PT Practice in Residential Aged Care

Electrotherapy considerations in aged care practice 361 Equipment Contraindications/ Uses (examples) Application Precautions See manufacturer’s instructions Pregnancy and given texts for dosage (contraindicated parameters over or near the uterus) Example: Chronic pain Precautions (a) Conventional type Circulatory insufficiency 80–120 Hz high frequency Risk of spread 0–30 mA low intensity Risk of exacerbating Pulse width 0.05 ms, 30 min pre-existing conditions (b) Acupuncture type (e.g. cardiac failure, 2–10 Hz low frequency skin conditions) High intensity (as tolerable Sensory loss 30 mAϩϩ) Pulse width 0.2 ms, 30 minϩϩ Ultrasound Contraindications Treatment of swelling Endogenous opioid release (no or low heat) Inbuilt stimulator Treatment of pain (e.g. pacemaker or Shortened soft tissue (c) ‘Burst’ other) Promotion of healing 2–5 Hz/70–100 Hz moderate Application near or intensity (0–30 mA) 30 min over a pregnant uterus or to eyes Skin test sharp/blunt or testes Warning given Check manufacturer’s Precautions instructions Circulatory problems Check texts referred to for Risk of spread or dosage parameters dissemination Risk of exacerbating Examples: pre-existing conditions Acute swelling (low intensity, Inability to pulsed) communicate e.g. 1:4, 30 s/ERA, 0.5 W/cm2 Sensory loss (Avoid treatment in initial bleeding phase of an injury) Chronic swelling (medium intensity, continuous) e.g. 2 min/ERA, 0.8–1.0 W/cm2 Acute pain (low intensity, pulsed) e.g. 30 s/ERA, 0.5 W/cm2 table continues

362 Appendix 4 Equipment Contraindications/ Uses (examples) Application Precautions Magnetic Healing (low intensity, pulsed) therapy e.g. 0.5 W/cm2 Laser (LLLT) Lengthening (medium–high intensity, continuous) e.g. 1:1, 5–15 min, 0.8–1.5 W/cm2 See manufacturer’s Chronic pain See equipment directions and guidelines Acute swelling manufacturer’s guidelines Pacemakers Chronic swelling Check output with magnet Be aware of metal Promote circulation supplied implants and healing Rapidly dividing cells e.g. Metastates/sepsis Acute 2–4 Hz Chronic 10–25 Hz Pain syndromes 50 Hz Contraindications Wound healing Check manufacturer’s Irradiation of the Pain guidelines and instructions eye area Acupuncture type (machines vary widely) Pregnancy (no Immunosuppressive application over or effect (in J/cm2) near pregnant uterus) Increase nerve sprouting Ͻ0.5 Acupuncture and regeneration (?) 0.5–1.0 Acute conditions 1.0–2.5 Subacute conditions 2.0–4.0 Chronic conditions Precautions Precautions Acute – daily Rx for 3 days, then 3 times per week. Rapidly dividing cells, Always ensure Low doses. After 3–6 treatments, and after increasing e.g. metastases, TB exposure is less the dose, if there is no change – then cease treatment where there is risk of than 8–9 J/cm2 Chronic – daily for 3 days, then spread or dissemination in any one session 2 times per week. Higher doses, less often to avoid inhibition Risk of exacerbation Chronic pain of pre-existing 0.9–1.8 J/radiant area conditions (e.g. skin Do not use near SWD Pulsed lasers Stimulations Ͻ1000 Hz (wound problems, infection, Well-lit enclosed room treatment) Inhibition Ͼ100 Hz (pain, OA, photosensitized Class 3B lasers – safety RA, post-surgical treatment) patients) (antimalarial, glasses required antibiotics, gold) for therapist and Over glands resident (endocrine/thyroid) Safety glasses are Inability to recommended for all communicate applications and types Use a warning sign

Electrotherapy considerations in aged care practice 363 Equipment Contraindications/ Uses (examples) Application Precautions Electrical Treatment time ϭ energy density stimulation Contraindications Acute swelling (mJ/cm2) ϫ treatment area (TENS, FES, (cm2)/laser average power (mW) NMES, FNS, Contraindicated over Promote circulation IF, HV, etc.) Laser average power (mW) ϭ inbuilt stimulators and healing pulse frequency ϫ pulse UV width ϫ peak power (e.g. pacemaker) Pain management See manufacturer’s guidelines and instructions Transthoracic Motor or sensory Machines vary widely applications stimulation Skin test – sharp/blunt Long duration direct Stiffness Check skin impedance, outputs, stimulation, suction current Wound treatment devices, dosage parameters Use within 3 m of SWD Ensure records kept including checks, treatment details, Contraindicated over or immediate results of treatment, etc. near a pregnant uterus Take care with machine Precautions maintenance; repeated uses Circulatory problems of electrodes, sponges and Risk of spread (e.g. covers can change their neoplasm, infection) conductivity and therefore Risk of exacerbating resultant treatment pre-existing conditions parameters (e.g. heart problems, hypertension, skin Erythemal skin test (E1) problems) Inability to Treatment frequency will vary communicate between daily to once every 3 Sensory loss (may use days depending on degree of low intensity erythema achieved (related to treatments with care) dosage required). Light to Unreliable residents Broken skin (careful – table continues decreased impedance leads to concentration in current flow) Contraindications Increase immune Application to eyes response Eye protection Kill bacteria required for Increase vitamin D therapist and synthesis resident Acne Ulcer management

364 Appendix 4 Equipment Contraindications/ Uses (examples) Application Precautions Precautions stimulative doses are useful Confirm photo- for healing of open wounds. sensitivity status A stronger reactive dosage unaltered (i.e. check may be useful for germicidal for photosensitizing purposes agents, medical Ensure coverage of area not conditions, being treated photoallergies) Acute skin condition Warm up lamp or infection Skin grafts Skin damage Infra-red radiation treatment Pressure pumps Contraindications Swelling/oedema Check skin/pain, sensitivity to pressure Circulatory insufficiency Increase interstitial Follow manufacturer’s guide- lines and read given protocols (arterial) pressure Ensure equipment maintenance Risk of exacerbating Stimulate venous and Example: Acute 30–35 mmHg pre-existing conditions lymphatic flow Chronic 45–50 mmHg Vascular 30–40 mmHg (e.g. acute muscle Partial venous stasis and Lymphoedema (arm) 40–60 mmHg, haematoma, DVT, skin ulceration (with care) (leg) 60–80 mmHg condition, acute Adjust rest periods depending on age, tissue being compressed infective process, (5–30 s); e.g. young/muscle injury 5–7 s rest, poor vascular cardiac failure) function 20–30 s rest Unreliable patient Precautions Inability to communicate Sensory loss SWD, short wave diathermy; MW, microwave; IRR, infra-red radiation; ERA, effective radiation area; FES, functional electrical stimulation; NMES, neuromuscular electrical stimulation; FNS, functional nerve stimulation; IF, interferential; HV, high voltage; DVT, deep vein thrombosis; PVD, peripheral vascular disease; OA, osteoarthritis; RA, rheumatoid arthritis; TB, tuberculosis. The physiotherapist must ensure that their duty of care responsibilities are maintained. Ensure familiarity with the specific equipment selected, the manufacturer’s guidelines and that the equipment satisfies relevant national standards. Choose the appropriate modality based on good clin- ical reasoning and known effects of the equipment. At all times be aware of infection control considerations and utilize high standards of practice in this regard.

Electrotherapy considerations in aged care practice 365 A full explanation should be given to the resident about the modality, how it works, its perceived benefits for them and what to expect during and after treatment. Position the resident comfortably and prepare them, the treatment area and the equipment. Ensure contraindications are checked as detailed above and also that sensitivity tests are completed. Appropriate warnings must be given and understood (and recorded as such), usually as (WGAU). Full outlines of these are available in the given references – refer to Robertson et al (2001). Standard practice in application: 1. Check contraindications. 2. Prepare – give the resident a full explanation and instructions, check treatment area and equipment. 3. Give appropriate warning. 4. Apply the treatment – remain within call. 5. Complete treatment and checks. 6. Document treatment. 7. Re-evaluate effects and effectiveness before next treatment and modify accordingly. References and further reading Robertson V J, Chipchase L S, Laakso E L et al 2001 Guidelines for the clinical use of electrophys- Cameron M H (ed) 1999 Physical agents in rehabili- ical agents. Australian Physiotherapy Association, tation. WB Saunders, Philadelphia St Kilda, Victoria. Email: national.office@physio- therapy.asn.au Forster A, Palastanga N (eds) 1981 Clayton’s electro- therapy: theory and practice, 8th revised edn. Wells P E, Frampton V, Bowsher D (eds) 1998 Pain: Baillière Tindall, London. management and control in physiotherapy. Heinemann Physiotherapy, London Lehmann J F (ed) 1982 Therapeutic heat and cold. Williams & Wilkins, Baltimore Wadsworth H, Chanmugan A P P 1983 Electrophysical agents in physiotherapy, 2nd edn. Science Press, Low J, Reed A 2000 Electrotherapy explained:principles NSW and practice, 3rd edn. Butterworth Heinemann, Oxford Nelson R, Hayes K, Currier D (eds) 1999 Clinical electrotherapy. Appleton and Lange, Stamford

5Appendix Mobility aids Aids to be reviewed: ■ walking sticks or canes (single, tripod, four-point) ■ hopper, Zimmer frame or ‘pick up’ frame (standard, with wheels) ■ wheelie walkers (three-wheeled, four-wheeled, seated, easy walker (low and high)) ■ rollator (easy-walker type, standard) ■ mechanical devices such as the standing hoist (with walking adaptation). For each aid we need to examine the following factors: ■ maintenance and other safety issues ■ individual fitting ■ suitability and recommendations for use ■ patient education with the aid ■ cost ■ availability. The prescription of suitable aids to maximize function, safety and mobility is one of the biggest tasks a physiotherapist must do. A broad spectrum of devices is available from the walking stick through to a rollator (Fig. A5.1) and furthermore through the use of mechanical equipment such as the standing/walking hoist for rehabilitation. It is extremely important to edu- cate patients in the correct use of the chosen aid. No doubt everyone has seen the wandering patient carrying a hopper frame above the ground and wondered how long it would be before an injury would occur if no sugges- tions for change were made and implemented. It is surprising how often walking sticks contribute to a poor gait pattern largely when used on the incorrect side. Stairs are a particular hazard and if encounters are planned then the physiotherapist will spend time practising with a resident to ensure safety and confidence. Walking sticks Maintenance and other safety issues Individual fitting It is imperative to check the rubber stopper/s on a regular basis to see that there has not been too much wear and therefore loss of gripping ability. Ensure the stick is inherently stable and that the grip is in good order and suitable for the resident. A stick should be fitted to ensure correct height. This is usually with the hand level equivalent with that of the greater trochanter (with the elbow 366

Mobility aids 367 Figure A5.1 Various walking aids (from left to right): rollator, walking stick, wheeled walker with tray and pneumatic tyres, and four-wheeled walker with seat and lockable hand brakes. comfortably bent) and the stick placed on the ground approximately 10 cm lateral to the fifth toe. A physiotherapist should check and recommend the height initially as bad habits and heights are often difficult to correct at a later date when the person has become accustomed to them. Moulded and foam handles are available for residents with arthritic and other such complaints who have deformity or weakness in the hand. Suitability and The walking stick provides the least assistance available and generally pro- recommendations vides little assistance aside from being a confidence booster. It may give slight assistance for balance and have some effect on weight-bearing also for use as long as it is used correctly. Two sticks can be prescribed for residents requiring extra assistance. Two sticks may be useful for residents with ataxia or some lower extremity amputees wearing prostheses. Some patients will benefit from three- or four-pronged sticks that are intrinsically more stable on the ground and do not require as much stability to be pro- vided from the individual, but only if used correctly so that all prongs are in contact with the ground at the same time. All too often only the prongs adjacent to the resident are in contact, thus causing the walking stick to be unstable and unsafe. Patient education A stick should be utilized on the opposite side to any weakness or disability with the aid present. Firstly the resident may use a three-point pattern (e.g. stick, weak leg, strong leg or conversely right stick, left leg, right leg) but they should work towards a two-point pattern (stick and opposite leg together, then

368 Appendix 5 strong leg), which is closer to a normal gait pattern. Two sticks may also be prescribed and either a two- or four-point pattern is then utilized. The physiotherapist should be careful to teach these patterns correctly. A four- point pattern with two sticks (e.g. right stick, left leg, left stick, right leg) is slower and proffers more assistance and stability although it is a little more disjointed. The two-point pattern (e.g. left stick and right leg together, then right stick and left leg together) is a more flowing and ‘normal’ pattern. Cost and Walking sticks are relatively cheap devices and are widely available. They availability are made from many different products including wood, metal and plastics. Some can be folded up in segments for easier carriage and storage. Hopper frames Maintenance and other safety issues (Zimmer frames The biggest drawback of a standard hopper frame is the requirement of the person operating it to be able to step, stop, lift the frame, place the frame or ‘pick up’ down further ahead, and step again. This is a very staccato and disjointed frames) movement pattern, which does not reflect the smooth and transient phases succinctly followed through in a normal gait pattern. Using the hopper frame requires the ability to stand (even though momentarily) unassisted whilst balancing and carrying the frame forwards. All these requirements place increased demand on the systems, lead to an abnormal gait pattern and do not allow for momentum and the learned repetitious pattern of walking which is so innate as a primary reflex since birth. Furthermore, this requires a pattern that is inherently more dangerous with increased periods of unsupported stance and therefore greater risk of falls and injury. Other safety issues that need to be addressed are again related to mainten- ance of rubber stoppers and handgrips. Individual fitting A hopper frame should be fitted such that the resident’s hands are at the level of the greater trochanters with the elbows comfortably bent. Suitability and Hoppers may provide a reasonable amount of stability when on the ground recommendations and may be suitable for residents who are unable to control the forward momentum of a wheeled aid. As alluded to above, it is very important to for use assess the safety of the resident utilizing the hopper as they do need to be able to stand unsupported momentarily in order to place the hopper frame forwards. During this movement the resident is potentially unstable in the posterior and lateral directions and the risk of a fall is high, with consequent fractured neck of femur or pelvis the outcome. Hopper frames are widely available and relatively cheap. Wheeled Maintenance and other safety issues hopper frames All rubber stoppers, slides and wheels should be checked on a regular basis. Rubber stoppers and slides can become worn or loose. Wheels can

Mobility aids 369 become worn, loose or blocked in movement by dust and hair picked up off the floor and environment. These frames are useful for those who need to go a little slower and need more stability than that provided by a wheelie walker. The wheeled hopper frame plus or minus rear slides is useful for some residents, espe- cially those who would not be able to control the increased forward momentum of a wheelie walker. Wheelie These are often the aid of choice for many reasons. For low care residents walkers especially who are ambulant and active within the community they are an excellent device. Wheelie walkers provide moderate assistance to bal- ance, can be relied upon often as a seat when fatigue sets in, come with the option of brakes (push-down, or hand brakes which lock), fold up eas- ily into a car, and tend to operate smoothly around corners and over small bumps. Obviously they are a big drawback if residents need to negotiate stairs and in these cases most people would require the assistance of a carer. The model with the seat, brakes and carry basket is always popular. It is important to note that pieces of equipment such as these should be chosen with the resident, who often takes great care over which colour and model is chosen. It is important to involve the resident as much as possible in these decisions – after all a mobility aid becomes a close friend after many years of good use and reliance. Patient acceptance is at the heart of effective use and a therapist must gather in support from the resident, carers and family members for the good use of walking aids to occur. Maintenance and It is important to check tyres, wheels, brakes, handgrips, seats and structure other safety issues regularly. Brakes are often in need of attention on wheelie walkers as worn tyres, broken or maladjusted cables can often lead to brakes not working. Individual fitting Wheelie walkers should be fitted to enable comfortable reach to the han- dles by the resident at approximately the height of the greater trochanters. Occasionally handles may be adjusted at a higher level to counteract poor walking posture and a flexed thoracic position, thereby facilitating more erect standing. It is important to consider how a resident will use the brakes (and indeed if they can) and to make a decision regarding what type of brakes, if any, would be more suitable for them. Several options exist in relation to brakes including a ‘push-down’ variety that applies rubber stoppers to the floor, regular bicycle type brakes, and brakes that can be locked into position either by a small push-in button or by a lever lock-down mechanism. Residents require varying abilities in order to use these mentioned devices and their appropriateness must be assessed. Patient education It is important to teach residents how to use the brakes and to encourage with the aid them to be involved in maintenance and checking of the aid at regular intervals. Residents should be encouraged to walk as upright as possible

370 Appendix 5 and not to let the aid ‘get away from them’. A poor flexed posture that is largely unsafe should be avoided. Cost Wheelie walkers are more expensive than sticks or hoppers but generally offer increased options and incorporate extra design features. Availability Wheelie walkers are widely available from both pharmacies and equipment suppliers. Easy walkers Easy walkers are very sturdy;some consider even ‘heavy’ aids. For this reason they seem particularly useful for very tall and/or very heavy (often male) residents. Because of their weight they do have increased stability but for frailer, weaker residents this seems to hinder rather than assist. The shorter easy walkers support mobile residents to the same degree as the wheelie walkers discussed above, yet do not have the benefits of easy packing into a car and providing a seat. Taller easy walkers (with forearm support) are another option for those requiring more support and stability. Tri-wheeled Another variation on the wheelie walker theme, three-wheeled walkers walkers are useful as they can be made narrower to fit through doorways or around furniture. The drawback is that this decreases the stability pro- vided and may indeed create an accident as the person attempts to manipu- late the walker whilst balancing and walking, and talking, and meeting all other criteria for standing and getting around. Additionally they do not provide as much mediolateral support in front and therefore are less reliable stability-wise. The therapist would do better in most instances to prescribe a four-wheeled walker and adjust the environment where necessary, and where possible. Rollators Rollators provide increased stability and safety when mobilizing for those with acute mobility difficulties and those requiring maximal assistance. As forearm support is proffered they rely on the ability of the person to grasp with two hands or at least to weight-bear through both upper limbs. Unlike wheelie walkers, rollators generally facilitate better posture as support is offered closer to the person’s centre of gravity rather than leaning forward to gain support and control at waist height. Maintenance and It is important to check the wheels, handgrips, forearm supports (or gut- other safety issues ters) and structure of rollators regularly as poor maintenance can lead to injury and poor use. Individual fitting Rollators should be adjusted in order to correctly fit residents’ heights and arm lengths. The forearm support should be at the level of the elbow in

Mobility aids 371 a flexed position with the resident standing tall. The length and angle of the forearm support can also be adjusted for individual fit. Rollators are widely available and although more expensive than other aids are often utilized by more than one resident, especially in a high care facility. Mechanical Technology is always progressing, or at least offering new options. Recently devices a standing hoist which brings a person into standing through a more physio- logically appropriate trajectory (of increased trunk flexion) was intro- duced. Older hoists would bring a person into weight-bearing in a position leaning backwards rather than through trunk flexion. Recent anecdotal evidence has pointed towards residents gaining strength in the lower limbs and benefiting functionally from being transferred in this new machine. Additionally under-leg supports and suspender straps can be used after removing the footplate of the machine to mobilize a resident. Even more appropriately, designers are now working on attaching forearm supports so the person walks as if in a rollator frame whilst having the safety of the harness attached. Maintenance and As with all mechanical devices and mobility aids, routine maintenance is other safety issues important for safety. Individual residents should be assessed for suitability and appropriate sling size recommended. Residents requiring assistance such as this are much more dependent and require a great deal of support; two staff members must be in attendance for this type of mobilization. These hoists are very expensive comparably and usually only available for a large number of residents in reasonably well-equipped facilities; they may be prescribed for their dual use as a walker and a standing hoist.

Index Note: Page numbers in italics refer to illustrations or tables. Abdominal muscles, pelvic floor Anal continence, 289 neurological conditions, muscles co-activation, 274–276 see also Defecation 265–269 abnormal tone, 266–267 Abdominal support garments, urge Anal incontinence, 292–293 proprioceptive dysfunction, incontinence management, 297 see also Defecation 267 walking in water, 261, Abnormal tone, aquatic Andropause, 24 267–269, 268–269 physiotherapy, 266–267 Anemia, 12 Ankle pain management, 262, Accountability, assessment, 45–48 262–264, 325 Active movement, definition, 99 oedema prevention, Activity restriction, pain recliners/‘gerichairs’, 135 palliative care, 343–344 postural stability, 258–259 consequences, 319 passive movement, 107–108 psychological factors, 262, Acute pain, 308–309 range loss, 16–17 Advance care directives, 346 range tests, 173 262–264 Advanced sleep phase syndrome, Ankle/hip strategy training, spastic hemiplegia, 266 balance retraining, 204, 204 strengthening, 260 18–19 Anorectal function, 288–293 Arm raises, 222, 222 Aerobic capacity, osteoporosis age-related changes, 290 Armrests, 133–134 Arm weights, 229–230, 230 assessment, 245 intestinal motility, 290 Arterial ulcers see Ulcers, arterial Aerobic exercise, osteoporosis coffee/caffeine, 288–289 Arteriosclerosis, arterial ulcers, 59 colonic motility, 288–289 Arthritis exercise programs, 247 defecation see Defecation falls, 51 Afferent fibres, nociception, 311, gastrocolic reflex, 288 management, water exercise, physiotherapy interventions, 312 263 Age 294–299 pain, 43, 317–318 voiding position/pattern, see also Rheumatoid arthritis physiological changes Ascending transmission, pain associated, 7–31 294 neurophysiology, 312–313 functional consequences, problems, 291–293 Ashworth Scale, 355 26 spasticity management response summary of changes, 27–28 anal incontinence, 292–293 see also Sensory functions; constipation, 291–292 measurement, 111 individual systems obstructed defecation, 292 Aspiration, 13 rectal filling, 289 Assessment, 32–48 rate of decline in functions, 7 Anticipatory postural responses, Age-related macular degeneration 161–162 accountability, 45–48 Anxiety management, water bed mobility, 36–38 (ARMD), 8–9 exercise, 263 fall risks, 9 Aortic stenosis, syncope, 56 ‘lying to sitting on side of Airway clearance, 119–120 Aphasia, communication bed’, 37–38 Akinesia difficulties, 78 mobility effects, 42 Aquatic physiotherapy, 251, 252, rolling, 36–37 Parkinson’s disease, 111–112 258–269 communication, 35–36, 45 Alendronate, osteoporosis therapy, balance, 258–259 continence, 43 243 functional ability maintenance, contributing factors to Algorithm, pain assessment, 319 260–262 Alignment, balanced standing, 169 general fitness, 264–265 functional difficulties, 42 Alzheimer’s disease dementia, 43–44 confusion, 78 physiotherapy assessments, 43 372

Index 373 documentation, 44, 45–48, defects, 161 Ball games, 227, 227 46 depth perception effects, 158 Bardel Scale, 353 legislation, 47 dizziness, 160 Barely mobile residents, 92–94 progress notes, 46–47 exercises see Balance, retraining hip movement, 162 assistive devices, 94 environmental considerations, 44 lateral stepping reactions, 162 carer workload, 93 functional ability/dependence musculoskeletal changes, cost cutting tragedies, 95–96 management, 114–115 level, 36–43 163–164 see also individual factors osteoporosis assessment, 245 restraints, 117–118 gait, 40–41 retraining see Balance, see also Immobility interpretation, 44–45 Bed cradles, 126 key factors, 35 retraining Bedding, peripheral neuropathies, pain, 42–43 sensory system decline, 158–160 126 principles, 33–35 visual acuity effects, 158 Bed mobility seated transfer, 39 see also Mobility assessment see Assessment sitting balance, 38 Balance assessment, 165–178 bed poles, 36, 37 sitting/standing transfer, 39, 39, balanced sitting, 166–167 dementia, 37 40 balanced standing, 169–170 hoist transfers, 37 standing ability, 39–40 gait, 170–172 osteoporosis, 37 swallow safety, 42 Bed poles, 36, 37 upper limb function, 42 clinical measures, 171 Bed rails, 126, 126, 146 wheelchair mobility, 41 gait cycle, 170–171 Bed rolling, physiotherapy Assisted active movement, higher level activities, assessments, 36–37 definition, 99 Beds, 124–126 Asthma, water exercise, 255 171–172 characteristics, 125 Atherothrombotic brain infarct impairment identification see falls risk, 146–147 (ABI), spasticity, 108 mattresses, 124–126 Attention demands, balance, Mobility, assessment palliative care assessments, 162–163 standing–sitting transfer, 168 Autonomic neuropathies, see also Functional motor task 338 continuous urinary pressure ulcer prevention, 126 incontinence, 286 assessment Behavioural changes/disturbances Autonomy Balanced sitting, 166–167 cognitive dysfunction, 74–75 life satisfaction, 73 Balanced standing, 169–170 pain assessment, 319 palliative care, 333 Balance, retraining, 191–208 Beneficence, palliative care, 333 Avascular necrosis, pain, 43 Benign paroxysmal positional osteoporosis exercise programs, vertigo (BPPV), 159–160, Back care, manual handling, 341 247 177–178 Back pain, water exercise, 262 Benzodiazepines, insomnia Backrest height, chairs, 131–132 task-oriented approach, 191–193 management, 75 Balance, 156–190 workstations, 193–205 Berg Balance Scale, 354 internal balance/gait/endurance anticipatory (proactive) advantages, 193–194 postural responses, 161–162 ankle/hip strategy training, measures, 182 Bladder outlet obstruction, aquatic physiotherapy, 258–259 204, 204 assessment see Balance block work, 201, 201–202 continuous urinary circuit training, 194 incontinence, 287 assessment coach/trainer, 195 Bladder training, 297 central nervous system changes, definitions, 193 Bloating, 13 independence, 195–196 Block work, balance retraining, 160–163 planning, 194–195 201, 201–202 anticipatory postural reach in standing, 200, Bone mineral density age-related changes, 24, 28 responses, 161–162 201 hormonal effects, 24 attention demands, 162–163 reach/step, 200, 201 in osteoporosis, 240, 244 sensory information research, 192–194 Botulinum toxin, spasticity seated reach, 197, 198 management, 109 processing/organizing, 161 sit-to-stand, 197, 199 strategy selection, 161–162 specific demands, 196–197 contrast sensitivity effects, 158 stairs, 202–203, 202 stepping out of the square, 203, 203 walking, 205, 205

374 Index Braden Scale, 355 footrests, 133 inadequate assessment of pain, pressure ulcers, 65–66 good design, 137–138 310 inappropriate, problems from, Bradycardia, water exercise, 257 medication links, 75 Brain infarct, atherothrombotic, 130 pain assessment, 319 legrests, 133 Cognitive dysfunction 108 palliative care assessments, 338 behavioural disturbances, 74–75 Breath holding, 119 recliners/‘gerichairs’, 134–137 disruptive vocalization, 74–75 Bubble blowing kit, 120 falls, 52, 55–56 Bumps, 50 benefits, 134–137 life satisfaction, 74–75 Buoyancy, 254–255 disadvantages, 91, 129, 136 management, water exercise, Buttock squeeze, urge feet elevation, 137 perceived comfort, 135 264 incontinence therapy, 297 pressure area prevention, screening, pain assessment, 319 ‘sundowning syndrome’, 75 Caffeine, anorectal function, 134 Cognitive periurethral muscle 288–289 spasticity control, 135–137 holds, urge incontinence seat, 129–131 therapy, 298 Calcium seat-to-backrest angle, 132–133 Collagen changes, flexibility, 17 daily requirements, 241 seat-to-floor height, 131 Colonic motility, 288–289 in osteoporosis, 241 Checklist for Nonverbal Pain anal incontinence, 293 Indicators, 322 Colour changes, falls risk, 147 Cancers Chest wall, ageing, 22 Communication passive movement Chronic airways disease, cognitive aphasia, 78 contraindications, 103 effects, 119 assessment, 35–36, 45 physiotherapy assessment, 34 Chronic obstructive pulmonary chair choice, 128 skin, aging, 14 disease (COPD), water exercise, difficulties and effect on life 255 Cardiac arrhythmias, syncope, 56 Chronic pain see Pain satisfaction, 78–79 Cardiorespiratory training, Circuit training, 194 inadequate assessment of pain, Circulation stimulation, pressure exercise, 215 ulcers management, 66–67, 68 310 Cardiovascular system Claudication pain, arterial ulcers, mime, 78 62–63 palliative care, 335 age-related changes, 20–21 Clinical Outcomes Variable Scale pictorial representations, 78–79 disorders, falls, 52, 56 (COVS), 184, 353 Community Aged Care Packages, 1 water exercise effects, 257, inside balance/gait/endurance Complex regional pain syndrome measures, 183 (CRPS), hand oedema, 114 264–265 sitting ability, 167, 178 Compression therapy, oedema Care plans standing ability, 168 management, 113 Clinical reasoning, care plan for Confusion, 77–78 immobility prevention, 95 residential aged care facilities, 3 diseases/disorders, 78 life satisfaction, 72 Clinical Test for the Sensory fall risk, drugs, 57, 57 Carers Integration of Balance (CTSIB), sexuality, 79 fall prevention, 151 179 Constipation, 291–292 injury prevention, spasticity Closed chain exercises, Contrast sensitivity osteoporosis physiotherapy, 246 balance effects, 158 control, 109 Clothing visual acuity, 174 manual handling education, 151 fall risk assessment, 149–150 Cough and sneeze patterns, pelvic workload, barely mobile palliative care assessments, 339 floor muscles, 299 Coaches, balance retraining, 195 Cryotherapy, 360 residents, 93 Coffee, anorectal function, pain management, 324 Carotid sinus syndrome, 21 288–289 palliative care, 342 Carpets, falls risk, 147 Cognition, 18 spasticity management, Case conferences, 357–358 chronic airways disease, 119 Cataracts, formation, 8 communication in assessment, 110–111 Central nervous system (CNS) 36 Cultural variations, chronic pain, balance see Balance 310 pain, 313 Cushions, chairs, 130–131 Central sensitization, pain neurophysiology, 313, 317 Chairs, 127–138 armrests, 133–134 backrest height, 131–132 choice, 127–129, 128–129 cushions, 130–131

Index 375 Cutlery, palliative care Detrusor muscle, 276 Electrotherapy, 359–365 assessments, 339 underactive contractility, 280 palliative care, 342 see also individual types Cycling, 235, 236 Diabetes mellitus, 23 Cystocele, 130, 287 arterial ulcers, 59 Emphysema, water exercise, 255 Cystourethrocele, 287 fall risk, 57 Endocrine system neuropathic ulcers, 64 Decubitus ulcers see Pressure age-related changes, 23–24, 28 ulcers Diaphragmatic breathing, pelvic disorders, falls, 52, 57–58 floor muscle strengthening, thyroid disorders, 23, 89 Deep breathing exercises, 299 Endurance assessment see palliative care, 344 Functional motor task Dictaphone, 90 assessment Defecation, 290 Digestion, 13 Enemas, anal incontinence therapy, obstructed, 292 Diminishing returns, exercise, 293 physiotherapy interventions, Enterocele, 287 294–296, 296 214 obstructed defecation, 292 see also Anal continence; Anal Disruptive vocalization, cognitive Entertainment, immobility, 90 incontinence Epley manoeuvre, 177–178 dysfunction, 74–75 Ethics, palliative care, 345–346 Defecation threshold volume, Diuresis, water exercise, 257–258 Euthanasia, 345–346 rectal filling, 289 Dizziness Exercise, 209–238 aerobic, 247 Dehydration balance defects, 160 aims, 213, 218–219 fall risk, 57 falls risk, 151 aquatic see Aquatic physio- skin changes, 15 vestibular function assessment, therapy; Exercise, in water Dehydroepiandrosterone (DHEA) 177–178 assessment, 212 production, 23 Dizziness Handicap Inventory, 178 behaviour modification, 221 Documentation benefits, 211 Delayed gastric emptying, 13 Delirium, fall risk, 55–56 exercise, 219–220 arterial ulcer prevention, 62 Dementia, 78 physiotherapy assessments see flexibility, 218 osteoporosis, 241–242 bed mobility, 37 Assessment pain management, 325 classification, 78 Doors, automatic, falls prevention, palliative care, 344–345 fall risk, 34, 55 quality of life, 210 management, water exercise, 264 147–148 diminishing returns, 214 physiotherapy assessments, Drag forces, hydrodynamic diseases/conditions, 211–212 documentation, 219–220 43–44 principles, 256 initial values, 214 sexuality, 79 Driving, night, problems, 8 intensity, 215–217 Dementia associated with Lewy Drug excretion, liver, 13 functional capacity, 215 bodies, 43 Drug therapy heart rate, 215 Demography, 1 maximal heart rate, 217 pain assessment, 319 fall risk, 52, 57, 57, 75, 151 measurements, 217 Density, water exercise, 254 immobility, 88, 89 perceived exertion, 215 Dental hygiene, 12 osteoporosis, 243–244 Rating of Perceived Exertion Depression, 77 Dual energy X-ray absorptiometry fall risk, 56 (DEXA), 244 Scale, 216, 216, 265 immobility, 89, 90 ‘Dual tasks while walking’, 184 talk test, 215–216 stroke, 94 Duke Mobility Skills Profile, 184 overload, 214 therapy Dynamic Gait Index, 183 principles, 213–214 Dynamic Visual Acuity (DVA) test, programmes, 214–215 ‘humour therapy’, 77 176–177 arm raises, 222, 222 water exercise, 263 Dynamometers, muscle strength arm weights, 229–230, 230 Depth perception, balance effects, measures, 173 ball games, 227, 227 158 cardiorespiratory training, Descending pain inhibitory Easy walkers, 372 systems Eating, chair choice, 128 215 pain management, 323 Eden Alternative, 80 pain neurophysiology, 315–317 Education, osteoporosis exercise Desktops, 134 Desmopressin, nocturia therapy, 283 programs, 247 Elbow, passive movement, 105–106 Elderly Mobility Scale, 353

376 Index Exercise (contd) contraindications, 252–253 shoes, 41 programmes (contd) asthma, 255 small rooms, 146 cycling, 235, 236 bradycardia, 257 walking sticks, 149 foot/ankle exercises, 223, chronic obstructive medical conditions, 34 224 pulmonary disease, 255 medications, 52, 57, 57, 75, 151 hand exercises, 231, 231 diuresis, 257–258 polypharmacy, 151 leg extensions, 222, 223 emphysema, 255 musculoskeletal problems, 51, neck exercises/shoulder fragile skin, 253 52, 53–54 shrugs, 230–231, 230 hypotension, 253, 257 age-related changes, 16 passive limb exercises, methicillin-resistant fibrositis, 51 225–226, 226 Streptococcus aureus, 253 neurological disease, 52, 54–55 ‘prayer position to traffic respiratory problems, 255 cognitive impairment, 52, control position’, 223, 225 hydrodynamic principles, 55–56 reaching for objects on wall, 254–256 confusion, 57, 57 228, 228 buoyancy, 254–255 delirium, 55–56 sideways walking, 233, 233 density, 254 dementia, 34, 55 sitting balance exercises, drag forces, 256 depression, 56 229, 229 hydrostatic pressure, 255 dizziness, 151 sit-to-stand practice, 226, laminar flow, 255–256 Parkinson’s disease, 34, 54 226 turbulent flow, 255–256 polymyalgia rheumatica, 51 squats/lunges, 231, 232 Shy–Drager syndrome, step-ups, 232, 232 hypertonicity, 267 stirring the pot, 233, hypotonicity, 267 150–151 233–234 metacentric principle, 255 vertebrobasilar insufficiency, timber exercise, 235, 235 non-swimmers, 253 trunk rotation, 225, 225 physiological effects, 257–258 151 walking, 227, 228 nutritional deficiencies, 52, writing, 234, 234 cardiovascular system, 257, reversibility, 214 264–265 57–58 specificity, 214 protection from staff involvement/education, renal effects, 257–258 220–221 precautions, 252–254 mobile residents, 145 as therapy, 211 thermodynamic principles, 256 in osteoporosis, 242 trainability, 212–213 types, 251–252 physiotherapist’s role, see also individual Expiratory peak flow, 355 techniques Eye, age-related changes, 8–10 151–152 risk assessment, 146–151 Exercise, in water, 251–273 Faces Pain Scales, 321 conditions Faecal impaction, anal clothing, 149–150 arthritis management, 263 environment, 146–148 back pain, 262 incontinence, 293 hearing aids, 150 dementia management, 264 Falls, 49–58, 50 intrinsic factors, 150–151 depression management, shoes, 149 263 acute illness, 53 spectacles, 150 gait problems, 268–269 barely mobile residents, 114 walking aids, 148–149 impaired cognition cardiovascular disorders, 52, 56 risk factors, 51, 52–53 management, 264 sensory decline, 52, 54 Parkinson’s disease, 267 hypotension, 56, 57, 57 age-related macular shoulder rehabilitation, postural hypotension, 54–55, 261–262 degeneration, 9 stairs, 261 150–151 colour changes, 147 truncal ataxia, 267 syncope, 56 hearing, 54 vertebral crush fractures, distractions in walking, 41 shadows, 147 262, 262 endocrine disorders, 52, 57–58 vision, 54 environmental hazards Falls Efficacy Scale, 354 beds, 146–147 Fatigue minimization, manual carpets, 147 handling, 341–342 floor materials, 147 Feet furniture, 146–147 elevation in recliners/ outside environment, ‘gerichairs’, 135 passive movement, 107 147–148

Index 377 Femoral-popliteal bypass surgery, stepping response to lateral Hand held retrievers, palliative physiotherapy assessment, 33 displacement, 181 care assessments, 339 Fibromyalgia, pain mechanisms, see also Balance assessment; Hand oedema, 114 316 Gait, assessment; Mobility, Hand, passive movement, 106, assessment Fibrositis, fall risk, 51 106, 107 Fingernails, 14 Functional reach, 353 Head/neck, passive movement, Fire hazards, 11 functional motor task Flaccidity, 112 assessment, 180 102–104 Health, good, 26 passive movement Functional Steps Test, 354 Hearing, ageing, 10, 12 contraindications, 103 Functional strength, measurement, loss (presbyacusis), 10, 92 Flexibility 173 falls, 54 ageing effects, 16–17 Furniture, falls risk, 146–147 exercise, 218 Hearing aids, fall risk assessment, Gait 150 Floor materials, falls risk, assessment, 40–41, 170–172 147 stance phase, 170 Heart rate, 7 swing phase, 170–171 exercise intensity, 215 Foot/ankle exercises, exercise, see also Functional motor 223, 224 task assessment Heat stress, skin changes, 15 balance see Balance assessment Heat therapy, 359–360 Foot problems, falls, 54 water exercise benefits, 268–269 Footrests, chairs, 133 see also Walking pain management, 324 Fractures, osteoporosis, 240 palliative care, 342 Fragile skin see Skin integrity Garden beds/paths, 148 High contrast sensitivity tests, Fukuda Stepping Test, 183 Gardening, 148 visual acuity, 174 Functional capacity, exercise Gastric emptying, delayed, 13 Hip Gastrocolic reflexes flexion contracture, 107 intensity, 215 movement, balance, 162 Functional electrical stimulation anal incontinence, 293 passive movement, 106–107 anorectal function, 288 protection, osteoporosis, (FES), 363 Gastrointestinal tract, ageing, pain management, 324 12–13, 27 242–243 spasticity management, 111 anemia, 12 Hip protector pads (HPP), Functional Independence Measure, aspiration/nasal regurgitation, 13 353 digestion, 13 242–243, 243 Functional motor task assessment, mouth, 12–13 Hip replacements 178–184 nutritional deficiencies, 12 balance/gait/endurance swallowing, 13 passive movement, 107 Gaze stability, vestibular function physiotherapy assessment, 33 measures, 182–184 assessment, 176–177 Hoists see Mechanical aids (hoists) exterior environment, Gender differences, chronic pain, Hopper walking frame, 40, 338, 310 368 183–184 General fitness, aquatic Hormone replacement therapy interior environment, physiotherapy, 264–265 (HRT), 243–244 ‘Gerichairs’ see Chairs Hormones, bone mineral density 182–183 Glenohumeral joint, movement effects, 24 osteoporosis assessment, loss, 105 ‘Humour therapy’ Good health, wheel, 26 depression therapy, 77 245 Grab rails, palliative care immune system effects, 25 Tinetti Fear of Falling Scale, assessments, 338–339 Hydrodynamic principles see Growth hormone, ageing, 23–24 Exercise, in water 184 Guillain–Barré syndrome, 112 Hydrostatic pressure, 255 clinical measures of internal Hydrotherapy, 251 Hall–Pike Dix test, 177 temperature homeostasis, 256 displacement, 180–181 Halmagyi impulse test, 176 Hyperaesthesia, peripheral clinical measures of sitting Hand exercises, 231, 231 neuropathies, 126 Hyperalgesia, pain, 313–314, 317 ability, 178 Hypercapnia, 23 clinical measures of standing Hyperkeratosis, 14 Hypertension, 20–21 ability, 179–180 Hyperthyroidism, 23 external displacement, 181–182 general physical performance/ mobility, 184 reaction time, 181 stepping responses, 180–181

378 Index Hypertonicity, aquatic exercise Inflammatory mediators, Lewy bodies, dementia associated benefits, 267 musculoskeletal pain, 317 with, 43 Hypnotic drugs, insomnia Initial values, exercise, 214 Life events, admission to residential management, 75 Insomnia, 19 aged care facilities, 1–2 Hypotension management, 75 Life satisfaction, 71–83 fall risk, 56 secondary, 75 autonomy, 73 drugs, 57, 57 Internal policy, immobility, 89–90 care plans, 72 postural see Postural Intestinal motility, age-related cognitive dysfunction, 74–75 (orthostatic) hypotension changes, 290 communication difficulties, water exercise, 253, 257 Isolation 78–79 in care, 72–73 confusion, 77–78 Hypothermia, skin changes, 15 hearing loss, 92 depression, 77 Hypothyroidism, 23 vision loss, 92 environmental factors, 74 Hypotonicity, aquatic exercise Isometric lower abdominal muscle isolation, 72–73 holds, urge incontinence lack of privacy, 72 benefits, 267 therapy, 298 learned helplessness, 73 Hypoxia, 23 leisure activities, 72 Joint instability, passive movement light switches, 74 Ice packs/baths, 110–111 contraindications, 103 mirrors, 74 Immobility, 87–97 positive interventions, 80–81, Joint range measurement, 355 80–81 categories, 87–88 Joint range of movement (ROM) Eden Alternative, 80 consequences/complications, programmes to improve, 73–74 ankle, 16–17 residents, 74–75 91–92, 93, 101 chair choice, 128 sexuality, 79–80 contributing factors, 88–90 flexibility, 16–17 sleep disorders see Sleep osteoporosis assessment, 245 disorders depression, 89 passive movement, 100–108 toilet facilities, 74 internal policy, 89–90 Justice, palliative care, 333 see also Quality of life medication, 88, 89 cost cutting tragedies, 95–96 Katz Index of Independence in Lifestyle modification, hoisting, 116–117 ADL, 353 osteoporosis, 241–242 see also Mechanical aids Kidneys, ageing, 14, 27 Light switches, life satisfaction, (hoists) Knees, passive movement, 107 74 implications, 90–91 Kyphosis potentially mobile residents, 94 Limbs prevention, care plans, 95 falls, 53 lower see Lower limbs problem management see below measure, 355 upper see Upper limbs spinal cord injury, 99 thoracic see Thoracic kyphosis vegetative states, 99 Liver, ageing, 13–14, 27 see also Barely mobile residents Lack of privacy, life satisfaction, 72 Low contrast sensitivity tests, Immobility, problem management, Laminar flow, 255–256 98–123 Laser therapy, 362–363 visual acuity, 174 abnormal tone, 108–112 Lower limbs palliative care, 343 flaccidity, 112 Lateral reach, 353 flexibility, mobility assessment, rigidity, 111–112 Lateral stepping reactions, balance, 173 spasticity, 108–111 fully dependent resident, 99 162 joint repositioning ability, movement maintenance, Laxatives see Osmotic laxatives somatosensory function importance, 99–100 Learned helplessness, 73 assessment, 175 oedema, 112–114 Legal issues, palliative care, hand, 114 passive movement, 106–108 passive movement see Passive 345–346 vibration sensitivity, movement Leg extensions, 222, 223 Immune system, ageing, 24–25, 28 Legislation, physiotherapy somatosensory function Inclinometers, ankle range tests, 173 assessment, 175–176 Increased daytime frequency, assessment documentation, 47 Lower urinary tract dysfunction, lower urinary tract dysfunction, Legrests, chairs, 133 279–287 281–282 Leisure activities, life satisfaction, increased daytime frequency, 281–282 72 nocturia, 279, 282–283

Index 379 storage related problems, 279 Menopause, 24 wheelie walkers, 369–370 urinary incontinence see urinary incontinence, 278 see also Walking aids Mobility Dependency Scale, 144, 144 Urinary incontinence Metacentric principle, water Mobility Scale for Acute Stroke voiding dysfunction, 279–280 exercise, 255 Patients, 184 voiding-related problems, 279 Modified Elderly Mobility Scale, 183 see also Voiding dysfunctions Methicillin-resistant Streptococcus Motor Assessment Scale (MAS), Lunges/squats, 173, 231, 232 aureus (MRSA), water exercise, 184, 353 Lungs, ageing effects see 253 sitting ability, 167, 178 Respiratory function/system, standing ability, 168 age-related changes Micturition, 277 Mouth, ageing effects, 12–13 ‘Lying to sitting on side of bed’ neurological control, 277–278 Movements, levels and types, 99 palliative care assessments, 338 Multichambered pressure cuffs, physiotherapy assessments, Mime, communication difficulties, oedema management, 113 78 Muscle spasms, problems, 109 37–38 Muscle strength measurement Lymphoedema Mini Mental State Examination, mobility assessment, 173 356 spring gauges, 173 arterial ulcers, 62 Muscle tone, abnormal management, 113 Mirrors, life satisfaction, 74 management, 108–111 Mobile residents, 143–155 see also Rigidity; Spasticity Magnetic therapy, 362 Musculoskeletal system palliative care, 343 fall protection, 145 age-related changes, 15–17, 27 functional capacity, 144–145 Malnutrition, fall risk, 57 balance, 163–164 Manual handling Mobility Dependency Scale, flexibility, 16–17 144, 144 skeletal muscles, 15–16 internal policies, 89 falls see Falls palliative care, physiotherapy, Mobility pain akinesia, 42 inflammatory mediators, 317 340–342 assessment pain neurophysiology, back care, 341 impairments, 172–178 fatigue minimization, lower limb flexibility, 173 317–318 muscle strength weakness, immobility causing, 92 341–342 measurement, 173 Myocardial infarction (MI), mechanical aids (hoists), 341 somatosensory function, syncope, 56 slide sheets, 340–341 175–176 training, 151 vestibular function see Nasal regurgitation, 13 walking belts, 340 Vestibular function, Nebulization, respiratory function, see also Patient handling assessment Massage visual function see Visual 120 pain management, 324 function assessment Neck exercises, exercise, 230–231, palliative care, 345 see also Functional motor skin integrity, 340 task assessment 230 Mattresses, 124–126 chair choice, 129 Negative ideas, about residential Maximal heart rate, exercise factors affecting, 115, 116 intensity, 217 reduced attention-sharing, 42 aged care facilities, 2 McGill Pain Questionnaire (MPQ), stroke effects, 94 Nervous system, ageing, 7, 17–20 320–321, 356 vision effects, 42 Mechanical aids (hoists), 115, 373 see also Balance cognition, 18 bed mobility, 37 reaction time, 17–18 fall prevention, 147 Mobility aids, 366–371 reflexes, 17 flaccidity, 112 easy walkers, 370 sleep see Sleep immobility, 116–117 pick-up walking frame Neural Tension Tests, 355 indications, factors, 116–117 (hopper/Zimmer), 40, 338, Neurological diseases/disorders manual handling, 341 368 aquatic physiotherapy see Medication see Drug therapy rollators, 370–371 Memorial Pain Card, 319–320 tri-wheeled walkers, 370 Aquatic physiotherapy Memory walking sticks see Walking falls, 52, 54–55 age-related changes, 19–20 sticks/canes see also individual pain perception, 316 wheeled devices, 148–149 brakes, 148–149 diseases/disorders wheeled hopper frames, 368–369

380 Index Neuromuscular status, chair Osteoarthritis, pain, 317–318 Outlet obstruction, voiding choice, 128 Osteopenia, definition, 240 dysfunctions, 280 Osteoporosis, 239–250 Night driving problems, 8 Overload, exercise, 214 Nine hole peg test, 356 bed mobility, 37 Oxybutynin chloride, urge Nociception bone mineral density, 240, incontinence therapy, 284 afferent fibres, 311, 312 244 Oxygen, supplementary, 120 pain neurophysiology, 311–312, calcium intake, 241 definition, 239 Pain, 307–331 315 dual energy X-ray acute, 308–309 spinal nerves, 312 aquatic physiotherapy, 262, Nociceptors, skin, 311 absorptiometry, 244 262–264 Nocturia, 279, 282–283 exercise programs, 246–248, arthritis, 43 Nocturnal detrusor overactivity assessment, 318–322 (NDO), 282 247–248 algorithm, 319 Nocturnal enuresis, 279, 286 avoidance, 248 behavioural changes, 319 Nocturnal polyuria, 282 benefits, 241–242 Checklist for Nonverbal Pain ‘No lift’ policy, 89, 152 resistance training, 246 Indicators, 322 Non-malificence, palliative care, walking, 248 cognitive impairment 333 weight training, 246 screening, 319 Non-swimmers, water exercise, fall risk, 51 cognitive status, 320 253 fracture risk, 240 demography, 320 Norton Scale, 355 passive movement Faces Pain Scales, 321 pressure ulcers, 65–66 contraindications, 103 McGill Pain Questionnaire, Numerical Rating Scale (NRS), 319 physiotherapy assessment, 34, 320–321 Nutritional deficiencies, 12 244, 245 Memorial Pain Card, 319–320 falls, 52, 57–58 postural deviations, 53 Numerical Rating Scale, 320 immune system effects, 25 risk factors, 241 observational/behavioural Nutrition, osteoporosis, 241, 241 risk modification, 241–244 measures, 322 Nystagmus drug therapy, 243–244 Pain Descriptor Scale, 321 ocular control tests, 174 exercise, 241–242 Pain Thermometer, 320 vestibular function assessment, falls prevention, 242 physical evaluation, 319 hip protection, 242–243 Rand COOP Chart, 319–320 177 lifestyle, 241–242 sensory functions, 320 nutrition, 241, 241 Structured Pain Interview, Obstructed defecation, 292 radiotherapy, 244 321 Obstructive/occlusive arterial vitamin D, 241 Verbal Descriptor Scale, Outcome measures, 353–356 319–320, 320–321, 321 disease (OAD) balance, 353–354 Visual Analogue Scale, 320 arterial ulcers, 59, 60, 61 circulation, 355 avascular necrosis, 43 cryotherapy contraindications, cognition, 356 central nervous system, 313 deformities, 355 chronic, 309–311 111 dexterity, 356 cultural variations, 310 Ocular control tests, 174 endurance, 355 de-emphasis, 310 Oedema, 112–114 falls risk, 354 exercise, 221 flexibility, 355 gender differences, 310 management, 113 functional status, 353 consequences, 318–319 recliners/‘gerichairs’ benefit, gait, 354 definition, 307 135 life satisfaction, 356 hyperalgesia, 313–314, 317 pain, 356 inadequate assessment, 310–311 Oestrogen levels, cognition, 18 posture, 355 learning/memory effects, 316 Optokinetic response, ocular pressure risk, 355 neurophysiology, 311–318 range of motion, 355 ascending transmission, control tests, 174 respiratory function, 355 312–313 Orthostatic hypotension see skin integrity, 355 central sensitization, 314, 317 strength, 355 Postural (orthostatic) tone, 355 hypotension Orthotic devices, spasticity management, 110 Osmotic laxatives anal incontinence therapy, 293 constipation therapy, 291

descending inhibitory clothing, 339 Index 381 systems, 315–317 cutlery, 339 grab rails, 338–339 palliative care, 344 musculoskeletal pain, 317–318 hand held retrievers, 339 precautions/contraindications, nociception, 311–312, 315 ‘lying to sitting on side of periaqueductal grey area, 101–102, 103 bed’, 338 flaccidity, 103 315–316 walking aids, 338 scapula, 104–105 sodium/potassium channel writing instruments, 339 trunk, 104 communication, 335 types of movement, 100 permeability, 314 manual handling see Manual upper limb, 105 spinal cord, 314–315 handling elbow, 105–106 supraspinal activity, 317 mobility/dexterity/function, glenohumeral joint, 105 osteoarthritis, 317–318 338–339 superior radio-ulnar joint, osteoporosis assessment, 245 skin integrity, 339–340 osteoporosis exercise programs, treatments, 342–345 105–106 247 algorithm, 337 wrist/hand, 106, 106, 107 peripheral nervous system, 313 aquatic physiotherapy, Pastor, Day and Marsden scale, phantom, 311 169, 181 physiotherapy assessments, 343–344 Patient handling, 152–154 42–43 classification, 337–338 manual handling training, 151 physiotherapy management, deep breathing exercises, ‘no lift’ policies, 152 322–325 risk management strategies, aquatic therapy, 325 344 153–154 cryotherapy, 324 exercise, 344–345 see also Manual handling descending pain inhibitory heat/cold therapy, 342 Pelvic floor, dysfunction, laser therapy, 343 274–303 system activation, 323 magnetic therapy, 343 Pelvic floor muscles (PFM), 274, exercise, 325 massage, 345 275 functional electrical passive limb exercises, 344 abdominal muscle co-activation, stretching exercises, 344 274–276 stimulation, 324 transcutaneous electrical cough and sneeze patterns, massage, 324 299 radiant heat sources, 324 nerve stimulation, strengthening, 298–299 spinal manual therapy, 323 342–343 urogenital prolapse, 288 transcutaneous electrical ultrasound, 343 tonic activity, 297–298 walking, 344 Perceived exertion, 355 nerve stimulation, 323–324 Parathyroid hormone (PTH), exercise intensity, 215 prevalence, 308 osteoporosis therapy, 243 Periaqueductal grey area (PAG), remote, 311 Parkinson’s disease 315–316 subjective experience, 313 akinesia, 111–112 Peripheral nerves treatment algorithm, 319 fall risk, 34, 54 entrapment, immobility, 92 Pain Descriptor Scale, 320 lungs, 23 pain, 313 Pain Thermometer, 320 physiotherapist’s role, 115 Peripheral neuropathies, 126 Palliative care, 332–347 physiotherapy assessments, Peripheral oedema, arterial ulcers, autonomy, 333 43 61–62, 63 beneficence, 333 water exercise benefits, 267 Peripheral vascular disease (PVD), cryotherapy, 342 Passive limb exercises, 225–226, arterial ulcers, 59 definition, 332–335 226 Phantom pain, 311 ethical/legal issues, 345–346 Passive movement, 100–108 Physical Mobility Scale (PMS), 184, justice, 333 definition, 99 353 non-malificence, 333 effects, 100 sitting ability, 167, 178 principles of, 333–334 head/neck, 102–104 standing ability, 168 quality of life, 332–333, lower limb, 106–108 Physical Performance and Mobility ankle, 107–108 Examination (PPME), 184 334–335 feet, 107 Physiotherapists, role, 1, 2 Palliative care, physiotherapy, hip, 106–107 Physiotherapy assessment, knees, 107 osteoporosis, 244, 245 335–346 assessment, 335–336, 336–339 beds, 338 chairs, 338

382 Index Pick-up walking frame Proprioceptive dysfunction, Reduced attention-sharing, (hopper/Zimmer), 40, 338, 368 aquatic physiotherapy, 267 mobility effects, 42 Pictorial representations, Proprioceptive neuromuscular Reflexes, 17 communication difficulties, facilitation (PNF), 105 Remote pain, 311 78–79 Renal failure, 14 Prostatectomy, stress urinary Residential Aged Care Facilities Pilates, osteoporosis incontinence, 285 physiotherapy, 246 (RACFs) Psyllium, anal incontinence admission and interim care Polymyalgia rheumatica, fall risk, 51 therapy, 293 Polypharmacy, falls risk, 151 plan, 3 Position changes, skin integrity, Pupillary light reflex, 9 assessment on admission see ‘Pusher’, 94 340 Assessment Post-micturition dribble, voiding Quality of care, 99 difficulties after admission, 2 Quality of life negative ideas about, 2 dysfunctions, 280 numbers, 1 Postural (orthostatic) hypotension, exercise, 210 Resident injuries, 49–70 osteoporosis assessment, 245 mechanisms, 49, 50 21 palliative care, 332–333, 334–335 Resistance training, osteoporosis fall risk, 54–55, 150–151 self-determination, 210 exercise programs, 246 Postural responses, anticipatory urinary incontinence, 281 Respiratory function/system (proactive), 161–162 see also Life satisfaction age-related changes, 21–23, 28 Posture chair choice, 128 RACF see Residential Aged Care chest wall, 22 defects, 53, 164 Facilities (RACFs) lungs, 21, 22–23 exercises, 247 chair choice, 128 osteoporosis assessment, 245 Radiotherapy, osteoporosis, 244 immobility, 118–120 for respiration in immobile Radio-ulnar joint, superior, passive maximizing/maintaining residents, 118 movement, 105–106 function, 118–120 stability, aquatic physiotherapy, Raloxifene, osteoporosis therapy, nebulization, 120 supine v. sitting, 118 258–259 243 supplementary oxygenation, Potassium channel permeability, Rand COOP Chart, 319–320 Range of motion 120 pain neurophysiology, 314 water exercise, 255 Potentially mobile residents, 94 osteoporosis assessment, 245 Respiratory function test, 355 ‘Prayer position to traffic control see also Joint range of Response measurement, spasticity management, 111 position’, 223, 225 movement (ROM) Restraints, 117–118 Presbyacusis, 10, 92 Rapid eye movement (REM) sleep, Reversibility, exercise, 214 Presbyopia, 9 Rheumatoid arthritis Pressure, 50 18 arterial ulcers, 59 Pressure pumps, 364 Rating of Perceived Exertion Scale passive movement Pressure-relief cushions, 130–131 Pressure ulcers, 64–67 (RPE), 216, 216, 265 contraindications, 103 ‘Reaching for objects on wall’, 228, Rigidity, 111–112 causes, 67 development, inappropriate 228 passive movement ‘Reach in standing’, balance contraindications, 103 bedding, 125–126 management, 66–68 retraining, 200, 201 Risedronate, 243 ‘Reach/step’, balance retraining, Risk management strategies, circulation stimulation, 66–67, 68 200, 201 patient handling, 153–154 Reaction time, 17–18 Rivermead Mobility Index, 184 prevention, 66, 67, 339–340 Rollators, 372–373 beds, 126 balance defects, 161 recliners/‘gerichairs’, 135 functional motor task Saccadic movements, ocular control tests, 174 risk assessment, 65–66 assessment, 181 severity scales, 65, 65, 65–66 Recliners see Chairs Scapula, passive movement, Privacy, lack of, 72 Rectal filling, 289 104–105 Proactive postural responses, Rectal prolapse, 287 161–162 Seat, chairs, 129–131 Progress notes, physiotherapy obstructed defecation, 292 assessments, 46–47 Rectoanal inhibitory reflex (RAIR), 289 Rectocele, 130, 287 obstructed defecation, 292

Index 383 Seated reach Sitting balance orthotic devices, 110 balance retraining, 197, 198 exercises, 229, 229 recliners/‘gerichairs’, clinical measures of sitting physiotherapy assessments, 38 ability, 178 135–137 ‘Sit-to-stand’ response measurement, 111 Seated transfer balance retraining, 197, 199, 199 serial casting, 110 physiotherapy assessments, 39 physiotherapy assessments, 39, spacers, 110 slide boards, 39 39, 40 passive movement practice, 226, 226 contraindications, 103 Seat-to-backrest angle, chairs, Specificity, exercise, 214 132–133 Skeletal muscles see Spectacles, fall risk assessment, 150 Musculoskeletal system Spinal cord Seat-to-floor height, chairs, 131 injury, 99 Secondary insomnia, 75 Skin pain neurophysiology, 314–315 Self-determination, quality of life, age-related changes, 14–15, 27 Spinal manual therapy (SMT), pain chair choice, 128 management, 323 210 nociceptors, 311 Spinal nerves, nociception, 312 Sensory cue responses, clinical Spine, flexibility, 16 Skin integrity Spring gauges, muscle strength measures of standing ability, massage, 340 measures, 173 179 palliative care, 339–340 Squats/lunges, 173, 231, 232 Sensory deprivation, immobility, position changes, 340 Stairs 92 water exercise, 253 balance retraining, 202–203, Sensory functions 202 ageing, 8–12, 12, 158–159 Sleep apnoea, 76–77 water exercise, 261 nocturia, 282 Stance phase, gait analysis, 170 balance, 158–160 Standing ability taste/smell, 10–11, 13 Sleep disorders, 18–19, 75–77 clinical measures, 179–180 pain assessment, 319 advanced sleep phase Clinical Outcomes Variable see also individual senses syndrome, 18–19 Scale, 168 Sensory information processing/ insomnia see Insomnia Motor Assessment Scale, 168 organizing, balance, 161 interventions, 76, 76 Physical Mobility Scale, 168 Sensory threshold volume, rectal REM sleep, 18, 76 physiotherapy assessments, filling, 289 ‘sundown syndrome’, 19 39–40 Serial casting, spasticity wall bars, 39–40, 40 management, 110 Sleep habits, exercise, 221 ‘Stand-to-sit’, 168 Sexuality, 79–80 Slide boards, 39 ‘Stepping out of the square’, 203, Shadows, falls risk, 147 Slide sheets, 340–341 203 Shear forces, 50 Small rooms, falls risk, 146 Stepping responses, external Sheepskins, pressure sore Smell, ageing, 10–11, 13 displacement, 181–182 prevention, 126 Smoke hazards, 11 Stepping response, to lateral Shoes, fall risk, 41, 149 Smooth pursuit, ocular control displacement, 181 Shoulder–hand syndrome, stroke, Step Test, 180–181 114 tests, 174 Step-ups, 232, 232 Shoulder rehabilitation, water Sodium channel permeability, pain ‘Stirring the pot’, 233, 233–234 exercise, 261–262 Stool-bulking agents, anal ‘Shoulder shrugs’, 230–231, 230 neurophysiology, 314 incontinence therapy, 293 Shy–Drager syndrome, falls risk, Soft tissue compliance, balance, 164 ‘Stops Walking to Talk’, 354 150–151 Somatosensory function Story-telling, 77 ‘Sideways walking’, 233, 233 Strength Singleton’s Test, outside assessment, 175–176 aquatic physiotherapy, 260 balance/gait/endurance Spacers, spasticity management, 110 balance, 163–164 measures, 183 Spastic hemiplegia, aquatic osteoporosis assessment, 245 Sitting ability osteoporosis exercise programs, clinical measures, 178 exercise benefits, 266 247 Clinical Outcomes Variable Spasticity, 108–111 Scale, 167, 178 Motor Assessment Scale, 167, atherothrombotic brain infarct, 178 108 Physical Mobility Scale, 167, 178 chair choice, 136 immobility associated, 92 management botulinum toxin, 109 cryotherapy, 110–111 functional electrical stimulation, 111

384 Index Stress, immune system effects, 25 Timed sitting, clinical measures of Ultrasound, 361–362 Stress urinary incontinence, 279, sitting ability, 178 palliative care, 343 285–286 Timed standing, clinical measures Ultraviolet light damage, skin Stretching exercises, palliative of standing ability, 179 ageing, 14 care, 344 Timed ‘Up and Go’ test (TUG), Ultraviolet light therapy, 363–364 Stroke 171, 182, 353, 354 Upper limbs depression, 94 Timed ‘Up and Go’ test (TUG) passive movement, 105 hand oedema, 114 (cognitive), 171, 182, 354 physiotherapy assessments, 42 mobility effects, 94 Upright perception, visual function physiotherapy assessment, 34 Timed ‘Up and Go’ test (TUG) assessment, 174–175 shoulder–hand syndrome, 114 (manual), 171, 182, 354 Urethral pressure, urethrovesical Structured Pain Interview (SPI), function, 276 321 Timed voiding, urinary Urethrovesical function, 276–287 ‘Sundown syndrome’, 19 incontinence management, 281 age-related changes, 278–279 cognitive dysfunction, 75 detrusor muscle, 276 Supplementary oxygenation, Tinetti Fear of Falling Scale, 184 female urethra, 276 respiratory function, 120 Toenails, 14 incontinence see Urinary Supraspinal activity, pain Toilet facilities, life satisfaction, neurophysiology, 317 continence Surgery, stress urinary 74 urethral pressure, 276 incontinence, 286 Toilet pedestals, 131 Urge incontinence, 279, 283–285 Swallowing, 13 Tooth loss, 12–13 causes, 284 immobility, 91 Trainability, exercise, 212–213 management, 284–285 Swallow safety, physiotherapy Trainer, balance retraining, 195 assessments, 42 Transcutaneous electrical nerve abdominal support garments, Swimming, 252 297 Swing phase, gait analysis, stimulation (TENS), 360–361, 170–171 363 buttock squeeze, 297 Syncope, 21, 56 pain management, 323–324 cognitive periurethral muscle Systemic lupus erythematosus, palliative care, 342–343 arterial ulcers, 59 Tri-wheeled walkers, 372 holds, 298 Truncal ataxia, water exercise isometric lower abdominal Tactile sensitivity, somatosensory benefits, 267 function assessment, 175 Trunk muscle holds, 298 passive movement, 104 oxybutynin chloride, 284 Tai chi, osteoporosis rotation exercise, 225, 225 physiotherapy interventions, physiotherapy, 246 Turbulent flow, 255–256 285, 296–297 Talk test, exercise intensity, Ulcers, 58–68 prevalence, 284 215–216 arterial see below symptoms, 283–284 neuropathic, 64 Urinary continence, 277 Taste, ageing, 10–11, 13 pressure see Pressure ulcers age-related changes, 278 Temperature homeostasis, vascular, 58–59 physiotherapy assessments, 43 venous, 63–64 Urinary incontinence, 278–279, hydrotherapy, 256 280–281 ‘Ten metre walk (timed)’, 182, 354 Ulcers, arterial, 59–63, 62 co-morbid conditions, 280–281 ‘Ten metre walk with head arteriosclerosis, 59 continuous, 279, 286–287 diabetes mellitus, 59 etiology, 281 rotation’, 182–183 lymphoedema, 62 management Thermal injury, 50 obstructive/occlusive arterial Thermodynamic principles, water disease, 59, 60, 61 resident treatment peripheral vascular disease, 59 preferences, 281 exercise, 256 prevention/risk identification, Thermoregulation, 15 60–63, 61 timed voiding, 281 Thoracic extension, 247 claudication pain, 62–63 menopausal effects, 278 Thoracic kyphosis, 13, 22 exercise, 62 prevalence, 278–279 peripheral oedema, 61–62, 63 quality of life issues, 281 effect on scapula movement rheumatoid arthritis, 59 stress, 279, 285–286 (passive), 104 systemic lupus erythematosus, see also individual types 59 Urinary tract dysfunction, lower Thyroid disorders, 23, 89 see Lower urinary tract ‘Timber’ exercise, 235, 235 dysfunction

Urinary tract infections (UTIs), lens, 8 Index 385 voiding dysfunctions, 280 mobility effects, 42 pathological conditions, 9 physiotherapy assessment, Urogenital dysfunction, presbyopia, 9 40–41 physiotherapy interventions, pupillary light reflex, 9 294–299 Visual acuity, 174 wheeled devices, fall voiding position/pattern, 294, balance effects, 158 prevention, 148–149 295 contrast sensitivity, 174 Visual Analogue Scale (VAS), 320, see also Mobility aids Urogenital prolapse, 287–288 321, 356 Walking belts, 94, 340 Uterine descent, 287 Visual field, visual function Walking sticks/canes, 366–368 assessment, 174 Vaginal vault prolapse, 287 Visual function assessment, falls risk, 149 Valsalva manoeuvre, syncope, 56 173–175 Wall bars, standing ability, 39–40, Vascular dementia (VaD), acuity, 174 ocular control, 174 40 physiotherapy assessments, 43 upright perception, 174–175 ‘Wall squat test’, 173 Vascular ulcers, 58–59 visual field, 174 Water Vasopressin, nocturia therapy, 283 Visuospatial perception, balance Vasovagal attacks, syncope, 56 defects, 161 exercise see Exercise, in water Vegetative states, immobility, 99 Vitamin D physiotherapy see Aquatic Venous ulcers, 63–64 daily requirements, 241 Ventilation, immobility, 91 immune system effects, 25 physiotherapy Verbal Descriptor Scale (VDS), metabolism, kidneys, 14 Water cushions, chairs, 131 in osteoporosis, 241 Waterlow Scale, 355 319–320, 320 Voiding dysfunctions, 279–280 Waterproof coverings, mattresses, Vertebral crush fractures, water outlet obstruction, 280 post-micturition dribble, 124–125 exercise, 262, 262 Weight-bearing, barely mobile Vertebrobasilar insufficiency (VBI) 280 underactive detrusor muscle residents, 94 falls risk, 151 benefits, 114 syncope, 56 contractility, 280 Weight distribution, balanced Vertigo urinary tract infections, 280 standing, 169 benign paroxysmal positional, see also Lower urinary tract Weight training, osteoporosis exercise programs, 246 159–160, 177–178 dysfunction; individual Wheelchair mobility, see also Dizziness diseases/disorders physiotherapy assessments, Vestibular function 41 age-related changes, 10, 13, 159 Walking, 227, 228 Wheeled hopper frames, assessment, 176–179 balance retraining, 205, 205 368–369 distractions in, fall risk, 41 Wheelie walkers, 369–370 dizziness, 177–178 osteoporosis, 248 Working memory, ageing effects, gaze stability, 176–177 palliative care, 344 19–20 nystagmus, 177 in water, 261, 267–269, Workstations, balance retraining Dynamic Visual Acuity test, 268–269 see Balance, retraining 176–177 see also Gait Wrist, passive movement, 106, Halmagyi impulse test, 176 106, 107 Vision, ageing, 8–10, 12 Walking aids Writing exercises, exercise, 234, age-related macular fall risk assessment, 148–149 234 degeneration see Age-related palliative care assessments, Writing instruments, palliative care macular degeneration 338 assessments, 339 (ARMD) cataract formation, 8 Yoga, osteoporosis physiotherapy, falls, 54 246 isolation, 92 Zimmer frames, 40, 338, 368 Zinc, immune system effects, 25