Physical Therapy for the Elderly
Evaluation begins with a patient interview to determine the individual's perception of the problems and their goals for treatment, and then proceeds to a physical exam. Typically, a physical therapist will assess a wide array of abilities, including strength, balance, transfers (rise from a chair), and walk.
Assessment of muscle strength, through manual muscle testing, can determine whether the strength of a particular muscle, graded from five (normal) down to zero (completely dysfunctional). Muscle weakness is commonly associated with problems walking and climbing stairs, as well as falls. Appreciating the relationship between strength and function can clarify the expected degree of difficulty an individual will have with daily tasks. Other areas evaluated include sensation, range of movement, coordination, and muscle tone (i.e., a measure of ability to relax when an extremity is passively moved).
Pain is another common problem that limits abilities. If pain is present, it is important to determine the duration of pain, describe what exacerbates and relieves the pain, get an indication of severity, and formulate a comprehensive treatment plan for pain control.
Impaired balance will affect the ability to walk safely and can contribute to falling. By observing an individual in the sitting or standing position, static balance can be determined. Dynamic balance, or balance during movement, can be assessed by watching an individual's ability to react to perturbation and displacement.
Physical therapists will judge walking safety, evaluate gait patterns and posture, and appraise a person's ability to transfer safely from bed or chair to a standing position. Transfer and gait can be described by the amount of assistance that is needed to safely accomplish these tasks and can be grossly classified as independent needing assistance (of one or more people), or unable. A specific gait pattern may point to a medical diagnosis, such as Parkinson's disease, stroke, or uncontrolled pain.
Sometimes home safety assessments can delineate problems in the environment that predispose the patient to falling. Common problems include scatter rugs, poorly lit areas, low chairs, and clutter.
Assessment tools are frequently used to standardize evaluation and measure treatment outcomes. These tools allow the physical therapist to record and communicate information in a consistent fashion. For example, both the Berg Balance Scale (scored from 0–56 with 56 being the optimal score) and Functional Reach Test (ability to reach forward, calculated in inches) measure balance. Mobility scales include the Elderly Mobility Scale (scores a person's ability to transfer, stand, reach, and walk) Timed Up and Go (amount of time required for a person to rise from a chair, walk 3 meters, turn and return to a seated position in the chair), and a 6-Minute Walk Test (measure of the distance a person can walk in this time). There are many activities of daily living scales (Barthel Index and Lawton Brody) that can be used to document a person's abilities to carry out basic tasks (i.e., dressing, bathing, walking, hygiene).
Functional ability is important as it affects quality of life, emotional status, and ability to remain independent.