Geriatric Rehabilitation

Foreword: Aging With a Progressive Neurologic Condition-Implications for Rehabilitation No abstract available

Aging With a Progressive Neurologic Disease: Rehabilitation Management of the Adult Aging With Parkinson Disease or Multiple Sclerosis The confluence of an aging population and increasing life expectancy of people with neurodegenerative diseases such as Parkinson disease and multiple sclerosis means that there is a growing segment of the population who are aging with a neurodegenerative disease. As such, rehabilitation professionals must be prepared for the combined challenges of age- and disease-related changes in physical function. First, a review of age- and disease-related problems experienced by older adults with Parkinson disease or multiple sclerosis will be presented, followed by a description of clinical practices that might be implemented by rehabilitation professionals to best address the problems experienced by these unique populations.

Aging With Multiple Sclerosis: An Agenda for Examining the Effects of Physical Activity Behavior This review discusses research on physical and cognitive function, physical activity behavior, and physical activity interventions in older adults with multiple sclerosis (MS). Research indicates that older adults with MS demonstrate reduced physical and cognitive function as well as physical activity compared with healthy older adults. Preliminary evidence suggests that levels and patterns of physical activity are associated with physical function and possibly cognition, and physical activity interventions can improve physical function in older adults with MS. Additional research is warranted that further clarifies the value and role of physical activity in managing the functional consequences of aging with MS.

An Exploration of Falls and Dual Tasking: A Prospective Cohort Study of People With Multiple Sclerosis Objective: To explore the relationship between dual-task cost and falls in people with multiple sclerosis. Methods: One hundred participants completed a falls screening questionnaire, Timed Up and Go (TUG), and TUG-Cognitive (TUG-C) at baseline. Dual-task cost was the percentage change in performance between TUG and TUG-C. Falls were recorded prospectively for 3 months. Results: Dual-task cost was not associated with increased risk of falls (P = .90, odds ratio = 1.00). Answering yes to a question about problems doing 2 things at once increased likelihood of falls (risk ratio = 2.07). Conclusion: A single question asking about dual tasking may be a useful screen for falls risk assessment.

Motor, Cognitive, and Behavioral Performance in Middle-Aged and Older Adults With Multiple Sclerosis Age-related changes in motor function from young to old age in persons with multiple sclerosis (MS) have been well-documented. However, little is known about motor, cognitive, and behavioral differences between middle-aged and older adults with MS, and global relationships among motor, cognitive, and behavioral factors in persons with MS. In this study, we recruited ambulatory middle-aged and older adults with MS to complete walking, dual-task, cognitive, and survey measures. We found no differences in performance between groups in our sample of mildly disabled individuals with MS, suggesting that individuals with mild disease may have reduced age-related declines in motor function.

Using the International Classification of Functioning, Disability, and Health to Guide Students' Clinical Approach to Aging With Pathology: Aging With Multiple Sclerosis Example Despite the wide acceptance of the International Classification of Function, Disability, and Health (ICF) model, there remains a fundamental gap in the utilization of the ICF to foster clinical decision-making in physical therapy students. This article proposes a shift from initiating the patient examination with assessment of body structures and functions to a model that incorporates adult learning theory and clinical expertise theory to facilitate students' transition to expert clinicians. The authors offer the example of an older patient with a neurological condition to demonstrate the reasoning process that delineates typical aging from the disease process for optimal patient outcomes.

Presbyphagia Versus Dysphagia: Normal Versus Abnormal Swallowing Symptoms in Older Adults With Parkinson Disease and Multiple Sclerosis The purpose of this article is to describe normal, age-related changes in the swallowing mechanism, clinically referred to as “presbyphagia.” The authors compare presbyphagia in the oral, pharyngeal, and esophageal phases of the swallow to abnormal, or impaired swallowing, termed “dysphagia.” This article focuses on how older persons with Parkinson disease and multiple sclerosis frequently have dysphagia symptoms, such as food residue, delayed swallow trigger, penetration, and/or aspiration, superimposed over presbyphagia. Information on the psychosocial and emotional impacts of dysphagia on persons with Parkinson disease and/or multiple sclerosis, along with common treatment approaches to alleviate swallowing difficulties, has also been discussed.

Do Age and Disease Stage Impact Cognition and Balance in Older Adults and Persons With Parkinson Disease? Background: The combination of age and having Parkinson disease (PD) may result in deficits in cognition and balance over and above that of healthy older adults. Objective: To determine the impact of age and disease on cognition and balance in younger and older adults with and without PD. Methods: Forty people with PD and 28 healthy adults participated. Cognition was assessed using the Montreal Cognitive Assessment. Balance was assessed using the Mini Balance Evaluation Systems Test (MiniBESTest). Results: People with PD performed worse on the Montreal Cognitive Assessment and MiniBESTest compared with healthy controls. No main or interaction effects of age were found. Conclusions: Although people with PD scored more poorly on the Montreal Cognitive Assessment and MiniBESTest than healthy adults, the results were independent of age in this sample.

Side-to-Side Variability in Muscle Function With Parkinson Disease Purpose of this study was to characterize side-to-side differences in quadriceps, hamstrings strength, and quadriceps activation in individuals with Parkinson disease (PD). Participants were individuals with PD (n = 17) with Unified Parkinson's Disease Rating Scale motor scores ranging from 9.5 to 61.0. Paired t tests compared strength and muscle activation between limbs for all individuals. The stronger quadriceps was 15.2% stronger (P < .001) and the stronger hamstring was 12.9% stronger (P = .001). Side-to-side differences in quadriceps activation was 18.9%, but insignificant (P = .072). No pattern explained side-to-side differences. Muscle strength asymmetry is variable, but present across a range of PD disease severity, which emphasizes the importance of a detailed clinical examination.