blood vessels, resulting in decreased blood flow. Look for decreased blood flow by palpating peripheral pulses (Femoral, popliteal, dorsalis pedis, posterior tibial, and carotid) for pulse depth in the peripheral arteries. Look for pallor, coldness, decreased hair growth, intermittent claudication [manifests as painful cramping in the legs or buttocks triggered by exercise and relieved by rest]. Position the patient with legs down to increase blood flow. Cold would decrease blood flow further and should be avoided. Avoid compression bandaging and mechanical compression
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Congestive Heart Failure (CHF)
CHF is a condition in which the heart's function as a pump is inadequate to meet the body's needs. 10% over age of 80 have congestive heart failure. Symptoms include shortness of breath, fatigue, swollen legs, and rapid heartbeat. Monitor vitals and report to medical staff if not noted in chart. Avoid interventions that bring additional fluid back to the heart which is already insufficient. Do not massage fluid back to heart, perform mechanical compression of the lower extremities, perform LE exercises with the head down. Also, position patient with the head of the bed up.
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Atrial Fibrillation (A-Fib)
Atrial fibrillation is the rapid quivering of the small chambers of the heart. Since they are quivering, they are not contracting forcefully, resulting in blood pooling in the atria. This contributes to the development of clots, which can break off and go to the brain, causing one type of stroke. An ECG is the method of diagnosis of A-Fib. The patient may feel palpitations, shortness of breath, fatigue, dizziness, syncope, etc. If this abnormal electrical impulse is conducted to the ventricles, there will be a rise in pulse. A fib is usually medically managed with meds and ablation surgery.
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Valve Stenosis
Valve stenosis is narrowing of a valve, often the aortic valve. This is significant because it makes the heart work harder to pump blood out and could affect reduce exercise tolerance.
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Age Changes: Respiratory System
CHANGES 1. Postural changes can impact chest expansion 2. The diaphragm becomes weaker 3. Changes in alveoli 4. Nerves in airway that facilitate coughing are less sensitive 5. Muscles that are near the airway have trouble keeping airways open EFFECTS -Decreased inspiratory volume -Increased incidence of pneumonia -Increased incidence of sleep apnea Respiratory Disorders that Increase in Incidence with Aging -PNEUMONIA, BRONCHITIS *Older individuals become more susceptible to pneumonia and bronchitis (which are seen in all ages) * Emphysema is increased in incidence in smokers * COPD is more common as you age coupled with other risk factors such as smoking. -SLEEP APNEA
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Ages Changes: Endocrine
CHANGES 1. The average fasting glucose level rises 6 to 14 mg/dL (milligrams per deciliter) for each 10 years after age 50. This is because the cells become less sensitive to the effects of insulin 2. Parathyroid hormone affects calcium and phosphate levels, which affect the strength of the bones. Parathyroid hormone levels rise with age 3. The adrenal gland on top of the kidney produces aldosterone which regulates fluids and electrolytes. Aldosterone reduction may cause drops in blood pressure and make patient more at risk for orthostatic hypotension EFFECTS 1. Increased incidence of adult onset diabetes mellitus 2. Increased incidence of osteoporosis 3. Electrolyte abnormalities and orthostatic hypotension Adult Onset Diabetes Mellitus - Type 1 diabetes don’t produce insulin. Type 2 diabetes don’t respond to insulin as well as they should and later in the disease often don’t make enough insulin. Insulin’s function is to help move glucose from the blood to the cells for use.
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Age Changes: Urinary System
CHANGES 1. Nephrons decrease in number 2. Arteries develop atherosclerosis, affecting filtration of blood 3. The bladder is less elastic and can’t control as much urine 4. Bladder muscles weaken 5. Blockage of urethra due to enlarged prostate in men 6. Less pelvic floor support resulting in stress incontinence EFFECTS 1. & 2. Decreased filtration of blood for excretion of drugs, regulation of BP, etc. 3.-5. Increased frequency and urgency 6. Stress incontinence
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Age Changes: Digestive System
CHANGES 1. Connective tissue layers thin 2. Blood supply to the digestive system decreases 3. Reduced motility (muscle-driven movement of food, liquids, and waste through the digestive tract) 4. Liver has reduced ability to detoxify substances and store glycogen EFFECTS 1. More likely to develop ulcers and GERD, meds and chemicals pass more easily 2. Decreased blood flow hinders absorption of drugs 3. Constipation: encourage fiber, fluid and activity 4. Increased risk for drug toxicity
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Related Geriatric Drug Issues
Increased drug use Altered pharmacokinetics in the elderly ◦ Absorption from digestive system ◦ Distribution ◦ Elimination – not removed as quickly ◦ Liver metabolism decreased ◦ Kidney excretion decreased (Bad) Positive feedback cycle: 1. Elderly need/take more drugs 2. Increased risk of side effects 3. Increased Symptoms 4. More drugs get prescribed 5. Repeat Adverse drug reactions Polypharmacy ◦ Occurs when a patient's drug regimen includes one or more unnecessary medication Other issues: financial, compliance Digestive Disorders Associated with Aging - GERD-Gastroesophageal Reflux Disease - Polyps/ Colon Cancer - Diverticulitis
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Age Changes: Integumentary System
CHANGES 1. Epidermis and subcutaneous tissue thins 2. Decrease in strength and elasticity of connective tissue 3. General decrease in number of melanocytes, increase in size of some areas 4. Sebaceous glands produce less oil 5. Blood vessels become more fragile and break 6. Decreased blood flow 7. Sweat gland produce less sweat EFFECTS 1. Skin more fragile, wrinkles, more at risk for tear, less subcutaneous tissue more at risk for cold intolerance 2. Wrinkles, at risk for tears 3. Pale skin with age spots 4. Dry, itchy skin 5. Easier bruising 6. Decreased thermal regulation and at risk for nerve damage (sensation deficits) and wounds that don’t heal. 7. More at risk for heat stroke Braden Scale - Pressure Ulcers
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Dementia Vs. Alzheimer's
Dementia https://medlineplus.gov/ency/article/000739.htm Alzheimer's (Type of Dementia) http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp
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Delirium
http://www.nlm.nih.gov/medlineplus/delirium.html Physical therapist assistants must be aware of rapid changes in mental states which may be a sign of medication toxicity, serious illness or pain. This requires immediate reporting to medical staff.
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Retropulsion
the involuntary tendency to walk or fall backward, primarily recognized as a symptom of Parkinson's disease or other neurological disorders due to postural instability. It often results in loss of balance, requiring intervention to prevent falls. Symptoms & Presentation: Individuals may take involuntary steps backward, lean backward, and have difficulty maintaining balance. It often occurs during daily activities like standing up from a chair, walking, or reaching for items.
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Cataracts vs Glaucoma vs Macular Degeneration
Cataracts are clouding of the lens and results in decreased visual acuity, poor night vision and glare. Glaucoma is a group of eye conditions that damage the optic nerve, the health of which is vital for good vision. This damage is often caused by an abnormally high pressure in your eye. Macular degeneration causes loss in the center of the field of vision.
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Diabetic and Hypertensive Retinopathy
Hypertensive retinopathy and diabetic retinopathy, while being similar in some features, show up differently on the retina. Hypertensive retinopathy has relatively few hemorrhages and a greater number of “cotton wool” spots than diabetic retinopathy, although there is little to differentiate the two for the patient.
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Older Patient's
Frequent fractures in older adults include the hip, compression fractures of the spine, wrist fractures and shoulder fractures. After a fall, radiographs must be taken because these are extremely common.
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CDC Recommendations - Aerobic
General Population 150-300 minutes (Mod. Intensity (50-70% max HR) 75-150 minutes vigorous intensity (70-85% max HR) Geriatric Population - Moderate-intensity aerobic activity, at least 150 minutes a week - Muscle-strengthening activity, at least 2 days a week
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Frailty in Older Persons
Define: Loss of some physical function along with a possible chronic disorder &/or disability
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Tracking Progress with Senior Fitness Tests
Chair stand test - Purpose: To assess lower body strength Arm curl test - Purpose: To assess upper body strength 2-minute step test - Purpose: To provide an alternative test of aerobic endurance Chair sit & reach test - Purpose: To assess lower body (primarily hamstring) flexibility Back scratch test - Purpose: To assess upper body (shoulder) flexibility 8 –ft up and go test - Purpose: To assess agility and dynamic balance
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