Geriatric Physical Therapy 3rd edition

592 CHAPTER 31  Health Policy and Advocacy in the United States: A Perspective for Geriatric Physical Therapy additional research is needed and further study is incor- objectives, the Falls Free Coalition. This coalition and its porated into the action plan. This step sets the course advisory committee continue to explore strategies and for implementing advocacy efforts. A growing field of assess its progress. The coalition has also developed re- grassroots advocacy consultation is developing in the sources to expand their advocacy reach with manuals United States to assist organizations in outlining their and guides for state action on falls prevention. The ad- action plans and identifying key steps to be successful in vocacy framework from problem identification to setting making changes to policies. a plan of action to assessing the progress by the National Council on Aging and its partners provide an effective Although the fifth step could be a significant part of model for advocacy success.25 step 4, it is singled out because of its importance. Broad- ening the community of advocates behind the action Advocacy: Seeking to Influence a Desired plan is essential. In today’s electronic communications Audience world, advocacy plans can be put into action in quick order. Rising above the rank-and-file advocacy initiatives Essential to an advocacy plan is identification of the takes a concerted effort to build a community of support arena that is most appropriate to address the policy con- and diminish opposition. Coalitions, alliances, and part- cern and the corresponding determination of the audi- nerships are as much the fabric of policy development ences to be influenced. Understanding whether the issue and advocacy world as lobbyists, elected officials, and is best addressed at the local, state, or national level is think tanks. The successful implementation of coalition critical. It also must be determined if the policy change efforts can build momentum, establish consistency in the is best addressed by administrative procedurals, regula- plan, and show broad public support. Campaigns have tions, or by legislation. As outlined in this chapter, the long used opposition research to inform their strategy legislative process is the most formal approach as it re- and approach. The best way to counter any opposition quires the passage of a bill to become a law. Regulatory to an advocacy plan is first to understand the source of agencies can rule on policies within the existing param- the opposition. Once the opposition is understood, ne- eters of the law and are often an appropriate venue to gotiations to seek a policy alternative that meets both advocate for policy changes. At other times, the policy groups’ needs can be initiated or the opposition can be change might only take a decision by the administrative engaged in a public debate on the policy. Coalitions, al- body that has been given the authority to make rulings liances, and partners are the force multiplier in advocacy on policies. It is important to note that policy always has plans with and without opposition and are a key element another option of the judiciary branch of government. to a successful advocacy plan. Although not utilized often, when legislative and regula- tory bodies have not been able to meet the objectives The final step is the assessment and evaluation process of your action plan, legal options can be pursued. The and it is essential in a process that is cyclical. The advo- Supreme Court of the United States is the pinnacle of cacy process never ends at a destination. Although there policy issues that have exhausted all other policy venues should be evaluative measures in each step of the advo- for addressing the issue under debate. cacy process, there is the need to take the necessary time to assess what worked and what could have been done Once the appropriate arena and venue have been more effectively or efficiently. This assessment and evalu- identified, the next step is to identify the audience to ation will feed into the data collection efforts described in which the case must be made. An audience might be the step 2 to inform the next round of advocacy efforts or body that has the power to promulgate policy. The pri- possibly identify new venues in which to make the case for mary audience in an advocacy plan is typically the policy change. maker, who should have been correctly identified in the action plan as the appropriate policy body with the au- A good example of the steps in action can be found thority to issue policy to meet the principles and out- by reviewing the process used by the National Council comes also articulated in the action plan. There are laws, on Aging (NCOA) with the Home Safety Council on rules, and regulations that govern how you interact with falls prevention. The recognition that falls prevention these authorities and the implementation of the plan. programs could improve health outcomes for older The research stage of the advocacy process should adults and other populations served as a catalyst for the consider compliance with the regulations that affect how development of an advocacy plan. The NCOA and this audience may be addressed. Alternatively, the “best” Home Safety Council built their policy case and priori- audience might be the group that welds power to influ- ties around government data on the impact of falls on ence the decision makers. A secondary audience that can cost and quality in health care with a desire to improve be used to influence promotion of the desired outcome access to programs to prevent these adverse events in is the media. Building public support for your policy health care. The NCOA and Home Safety Council con- issue is essential to the advocacy process. These audi- vened stakeholders to develop a National Action Plan ences usually are identified in step 4 using the advocacy and a corresponding blueprint for health policies to re- framework. If the desired policy encompasses a broad duce falls and increase falls prevention within the health issue that appeals to multiple constituents, the likelihood care system and in the community. These stakeholders developed the plan and built a coalition to implement its

CHAPTER 31  Health Policy and Advocacy in the United States: A Perspective for Geriatric Physical Therapy 593 for success is enhanced. Engaging the press and ing the limitations and possibilities of the health care de- other media in the issue is vital for success of the advo- livery system. Health policies should also outline the need cacy plan. for policy changes to enable all health care professionals to serve to their fullest capabilities and for patients to be To achieve policy change, one needs to set forth a assured safety and access. Balancing these policy objec- well-conceived plan. This plan should identify the issue tives in health care continues to challenge our policy that the policy body should solve; establish a clear path makers and advocacy organizations. that identifies the arena, audience, and authority for policy change; and establish evidence and support for It is essential regardless of setting of practice, political the issue and proposed policy solution. This advocacy perspective, or policy expertise that physical therapists process will help inform and engage policy makers, both engage in the health policy and advocacy process. As elected and appointed. This advocacy process can help health care professionals, physical therapists are obli- physical therapists become a participant in the nation’s gated to comply with existing laws, regulations, and representative democracy at all levels. Health policy and policies. Advocacy is part of your professional responsi- changes to health policy are only as effective as the indi- bility. Competency in health policy and advocacy will viduals who participate in the advocacy process are at only further the profession’s ability to serve patients and making their case for their principles and priorities. help them reach their full potential. CONCLUSION REFERENCES Policy and advocacy go hand in hand. To enact or change To enhance this text and add value for the reader, all policy takes a concerted effort to influence the bodies that references are included on the companion Evolve site possess the power to make these changes. Health policy is that accompanies this text book. The reader can view the a complex balancing act of decisions that policy makers reference source and access it online whenever possible. must make to improve access, enhance quality, and reduce There are a total of 25 cited references and other general cost. Understanding health policy will assist understand- references for this chapter.

INDEX A Adverse drug reactions (ADRs) (Continued) Aging (Continued) inadequate patient education/compliance physiological changes of. See Physiological Abdominal strength testing, 302-303 and, 42 changes. ABI. See Ankle/brachial index (ABI). inappropriate medications and, 42 role of physical activity and exercise in, Abilify. See Aripiprazole. multiple disease states and, 42 64-65, 64b, 65b, 65f, 85 Accelerometers, 454t older adults and, 467 optimal aging and, 3-4, 17 Accommodation loss, visual, 109 to opioids, 518-519 reversing decline and preventing disease, ACE inhibitors. See Angiotensin-converting websites on, 469b 36-37 slippery slope of, 3-4, 3f, 65-66, 66b, 66f, 67t enzyme (ACE) inhibitors. Advocacy, 590-593. See also Health policy. successful, 3, 17 Acetaminophen, 51-52, 51t definition of, 583, 590 theories on, 27-28 Acetylcholine, 44 desired audience for, 592-593 usual, 3 Acid-base imbalances, 160, 161t framework for, 591-592, 591f Acquired immunodeficiency syndrome (AIDS), AGS. See American Geriatrics Society (AGS). Aerobic capacity AIDS. See Acquired immunodeficiency 59 exercise/physical activity and ACSM. See American College of Sports physiology of, 230-234, 231f, 232f, 234f syndrome (AIDS). public health benefits of, 229-230, 230b Albumin, evaluation of, 160, 370 Medicine (ACSM). factors influencing, 229 Alkylating agents, 60t Action Research Arm Test, 282t impaired, 228-250 Alleles in Alzheimer’s disease, 141b Active death, 502 case example of, 244-247, 245t, 246t Allen, Jenny Wood, 523 Active life expectancy, 21-22 cycle created by, 229, 230f Alpha-blockers for hypertension, 53t Active range of motion (AROM), 278-281, evaluation, diagnosis, and prognosis of, Alzheimer’s disease, 140-141 238-241, 239b, 240t, 241b 279-280t physical therapy examination in, 234-238, alleles in, 141b Activities of daily living 235t, 236b, 237t, 238t clinical presentation of, 141 plan of care interventions in, 241-244, cognitive reserve and, 134 basic, 24 242b, 244b common mistakes in working with patients chronic conditions and, 23, 23f measurement of, 74-75, 75t developmental disabilities and, 559-561 with, 150b instrumental, 24, 25f Aerobic exercise, 74-76 Down syndrome and, 556 contraindications for, 76, 239b drug therapy for, 48 families and, 210-211, 210f duration of, 74 early. See Mild cognitive impairment (MCI). postural impairments and, interventions equipment for, 76 hospice care for patients with, 508 heart rate and, 231 incidence of, 131 targeting, 305-306, 306f, 307f impaired aerobic capacity and, 242-243, 242b Ambulation, 316-334. See also Gait; Mobility; Activities-specific Balance Confidence Scale, indications for, 75-76 measurement of, 74-75, 75t Movement; Walking. 347-348, 453-454t for older athletes, 542 community, 322-323, 328-329 Activity, ICF definition of, 90 pain management and, 407 endurance, evidence-based recommendations Activity limitations, 90, 91-92 public health benefits of, 229-230, 230b stroke volume and, 231-232, 232f for, 67t impaired joint mobility and, 253-254, 253f wellness and, 455 examination of, 316, 324-327, 325t, 326t motor control impairments and, 272-273, 274f functional, requirements for, 321-324 Acuity, visual Affective function, 92 changes in, accommodation of, 105-107, AFO. See Ankle-foot orthoses (AFO). assistive devices and, 323 Ageism, 14-15 individual constraints and, 321-322 105t, 106f, 107f AGEs. See Advanced glycation end-products speed and distance, 322-323, 322b driving and, 117-118 stair negotiation and, 324 Acute care hospitals, reimbursement for, 572, (AGEs). task and environment demands and, Aging, 27-28, 37 572b 323, 323b Acute musculoskeletal trauma, 529 cognitive changes and, 131-134, 133t, 135t impairments, 327-329 Acute pain, 395, 398 gait and, 317-319, 319b, 320t AMEDEO, 10 homeostasis and, 28-36, 28f, 29f American College of Sports Medicine (ACSM), TENS and, 405, 406t ADA. See Americans with Disabilities Act body composition and, 31, 31f 67, 166b cardiovascular tissues and, 32-34, 32b American Geriatrics Society (AGS), 479-480 (ADA). collagenous tissues and, 31-32, 32b American Physical Therapy Association (APTA) Adaptability, families and, 211-213, 212f hormones and, 36 Adaptation, 217 immune system and, 35-36 2020 Vision Statement, 500 Addiction, definition of, 516b nervous system and, 34-35, 35b Code of Ethics, 590 Adiposity, sarcopenia and, 267 skeletal tissue and, 29-31, 29f, 30b documentation guidelines of, 475, 476b Adjustment Disorder With Depressed Mood, implications for rehabilitation, 16-27 on Medicare caps, 576 joint mobility with, 248-253, 249b, 249t, Americans with Disabilities Act (ADA), 554, 554b characteristics of, 121-122, 122b Aminoglycosides, 59t Admissions, hospital. See Hospital admissions. 251f, 253f AMP. See Amputee Mobility Predictor (AMP). ADRs. See Adverse drug reactions (ADRs). motivation and, 183-184, 184t Amputation, lower limb Adult learning orientation, 190 pain and, 398 epidemiology of, 427, 439 Advance directives, 520-522 impact and outcomes in, 427-428 Advanced glycation end-products (AGEs), 250 incidence of, 427 Adverse drug reactions (ADRs), 38, 42-43, 63 from chemotherapy, 60-61 common, 43-44 inadequate drug testing/regulation and, 42 Page numbers followed by f, t or b indicate figures, tables, or boxes, respectively. 594

INDEX 595 Amputation, lower limb (Continued) Aripiprazole, 47, 146t Atrial fibrillation, evaluation of, 162, 162f prosthetic management in. See Prosthetics, AROM. See Active range of motion (AROM). Auditory hallucinations, dementia and, 119 lower limb. Arrhythmias Auscultation, 169-170 transfemoral, case study of, 442-445 evaluation of, 162, 162f coronary artery disease and, 175b Amputee Mobility Predictor (AMP), 441 treatment of, 53t, 54-55 of heart sounds, 169-170, 170f Analgesics Arterial blood gases, 160, 161t of lungs, 170, 171f, 171t in coronary artery disease, 175b pneumonia and, 177b nonopioid, 50-52, 51t, 517-518 in pneumonia, 177b Autolytic debridement, 375-377 opioid, 50, 51t, 518-519 Arterial oxygen content, 233 Autonomy, patient, 14 routes of administration, 519 Arterial wounds, 366-368, 367f Axial (core) strengthening exercises, 305 Andragogy, definition of, 190 Arteriovenous oxygen difference, 233-234, 234f Azapirones Androgen replacement therapy, 57-58, 57t Arthritis for anxiety, 45-46 Anemia, 158 activity limitations and, 23, 23f generic/trade name, 45t Anesthesia, effects of, 33-34 pain due to, 396 Angina pectoris prevalence of, 249t B evaluation of, 161-162, 236b Arthritis Foundation Self-Help program, 408 treatment of, 53t, 55 Arthritis Self-Efficacy Scale (ASES), 402 Back Pain Functional Scale (BPFS), 297, 299b Angiotensin II receptor blockers, 53t Arthrokinematics, 252, 302, 319 Balance, 331-358. See also Falls. Angiotensin-converting enzyme (ACE) Arthroplasty. See Total hip arthroplasty; Total assessment of inhibitors, 53-54, 53t knee arthroplasty. with developmental disabilities, 561 Ankle/brachial index (ABI), 371-372, 372f, 372t Articular cartilage, 294 in postural impairments, 303 Ankle-foot orthoses (AFO), 414-415, 416-419, ASES. See Arthritis Self-Efficacy Scale (ASES). Aspiration, pneumonia and, 176 examination and evaluation of, 335-348, 417f, 418f, 419f. See also Orthoses, lower Assessment 336b, 336f, 338b limb. for cerebrovascular accident patients, 423 advocacy and, 592 aerobic endurance, 342 for late-onset poliomyelitis, 424 functional. See Functional assessment. environmental, 347 for peripheral neuropathies, 423-424 Assistive devices fear of falling, 347-348, 348b Ankles ambulation with, 323 gait and functional balance, 342-347, disorders, orthoses and, 422-423 balance and, 352-353, 353f postural perturbations and, 334-335, 334f developmental disabilities and, 561 343-345t Antacids, 56 impaired aerobic capacity and, 243-244 neuromuscular, 341-342 Antecedent-Behavioral-Consequences in impaired joint mobility, 260 participation, 348 strategies, 145-148, 147b in pain management, 407 psychosocial, 347 Anterior colporrhaphy. See Anterior vaginal Ataxia, 276-277 sensory, 338-341, 339f, 340f, 341f, 348b repair. Athletes, older, 523-554, 524f somatosensory, 340 Anterior vaginal repair, 392 age-related changes in, 526f older athletes and, 539-541, 539f, 540f, Antianxiety agents generic/trade names, 45t cardiopulmonary, 527-528, 528f 541f, 552f impact on physical therapy, 44-47 injuries and physical, 528-531 orthotic prescription and, 413 Antibacterial drugs, 58-59, 59t postural control and, 332-335, 334f Anticholinergic agents acute, traumatic injuries, 529 wellness programs for, 452-454 for Parkinson’s disease, 49, 49t osteoarthritis and joint arthroplasty, Balance training, 351-352 for urge urinary incontinence, 391-392 Balanced Budget Act, 569 Anticholinergic effects, drug-related, 44 530-531, 531b postacute care and, 482 Anticoagulants, 53t, 55-56 overuse injuries, 529-530, 529f therapy cap of, 576 Antidepressants, 128-129, 129t musculoskeletal, 526-527, 527f Barbiturates, 49t generic/trade names, 45t case studies of, 549-552 Basement membrane, 33, 355 impact on physical therapy, 45-46 definition of, 524-526, 525f, 525t Bathrooms, environmental design of, 115 Antihypertensive agents, 52-54, 53t groups of, 524-526, 525t BBBs. See Bundle branch blocks (BBBs). Anti-Kickback statute, 578 movement dysfunction and assessment in, BDI. See Beck Depression Inventory (BDI). Antimalarial agents, 51t 531-532 Beck Depression Inventory (BDI), 123, 124t Antimetabolite agents, 60t opportunities and organizations for, 526 Beers Criteria, 467-468, 468b Antimicrobial dressings, 376t rehabilitation for, 537-538 Behavioral coping strategies, 213b, 214 Antineoplastic antibiotics, 60t core/balance and, 539-541, 539f, 540f, Behavioral management of dementia, Antipsychotic agents for dementia, 146t 541f, 552f 145-148, 147b, 147t generic/trade names, 45t drive to compete/remain active and, Behaviorist learning theory, 189-190 impact on physical therapy, 47-48 Beliefs Antiseizure agents, 49t, 50 541-542 Antithyroid agents, 57t impairments and, 538-539, 539f culture and, 198f Antiviral drugs, 59, 59t sport-specific, 542 motivation and, 185, 187t Anxiety, 44-46, 45t Benzodiazepines Anxiolytics, 146t golf, 545-547, 545f, 546b, 546f effects of, 44-45 Apathy, dealing with, 188-189 running, 542-543 generic/trade names, 45t Apoptosis in sarcopenia, 267 SAID principle and, 541 for seizures, 49t APTA. See American Physical Therapy swimming and aquatic exercise, use of, 45 Association (APTA). Berg Balance Scale, 282t, 343-345t, 346, Aquatic exercise, 76-77, 77f, 543-545, 544f 543-545, 544f Aricept. See Donepezil. tennis, 547-549, 547f, 548f, 549f 473-474 Selective Functional Movement Assessment Best evidence, 7 for, 532-537 interpreting, 536-537, 538b asking answerable questions in, 7-8 scoring system, 533-536, 533b critically assessing the evidence in, 10-13, seven basic movements of, 533, 534-535t, 12b, 13b 535f, 536f, 537f, 538f searching the literature in, 8-10, 8b, 9f, 10b Beta-blockers, 53-55, 53t

596 INDEX BiCAAL (bichannel adjustable ankle control) C Cerebral palsy, 556-557 joint, 418, 418f Cerebrovascular accident (CVA) Cachexia, 27-28 Bilateral sensorineural hearing loss, 111, 111f CAD. See Coronary artery disease (CAD). orthoses and, 423 Biofeedback for strengthening pelvic muscles, Caffeine, urinary incontinence and, 391 prosthetic determination and, 437 Calcium abnormalities, 158, 159t Cervical movement pattern tests, 535, 538f 389 Calcium alginate dressings, 376t Cervical spinal stenosis (CSS), 296 Biologics dressings, 376t Calcium channel blocking agents, 53, 53t, CES-D. See Center for Epidemiological Studies Biopsychosocial model of persistent pain, 54-55 Depression Scale (CES-D). 397-398 Call to Action on Disability, 553 Chair stand test, 453-454t Bipolar disorder, 46-47 Campbell, John, 523 Change Bladder. See also Urinary incontinence (UI). Canadian Occupational Performance families and, 211-213, 212f continence and, 382-383 Measure, 282t resistance to, 192-193 overactive, 384 Cancer Chart review in evaluation of acute and Bladder training, 390 Blood gases, values for, 155t chemotherapy for, 60-61, 60t medically complex patients, 154-165 Blood lipids, 155t, 156-157 chronic pain due to, 395 admission or reason for visit and, 154 Blood pressure. See Hypertension. risk factors associated with, 167b electrocardiogram and, 160-162, 162f BMD. See Bone mineral density (BMD). skin, 358, 358f laboratory tests and. See Laboratory tests. BMI. See Body mass index (BMI). Candida, 357-358, 358f operative reports and, 162-165, 163-165t, Body composition CAP. See Community-acquired pneumonia aging changes in, 31, 31f 166b, 167b evaluation of, 173-174 (CAP). Chemotherapy, 60-61, 60t Body functions, 90-91 Capitation, definition of, 569, 569t CHF. See Congestive heart failure (CHF). postural spinal alignment and, 294-295, Cardiac enzymes, 157t, 160 Child, Julia, 135t Cardiac output, 232-233, 232f Chin tuck stretch, 82f 294f, 295f Cardiac surgery, TENS and, 406t Chloride abnormalities, 159t Body mass index (BMI), 173-174 Cardiopulmonary changes, age-related in, Cholinergic agents for dementia, 48 Body roll during freestyle stroke, 543-544 Cholinesterase inhibitors, 146t Body structures, 90-91 527-528, 528f Chondroid structures, 250 Cardiovascular disease Chronic conditions postural spinal alignment and, 294-295, 294f, 295f depression and, 125 activity limitations and, 23, 23f developmental disabilities and, 556 physical inactivity and, 65, 65b Body weight risk factors for, 234, 235t prevalent, 22, 22f evaluation of, 173-174 Cardiovascular drugs, 52-56, 53t Chronic custodial care, insurance coverage urinary incontinence and, 390-391 Cardiovascular system impaired aerobic capacity and, of, 581 Body-weight–supported treadmill training Chronic obstructive pulmonary disease, 512 (BWSTT), 288 245-246 Chronic pain, 395 prosthetic determination and, 433-434 Chronic Pain Coping Inventory (CPCI), 402 Bone Cardiovascular tissues, 32-34, 32b Cigarette smoking, 447 age-related changes in, 29-30, 250-251, Cardiovascular training for ambulation CINAHL. See Cumulative Index of 294-295, 295f exercise to enhance quality/quantity of, 455 impairments, 328 Nursing and Allied Health Literature Caregivers (CINAHL). Bone loss, risk factors for, 30b Claudication scale, 236b Bone mass profiles, 29f cognitive impairment and, 150-151 Clinical decision making, 4, 93-96, 94f, 97f Bone mineral density (BMD) families and, 217-222 in home health care frequency/duration, age-related changes in, 527 developmental transitions in, 218 474-475 exercise or hormone replacement therapy dimensions of care in, 218-219 Clinical expertise in physical therapy, 6-7, 6f formal caregiving systems, 220-221 Clinical management, 154-160 and, 30-31 HIPAA and, 221-222 height and, 295 spouse as caregiver, 219-220 laboratory values in, 155t Borg Rating of Perceived Exertion (RPE), 69, supporting, 221 presenting signs and symptoms in. See Carpeting, selection of, 114-115 69t, 75, 75t, 236b Cartilage, articular, 294 Evaluation: of acute and medically Boundaries, family, 209-210, 209f Case management in palliative and hospice complex patients. Bowel incontinence, OASIS assessment of, care, 510-511 Clinical Test of Sensory Interaction and Casts, total contact, 374-375 Balance (CTSIB), 340-341 466b CBC. See Complete blood count (CBC). Clock Drawing Test (CDT), 144-145t BPFS. See Back Pain Functional Scale (BPFS). CBT. See Cognitive behavioral therapy (CBT). Closing the Gap, 553 BPI. See Brief Pain Inventory (BPI). CDC. See Centers for Disease Control and CNS. See Central nervous system (CNS). Braces, impaired joint mobility and, 260 Prevention (CDC). Coagulation, 155t, 157 Brain, aging and, 131-132, 184t CDT. See Clock Drawing Test (CDT). Coagulation disorders, drugs for, 55-56 Braking walkers, 310, 310f Cells, types of, 30 Cochlear conductive presbycusis, 110-111 Breakthrough pain, 516, 517f Cellulitis, 356-357, 356f Cochlear implants, 111, 111f Bridge exercises, 72f Center for Epidemiological Studies Depression Codes of Ethics, APTA, 590 Brief Pain Inventory (BPI), 400-401 Scale (CES-D), 123, 124t Cognex. See Tacrine. Brink scale, 386 Centers for Disease Control and Prevention Cognition Bromocriptine, 49 (CDC) executive functioning and, 132-134, 135t Bronfenbrenner’s model of ecological develop- physical activity guidelines for older adults, learning and, 197-202, 201b normal, 132, 133t, 134f ment, 208, 208f 64, 64b aging and, 131-132, 135, 135f Bundle branch blocks (BBBs), 162, 162f Central nervous system (CNS), 332-335, 334f preservation of, 135-137, 135f, 136t Burns, George, 135t Central processing in balance, 334-335 prosthetic determination and, 438 Bursitis, 543 Cephalosporins, 59t BWSTT. See Body-weight–supported treadmill training (BWSTT). Byrd, Robert, 135t

INDEX 597 Cognitive behavioral therapy (CBT), 129, Coronary artery disease (CAD) (Continued) Dementia, 139-150, 140t, 167 408-409 risk factors for, 163, 166b acquired versus persistent, 139-140 signs and symptoms of, 175b Alzheimer’s disease. See Alzheimer’s disease. Cognitive impairment, 131-137 assessment of, 142-143, 144-145t Alzheimer’s disease. See Alzheimer’s disease. Corticosteroids, 51t caregiving for a spouse with, 219-220 assessment of, 133t COX-2 drugs, 51, 51t depression versus, 125, 126t, 147 caregiver issues and, 150-151 CPCI. See Chronic Pain Coping Inventory drug therapy for, 47-48 case study, 151-152 environmental issues in, 118-119 delirium. See Delirium. (CPCI). incidence of, 131 dementia. See Dementia. Crossing the Quality Chasm, 588 Lewy body, 142 falls and, 349-350t Crying, as a coping strategy, 213b in long-term-care residents, 497-498 incidence of, 131 Crystal intelligence, 133t, 134f management of, 143-150, 143b, 146t, mild, 137-138, 137b, 137t, 138f CSQ. See Coping Strategies Questionnaire 147b, 147t, 150b, 152 normal cognitive changes versus, 131-134, mild cognitive impairment and, 137, 137b 133t, 134f, 135, 135f, 135t (CSQ). pain assessment in patients with, 402-403 prevention of, 135-137, 135f, 136t CSS. See Cervical spinal stenosis (CSS). reversible, 48 CTSIB. See Clinical Test of Sensory Interaction vascular, 142 Cognitive learning theory, 190 Cognitive model of depression, 123 and Balance (CTSIB). Dementia Mood Assessment Scale, 125 Cognitive reserve, 134 Culture Demography, 17-21, 17f, 18f, 20f, 21f Cognitive–perceptual–emotional coping Denervation/reinnervation process, 264 communication and, 212-213 Denial, 213b strategies, 213b, 214 home health care and, 460, 461-462b Depression, 121-128 Cohesion, family, 211, 212f learning and, 196-197, 198f Collagen, 31-32, 32b, 249-250 Cumulative Index of Nursing and Allied assessment of, 121-123, 122b, 124t, 125b Collagen dressings, 376t case study, 130-131 Collagenous tissues, 31-32 Health Literature (CINAHL), 9 characteristics of, 121-122, 122b Color discrimination, driving and, 118 Cushions, 374 dementia versus, 125, 126t, 147 Color vision, changes in, 105t, 109 Custodial care, 580-581 Down syndrome and, 556 Colposuspension, 392 Cytokines, sarcopenia and, 267 drug-related, 43 Communication Cytomegalovirus, drugs for, 59t in long-term-care residents, 497-498 management of, 128-131, 152 culture and, 198f D families and, 212-213, 215b with exercise/physical activity, 129-131 health, best practices in, 197-201, 201b Dark adaptation, changes in, 105t, 108-109, with pharmacotherapy, 46, 128-129, 129t in home health care, 475 118 with psychotherapy, 129 restorative programs and, 497 models of, 123 Community ambulation, 322-323, 328-329 Darwin, Charles, 135t pain and, 127, 401 Community residencies, 555 DASH. See Disabilities of the Arm, Shoulder, physical illness, function, and, 125-128, 126b Community-acquired pneumonia (CAP), 176 rates of, 121 Comorbidity and Hand Questionnaire (DASH). terminology for, 122 disability and, 23-24 Death unique features of, in older adults, 125, impact of, 154b Competence, definition of, 113 advance directives and, 520-522 125b, 126t Complete blood count (CBC), 155t, 157-158 causes of, 21, 501 Depressive Signs Scale, 125 Compliance. See Patient compliance. confronting reality of, 520-521 Depth perception Compression therapy, 375 dealing with dying and, 521 Computers, adaptations for visual sensory “good death,” concept of, 500 balance and, 339, 340f handling of, culture and, 198f changes in, environmental adaptations to, changes, 106-107, 107f nearing death awareness, 504, 513 Conductive hearing loss, 110 physiological process of dying, 501-504 105t, 109-110, 118 Confusion, drug-related, 43 Dermal wounds. See Integumentary Congestive heart failure (CHF), 53t, 54, 92 multisystem signs of approaching death, Connective tissues, 33, 248-250, 249b 502t impairments. Conservative sharp debridement, 377 Dermis, 355-356, 356f Contextual factors, ICF definition of, 90 progressive changes in the terminal phase, Developmental disabilities, 553-568 Continence, urinary, 382-384, 383f 501b Contractions, types of, 73 cardiovascular disease and, 556 Contractures in long-term-care residents, 496 psychosocial and spiritual signs, symptoms, case studies, 563-565, 564b Contrast changes, environmental adaptations and interventions in the actively dying, cerebral palsy, 556-557 503t community-based services for to, 105t, 109, 110f Contrast sensitivity, 339, 339f reframing physical loss and dying, 521 legislation on, 553-554, 554b, 555 Coping strategies of families, 213-214, 213b, Debridement, 375-377, 378 residential facilities, 554-555 Decision making definition of, 553 215b demographics of, 554-555, 556 Coping Strategies Questionnaire (CSQ), 402 clinical, 4, 93-96, 94f, 97f Down syndrome, 556 Core integrated strategy for, 96-103, 97f, 98b, Alzheimer’s disease and, 556 depression and, 556 older athletes and, 539-541, 539f, 540f, 541f 100f, 101f obesity and, 555-556 strengthening exercises, 305 Decision tree, 99 examination and evaluation in, 558-561, Cornell Scale for Depression in Dementia, 125 Deficit Reduction Act, 576 Coronary artery disease (CAD) Degenerative osteoarthritis, 296 558b case study of, 166b Dehydration, 179-180, 180b behavioral response in, 558 evaluation of, 174 Delayed-onset muscle soreness (DOMS), history in, 558 as a leading cause of death, 181 motor function and functional activities 529-530 Delirium, 138-139 in, 559-561 neuromusculoskeletal status in, 558-559, common risk factors for, 138, 138b comparative features of dementia, 559t depression, and, 126t evaluation of, 166-167 prevention and treatment of, 139 types of, 166 DeLorme, Thomas, 67

598 INDEX Developmental disabilities (Continued) Do Not Resuscitate (DNR), 471, 520 Drugs (Continued) intellectual disabilities, 557-558 Documentation gastrointestinal, 56 obesity and, 555-556 glucocorticoids, 52 prevention- and wellness-focused initiatives home health, 460-464, 463b, 465b, 466t, home health care and reconciliation of, related to, 553 475, 476b 467-469, 468b, 469b program planning/implementation and, hormonal, 56-58, 57t 561-563 Medicare requirements, 577-578, 577b improper testing and regulation of, 42 habilitation vs. rehabilitation, 562-563, Domestic Volunteer Service Act, 554 lithium, 62-63b 562f DOMS. See Delayed-onset muscle soreness Medicare and, 572t resources in, 563, 563b neurologic, 48-50, 49t service system for, 555 (DOMS). nonopioid analgesics, 50-52, 51t Donepezil, 48, 146t opioid analgesics, 50, 51t DGI. See Dynamic gait index (DGI). Dopamine, Parkinson’s disease and, 48-49 psychotropic, 44-47, 45t Diabetes mellitus Down syndrome respiratory, 56 sedative-hypnotic, 44-46, 45t activity limitations and, 23, 23f Alzheimer’s disease and, 556 for stress incontinence, 391 amputation due to, 427, 434 depression and, 556 for urge urinary incontinence, 391-392 drug therapy for, 57t, 58 obesity and, 555-556 websites for updates on, 63b risk factors associated with, 167b Dressings, wound, 375, 376t types of, 58 DRGs. See Diagnosis-related groups (DRGs). DSM-IV. See Diagnostic and Statistical Manual Diabetic neuropathic ulcers, 368-370, 368t, Driving of Mental Disorders, ed. 4 (DSM-IV). ability, evaluation of, 225-226, 225b, 226b 369t importance of, 224-225 Dual tasking, 329 Diabetic peripheral neuropathy, orthoses and, as a problem for older adults, 222-224, 223b Duke Activity Status Index, 237, 238t resources about, 224b Durable medical equipment (DME), 575, 575b 422-423 sensory changes and, 117-118 Durable medical equipment regional carriers Diagnosis warning signs indicating limitations/ (DMERCs), 430-431 approaches to, 99-103, 100f, 101f cessation of, 473b Dying. See Death. integrated decision-making strategy and, Drug reactions, adverse. See Adverse drug Dynamic gait index (DGI), 327, 343-345t, 99-103, 100f, 101f reactions (ADRs). 346-347 patient/client management model and, Drug therapy Dynamic posture, 292 Dynamometry, hand-held muscle, 77, 78t 94f, 95 for apathy, 189 Dyspnea scale, 236b Diagnosis studies, 10-11 avoiding harmful interactions between Dysrhythmias, 161-162 Diagnosis-related groups (DRGs), 569, 572 Dysthymic Disorder, 122 physical therapy and, 61 Dystonias, 276 Diagnostic and Statistical Manual of Mental case studies, 62-63b, 62-63b Dysvascular amputation, 427 distinguishing drug effects from symptoms, Disorders, ed. 4 (DSM-IV) E depression, 121-122 61 vascular dementia, 142 improving education and compliance with, EASY tool. See Exercise Assessment and Digitalis glycosides, 53t, 54 Screening for You (EASY) tool. Dining areas, environmental design of, 115 62-63 Directional training, 329 promoting synergistic effects of physical EBRSR. See Evidence-Based Review of Stroke Disabilities of the Arm, Shoulder, and Hand Rehabilitation (EBRSR). therapy with, 61 Questionnaire (DASH), 261 scheduling physical therapy around dosage Eccentric step down, 72f Disability, 93 ECG. See Electrocardiogram (ECG). schedule, 61 Ecological development, Bronfenbrenner’s comorbidity and, 23-24 strategies for coordinating physical therapy developmental. See Developmental disabilities. model of, 208, 208f in health status model, 87-89, 88f, 89f, 92 with, 61 Economic status, 21, 21f physical function and, 24-25, 25f, 26f websites for drug updates, 63b Education, patient. See Patient education. WHO’s classification of. See International Drug use patterns, 38-39, 39f, 39t Education for All Handicapped Children’s Drugs Classification of Functioning, Disability absorption of, 40 Act, 554 and Health (ICF). altered response to, 39-41, 40f, 41f Elastin, 250, 355-356 Disablement models, 87-89, 88f, 89f Eldepryl. See Selegiline. comparison of, 89-90, 90b and inadequate drug testing/regulation, 42 Elderly. See Older adults. Disease and inadequate patient education/ Electrical stimulation chronic. See Chronic conditions. exercise for prevention of, 36-37 compliance, 42 for strengthening pelvic muscles, 389-390 multiple disease states and, 42 for wound healing, 378t, 379-380 International Classification of Functioning, pharmacodynamic changes and, 41, 41f Electrocardiogram (ECG), 160-162, 162f Disability and Health on, 90-91 pharmacokinetic changes and, 40-41 Electrolytes, 158, 159t analgesics. See Analgesics. Emergency Medical Treatment and Labor Act in Nagi’s model, 90-91 antianxiety, 44-47, 45t prevention of. See Wellness. antibacterial, 58-59, 59t (EMTALA), 586 Disease-modifying antirheumatic drugs antidementia, 47-48, 143-145, 146t, 152 Emergency situations in the home, 470-471, antidepressant, 45t, 46, 128-129, 129t (DMARDs), 51t, 52 antiinflammatory, 50-52, 51t 471b Distance walk test, 453-454t anti-Parkinson, 48-50, 49t, 62-63b Employee safety, home health care and, 471 Diuretics, 53-54, 53t antipsychotic, 45t, 47-48 EMTALA. See Emergency Medical Treatment Dizziness. See also Balance. antiseizure, 49t, 50 antiviral, 59, 59t and Labor Act (EMTALA). drug-related, 43-44 cardiovascular, 52-56, 53t Enablement, 87-89, 88f, 89f evaluation of, 179, 179b chemotherapeutic, 60-61, 60t Endocrine drug groups, 57t DMARDs. See Disease-modifying antirheu- disease-modifying, 51t, 52 Endocrine function, sarcopenia and, 265-266, dosage schedule and, 61 matic drugs (DMARDs). for end-of-life pain control, 517-519, 518f 265b DME. See Durable medical equipment (DME). excretion of, 40-41 DMERCs. See Durable medical equipment regional carriers (DMERCs).

INDEX 599 Endocrine system, prosthetic determination Erythromycins, 59t Examination (Continued) and, 433-434 Escalators, 117 in developmental disabilities. See Develop- Estrogen mental disabilities: examination and End-of-life care, 500-524 evaluation in. advance directives and, 520-522 age-related changes in, 36 in impaired aerobic capacity, 234-238, 235t, comfort care measures in, 513-514 antineoplastic, generic/trade names for, 60t 236b, 237t, 238t, 244-246, 245t concept of a “good death,” 500 Estrogen replacement therapy, 57, 57t integrated decision-making strategy and, confronting reality of death, 520-521 Ethnicity. See also Culture. 96-99, 98b dealing with death and dying, 521 health care access and, 587 of joint mobility, 253-257, 255b hospice care and. See Hospice care. older adults and, 19 of long-term-care residents, 491-493, 491b, nearing death awareness and, 504, 513 Evaluation 493t pain and symptom management in, 514-519 of acute and medically complex patients, in motor control impairments, 278-282, defining pain at end of life, 514 279-280t, 282t pain assessment and, 516-517 153-185 of pain. See Pain: examination and pharmacologic measures for, 517-519, 518f balance and risk of falls, 335-338, 336b, evaluation of. prevalence of pain, 514-516, 515f, 516b, patient/client management model and, 516f 336f, 338b 94f, 95 types of physical pain, 516, 517f chart review in, 154-165 in prosthetic determination, 432-438, 433b, palliative sedation, 519-520 442-443 physiological process of dying, 501-504 admission or reason for visit and, 154 in urinary incontinence, 384-387, 385b, multisystem signs of approaching death, 502t electrocardiogram and, 160-162, 162f 386b, 393 progressive changes in the terminal phase, laboratory tests and. See Laboratory 501b Excretion, drug, 40-41 psychosocial and spiritual signs, symptoms, tests. Executive functioning, 132-134 and interventions in the actively dying, operative reports and, 162-165, Exelon. See Rivastigmine. 503t Exercise. See also Aerobic exercise; Exercise spiritual awareness and, 521 163-165t, 166b, 167b dehydration and, 179-180, 180b prescription. Endurance. See Aerobic capacity. developmental disabilities. See Develop- aerobic capacity and Endurance ambulation, 67t Environment mental disabilities: examination and impaired, 242-243, 242b evaluation in. physiology of, 230-234, 231f, 232f, 234f ambulation and, 323, 323b, 329 dizziness and, 179, 179b aquatic, 76-77, 77f, 543-545, 544f of dementia patients, 145-148 impaired aerobic capacity and, 238-241, balance and, 352, 452-454 home, 460, 461-462b 239b, 240t, 241b, 246, 246t bone quality/quantity and, 455 in hospice and palliative care, 513 impaired joint mobility, 257, 258b dementia and, 147-148 Environmental design, 104-121 in long-term-care facilities, 491-493, for depression, 129-131 balance/falls and, 347, 353 491b, 493t evidence-based recommendations for, 85, 85t dementia and, 118-119 metabolic syndrome and, 180-181, 180b for frail older adults, 455 general principles of, 113-119 prevention and, 181 golf, 545-547, 545f, 546b, 546f review of systems and, 165-178 heart rate and, 34 driving, 117-118 auscultation, 169-170, 170f, 171f, 171t home exercise programs, 473b, 477-478 escalators, 117 body weight/body composition, 173-174 in hospice and palliative care, 512-513 personal/living space, 114 coronary artery disease and, 174, 175b for impaired joint mobility, 258-259 physical therapy clinics, 115-116 heart failure and, 175-176, 175b in long-term care, 493-495 residential facilities, 114-115 mental status, 165-167 in pain management, 407-408 stairs, 116-117, 116f nutritional status and physical plyometric, 82-83, 84f hearing changes and, 105t, 110-111, 111f for postural muscle imbalances, 304-305, home safety and, 469-470, 470b, 471t appearance, 170-173, 172t taste/smell changes and, 105t, 111-113 pneumonia and, 176-177, 177b 304f, 306, 307f teaching/consulting strategies for, 119-120 pulmonary function, 169 public health and, 229-230, 230b touch changes, 105t, 113 sepsis and, 178, 178b resistance, 268-270, 268b, 527 vision changes and, 104-110, 105t urinary tract infections and, 177-178, for reversing decline and preventing disease, color, 105t, 109 contrast, 105t, 109, 110f 177b 36-37, 85 dark adaptation, 105t, 108-109 vital signs, 167-169, 168b, 169t, role in aging, 64-65, 64b, 65b, 65f, 85 depth perception, 105t, 109-110 glare, 105t, 107-108 238-239, 240t optimal, 3-4, 17 illumination, 105t, 107, 108f advocacy and, 592 reversing decline and preventing disease, visual acuity, 105-107, 105t, 106f, 107f integrated decision-making strategy and, visual field, 105, 105t, 106f 36-37 Environmental factors, ICF definition of, 90 99-103, 100f, 101f running, 542-543 Environmental press, definition of, 113 of lower limb orthoses, 421-422 skeletal tissue and, 30-31 Enzymatic debridement, 377 of pain. See Pain: examination and strengthening. See Strengthening exercise. Enzymes, cardiac, 157t stretching. See Stretching exercises. Epidermis, 355, 356f evaluation of. stroke volume and, 231-232, 232f Episode of illness, definition of, 569t patient/client management model and, Tai Chi, 83-85 Equipment tennis, 547-549, 547f, 548f, 549f for aerobic exercise, 76 94f, 95 wellness and, 448-449, 449t, 450 for aquatic exercise, 76 Evidence-based practice, 2-3, 3f in hospice and palliative care, 513 baseline measures for, 452, for strengthening exercise, 80-81, 80b, 82f best evidence and. See Best evidence. 453-454t clinical expertise and, 6-7, 6f exercise programs and, 85, 85t screening for, 451, 451t, 452t patient-client preferences and motivations types of programs for, 452-456 Exercise Assessment and Screening for You and, 14 (EASY) tool, 451, 451t in wound care, 374 Evidence-Based Review of Stroke Rehabilitation (EBRSR), 288, 289-290 Examination. See also Evaluation. of balance and risk of falls, 335-338, 336b, 336f, 338b

600 INDEX Exercise prescription, 68-74 Families (Continued) Force transmission, 252-253, 253f contractions, types of, 73 daily functions and tasks of, managing, Forward head posture (FHP), 293-294, 293f duration, 74 210-211, 210f FOs. See Foot orthoses (FOs). frequency, 73, 74t definition of, 207-208 400-m walk test, 75 functional training. See Functional training. driving and, 222-226, 223b, 224b, 225b, Four-square step test (FSST), 343-345t, 346 motor learning, 73 226b FPS. See Faces Pain Scale (FPS). overload, 68-69, 69t in later life, 214-215 Fractionated movement deficits, 276, 284t sets, 74 life span development and, 208-209, 208f Fractures. See also specific fractures. specificity, 69-70, 70f, 71t, 72f, 73f older adults’ roles in, 19-20, 217 older parent-adult child relationships, activity limitations and, 23, 23f, 251 Exercise stress test, 75 215-216 osteoporosis-related, 295-296 Expertise in physical therapy, clinical, 6-7, 6f retirement and, 216-217 Frail, definition of, 488 Extensibility, 256-257 role in physical therapy, 207 Frail older adults External supports for postural impairments, stress management and, 211-215, 212f, exercise for, 455, 494 213b, 215b frequency and duration of home health care 308-310, 309f, 310f, 311f themes and boundaries, 209-210, 209f Extrapyramidal symptoms, drug-related, 44 for, 474, 474f Extremities. See Lower extremities; Upper Family history, 255 Frailty Fat, lean mass and, 31, 31f extremities. Fatigue. See Muscle fatigue. as a clinical syndrome, 66, 66b Extremity postural exercise, 304f, 305 Fear falls and, 351, 351f in long-term-care facilities, 488-489, 489f, F of falling, 347-348, 348b motivation and, 188-189 490b FABQ. See Fear Avoidance Beliefs Fear Avoidance Beliefs Questionnaire (FABQ), sarcopenia and path to, 263, 264f Questionnaire (FABQ). transitioning to, 320 401-402 Fraud, 578 FAC. See Functional ambulation categories Fee for service, definition of, 569, 569t Freestyle stroke, 543-544 (FAC). FES. See Functional electrical stimulation Frequency of exercise, 73, 74t FSST. See Four-square step test (FSST). Faces Pain Scale (FPS), 399, 400f (FES). FTSST. See Five times sit to stand test (FTSST). Facilitatory insoles, 353, 353f FES-I. See Falls Efficacy Scale International Fullerton, Ross, 83 Fainting. See Syncope. Function Falls, 331-358. See also Balance. (FES-I). depression, physical illness, and, 125-128, FHP. See Forward head posture (FHP). definition of, 331 Fibroblasts, 248 126b developmental disabilities and, 561 Fibrous structures, age-related changes in, 250 health and, 25-26, 26f, 87-89, 88f, 89f drug-related, 43-44 Fick equation, 230-231, 231f examination and evaluation of, 335-348, FIM. See Functional Independence Measure families and, 217 physical, disability and, 24-25, 25f, 26f 336b, 336f, 338b (FIM). WHO’s classification of. See International aerobic endurance, 342 FIM motor items test, 282t environmental, 347 Finger–thumb opposition test, 279-280t Classification of Functioning, Disability fear of falling, 347-348, 348b Finger-to-nose test, 279-280t and Health (ICF). gait and functional balance, 342-347, Five times sit to stand test (FTSST), 341-342, Functional ambulation categories (FAC), 327 Functional assessment, 24 343-345t 343-345t of ADLs, 24, 25f neuromuscular, 341-342 Fixing to stay, 457-458 home health care and, 471-472, 472t participation, 348 Flaccidity, 274-275 of long-term-care residents, 492-493, 493t psychosocial, 347 Flexibility of mobility, 24 sensory, 338-341, 339f, 340f, 341f, of reactional activities, 25 in balance assessment, 342 Selective Functional Movement Assessment. 348b families and, 212, 212f See Selective Functional Movement somatosensory, 340 gait and, 319, 327-328 Assessment (SFMA). fear of, 347-348, 348b tests of, 82t, 453-454t of work performance, 24-25, 26f history of, 491-492, 491b Flexibility exercise, 407 Functional electrical stimulation (FES), 423 home health care and, 469 Flexible curve ruler, 297-299, 300f, 301f Functional Independence Measure (FIM), intervention for, 348-353, 349-350t, 351f, Floor coverings, selection of, 114-115 322, 484 Fluid intelligence, 133t, 134f Functional Outcome Assessment Grid 353f Fluid management, urinary incontinence and, (FOAG), 559t, 560 in long-term-care facilities, 491, 491b, 495 Functional training, 70-71, 73f mortality from, 353 391 for impaired aerobic capacity, 243, 244b prevention of Fluoroquinolones, 59t speed and power in, 71 Fluoxetine, 46, 129t Functioning, ICF definition of, 90 policies for, 586-587 FOAG. See Functional Outcome Assessment Furniture, selection of, 115 programs for, 452-454, 495 risk factors for, 331-332, 333f, 336b, 338, Grid (FOAG). G Foam dressings, 376t 349-350t, 469 Food and Drug Administration, drug testing Gait. See also Ambulation; Walking. seriousness of, 331 age-related changes in, 317-319, 319b, 320t Falls Efficacy Scale International (FES-I), by, 42 amputation and, 429 Foot assessment of 347-348, 348b with developmental disabilities, 560-561 Falls Free Missouri, 454 deformities, orthoses and, 422-423 functional balance, 342-347, 343-345t Families, 207-233 postural impairments and, 310, 311f examination and evaluation of, 324-327, Foot orthoses (FOs), 414-416, 415f, 416f, 325t, 326t caregiving and, 217-222 developmental transitions in, 218 417f. See also Orthoses, lower limb. dimensions of care in, 218-219 Footwear formal caregiving systems, 220-221 HIPAA and, 221-222 balance and, 353, 353f spouse as caregiver, 219-220 ulcerations and, 374-375 as complex systems, 209

INDEX 601 Gait (Continued) Guide to Physical Therapist Practice Hearing loss impairments of (Continued) conductive, 110 falls and, 349-350t learning and, 202 plan of care and interventions for, 327-329 on postural impairments, 303 sensorineural, 110-111, 111f normal, 316-319, 318t, 330 prognosis and plan of care in, 102-103 observation of, 279-280t prosthetic prescription and, 439, 443 Heart orthotic prescription and, 413 on wellness, 450 activity limitations and, 23f pathologic changes in, 319-321 age-associated changes, 184t speed of, 67t, 324-326, 325t, 329, 343-345t, H 347 Heart failure home health care and, 471-472, 472t Habilitation vs. rehabilitation, 562-563, 562f evaluation of, 175-176 wellness and, 453-454t Half-life, drug, 40-41 signs and symptoms associated with, 175b Hamstrings, stretching, 82f, 541f Gait training, 490-491, 495 Hand-held muscle dynamometry, 77, 78t Heart rate Galantamine, 48 Handicap. See Participation. age-related decline in, 32 Gandhi, 135t HBOT. See Hyperbaric oxygen therapy evaluation of, 167, 168b GARS-M. See Modified gait abnormality maximal, factors influencing, 32, 231 (HBOT). oxygen consumption and, 231, 231f rating scale (GARS-M). HDL. See High-density lipoproteins (HDL). predicted maximum, 512 Gastrointestinal disorders, drugs for, 56 Head alignment, 299-300, 302f resting, 167, 512 Gastrointestinal system, adverse drug Health. See also Wellness. target, exercise and, 74-75, 75t reactions and, 43 definition of, 87, 447 Heart rate reserve (HRR), 167, 168b GDS. See Geriatric Depression Scale (GDS). function and, 87-89, 88f, 89f Heart rate variability (HRV), 528 Gender Heart sounds, auscultation of, 169-170, 170f families and, 217 Heel cord stretch, 83f depression and, 127 improving, of older adults, 581 Height, bone mineral density and, 295 pain and, 397 WHO’s classification of. See International Helplessness, learned, 204-205 Genetics, sarcopenia and, 267-268 Hematocrit, 157 Geography, health care access and, 587 Classification of Functioning, Disability Hemiplegic gait, 320-321 Geriatric Depression Scale (GDS), 123, 124t and Health (ICF). Hemoglobin, 157 Geriatric Pain Measure (GPM), 401 Health care Heparin, 55-56 Geriatric pharmacology. See Pharmacology, access to, 568-570, 568f, 569t, 570b, Herpes zoster, 357, 357f 585-588, 585f Herpesviruses, drugs for, 59t geriatric. cost and financing of, 585, 585f, 589-590 Heterocyclic antidepressants, 128, 129t Gerontological research, initial emergence of, funding for, 568-569, 568f HHAs. See Home health agencies (HHAs). Patient Protection and Affordable Care Act, High-density lipoproteins (HDL), 174 16 568, 586 Hinged ankle-foot orthoses, 418, 419f Glare, sensory changes and, 105t, 107-108, 116 quality and outcomes, 585, 585f, 588-589, Hip fracture, dementia and, 149-150 Glenn, John, 135t 588f HIPAA. See Health Insurance Portability and Glenohumeral pain, 543 trends and future of, 25-26 Glucocorticoids, 52 utilization of services, 25-26, 26f Accountability Act (HIPAA). Glycoconjugates, 249 Health insurance, 567-568. See also Medicaid; Hip-knee-ankle flexion strategy, 306f Goals Medicare; Reimbursement. Hip-knee-ankle-foot orthoses (HKAFO), cost control methods in, 569-570, 569t, motivation and, 185, 187t 570b 414-415, 420-421 setting funding for, 568-569, 568f Hippocratic Oath, 585 number of individuals without, 586 Hips in home health care, 472-474, 473b, 474b private, 568 patient participation in, 193-203, 194b, for prosthetics, 429-431 arthroplasty. See Total hip arthroplasty. role in improving the health of older adults, response to postural perturbations, 334f, 335 195t, 198f, 201b 581 History. See Family history; Patient history. Gold compounds, generic/trade names, 51t web-based resources on, 581, 582b HIV. See Human immunodeficiency virus (HIV). Golf, 545-547, 545f, 546b, 546f Health Insurance Portability and HKAFO. See Hip-knee-ankle-foot orthoses Governance process, family, 209 Accountability Act (HIPAA), 221-222 GPM. See Geriatric Pain Measure (GPM). Health policy, 583-594. See also Advocacy. (HKAFO). Graded exercise testing, 236-237 components of, 584-585, 584f HOAC. See Hypothesis-Oriented Algorithm Grandparents, 20, 216 definition of, 583 GRFVs. See Ground reaction force vectors domains of, 585-590, 585f for Clinicians (HOAC). access and availability, 585-588, 585f HOAC II. See Hypothesis-Oriented Algorithm (GRFVs). cost and financing, 585, 585f, 589-590 Ground reaction force vectors (GRFVs), 317, quality and outcomes, 585, 585f, for Clinicians II (HOAC II). Home exercise programs, 473b, 477-478 319 588-589, 588f Home health agencies (HHAs), 459b, 460-464, Growth hormone, sarcopenia and, 266 Health promotion, 88f, 447. See also Wellness. Health status, 87 463b, 574 Guide to Physical Therapist Practice Home health care, 457-484 definition of disablement, 87-88 clinical decision making and, 93-96, 94f definition of posture, 292 model of, 87-89, 88f, 89f advantages of, 457 diagnosis in, 99-103, 100f, 101f Hearing assessment in evaluation in, 99-103, 100f, 101f activity limitations and, 23f examination in, 96-99, 98b changes in emergency situations, 470-471, 471b impaired aerobic capacity classifications, 241 fall-risk screening, 469 impaired joint mobility in, 257 driving and, 118 functional, 471-472, 472t integumentary impairments and, 370, environmental adaptations to, 105t, home safety, 469-470, 470b, 471t 372-373 medication reconciliation and, 467-469, orthotic prescription and, 413-414 110-111, 111f palliative care and, 509 Hearing aids, 111 468b, 469b patient/client management model in, 94-96, OASIS and consent and, 465-467, 465b, 94f 466b, 466t personal safety, 471 coordination of patient care in, 476-477

602 INDEX Home health care (Continued) Hospice care (Continued) Inclinometers, 299, 301f demographics, 25-26 palliative care vs., 504-505 Incontinence discharge planning at start of care, 475 patient profile, 507-508, 508t goal setting in, 472-474, 473b, 474b physiological process of dying and, 501-504 bowel, 466b home exercise programs, 473b, 477-478 multisystem signs of approaching death, falls and, 349-350t initial visit, 464-465, 467b 502t urinary. See Urinary incontinence (UI). patient education on, 475 progressive changes in the terminal phase, Individualized care, motivation and, 185, 187t physical therapist assistant utilization in, 501b Individualized Service Plan (ISP), 562-563, 562f 478, 479b psychosocial and spiritual signs, symptoms, Infections, treatment of, 58-59, 59t physical therapist’s role in, 458-460 and interventions in the actively dying, Inflammation home environment and, 460, 461-462b 503t drug therapy for, 50-52, 51t rehospitalization and, 459-460, 459b total-body, management of, 35-36 physician communication in, 475 Hospital admissions Influenza A, 59t projecting number and timing of visits in, chart review and, 154 Information processing, learning styles and, 474-475, 474f increase in, 153 reimbursement for 201-202 average costs of, 581 Hospitalization, Medicare coverage of, 572, Information-seeking behavior, 184 Medicare and, 574, 581 572b Injuries in older athletes, 528-531, 529f, 531b definition of homebound, 457-458, 458b Inpatient postacute care settings, 482-503 documentation in, 460-464, 463b, HRR. See Heart rate reserve (HRR). 465b, 466t, 475, 476b HRT. See Hormone replacement therapy future trends in, 498-499 self-management and transitions in, 479-480 inpatient rehabilitation facilities, 482-484, subsequent visits, 475, 476b (HRT). technology and, 478-479, 480b HRV. See Heart rate variability (HRV). 483b Human immunodeficiency virus (HIV), 59t long-term-care facilities. See Long-term-care Home safety, assessment of, 469-470, 470b, Humanist learning theory, 190 471t Humor, as a coping strategy, 213b (LTC) facilities. Hydantoins for seizures, 49t skilled nursing facilities, 482, 484-485 Homebound, Medicare definition of, 457-458, Hydration, wound healing and, 360 458b Hydrocolloid dressings, 376t reimbursement for, 484, 485-486, 485b Hydrofiber dressings, 376t Inpatient rehabilitation facilities (IRFs), Homeostasis, aging and, 28-36, 28f, 29f Hydrogel dressings, 376t body composition and, 31, 31f Hyperbaric oxygen therapy (HBOT), 378t, 482-484, 483b, 572-573, 573b cardiovascular tissues and, 32-34, 32b Inpatient Rehabilitation Facility-Patient collagenous tissues and, 31-32, 32b 380 hormones and, 36 Hyperlipidemia, 55 Assessment Instrument (IRF-PAI), 484 immune system and, 35-36 Hypermetria, 284t Inserts, shoe. See Shoes. nervous system and, 34-35, 35b Hypertension, 162 Insoles, balance and, 353, 353f skeletal tissue and, 29-31, 29f, 30b Insomnia, benzodiazepines for, 45 drugs for, 52-54, 53t Institutionalization, depression and, 127-128 Hormonal agents, 56-58, 57t evaluation of, 168-169 Instrumental activities of daily living, 24, 25f Hormone replacement therapy (HRT), 36 Hyperthyroidism, 58 Hypertonicity, 275 families and, 210-211, 210f bone mineral density and, 30-31 Hypokinesia, 277, 284t Insulin, 57t, 58, 265-266 impact on physical therapy, 56-58, 57t Hypotension, orthostatic. See Orthostatic Insulin resistance syndrome (IRS), 180 sarcopenia and, 266 Insurance. See Health insurance; Medicaid; Hormones hypotension. age-related changes in, 36, 265-266, 265b Hypothesis-Oriented Algorithm for Clinicians Medicare; Reimbursement. antineoplastic, generic/trade names for, 60t Integrated decision-making strategy, 96-103, Hospice care (HOAC), 96, 97f comfort care measures in, 513-514 Hypothesis-Oriented Algorithm for Clinicians 97f, 98b, 100f, 101f concept of a “good death,” 500 Integumentary impairments, 354-386. See also equipment/environment and, 513 II (HOAC II), 96 exercise and, 512-513 Hypothetico-deductive strategy, 100 Wound healing. history of, 507 Hypothyroidism, 58 age-related skin changes and, 355-358, 356f interdisciplinary model of care and, 505-506, Hypotonicity, 274-275 skin cancer, 358, 358f 506f I skin conditions, 356-358, 356f, 357f, 358f Medicare reimbursement for, 505-506, 505b, arterial wounds, 366-368, 367f ICD-10. See International Classification of comorbid conditions associated with, 355 574, 574b Disease, The, Tenth Revision (ICD-10). compression therapy for, 375 models of physical therapy practice in, diabetic neuropathic ulcers, 368-370, 368t, ICF. See International Classification of 509-512 Functioning, Disability and Health (ICF). 369t case management, 510-511 examination and evaluation of, 370-374, rehabilitation in reverse, 510 ICIDH. See International Classification of rehabilitation light, 509-510 Impairments, Disabilities, and Handicaps 371f, 372f, 372t, 373t skilled maintenance, 511-512 (ICIDH). pressure relief for, 374-375 supportive care, 512 pressure ulcers, 362-365, 362t, 363f, 365t, nearing death awareness and, 504 IIQ. See Impact Questionnaire (IIQ). outcomes in, 508-509 Illness 374-375 pain and symptom management in, 514-519 skin tears, 361-362, 361t defining pain at end of life, 514 concept of, 66 venous insufficiency ulcers, 365-366, 366f pain assessment and, 516-517 depression, function, and, 125-128, 126b Integumentary system. See also Skin. pharmacologic measures for, 517-519, 518f Illumination changes, accommodation of, impaired aerobic capacity and, 245 prevalence of pain, 514-516, 515f, 516b, prosthetic determination and, 437-438 105t, 107, 108f Intellectual disabilities, 557-558 516f Immune system, age-related changes in, 35-36, Intelligence types of physical pain, 516, 517f categories of, 133t 184t fluid versus crystal, 134f Impact Questionnaire (IIQ), 387 IQ tests and, 132, 197 Impairment Intermediate care facilities, 554-555 Intermediate Care Facilities/Mental of body structure or function, 91 ICF definition of, 90-91 Retardation Program, 554 in older athletes, 538-539, 539f Impingement sign test, 535, 537f International Classification of Disease, The, Tenth Revision (ICD-10), 91

INDEX 603 International Classification of Functioning, Kruel protocol, 76 Long-term-care (LTC) facilities Disability and Health (ICF), 64, 65f, Kyphosis contracture management and risk reduction 89-93, 89f in, 496 external postural supports for, 308-310, dementia and depression in, 497-498 activity limitations and, 91-92, 321 309f environmental design of, 114-115 comparison of disablement concepts, 89-90, examination and evaluation in, 491-493, thoracic, 252, 253f, 293 491b, 493t 90b Kyphosis Index (KI), 297-299, 300f, 301f exercise in, 493-495 concept of disability, 93 fall risk reduction in, 495 definitions of, 90b L frailty in, 488-489, 489f, 490b disease/health condition and, 90-91 future trends in, 498-499 impairment of body structure or function Laboratory tests gait training in, 495 types of, 154-160 goal of, 488 and, 91 arterial blood gases, 160, 161t Medicaid and, 580 participation restriction and, 92 blood lipids, 156-157 Medicare and, 487, 490-491, 490b structure of, 91b coagulation profile, 157 pressure ulcer management and risk International Classification of Impairments, complete blood count, 157-158 reduction in, 496-497 electrolytes, 158 resident profile, 486-488, 487t Disabilities, and Handicaps (ICIDH), 89 serum enzymes and markers, 155-156, restorative programs in, 497 Interpersonal model of depression, 123 157t restraint reduction in, 495-496 Interventions values for, 155t screening in, 489-491, 490b to improve motivation and behavior, 186-188, Late-onset poliomyelitis, orthoses and, 424 Low-density lipoproteins (LDL), 174 186t, 187t Lateral rotation with flexion test, 534-535t, Lower extremities patient/client management model and, 94f, 537f, 538f alignment of, 300, 302f 95 LBD. See Lewy body dementia (LBD). amputation. See Amputation, lower limb. LDL. See Low-density lipoproteins (LDL). motor control impairments in, interventions Intervertebral discs, age-related changes in, 294 Learned helplessness, case study of, 204-205 Iowa Pain Thermometer (IPT), 399, 400f Learned-helplessness model of depression, for, 290 IPT. See Iowa Pain Thermometer (IPT). orthoses for. See Orthoses, lower limb. IQ tests, 132, 197 123 prosthetics for. See Prosthetics, lower limb. IRF-PAI. See Inpatient Rehabilitation Facility- Learning. See also Patient education. ulcers, differential diagnosis of, 373t Low-level laser therapy (LLLT), 407 Patient Assessment Instrument (IRF-PAI). assessment of, 203 LSS. See Lumbar spinal stenosis (LSS). IRFs. See Inpatient rehabilitation facilities (IRFs). case studies on, 203-206 LTC facilities. See Long-term-care (LTC) IRS. See Insulin resistance syndrome (IRS). cognitive aspects of, 197-202, 201b ISP. See Individualized Service Plan (ISP). culture and, 196-197, 198f facilities. definition of, 189 Lumbar spinal stenosis (LSS), 296 J educational/cultural background and, Lumbar supports Joints 196-197 for postural impairments, 308-310, 309f, connective tissue of. See Connective tissues. hearing changes and, 202 310f, 311f impaired mobility of, 248-268 motor, 73 evaluation and diagnosis of, 257, 258b motor changes and, 202 sitting postures and, 306, 307f influence on activity and participation, 253 neurological aspects of, 202 Lungs injuries and, 23, 23f physiological aspects of, 202 interaction of factors contributing to, psychological aspects of, 191-193 aging of, 184t 249f readiness for, 190, 201 auscultation of, 170, 171f, 171t intervention in, 257-260 strategies for affecting, 196 assistive/adaptive devices and equipment, styles of, 201-202 M 260 theories of, 189-191, 191t manual intervention techniques, visual changes and, 202 MA Plan. See Medicare Advantage (MA) Plan. 259-260 Levator ani muscles, 383-384 Macrotrauma, 529 patient education, 258-259 Levodopa, 49-50, 49t Magnesium abnormalities, 159t outcomes in, 260-262 Lewy body dementia (LBD), 142 Maintenance care. See Custodial care. mobility of Licensure, 587-588 Major Depressive Episode, criteria for, aging and, 248-253, 249b, 249t, 251f, Life expectancy, 18-19 253f active, 21-22 121-122, 122b definition of, 248 developmental disabilities and, 554 Mandela, Nelson, 135t examination of, 253-257, 255b Life habits questionnaire, 348 Manic depression. See Bipolar disorder. pain, falls and, 349-350t Life span development, 208-209, 208f Manual joint mobilization/manipulation, range of motion and. See Range of motion. Lifestyle structures of, changes in, 250 aging and, 27 259-260, 306 urinary incontinence and, 390 Manual muscle testing (MMT), 79, 341-342, 492 K Ligaments, spinal, 294, 295f MAOs. See Monoamine oxidase inhibitors Light touch sensation test, 279-280t KAFO. See Knee-ankle-foot orthoses (KAFO). Lighting, appropriate, 105t, 107, 108f, 114, 116 (MAOs). Karvonen method, 74-75, 75t Literacy, health, 196, 197-201, 201b Marital status, mortality and, 19, 20f Kelley, Johnny, 523 Lithium Masters Events, 523-524, 525t, 526 KI. See Kyphosis Index (KI). for bipolar disorder, 47 Mattresses, 374 Kidneys, 184t drug therapy case study, 62-63b McGill Pain Questionaire, 400-401 Klein, Helen, 523 Living arrangements of older adults, 19-20 MCI. See Mild cognitive impairment (MCI). Knee arthroplasty, total. See Total knee Living space, environmental design of, 114 MCID. See Minimum clinically important LLLT. See Low-level laser therapy (LLLT). arthroplasty. Locus of control, definition of, 190 difference (MCID). Knee-ankle-foot orthoses (KAFO), 414-415, Longitudinal arch supports, 416, 416f MDRT. See Multi-directional reach test (MDRT). Mead, Margaret, 590-591 419-420, 420f Mechanical debridement, 377 for late-onset poliomyelitis, 424 Medial rotation with extension test, 534-535t, Kruel, Fernado Martins, 76 537f

604 INDEX Medicaid, 568-569, 580 Metabolic syndrome, 180-181, 180b Motor control (Continued) dual coverage by Medicare and, 580 Metabolism activity limitations and participation fraud and abuse, 578 restrictions from, model of, 272-273, long-term care and, 487 age-related changes in, 265-268, 265b, 268b 274f nursing homes/custodial care coverage, 580 deteriorating muscle quality and, 265 ataxia, 276-277 value-based purchasing of, 580-581 drug, 40 current evidence underlying interventions Metatarsal (MT) pad, 416, 417f in, 288-290 Medical records. See Documentation. Metatarsalgia, orthoses and, 422 diagnosis and prognosis of, 282-286, Medicare, 567-568, 569 Methicillin-resistant Staphylococcus aureus 283f, 284t, 285b, 285f, 290 examination in, 278-282, 279-280t, 282t, acute care hospitals and, 572, 572b (MRSA), 357 290 community services, prevention, wellness, Microtrauma, 529-530, 529f fractionated movement deficits, 276 Mild cognitive impairment (MCI), 137-138, hypokinesia, 277 and, 574-575, 581 major body structure and functional, 273b cost control methods of, 569-570, 576-577 137b, 137t, 138f paresis, 273-274, 275f documentation requirements of, 577-578, Mini-Cog, 144-145t perceptual deficits, 277-278 Mini-Mental Status Examination (MMSE), plan of care and rehabilitation approach 577b for, 286-288, 287f drug costs, 572t 132, 144-145t, 498, 561 somatosensory loss, 277 dual coverage by Medicaid and, 580 Minimum clinically important difference durable medical equipment and, 575, 575b neural structures responsible for, 272, 273f enrollee demographics, 25f, 26f (MCID), 12 Motor function, developmental disabilities fraud and abuse, 578 MIRE. See Monochromatic infrared energy home health care and, 480-481, 574 and, 559-561 (MIRE). Motor learning, 73 definition of homebound, 457-458, 458b Mitochondrial dysfunction in sarcopenia, 267 Motricity Index, 279-280t documentation requirements, 460-464, Mixed/unspecified pain, 395 Movement. See also Ambulation; Selective MMA. See Medicare Prescription Drug, 463b, 465b, 466t, 475, 476b Functional Movement Assessment (SFMA). justification of continued homebound Improvement, and Modernization Act age-related changes in, 34 (MMA). functional, 71t care, 473-474, 474b MMSE. See Mini-Mental Status Examination impaired. See also Joints: impaired hospice benefits, 505, 505b, 574, 574b (MMSE). inpatient rehabilitation facilities and, MMT. See Manual muscle testing (MMT). mobility of. Mobility. See also Ambulation; Joints. fractionated movement deficits, 276 482-484, 483b, 572-573, 573b aids to, 323 in older athletes, 531-532 long-term care and, 487, 490-491, 490b community, 322-323, 328-329 slowness of, 79-80 outpatient therapy services and, 573-574, definitions of terms related to, 322b Movement system diagnoses for motor control disability, 65, 322, 322b Impairments, 283, 283f, 284t 573f enhancing, 455-456 MRSA. See Methicillin-resistant Staphylococ- Part A of, 464-465, 465b, 474, 570-571, functional assessment of, 24 cus aureus (MRSA). resistance exercise and, 269 MSAS-SF. See Memorial Symptom Assessment 571b Modified Ashworth Scale, 279-280t Scale-Short Form (MSAS-SF). Part B of, 504, 570-571, 571b, 576-577 Modified gait abnormality rating scale Multi-directional reach test (MDRT), 331-332, Part C of, 571 (GARS-M), 326-327 343-345t, 346 Part D of, 571 Modified Oxford scale, 386-387 Multifocal glasses, 116-117 on prosthetic prescriptions, 430-431 Modified Physical Performance Test, 488-489, Multiple disease states, adverse drug reactions skilled nursing facilities and, 484, 485-486, 490b and, 42 Modified side plank, 72f Multisegmental extension test, 534-535t, 535f 485b, 567-568, 573 Modified Sit and Reach, 453-454t Multisegmental flexion test, 534-535t, 535f value-based purchasing and, 578-580 Monoamine oxidase inhibitors (MAOs), 45t, Multisegmental rotation test, 534-535t, 536f Medicare Advantage (MA) Plan, 486 46, 128, 129t Muscle energy treatment (MET), 306-307 Medicare Contracting Reform, 575-576 Monochromatic infrared energy (MIRE), Muscle fatigue. See also Muscle performance, Medicare Payment Advisory Commission 378t, 379 impaired. Mood Disorder Due to a Medical Disorder cerebral palsy and, 557 (MedPAC), 460 with Depressive Features, 122 drug-related, 43 Medicare Plus Choice. See Medicare Mood stabilizers for dementia, 146t Muscle fibers, 263-265, 264b, 527 Morbidity, 22-24 Muscle mass, 263-264, 264b Advantage (MA) Plan. comorbidity and disability and, 23-24 Muscle performance, impaired, 263-278 Medicare Prescription Drug, Improvement, disease and disability and, 23, 23f resistance exercise for, 268-270, 268b falls and, 353 sarcopenia and, 263-268, 264b, 264f, 265b, and Modernization Act (MMA), 575 prevalent activity limitations and, 22-23 Medications. See Drug therapy; Drugs; specific prevalent chronic conditions and, 22, 22f 268b, 271 Mortality, 21-22 Muscle strength drugs. falls and, 353 MedPAC. See Medicare Payment Advisory marital status and, 19, 20f age-related changes in, 65-66, 264-265, 319 Moses, Anna Mary Robertson “Grandma,” in ambulation impairment, 328 Commission (MedPAC). 135t in balance and falls, 341-342, 352 Melanoma, 358, 358f Motivation exercise for. See Strengthening exercise. Memantine, 48, 146t components of, 183-189, 184t, 186t, 187t of long-term-care residents, 492-493 Memorial Symptom Assessment Scale-Short definition of, 183 in older athletes, 540, 540f measuring, 186, 186t orthotic prescription and, 413 Form (MSAS-SF), 514, 515f Motor control postural impairments and, 302-303 Memory loss impairments, 272-294 Muscle tone, abnormal, 274-275 abnormal muscle tone, 274-275 aging and, 132-134 types of, 132-134 Men life expectancy of, 18-19 marital status and, 19, 20f Mental function, 92 Mental illness, activity limitations and, 23, 23f Mental status, evaluation of, 165-167 MET. See Muscle energy treatment (MET). Metabolic acidosis, 161t Metabolic alkalosis, 161t

INDEX 605 Muscle weakness, drug-related, 43 Nonopioid analgesics, 50-52, 51t, 517-518 Orosco, Jesse, 135t Muscles. See also Muscle performance, Nonsteroidal antiinflammatory drugs Orthoses, lower limb, 412-428 impaired; specific muscles. (NSAIDs), 50-52, 51t, 517-518 ankle-foot orthoses, 414-415, 416-419, age-related changes in, 35, 527 NPAD. See Neck Pain and Disability Scale 417f, 418f, 419f postural spinal alignment and, 295 (NPAD). clinical applications of, 422-423 sarcopenia, 263-268, 264b, 264f, 265b, NPWT. See Negative-pressure wound therapy decision-making considerations for use of, 268b (NPWT). 413-414, 414b atrophy of, 263, 437 NRS. See Numeric Rating Scale (NRS). definition of, 412-413 functional movements and, 71t NSAIDs. See Nonsteroidal antiinflammatory examination for, 413, 413b postural imbalances, exercises to correct, fit and effectiveness of, evaluating, drugs (NSAIDs). 304-305, 304f Numeric Rating Scale (NRS), 399, 400f 421-422 Musculoskeletal system Nursing facilities, skilled. See Skilled nursing functions of, 412-413 hip-knee-ankle-foot orthoses, 414-415, activity limitations and, 23f facilities (SNFs). impaired aerobic capacity and, 245 Nursing homes. See also Inpatient postacute 420-421 prosthetic determination and, 435-436, 435f interaction between orthotists and physical of senior athletes, 526-527, 527f care settings. spinal impairments and, 295-296, 296b demographics, 25 therapists on, 424-425 insurance for, 581 knee-ankle-foot orthosis, 414-415, 419-420, N Medicaid coverage for, 580 Nutrition 420f Nagi, Saad, 88 sarcopenia and, 270-271 materials in, 415 Nagi’s model of health status, 87-89, 88f, 89f wellness and, 448, 448t outcome assessment in, 424 wound healing and, 360-361 postural impairments and, 310, 311f concept of disability, 93 Nutritional deficiency, signs and symptoms shoes and foot orthoses, 414-416, 415f, disease in, 90-91 International Classification of Functioning, of, 172t 416f, 417f Nutritional status, evaluation of, 170-173, terminology related to, 414-415 Disability and Health and, 89-90 therapeutic goals of, 412, 413b Namenda. See Memantine. 172t trunk-hip-knee-ankle-foot orthoses, 414-415, Naming test, 144-145t Narcotics, 50, 51t O 420-421 National Correct Coding Initiative (NCCI), Orthostatic hypotension, 168 OAA. See Older American Act Amendments 577 (OAA). from antipsychotics, 50 National Council on Aging (NCOA), 592 drug-related, 43 National health insurance. See Medicaid; OAB. See Overactive bladder (OAB). Orthotics. See Orthoses, lower limb. OASIS. See Outcome and Assessment Orthotists, 424-425 Medicare. Osteoarthritis. See also Arthritis. National Senior Olympics, 526 Information Set (OASIS). in older athletes, 530-531, 531b NCCI. See National Correct Coding Initiative Obesity, developmental disabilities and, orthoses and, 423 posture and, 296 (NCCI). 555-556 Osteopenia, 251, 296b NCOA. See National Council on Aging Observational task analysis, joint mobility Osteoporosis criteria for, 296b (NCOA). and, 256 definition of, 295 NDI. See Neck Disability Index (NDI). Obstacle course training, 329 falls and, 349-350t Nearing death awareness, 504, 513 Occupational/vocational wellness, 450 manual intervention techniques for, 260 Neck Disability Index (NDI), 260-261, 401 ODI. See Oswestry Disability Index (ODI). posture and, 295-296 Neck Pain and Disability Scale (NPAD), Office of Inspector General (OIG), 578 risk factors associated with, 167b, Older adults 260-261 296b Negative-pressure wound therapy (NPWT), definition of, 17 screening for, 451, 452t demographics of, 17-21, 17f, 18f, 20f, 21f with vertebral compression fracture, 378t, 380-381 economic status of, 21, 21f Nervous system, age-related changes in, family roles and relationships of, 19-20 311-315, 312f, 313f, 314f frail. See Frail older adults. young women and, 30 34-35, 35b improving the health of, 581 Oswestry Disability Index (ODI), 261, 297, Neural presbycusis, 110-111 increase in hospital admissions among, 153 Neurobiological model of depression, 123 living arrangements of, 19-20 298b Neurologic agents, 48-50, 49t morbidity and, 22-24, 22f, 23f Otto Bock’s C-leg, 429 Neuromuscular screening mortality and, 21-22 Outcome and Assessment Information Set Older American Act Amendments (OAA), 554 impaired aerobic capacity and, 245 Older athletes. See Athletes, older. (OASIS), 460-464, 463b, 465b impaired motor control and, 278-282, Older parent-adult child relationships, 215-216 completion of, 465-467 Olfactory system, changes in, 105t, 111-113 discharge and, 477 279-280t, 282t Olympics, National Senior, 526 quick tips, 466t Neuromuscular system Omnibus Reconciliation Act of 1987, 495-496 recertification and, 477 Operative reports, 162-165, 163-165t, 166b, on urinary and bowel incontinence, 466b balance and, 335, 341-342 Outcomes, 94f, 589 prosthetic determination and, 436-437 167b Out-of-pocket costs for Medicare services, Neuromusculoskeletal status, developmental Opioid analgesics, 50, 51t 572, 572b disabilities and, 558-559, 559t adverse effects, 518-519 Outpatient therapy services, Medicare and, Neuropathic pain, 395 for end-of-life pain control, 518-519 Neuropathies, peripheral. See Peripheral OPN model. See Ozer-Payton-Nelson (OPN) 573-574, 573f Overactive bladder (OAB), 384 neuropathies. model. Overhead deep squat test, 534-535t, 536f Neuropeptide-modifying agents, 146t Optimal aging, 3-4, 17, 248, 447 Overload, 68-69, 69t, 73f Neuroplasticity, 286 Optimal posture, 292 Oxybutynin, 391 Neurotrophins, 131 Orientation to learning, 190 Nitrates, organic, 53t, 55 Nitroglycerin, 55 Nociceptive pain, 395

606 INDEX Oxygen Pain management (Continued) Patient history (Continued) arterial levels of, 233 physical therapy interventions, 404-408 in integumentary impairments, 370 arteriovenous difference in, 233-234, 234f exercise, 407-408 joint mobility and, 254-255 venous levels of, 233 low-level laser therapy, 407 of long-term-care residents, 491-492, 491b manual therapy, 404-405 in pain management, 398-399 Oxygen consumption, 230-231 protective and supportive devices, 407 in postural impairments, 297 evaluation of, 240-241 TENS, 405-407, 406t in prosthetic determination, 433, 433b heart rate and, 231, 231f thermal agents, 404 in urinary incontinence, 384-386, 385b, maximal. See Vo2max. plan of care in, 403 392-393 Oxygen demand, increased, 234-238 PAINAD. See Pain Assessment in Advanced Patient management, elements of, 94f Ozer-Payton-Nelson (OPN) model, 194-195, Dementia (PAINAD). Patient Protection and Affordable Care Act, 194b, 195t, 472 Palliative care 568, 586 definition of, 504 Patient Specific Functional Scale (PSFS), 401 P equipment/environment and, 513 Patient-centered physical therapists, 5-7, 6f exercise and, 512-513 Patient-client preferences and motivations, 14 PACE. See Programs of All Inclusive Care for hospice care vs., 504-505 Pattern recognition, 100f the Elderly (PACE). Medicare hospice benefit for, 505, 505b Paxil. See Paroxetine. models of physical therapy practice in, Payne-Martin Skin Tear Classification System, PaCO2. See Partial pressure of carbon dioxide 509-512 (PaCO2). case management, 510-511 361t rehabilitation in reverse, 510 PDI. See Pain Disability Index (PDI). PAG matter. See Periaqueductal gray (PAG) rehabilitation light, 509-510 Pediatric Evaluation of Disability Inventory matter. skilled maintenance, 511-512 supportive care, 512 (PEDI), 559t, 560 PAICP. See Pain Assessment Instrument for sedation, 519-520 Pedometers, 454t Cerebral Palsy (PAICP). Pelvic Floor Distress Inventory (PFDI), 387 Palpation Pelvic floor muscles. See also Urinary Pain, 395. See also Pain management. coronary artery disease and, 175b age-related changes and, 398 pneumonia and, 177b incontinence (UI). biopsychosocial model of, 397-398 biofeedback for, 389 breakthrough, 516, 517f PaO2. See Partial pressure of oxygen (PaO2). continence and, 382-384, 383f cerebral palsy and, 557 Paresis, 273-274, 275f, 285f electrical stimulation for, 389-390 classification of, 395 Parkinson’s disease examination of, 386-387 depression and, 127, 401 exercises for, 387-389, 389b in end-of-life care drug therapy for, 48-50, 49t, 62-63b vaginal weights for, 390 assessment of, 516-517 hypokinesia and, 277 Pelvic Organ Prolapse and Incontinence Sexual defining pain in, 514 Parlodel. See Bromocriptine. prevalence of, 514-516, 515f, 516b, 516f Paroxetine, 46, 129t Function Questionnaire (PISQ), 387 types of physical pain, 516, 517f Par-Q. See Physical Activity Readiness Penicillins, 59t examination and evaluation of, 398-403 Per diem, definition of, 569t case studies, 409-411 Questionnaire (Par-Q). Perceived exertion, rate of. See Borg Rating of pain history and, 399-403, 400f Partial pressure of carbon dioxide (PaCO2), 160 patient history and, 398-399 Partial pressure of oxygen (PaO2), 160 Perceived Exertion (RPE). in patients with dementia, 402-403 Participation, 90, 92, 348 Perceptual deficits, 277-278 physical, 403 Participation restriction, 90, 92 Performance oriented mobility assessment in postural impairments, 297, 298b, 299b gender differences in, 397 impaired joint mobility and, 253-254, 253f (POMA), 327 intensity of, 399, 400f motor control impairments and, 272-273, Performance-based activity measures of joint joint, falls and, 349-350t phantom sensation of, 436 274f mobility, 256 prevalence of, 395-396 PASE. See Physical Activity Scale for the Performance-based outcome instruments of quality of, 399 tools for assessing, 399-403, 400f Elderly (PASE). impaired joint mobility, 261-262 total , concept of, 516f Patient compliance Pergolide, 49 Periaqueductal gray (PAG) matter, 382-383, Pain Assessment in Advanced Dementia drug reactions and, 42 (PAINAD), 403 improving, 62-63 383f motivation and, 183-189, 184t, 186t, 187t Peripheral neuropathies Pain Assessment Instrument for Cerebral Palsy Patient education, 189-193, 206. See also (PAICP), 557 orthoses and, 423-424 Learning. prosthetic determination and, 436 Pain Disability Index (PDI), 401 about drug therapy, 42 Peripheral vascular disease (PVD) Pain management, 395-418. See also Pain. case studies on, 203-206 amputation due to, 427 culture and, 196-197, 198f impairment in, 91 case studies, 409-411 on home health care, 475 prosthetic determination and, 436 challenges in, 396-397, 396b on impaired aerobic capacity, 244b Permax. See Pergolide. cognitive–behavioral approaches to, on impaired joint mobility, 258-259 Persistent pain, 395, 397-398, 405-407 improving, 62-63 Personal factors, ICF definition of, 89-93, 89f 408-409 motivation and. See Motivation. Personal space, environmental design of, 114 cost of, 397 on prosthetics, 440, 441b Personality drug therapy, 50-52, 51t therapist’s perception of, 192 changes in, 134, 135t in end-of-life care, 514-519 Patient Health Questionnaire (PHQ)-9, 124t motivation and, 185 Patient history, 98, 98b Person-based practices, 561-562 pain assessment in, 516-517 in balance and risk of falls, 337-338, 338b Person-centered planning interview, 564, 564b pharmacologic measures for, 517-519, in developmental disabilities, 558 Pes planus, orthoses and, 422 in examination for an orthosis, 413, 413b PFDI. See Pelvic Floor Distress Inventory 518f in impaired aerobic capacity, 234, 235t, 244 prevalence of pain, 514-516, 515f, 516b, (PFDI). Phantom sensation of pain, 436 516f types of physical pain, 516, 517f patient self-management programs, 408

INDEX 607 Pharmacodynamic changes, 41, 41f PISQ. See Pelvic Organ Prolapse and Posture (Continued) Pharmacokinetics, 40-41 Incontinence Sexual Function normal, 292 Questionnaire (PISQ). observation of, 279-280t absorption in, 40 optimal, 292 age-related effects on, 40f Plan of care, integrated decision-making shortened muscles and, 82t distribution in, 40 strategy and, 102-103 excretion in, 40-41 Potassium abnormalities, 159t metabolism in, 40 Plant alkaloids, 60t Poverty line for older adults, 21, 21f Pharmacology, geriatric, 38-69. See also Drugs. Platelets, 158 Power common adverse drug reactions and, 43-44 Plumb line tests, 297, 300f patient profile for, 38-43, 39f, 39t, 40f, 41f Plyometric exercise, 82-83, 84f aging and loss of, 83 Phenylpropanolamine (PPA), 391 Pneumonia, clinical presentation of, 176-177, functional training and, 71 PHN. See Postherpetic neuralgia (PHN). PPA. See Phenylpropanolamine (PPA). Phosphorus abnormalities, 159t 177b PPG. See Photoplethysmography (PPG). Photoplethysmography (PPG), 372, 372f PNF procedures. See Proprioceptive neuromus- PPS. See Prospective Payment System (PPS). PHQ-9. See Patient Health Questionnaire PPT. See Physical performance test (PPT). cular facilitation (PNF) procedures. Prealbumin, evaluation of, 370 (PHQ)-9. Pocket amplifiers, 111, 111f Premature ventricular contractions (PVCs), Physical activity. See also Exercise; Exercise Point of Care Technologies, 480b Policy-based practices, 561-562 162, 162f prescription. Poliomyelitis, late-onset, 424 Presbycusis, environmental adaptations to, definition of, 64 Polypharmacy impaired aerobic capacity and, 243 110-111, 111f public health benefits of, 229-230, 230b characteristics of, 39t Pressure Sore Status Tool (PSST), 373-374 role in aging, 64-65, 64b, 65b, 65f, 85 definition of, 38 Pressure Ulcer Score for Healing (PUSH) tool, falls and, 349-350t optimal, 3-4, 17 problems of, 38-39, 39f 373 reversing decline and preventing disease, POMA. See Performance oriented mobility Pressure ulcers, 362-365, 365t 36-37 assessment (POMA). etiology of, 362-364, 362t, 363f wellness programs and Positive reframing, 213b interventions for, 364-365 Postacute inpatient management. See Inpatient in long-term-care residents, 496-497 baseline measures for, 452, 453-454t, 454t prevention of, 364 screening for, 451, 451t, 452t postacute care settings. risk factors for, 364, 365t types of programs for, 452-456 Posterior leaf spring ankle-foot orthoses, treatment of, 374-375 Physical Activity Readiness Questionnaire Presynaptic adrenergic depleters, 53t (Par-Q), 451 417-418, 417f Prevention, ultimate goal of, 181 Physical Activity Scale for the Elderly (PASE), Postherpetic neuralgia (PHN), 357 Preventive health care, insurance and, 574-575, 237-238, 454t Postthoracotomy, TENS and, 406t Physical appearance, evaluation of, 170-173, Postural alignment 581 172t Primary prevention, 181 Physical dependence, definition of, 516b extremity, 300, 302f Private health insurance, 569-570. Physical function gait and, 319 activity limitations and, 92 head, 299-300, 302f See also Health insurance. disability and, 24-25, 25f, 26f spinal curve, 297-299, 300f, 301f Probabilistic diagnostic reasoning, 100, 100f health, families, and, 217 total body, 297, 300f Prognosis Physical performance test (PPT), 343-345t, 346 Posture Physical stress theory (PST), 28, 28f, 29f, age-related changes in, 294-295, 294f, 295f integrated decision-making strategy and, 67-68, 68b assessment of, 296-303 102-103 Physical therapist assistants, home health care and, 478, 479b alignment, 297-300, 300f, 301f, 302f patient/client management model and, 94f, Physical therapists, patient-centered, 5-7, 6f balance, 303 95 Physical therapy clinics, environmental design history, 297 of, 115-116 objective testing and, 297, 298b, 299b Prognosis studies, 10, 11-12 Physical wellness, 447-449, 448t, 449t range of motion, 301-302 Programs of All Inclusive Care for the Elderly Physician Quality Reporting Initiative, 579, 589 respiratory function, 303 Physician Self- Referral laws, 578 strength, 302-303 (PACE), 575 Physiological changes, 27-40, 66 balance and, 332-335, 334f Progressive resistance training (PRT), 527 aerobic capacity and, 229 impairments, 292-319 Pronation, 302f associated with death, 501-504 case example of, 311-315, 312f, 313f, 314f Proprioception multisystem signs of approaching death, consequences of less than optimal balance and, 332 502t posture, 293-294 orthotic prescription and, 413 progressive changes in the terminal phase, flexion-biased activities and, 292-293 Proprioceptive neuromuscular facilitation forward head posture, 293, 293f 501b osteoarthritis and, 296 (PNF) procedures, 307-308 in body composition, 31, 31f osteoporosis and, 295-296, 296b Prospective Payment System (PPS) in cardiovascular tissues, 32-34, 32b plan of care for, 303-310 in collagenous tissues, 31-32, 32b home health care and, 460-462 exercise interventions and, 36-37, 66 ADL interventions, 305-306, 306f, inpatient postacute care and, 482 in hormones, 36 307f in the immune system, 35-36 inpatient rehabilitation facilities, 484 learning and, 202 exercise instruction resources, 306, 307f skilled nursing facilities, 485-486, 485b motivation and, 184, 184t external supports, 308-310, 309f, 310f, outpatient, 569 in the nervous system, 34-35, 35b Prosthetics, lower limb, 426-448. See also in skeletal tissue, 29-31, 29f, 30b 311f Amputation, lower limb. manual therapy, 306-308, 308f case study, 442-445 postural muscle imbalance exercises, clinical team for, 426, 432 components in, 429, 430t, 431f, 432f 304-305, 304f costs associated with, 428 spinal stenosis and, 296 design of, 426, 428-431 thoracic kyphosis, 252, 253f, 293 diagnosis, prognosis, and rehabilitation in, joint mobility and, 248, 253 439-440 educational questionnaire for, 441b

608 INDEX Prosthetics, lower limb (Continued) Range of motion (Continued) Resistance to change, 192-193 examination, physiological changes, and in balance, 342, 352 Respiratory acidosis, 161t determination of, 432-438, 433b hospice care and, 513 Respiratory alkalosis, 161t cardiovascular and endocrine systems in, long-term-care facilities and, 491 Respiratory disorders, 56 433-434 Respiratory rate, average ranges of, 169 cognitive system in, 438 Rapid alternating movements test, 279-280t Resting metabolic rate (RMR), 265 integumentary system in, 437-438 Rate pressure product (RPP), 169 Restlessness, terminal, 502 musculoskeletal system in, 435-436, 435f RBC count. See Red blood cell (RBC) count. Restorative programs, long-term-care, 497 neuromuscular system in, 436-437 Reach, functional, 342-346, 343-345t Restraints, long-term care and, 495-496 functional levels for, 430t, 431f Reaching strategy, postural perturbations and, Retirement, families and, 216-217 insurance guidelines for, 429-431 Retooling for an Aging America, 5 outcome measures and assessment in, 334f, 335 Reversible dementias, 48 441-442 Readiness, learning, 190, 201 Review of symptoms, 163-165t plan of care, 440-441, 441b Reason for visit, chart review and, 154 Review of systems. See Systems review. prescription for, 430t Reciprocity and exchange, caregiving and, 218 Risk factor stratification, 163-165, 166b, 181 Recovery Audit Contractors (RACs), 577 Rivastigmine, 48, 146t Provider-based practices, 561-562 Recreation RMDQ. See Roland-Morris Disability Prozac. See Fluoxetine. PRT. See Progressive resistance training (PRT). falls and, 349-350t Questionnaire (RMDQ). Pseudoaddiction, 516b functional assessment of, 25 RMR. See Resting metabolic rate (RMR). Pseudodementia, 125, 126t Red blood cell (RBC) count, 155t, 157-158 Rocker bars, 416, 417f Pseudotolerance, 516b Regeneration of muscle, impaired, 264 Roland-Morris Disability Questionnaire PSFS. See Patient Specific Functional Scale Rehabilitation aging population and, 16-27 (RMDQ), 261, 401 (PSFS). habilitation vs., 562-563, 562f Romberg test, 343-345t PSST. See Pressure Sore Status Tool (PSST). in the home. See Home health care. Ross, Elizabeth Kubler, 521 PST. See Physical stress theory (PST). inpatient facilities, 482-484, 483b Rotator cuff tears, 529-530, 549-551 Psychological factors RPE. See Borg Rating of Perceived Exertion reimbursement for, 485-486, 485b in ambulation, 321-322 for older athletes, 537-538 (RPE). in learning situation, 191-193 RPP. See Rate pressure product (RPP). Psychological function, activity limitations core/balance and, 539-541, 539f, 540f, Running, 542-543 541f Rural areas, health care access and, 587 and, 92 Psychological wellness, 447, 448t, 449 drive to compete/remain active and, S Psychosis, definition of, 47 541-542 Psychosocial factors in balance and falls, 347 Safe Seniors Act, 586-587 Psychotherapy for depression, 129 impairments and, 538-539, 539f Safety, 588-589 Psychotropic medications, 44-47, 45t sport-specific, 542 Public policy, 589 in aerobic exercise, 76 PubMed, 9-10 golf, 545-547, 545f, 546b, 546f in aquatic exercise, 76 Pulmonary function, evaluation of, 169 running, 542-543 employee, 471 Pulmonary system, impaired aerobic capacity SAID principle and, 541 home, 469-470, 470b, 471, 471t swimming and aquatic exercise, in strengthening exercise, 80 and, 245-246, 246t SAID principle. See specific adaptations to Pulse pressure, 168 543-545, 544f PUSH tool. See Pressure Ulcer Score for tennis, 547-549, 547f, 548f, 549f imposed demands (SAID) principle. postacute, future trend of, 479 Sanders, Col., 135t Healing (PUSH) tool. prosthetics and, 439-440 Sarcopenia, 27, 28-29 Pusher syndrome, 277-278 in reverse, 510 PVCs. See Premature ventricular contractions Rehabilitation Act (1973), 554 consequences of, 263-268, 264b, 264f, Rehabilitation light, 509-510 265b, 268b, 271 (PVCs). Rehospitalization, 459-460, 459b PVD. See Peripheral vascular disease (PVD). Reimbursement, 566-584. See also Health frailty and, 488 insurance; Medicaid; Medicare. nutritional intake as a countermeasure for, Q in acute care hospitals, 572, 572b for home health care, 460-464, 463b, 465b, 270-271 Quality of health care, 585, 585f, 588-589, 466t prevalence of, 263 588f for hospice care, 505, 505b Saunders, Cicely, 507, 514-516 for inpatient rehabilitation facilities, Scabies, 358, 358f Quality of life, 87 482-484 Scales of Independent Behavior–Revised for prosthetics, 429-431 R for skilled nursing facilities, 484, 485-486, (SIB-R), 559t, 560 485b Schenkman’s model of integration and task Race Reintegration to Normal Living Index, 282t health care access and, 587 Reminyl. See Galantamine. analysis, 96, 97f life expectancy and, 18-19 Repolarization, drugs prolonging, 53t Scientific literature, best evidence and, 8-10, older adults and, 19 Res-Care-Assisted Living (Res-Care-AL) Intervention, 186-187 8b, 9f, 10b RACs. See Recovery Audit Contractors Residential facilities Scoliosis, 308-310, 309f (RACs). environmental design of, 114-115 Screening Tool of Older Person’s Potentially for individuals with developmental RAND 36-Items Health Survey, 237, 237t disabilities, 554-555 Inappropriate Prescriptions (STOPP), Range of motion Resilience 467-468 and coping within families, 214 Secondary prevention, 181 age-related changes in, 251-252, 251f, 317, motivation and, 185 Sedation 319 Resistance exercise, 268-270, 268b, 527 drug-related, 43 palliative, 519-520 assessment of Sedative-hypnotic agents in joint mobility, 256-257 generic/trade names, 45t for orthotic needs, 413 impact on physical therapy, 44-47 for posture/postural alignment, 301-302

INDEX 609 Sedentary death syndrome, 65 Shoes, 414-416, 415f, 416f, 417f, 423 Sodium channel blocking agents, 53t Sedentary lifestyle, 4 Short Blessed Test, 144t Soft tissue mobilization (STM), 307-308, Segmental mobility testing, 257 Short Physical Performance Battery (SPPB), Seizure disorders, drug therapy for, 49t, 50 308f Selective Functional Movement Assessment 343-345t, 453-454t Soft tissues, postural spinal alignment and, Shortened muscles, posture and, 82t (SFMA), 532-537 Shoulder press, 540f 295 interpreting, 536-537, 538b Shrinkers, 435, 435f Somatosensory loss, 277 on mobility problems, 539 SIB-R. See Scales of Independent Behavior– Somatosensory system in balance and falls, scoring system for, 533-536, 533b seven basic movements of, 533, 534-535t, Revised (SIB-R). 332, 340 Sickness Impact Profile, 441 SOT. See Sensory organization test (SOT). 535f, 536f, 537f, 538f Single-leg bridge without arms, 72f Spasticity, 275 Selegiline, 49 Single-leg stance (SLS), 342, 343-345t Special Olympics Healthy Athlete program, Self-concept Single-limb stance test, 453-454t, 534-535t, 561-562 changes in, 190 536f Specific adaptations to imposed demands positive, 184 SIS. See Supports Intensity Scale (SIS). Self-determination, motivation and, 185 Sit-to-stand, observation of, 279-280t (SAID) principle, 541 Self-efficacy, motivation and, 184-185, 186, Six-minute walk test, 67t, 75, 235-236, 282t, Specificity concept, 69-70, 70f, 71t, 72f, 73f Speed 186t 326, 326t Self-regulation, 183-184 Skeletal muscle functional ambulation and, 322-323, 322b Self-reports functional training and, 71 diseases and conditions associated with, gait, 67t, 324-326, 325t, 329, 343-345t, of depression, 122-123, 124t 267, 268b of impaired aerobic capacity, 237-238, 237t, 347 loss of, sarcopenia and, 263 home health care and, 471-472, 472t 238t, 260-261 in older athletes, 540, 540f wellness and, 453-454t of joint mobility, 256 Skeletal tissue, 29-31, 29f, 30b Spinal column, core/balance and, 539-540, Semitandem stance, 453-454t Skilled maintenance in palliative and hospice 539f, 540f Semmes-Weinstein monofilament test, 371, Spinal curve alignment, 297-299, 300f, 301f care, 511-512 Spinal mobilization combined with passive 371f Skilled nursing facilities (SNFs), 482, 484-485 motion, 306 Senility, 139-140 Spinal osteoarthritis, 296 Senior athletes. See Athletes, older. reimbursement for, 484, 485-486, 485b, 573 Spinal stenosis, 296 Senior Olympics, 526 Skilled services for home health, 465b Spine. See also specific regions of the spine. Sensitivity to failure, 192 Skin. See also Integumentary impairments; age-related changes in, 294-295, 294f, Sensorineural hearing loss, 110-111, 111f Sensory changes Wound healing. 295f age-related changes in, 184t, 355-358, 356f impairments of, 295-296, 296b balance and falls and, 338-341, 339f, 340f, ligaments of, 294, 295f 341f, 348b skin cancer, 358, 358f Spirituality skin conditions, 356-358, 356f, 357f, 358f as a coping strategy, 213b driving and, 117-118 examination and evaluation of, 370-374, dying and, 521 environmental accommodation of. See also wellness and, 449 371f, 372f, 372t, 373t Sport-specific training (SST) Environmental design. grafts, 377 golf, 545-547, 545f, 546b, 546f hearing, 105t, 110-111, 111f orthoses and, 414 running, 542-543 taste and smell, 105t, 111-113 prosthetic determination and, 437-438 SAID principle and, 541 touch, 105t, 113 tears, 361-362, 361t swimming and aquatic exercise, 543-545, vision, 104-110 Sleep, wellness and, 447 Sleeves, suspension, 429, 431f 544f color and, 105t, 109 Slippery slope tennis, 547-549, 547f, 548f, 549f contrast and, 105t, 109, 110f of aging, 3-4, 3f, 65-66, 66b, 66f, 67t Spouse as caregiver, 219-220 dark adaptation and, 105t, 108-109 of cognition, 135, 135f SPPB. See Short Physical Performance Battery depth perception and, 105t, 109-110 Slowness of movement, 79-80 glare and, 105t, 107-108 SLS. See Single-leg stance (SLS). (SPPB). illumination and, 105t, 107, 108f SLUMS. See St. Louis University Mental SSRIs. See Serotonin selective reuptake visual acuity and, 105-107, 105t, 106f, Screen (SLUMS). inhibitors (SSRIs). 107f Smell, changes in, 105t, 111-113 SST. See Sport-specific training (SST). visual field and, 105, 105t, 106f Smoking, 447 St. Louis University Mental Screen (SLUMS), stairs and, 116-117, 116f SNFs. See Skilled nursing facilities (SNFs). Sensory integration testing, 340-341, 341f, Sniff test, 144-145t 144-145t 348b Social ecological model based interventions, Stabilization exercises, 259 Sensory organization test (SOT), 341, 341f, Stair-climbing 348b 186-187 Sensory system, balance and, 332-334 Social function, activity limitations and, 92 ambulation and, 324 Sepsis, evaluation of, 178, 178b Social learning theory, 190 ten stairs, 67t Serotonin selective reuptake inhibitors (SSRIs), Social Security Act Stairs, environmental design of, 116-117, 116f 46, 128-129, 129t Static posture, 292 Serotonin/norepinephrine reuptake inhibitors, gender differences in, 24-25 Statins, 53t, 55 128, 129t Title 18 of, 568. See also Medicare. Stepping strategy, postural perturbations and, Sertraline, 46, 129t Title 19 of, 554, 562, 580. See also Serum enzymes and markers, 155-156, 157t 334f, 335 Serum glucose levels, 158-160 Medicaid. Stirrups, 416-417, 417f SFMA. See Selective Functional Movement Social support networks STM. See Soft tissue mobilization (STM). Assessment (SFMA). Stomach, age-associated changes, 184t Shaw, G.B., 135t motivation and, 185, 187t STOPP. See Screening Tool of Older Person’s wellness and, 450 Social wellness, 447, 448t, 449-450 Potentially Inappropriate Prescriptions Sockets, prosthetic, 428-429, 431f, 438 (STOPP). Sodium abnormalities, 159t

610 INDEX Strategy of exhaustion, 99-100 T Total-body inflammation, management of, Strengthening exercise, 77-81, 77f. See also 35-36 Tacrine, 48 Muscle strength. Tactile sensitivity Touch, changes in, 105t, 119 axial (core), 305 Tragus-to-wall measurement, 299-300, 302f CDC recommendations for, 64, 64b accommodation of changes in, 105t, 113 Transcutaneous electrical nerve stimulation contraindications for, 80 orthotic prescription and, 413 equipment for, 80-81, 80b, 82f Tai Chi, 83-85 (TENS), 405-407, 406t evidence-based recommendations for, 67t falls and, 331-332, 452-454 Transfemoral prosthesis, 429, 436, 442-445 history of, 67 for impaired joint mobility, 259 Transient pain, 395 for impaired joint mobility, 258-259 Talk test, 69, 69t Transparent film, 376t indications for, 79-80 Tampa Scale for Kinesiophobia, 402 Transtheoretical model (TTM), 190-191, 191t measurement of, 77-79, 78t, 79t Tandem and semitandem stance, 453-454t Tricyclic antidepressants, 45t, 46, 128-129, pain management and, 407-408 Tandem Romberg test, 343-345t specificity and, 69-70, 70f, 71t, 72f, 73f Taste, changes in, 105t, 111-112, 119 129t wellness and, 454-455 Tax Relief and Health Care Act, 579 Trunk Stress management, families and, 211-215, TBI. See Toe/Brachial index (TBI). Technology, home health care and, 478-479, core stability and, 539 212f, 213b, 215b stretches for, 305 Stress urinary incontinence, 384 480b tennis and, 548 Telehealth, 478-479 Trunk-hip-knee-ankle-foot orthoses pharmacologic interventions for, 391 Tennis, 547-549, 547f, 548f, 549f urethral bulking agents and surgical TENS. See Transcutaneous electrical nerve (THKAFO), 414-415, 420-421 TTM. See Transtheoretical model (TTM). interventions for, 392 stimulation (TENS). TUG. See Timed Up and Go (TUG). Stretching exercises, 81, 82f, 82t, 83f Tension-free vaginal tape (TVT), 392 TVT. See Tension-free vaginal tape (TVT). Teresa, Mother, 507 TW/LW. See Thoracic to lumbar width ratio for impaired joint mobility, 258 Terminal restlessness, 502 for older athletes, 540-541, 541f Tertiary prevention, 181 (TW/LW). for trunk and extremities, 305 Tetracyclines, 59t Tyrosine kinase inhibitors, 60t Strial presbycusis, 110-111 Therapy studies, 10-11, 12, 12b Stroke Impact Scale, 282t Thermal agents, 404 U Stroke volume, 231-232, 232f Thermal sensitivity changes, accommodation Subchondral bone, 251 UDI. See Urogenital Distress Inventory (UDI). Subcutaneous tissue, 356, 356f of, 105t, 113 UI. See Urinary incontinence (UI). Suburethral sling operation, 392 THKAFO. See Trunk-hip-knee-ankle-foot Ulcers Successful aging, 3, 17 Succinimides for seizures, 49t orthoses (THKAFO). diabetic neuropathic, 368-370, 368t, 369t Suicide, 128 Thomas test position, 83f pressure. See Pressure ulcers. Sulfonamides, 59t Thoracic kyphosis, 252, 253f, 293 venous, 365-366, 366f Supportive care in palliative and hospice care, Thoracic to lumbar length ratio (TL/LL), Ultrasound in wound healing, 378-379, 378t Universal health insurance programs, 567 512 297-299, 300f, 301f University of Texas Treatment-based Diabetic Supportive residencies, 555 Thoracic to lumbar width ratio (TW/LW), Supports Intensity Scale (SIS), 559t, 560 Foot Classification System, 368-369, 369t Suspension sleeves, 429, 431f 297-299, 300f, 301f Upper extremities, 288-290 Suspensory strategy, postural perturbations Thurmond, Strom, 135t Urethral bulking agents, 392 Thyroid disorders, drug therapy for, 57t, 58 Urge urinary incontinence, 384, 391-392 and, 334f, 335 Tibialis anterior, exercise for, 73f Urinalysis, 155t Swimming, 543-545, 544f Time and change test, 144-145t Urinary incontinence (UI), 382-398. See also Syncope, 179 Timed Up and Go (TUG), 282t, 326, 326t, Systematic reviews, 11, 12-13, 13b Pelvic floor muscles. Systems review 343-345t, 347 case example of, 392-394 home health care and, 471 continence mechanism and, 382-384, 383f auscultation, 169-170, 170f, 171f, 171t wellness and, 453-454t definition of, 382 body weight/body composition, 173-174 Tissues. See also Connective tissues. examination in, 384-387, 385b, 386b chart review and, 163-165t, 163-165, 166b, cardiovascular, 32-34, 32b interventions for, 387-392, 389b collagenous, 31-32, 32b OASIS assessment of, 466b 167b skeletal, 29-31, 29f, 30b pathophysiology and risk factors for, 384 in coronary artery disease, 174, 175b TL/LL. See Thoracic to lumbar length ratio prevalence of, 382 in examination for an orthosis, 413, 413b Urinary tract infections (UTIs), 177-178, 177b in heart failure, 175-176, 175b (TL/LL). Urogenital Distress Inventory (UDI), 387 in impaired aerobic capacity, 234, 244-246, To Err Is Human, 588 U.S. Healthy People 2010, 553 Toe/Brachial index (TBI), 371-372, 372f Usual aging, 3 245t Tolerance, 516b UTIs. See Urinary tract infections (UTIs). in integumentary impairments, 370 Tolterodine, 391 of joint mobility, 255 Total body alignment, 297, 300f V of long-term-care residents, 492 Total contact casts, 374-375 mental status, 165-167 Total hip arthroplasty Vaginal weights, 390 nutritional status and physical appearance, Value-based purchasing documentation of home health care for, 475 170-173, 172t goal setting after, 473-474 Medicaid and, 580-581 in pneumonia, 176-177, 177b older athletes and, 531b Medicare and, 578-580 in prosthetic determination, 433, 433b, returning to golf after, 546, 546b VAS. See Visual Analog Scale (VAS). Total knee arthroplasty Vascular dementia, 142 442 older athletes and, 530-531, 531b Vasodilators, 53, 53t pulmonary function, 169 returning to golf after, 546, 546b VDS. See Verbal Descriptor Scale (VDS). in sepsis, 178, 178b TENS and, 406t Venous insufficiency ulcers, 365-366, 366f in urinary tract infections, 177-178, 177b Total pain, concept of, 516f Venous oxygen content, 233 vital signs, 167-169, 168b, 169t Verbal Descriptor Scale (VDS), 399, 400f

INDEX 611 Verbal Numerical Scale (VNS), 399 W World Health Organization (WHO) Vertebrae, age-related changes in, 294-295, definition of health, 87, 447 Wagner Wound Classification System definition of osteoporosis, 295 294f, 295f (WWCS), 368-369, 368t definition of palliative care, 504 Vertebral compression fractures, 311-315, on developmental disabilities, 553 Walk test International Classification of Functioning, 312f, 313f, 314f distance, 453-454t Disability and Health. See International Vertigo, 179, 179b 400-m walk test, 75 Classification of Functioning, Disability Vestibular system, balance and, 334, 339-340 six-minute, 67t, 75, 235-236, 282t, 326, and Health (ICF). Vestibular training, 352 326t Vibrating insoles, 353 Wound bed preparation, 374 Vibration, perception of, 332 Walkers, four-wheeled breaking, 310, 310f Wound healing. See also Integumentary Vision Walking. See also Ambulation; Mobility. impairments. activity limitations and, 23f impaired joint mobility and, 253 debridement and, 375-377 balance and falls and, 334, 338-339, 339f, speed of, 282t dressings in, 375, 376t Walking programs, 456 electrical stimulation for, 378t, 379-380 340f, 349-350t Wallpaper illusion, 117 factors delaying, 359-360, 359b changes in, environmental adaptations to, Warfarin, 56 hyperbaric oxygen for, 378t, 380 Warm-up vs. stretching, 541 interventions for, 374 104-110 WBC count. See White blood cell (WBC) monochromatic infrared energy for, 378t, color, 105t, 109 contrast, 105t, 109, 110f count. 379 dark adaptation, 105t, 108-109 Weight, body. See Body weight. negative-pressure wound therapy for, 378t, depth perception, 105t, 109-110 Wellness, 446-460, 448f glare, 105t, 107-108 380-381 illumination, 105t, 107, 108f exercise and, 448-449, 449t, 450 normal, 358-361 visual acuity, 105-107, 105t, 106f, 107f Medicare and, 574-575 nutrition, hydration, and, 360-361 visual field, 105, 105t, 106f physical, 447-449, 448t, 449t, 450 physical therapist’s role in, 361 Visual acuity promotion of, 88f, 447 surgical interventions for, 377-378 balance and, 334, 339 psychological, 447, 448t, 449 ultrasound in, 378-379, 378t changes in, environmental adaptations to, scope of practice, 450-456 Wounds, examination and evaluation of, 105-107, 105t, 106f, 107f baseline and outcomes assessment, 452, 370-374, 371f, 372f, 372t, 373t driving and, 117-118 453-454t, 454t WWCS. See Wagner Wound Classification dynamic, 117-118 Visual Analog Scale (VAS), 399, 400f screening for physical activity and System (WWCS). Visual deficits, learning and, 202 wellness programs, 451, 451t, Wyatt v. Stickney case, 554 Visual field changes 452t balance and, 339 X environmental adaptations to, 105, 105t, types of physical activity and exercise programs, 452-456 Xerosis, 356, 356f 106f, 118 Vital signs, evaluation of, 167-169, 168b, social, 447, 448t, 449-450 Y White blood cell (WBC) count, 155t, 158 169t, 238-239, 240t WHO. See World Health Organization Yoga, 524f Vitamin C, 360-361 for impaired joint mobility, 259 Vitamin D deficiency, 266 (WHO). for trunk rotation, 539f VNS. See Verbal Numerical Scale (VNS). WOMAC arthritis disability index, 401 Vocational wellness, 450 Women Z Vo2max, 230-231 with developmental disabilities, 554 Zinc, wound healing and, 360-361 age-related decline in, 32-33 family roles of, 19-20 Zoloft. See Sertraline. senior athletes and, 527-528, 528f life expectancy of, 18-19 Zung Self-Rating Depression Scale, 123, 124t marital status and, 19, 20f osteoporosis and, 30 Work, functional assessment of, 24-25, 26f