TOPICS IN GERIATRIC REHABILITATION

Caregiver Support Role in Occupational Therapy Video Telehealth: A Scoping Review
Gately ME, Metcalf EE, Waller DE, McLaren JE, Chamberlin ES, Hawley CE, Venegas M, Dryden EM, O'Connor MK and Moo LR
Caregiver involvement may facilitate patient participation in occupational therapy (OT) video telehealth. However, little is known about the extent to which caregivers participate and what they do. This scoping review aims to, 1) describe the caregiver role supporting patient participation in OT video telehealth, and, 2) identify barriers and facilitators to caregiver involvement. Findings reveal caregiver involvement in a range of OT evaluation and intervention processes, with details on what caregivers did overall lacking. Barriers and facilitators are also described. This study underscores the need for clear and robust descriptions of caregiver participation to increase best practices in video telehealth.
Gait Speed and Confidence Levels in Persons Using 1 and 2 Canes While Walking a 4-m Course
Lisenby MA
This is the first article that the researcher is aware of that compares walking speed and confidence levels with 1 cane versus 2 canes. An observational study was conducted with 30 participants who had difficulty walking. Gait speed was assessed on a 4-m course with the participants using 1 cane, then 2 canes. Of 30 participants, 28 walked faster and demonstrated improved confidence with 2 canes. Use of 2 canes with gait might be a technique that people want to consider to improve confidence or to improve walking speed, or improve both.
Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss
Lu YH, Rosner B, Chang G and Fishman LM
Assess the effectiveness of selected yoga postures in raising bone mineral density (BMD).
Communication Difficulty and Relevant Interventions in Mild Cognitive Impairment: Implications for Neuroplasticity
Johnson M and Lin F
Mild Cognitive Impairment (MCI) represents a critical point for controlling cognitive decline. Patterns of communication difficulty have been observed in patients with MCI and warrant examination and management. The present systematic review examined (1) characteristics of communication difficulty in MCI by focusing on two domains: expressive and receptive communication, and (2) cognitive interventions that addressed communication difficulties in individuals with MCI. Of the 28 observational studies we reviewed, expressive and receptive communications were generally impaired in individuals with MCI, compared to their healthy counterparts. However, only one of seven interventions effectively improved communication related outcomes. We finished the paper with a discussion about how neuroplasticity influences communication abilities in individuals with MCI to inform the future development of interventions for communication difficulty.
Cognitive Consequences of Aging with HIV: Implications for Neuroplasticity and Rehabilitation
Vance DE, McDougall GJ, Wilson N, Debiasi MO and Cody SL
Combination active antiretroviral therapy prevents HIV from replicating and ravaging the immune system, thus allowing people to age with this disease. Unfortunately, the synergistic effects of HIV and aging can predispose many to become more at-risk of developing cognitive deficits which can interfere with medical management, everyday functioning, and quality of life. The purpose of this article is to describe the role of cognitive reserve and neuroplasticity on cognitive functioning in those aging with this disease. Specifically, the role of environment and the health of these individuals can compromise cognitive functioning. Fortunately, some cognitive interventions such as prevention and management of co-morbidities, cognitive remediation therapy, and neurotropic medications may be of value in preventing and rehabilitating the cognitive consequences of aging with HIV. Novel approaches such as cognitive prescriptions, transcranial direct stimulation, and binaural beat therapy may also be considered as possible techniques for cognitive rehabilitation.
Plasticity in Early Alzheimer's Disease: An Opportunity for Intervention
Hill NL, Kolanowski AM and Gill DJ
The scientific evidence of plasticity, or the brain's dynamic ability to alter its organization and activation throughout one's lifetime, has increased significantly over the last decade. This analytic review evaluates selected evidence regarding the persistence of plasticity in people with early-stage Alzheimer's disease (AD). Functional neuroimaging provides persuasive evidence of plasticity throughout aging as well as the early stages of dementia, including the possibility of a heightened response during the prodromal period of AD. Behavioral outcomes research demonstrates the ability of people with early-stage AD to relearn previously forgotten information or otherwise improve cognitive abilities following a cognition-focused intervention. Both of these bodies of evidence support the existence of compensatory processes at work, even in the presence of dementia-related pathology. This retained ability of the brain to adapt to neurodegenerative disease in an attempt to maintain function may provide a valuable opportunity for intervention, particularly in the prodromal or earliest stages of AD.
NEURO-ONCOLOGIC PHYSICAL THERAPY FOR THE OLDER PERSON
Ching W and Luhmann M
Due to the uncertainty of the course of diagnoses, patients with neuro-oncological malignancies present challenges to the physical therapist. At times, the presentation of impairments and disabilities of these patients with neuro-oncological diagnoses do not necessarily coincide with the involved area of the brain or spinal cord. It is our intention to provide guidance to the physical therapist who will be working with these patients with neuro-oncological diagnoses, in hopes that their encounters will be more productive and meaningful. This article describes a brief overview of common central nervous system malignancies, its medical treatment, as well as possible complications and side effects that would need to be considered in rehabilitating these patients. Special consideration is given to the elderly patients with neuro-oncological diagnoses. Pertinent physical therapy assessments and interventions are discussed.
Driving Retirement in Older Adults with Dementia
Croston J, Meuser TM, Berg-Weger M, Grant EA and Carr DB
In order to characterize the driving and mobility status of older adults with dementia, a questionnaire was mailed to 527 informants; 119 were returned. The majority of patients were diagnosed with Dementia of the Alzheimer's Type. Only 28% were actively driving at the time of survey. Informants rated 53% of current or recently retired drivers as potentially unsafe. Few informants reported using community/educational resources. Individuals with progressive dementia retire from driving for differing reasons, many subsequent to family recognition of impaired driving performance. Opportunities for education and supportive assistance exist but are underutilized.
CareWatch: A Home Monitoring System for Use in Homes of Persons With Cognitive Impairment
Rowe M, Lane S and Phipps C
Currently, informal caregivers provide the bulk of care for persons with cognitive impairment who live in the home, often at significant cost in terms of their own physical, mental, and emotional health. This is a report of the development of a home monitoring system, CareWatch, designed for use in homes of persons with cognitive impairment such as Alzheimer's disease. The purpose of CareWatch is to prevent unattended home exits, particularly during the night, and to improve caregiver sleep. We report on the development of CareWatch and on 2 clinical trials underway to test its effectiveness in the home setting.
Fitness and Mobility Exercise (FAME) Program for stroke
Eng JJ
Given the potential of exercise to positively influence so many physical and psychosocial domains, the Fitness and Mobility Exercise (FAME) Program was developed to address the multiple impairments arising from the chronic health condition of stroke. We present the details of this exercise program and the evidence which has shown that the FAME Program can improve motor function (muscle strength, balance, walking), cardiovascular fitness, bone density, executive functions and memory. The FAME Program can help to improve the physical and cognitive abilities of people living with a stroke and reduce the risk of secondary complications such as falls, fractures and heart disease.
Impact of the COVID-19 Pandemic on Individuals With Low Vision: Life Goes On
Hsu YP and Pingale V
This qualitative case study explored the impact of lockdown and social distancing measures used during COVID-19 on the lives of individuals with low vision. A purposive sample of 6 participants with low vision was recruited. Data were collected using in-depth semistructured interviews consisting of 10 open-ended questions. A thematic analysis was conducted to understand the unified subjective experiences of the participants. The analysis revealed 4 themes: (1) Changes, a lot of them; (2) Emotional roller coaster; (3) Life goes on; and (4) Technology as the catalyst. Participants demonstrated ongoing adaptation to meet the changing demands imposed by the pandemic.
Falls and Fall-Related Injuries in an Evidence-Based Tai Ji Quan Intervention in Rural West Virginia Churches
Jones DL, Selfe TK, Wilcox S, Cosner CT, Mitchell J, Ray BD, Stipec C, Switay D and Mancinelli CA
This paper identifies the independent predictors of falls in an implementation study of Tai Ji Quan: Moving for Better Balance (TJQMBB) in older adults in rural West Virginia churches.
Analysis of Physical Therapy Intervention Outcomes for Urinary Incontinence in Women Older Than 65 Years in Outpatient Clinical Settings
Neville CE, Beneciuk J, Bishop M and Alappattu M
Conservative interventions provided by physical therapists for the treatment of bladder control problems in adult females are strongly supported in the literature and in clinical practice guidelines. However, physical therapy (PT) intervention outcomes specifically for women over the age of 65 with urinary incontinence (UI) in outpatient settings in the United States have not been extensively reported.
Investigation of the Effects of COVID-19 on Perception, Attention, Memory, Balance, and Quality of Life in the Elderly
Aydoğan Z, Baş B and Aksoy S
This study was conducted with elderly individuals who had recovered from COVID-19 to investigate the effects of COVID-19 on balance, perception, attention, memory, and quality of life and produce rehabilitative solutions for these problems.
Antineoplastic therapy side effects and polypharmacy in older adults with cancer
Stout NL and Wagner SS
The geriatric oncology population requires special consideration in rehabilitation care planning due to drug side effects and potential drug interactions that occur with cancer treatment. Antineoplastic therapies incite side effects that are frequently managed with additional pharmacological interventions, often resulting in a cascade of drug side effects. Moreover, this population is disproportionately affected by multiple pre-existing co-morbidities that require the use of multiple medications. The aggregate impact of these pharmacological strategies increases the risk for adverse effects. This article will review the complexities of these drug interactions and will provide insight and awareness to guide rehabilitation interventions.
Aging Adults' Preferences for Wellness Program Activities and Delivery Characteristics: A Cross-Sectional Survey
Talley KMC, Cheung C, Mathiason MA, Schorr E, McMahon S and Wyman JF
Lifestyle wellness programs help prevent and manage chronic diseases, yet few are designed for aging adults.
Clinical-Community Connections: Incorporating Evidence-Based Programs for Improved Patient Outcomes
Schrodt LA, Sledge RA, Hergott C, Rohrer B, Sidelinker J, Brach JS, Vincenzo J, Shirley KD and Shubert TE
Incorporating evidence-based community programs into clinical care recommendations and goals may help bridge the clinic-to-community transition for older adults. Engagement in evidence-based programs can help older adults manage chronic conditions and reduce fall risk through behavior change and self-management following a clinical episode of care. This paper describes evidence-based fall prevention and physical activity programs, provides resources to locate programs, and strategies to match older adults to the right programs.
Speech and Swallowing in Parkinson's Disease
Tjaden K
Dysarthria and dysphagia occur frequently in Parkinson's disease (PD). Reduced speech intelligibility is a significant functional limitation of dysarthria, and in the case of PD is likely related articulatory and phonatory impairment. Prosodically-based treatments show the most promise for addressing these deficits as well as for maximizing speech intelligibility. Communication-oriented strategies also may help to enhance mutual understanding between a speaker and listener. Dysphagia in PD can result in serious health issues, including aspiration pneumonia, malnutrition, and dehydration. Early identification of swallowing abnormalities is critical so as to minimize the impact of dysphagia on health status and quality of life. Feeding modifications, compensatory strategies, and therapeutic swallowing techniques all have a role in the management of dysphagia in PD.
Evidence-Based Strategies for Preserving Mobility for Elderly and Aging Manual Wheelchair Users
Requejo PS, Furumasu J and Mulroy SJ
Elderly and aging manual wheelchair (MWC) users have increased risk for accelerated loss of function and mobility that greatly limits independence and affects quality of life. This review paper addresses important issues for preserving function and mobility for elderly and aging individuals who use a MWC by presenting the current available evidence and recommendations. These include recommendations for maximizing function, by decreasing pain, improving the ability to self-propel, and prolonging mobility and endurance through ergonomics, individualized wheelchair selection and configuration, and adaptations for increasing the capacity to handle the daily mobility demands through training, strengthening, and exercise. Each recommendation is supported by current research in each relevant area.
Reasons Affecting the Choice of Patient-Identified Goals Set by Occupational Therapists in Low Vision Rehabilitation
Smith TM
Goal setting is done in collaboration with the patient, but patient identified (PID) goals are not always addressed. The purpose of this study was to determine reasons PID goals are not set in low vision rehabilitation and for which tasks.