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Geriatric Rehabilitation. What would be the most appropriate assistive device? 78 y/o F S/P (L) TKA w/ severe RA of hands, shoulders, knees Large based quad cane Crutches Two-wheel walker Forearm supports attached to a two-wheel walker Wheelchair. Hoenig H. JAGS, 1997 & GRS. - PowerPoint PPT Presentation
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Geriatric RehabilitationGeriatric Rehabilitation
What would be the most appropriate assistive device?
78 y/o F S/P (L) TKA w/ severe RA of hands, shoulders, knees
A. Large based quad cane B. Crutches C. Two-wheel walker D. Forearm supports attached to a two-wheel
walkerE. Wheelchair
Hoenig H. JAGS, 1997 & GRS.
Rehabilitation: Rehabilitation: ConceptsConcepts
ImpairmentDisability Handicap
Geriatric RehabilitationGeriatric Rehabilitation
General Aspects• Identify the correct diagnosis !• Assess for comorbidities• Involve the patient (& family) • Team approach to care• Prevent complications(A,B,C,…)
Geriatric RehabilitationGeriatric Rehabilitation
MD
Therapists
RN
Other
Patient
SW, Dietary, PT, OT, SpT, RecT
Rehabilitation TechniquesRehabilitation Techniques
ExerciseAssistive Devices• Mobility aids• Orthotics• Adaptive methods/equipment.
Assistive Devices- Mobility AidsAssistive Devices- Mobility Aids
Device Supports• Canes 15-20 % of body weight
• Crutches 100% of body weight • Walker ~ 50 % (not 100) of body weight
Geriatric RehabilitationGeriatric Rehabilitation
Prevent complications A B C sA. Aspiration, Anorexia, inActivityB. Bedsores,C. Constipation, Contractures, CognitionD. DVTs, Depression, DUsE. Else: infections (UTI, Pneumonia), pain,
incontinence
Geriatric RehabilitationGeriatric Rehabilitation
Specifics• Joints
– Elective replacements– Fractures
• Stroke• General Medical Problems
Hip Fractures 250,000/yearAmputations 50,000/year
Spinal/Compression FractureSpinal/Compression FractureMortality unclear
Age-adjusted mortality 2.15 (FIT) (a)
RR 1.66 F, 2.38 M (b)
Life expectancy (c)
Men: 6.1 y (60-69y) 1.4 y (>80)Women: 1.9 y 0.4 y
(a) Osteoporos Int 2000;111:556-561.(b) Lancet 1999;353:878-882.(c) Arch Intern Med 1999;159:1215-20
Am J Med 1997; 103:12S-19S & Lancet 1999;353:878-882
Hip FractureHip FractureMortalityMortality
Acute: 3% F 8% M die1 year: 20% F 30-40 % M (<80 y)
>50 % M (>80y)
2 year: Returns to rate of general population
Hip FracturesHip Fractures Outcome at 1 yearOutcome at 1 year
40% cannot walk independently60% require assistance with ADL80% need help with IADL.
Functional Recovery S/P Hip FxFunctional Recovery S/P Hip Fx
Independent Function Before 6 months after
•Dress 86 49
•Transfer 90 32
•Walk across a room 75 15
•Walk half a mile 41 6
Percentage Able toPerfrom
JAGS 1992;40(9):863.
Joints/FracturesJoints/Fractures
Dx: fracture type determines surgical intervention– Pins/Screws/Plates– THA
Go to pictures
Intertrochanteric Fracture
Gardner’s 4
Lateral View
AP View
Joints / FracturesJoints / FracturesComorbidities:
OsteoporosisCalcium & Vitamin DHormone status: Estrogen, TestosteroneMedications: Steroids, thiazides,“too late” for DEXA ? use for f/uOther complications . . .
Joints/FracturesJoints/FracturesComplications
AA – Activity (asap), BB – Look at skin! (NURSING!)
CC – Laxatives (see pain below)D D – DVT prevention, DislocationMultiple regimens—LMWH, Warfarin, FondaparinaxEE- Else
Infections – Make sure foley out ASAPPain– Not moving so it doesn’t hurt is NOT good pain control!
(Use routine + PRN meds)
AmputationAmputation
Common 50,000/ yearLevel of amputation:
BKA- - work by 40-60%AKA- - work by 90-120%
Stump healingContracturesRisk of contralateral amputation - 20% @ 2 years
700,000 strokes/ yearRecurrence rate 7-10% annually
StrokeStroke Diagnosis:Diagnosis:
Etiology (hemorrhage, thrombotic, embolic)Developing interventions in acute phase
Location (frontal, posterior, left vs right)May be factor in deficits and treatments needed
Coordinated care improves outcomes.
Recovery: Proximal to distalRecovery: Proximal to distalFlaccid to spastic to recoveryFlaccid to spastic to recovery
StrokeStroke
Rehabilitation is complex due to the variety of causes and residual deficits
Recovery and time needed to reach maximal recovery affected by the number of deficits.– Hemiparesis, hemianopsia & sensory deficits
are less likely to ambulate (I) and will require a longer time than those with hemiparesis only
StrokeStroke
Comorbidities are often multiple: DM, Alcohol and Tobacco (withdrawal),Hypertension, Hyperlipidemia
StrokeStroke
Complications:AA AspirationSpeech, LRI / ActivityBB Watch skin, (NURSING!)
CC Laxatives, prevent contractures, DD DVT prev, low threshhold for depression, E E Reflex sympathetic dystrophy (pain),
infection, subluxation…
General Medical/ DeconditioningGeneral Medical/ Deconditioning
Dx:Comorbidities:Complications: