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The motor task of walking is ultimately a product of the characteristics of the individual, the environment in which one is immersed, and the task(s) performed while walking. As physical therapists we must be mindful of all components and strategically integrate appropriate challenges when targeting gait interventions. This course is designed to present the predictable set of age related changes of temporal & spatial gait characteristics and review the environmental & task demands of community ambulation. The value of collecting gait speed data, and its relationship to health, function, and mortality are emphasized.
Julie Ries is a physical therapist and professor of physical therapy at Marymount University in Arlington, Virginia. She has a special interest in physical therapy with older adults, particularly those with cognitive deficits such as Alzheimer’s disease, and her recent research has been in the area of outcome measures and balance interventions in this population.
Join us as we take a look at the impact of aging on body systems and how these changes might potentially affect gait. We'll then dig deeper on why differentiating normal versus pathological gait change is an important role of Physical Therapy.
Having a clear understanding of the speed and distance requirements and potential environmental demands are key for PTs to prepare their older adult patients for successful community mobility. Skilled assessment of the potential physiological & psychological constraints on patient mobility will help to direct PTs toward the most efficacious treatments.
3. Walking Speed
In this chapter we’ll wrap up Dr. Ries’ course on an introduction to Functional Mobility & Gait through by Walking Speed. We’ll consider the predictive power of gait speed and the pragmatics of gauging gait speed in the clinic will be reviewed. Considerations for assistive device use and gait speed reference values will be presented.
In formulating optimal interventions, there may be special considerations within the context of assessing and treating gait dysfunction in older adults. The slippery slope of aging describes a progressive decline of function over time, and we know that 6-7% of older adults meet the definition of frailty. With behavioral “buy-in” and appropriate level of challenge, we can impact gait and function in frail and pre-frail individuals, perhaps even reversing the direction they are traveling on the slope. The inter-relatedness of gait and cognition is well represented in the research literature and holds important implications for our assessment and treatment of older adults. Recent literature in both of these areas is presented in this course.
Falls are a major concern for older adults, their families, and the health professionals who care for them. Falls have many contributing factors, some of which are modifiable. Why should clinicians be concerned about falls in later life? What is the underlying neurophysiological mechanism of postural control, and how does postural control change over the lifespan? This course will seek to answer these key questions and more related to falling risk in geriatric patients. In particular, consideration of the physiological and practical aspects of postural control and risk assessment will provide participants with an improved understanding of balance and fall risk. This first course in a three course series provides a foundation for clinicians’ ability to critically reason through potential contributors to risk of falling, plan their screening/assessment and select interventions for older adults with balance impairment and risk of falling.
After completing this course, continue to the next two courses in the series for more detail on assessment and intervention for impaired balance and risk of falls:
How do we screen and assess balance and fall risk? There are many screening and assessment tools to choose from. By completing this course participants will know how to choose a screening tool and/or assessment tool for their patient. The course begins by setting the stage and discussing what clinicians should be looking for, how to screen for it, and how to select the risk factors to further evaluate patients in order to prescribe an appropriate intervention or refer out. Depending on the patient’s screening results, a clinician will be able to use the appropriate assessment tool and document a good clinical assessment.
Be sure to view the other two courses in the series for more detail on assessment and intervention for impaired balance and risk of falls:
Once an older adult has been identified as being at risk of falling, Physical Therapists and other health professionals must develop and prioritize a problem list, set meaningful and measurable goals, assess outcomes of intervention, and make plans for discharge. This course will consider each of these factors, with an emphasis on evidence-based interventions and effective documentation and communication, so that Physical Therapists and other health professionals can be as effective as possible in reducing risk of falling for the older adults in their care. This final course in our three course series completes the triad of 1) understanding the neurophysiology of postural control and the age-related and disease related factors that may compromise efficacy of balance systems, 2) determining an older person’s individualized risk of falling using both screening and multifactorial risk assessment strategies and 3) developing evidence-based interventions that will reduce that risk.
For more detail on assessment and intervention for impaired balance and risk of falls, view the other courses in this series: