????????? Rehabilitational Exercises for Community Elders

1
?????????Rehabilitational Exercises for
Community Elders

• ???? ??????
• ???

2
?? Aging

• ?????????,????????????????????????
• Aging is associated with a higher incidence of
  physical impairment functional disability.

3
?????

• ?????
• -??????????
• Maximal oxygen uptake (VO2 max)
• Metabolic equivalents (METs)
• ??????????27????,??????????(65???????60?)
• VO2C.O. (a-v)O2diff
• ????????????(cardiac output)????

4
????????

• - ? Max HR with age220-??
• - ? Stroke volume with age??????,??????
  (preload) ,????????,????(afterload)
• -????????????(baroreceptors)???????(orthostatic
  hypotension)?????? (?????)
• -??????????????,??????????????????,?????????????,
  warm-up?cool-down????????

5
????????

• ??MET????????
• ??/?? METS
• Max MET capacity, 75??? 2-4
• ?? 2-3 m/h
• ??stretch??
• ??????
• Max MET capacity, 65-75? 5-7
• ?? 4 m/h
• ????8??/??
• ???, ???????
• ??(??)
• ????
• Max MET capacity, 65? gt7
• ??/?? 5m/h
• ????11-12m/h
• ??, ??

6
???????

• ??????,??(force/time)?????,???????????????????????
  ?????????????????????
• Fast-twitch fibers???
• ?????(disuse atrophy)
• ,??slow-twitch fibers?
• ?????????
• ????????,???????(immobilization)???slow-twitch
  fibers????????fast-twitch fibers???

7
???????

• ?????????immobilization?????????
• -??,???????????????(?)?
• -???????????????(?) ?
• ??????,??????????????????,?????????
• -? ??? ?????

8
????????????

• ??
• ????????
• ??????????????
• ????
• ??????
• ????
• Tremor???(gt69?,43 have hand tremor, 7 have head
  tremor titubation)
• ?????,???
• ???? Dysmetria (gt65?)
• ???????? Dysdiadochokinesia
• ???????gt???gt??

9
????????????

• ????
• ??????(vibratory sense)???gt?
• ???(propriception)????
• ???????????????????
• ?????????????
• ????
• ?????(ankle jerks)?????
• knee?biceps?triceps reflexes ????
• Abdominal reflex ????
• Babiskis sign ????(?????????)
• ???????20-25 (dolls eyes)

10
?????

• Collagen(??)?????
• ???????????
• ????
• Elastin fibers(??????????,????????????????)???????
  ??,???????rigid??????
• ??????????(stiffness)
• ?????????????????
• ??????????????

11
?????

• ??????,??????????????????????
• ?????(osteoporosis)?????????3????hip, wrist
  vertebrae
• ????????????
• -????????(gt30?)1000mg/?
• ???? 1500mg/?
• -Estrogen replacement therapy (ERT)
• -?????????(Weight-bearing)
• ??

12
??

• ??????????,??
• Vestibular, somato-sensoryvisual systems
  (???????)
• Central coordination, motor planning
• cerebral cortex, cerebellum, basal ganglia
  (???????)
• Flexibility of joints, the muscular strength, the
  response speed (?????????)
• ?????????,?????,?????????,?????????????????????

13
??

• ?????????,????????????,???????????
• ????,swing phase??,double support ?????????????
• ??????????????????????
• ???????????????????????

14
?? Cognition

• ??????????????????????????????????,?dementia???,d
  epression???,delirium??

15
????

• ???????????????????,????????????Wagner(1999)??65??
  ??????3/4??????????,1/2???????????,??1/4??????????
  ??
• ?????????94?????,65??????????????(65)
  ,?????????????(55)???????(27)?????????(22)?????
  ??????????????????????????????(Badger, 1993)?

16
Geriatric Rehabilitation

• Intervening to reverse disability caused by
  specific disease or injury (eg., stroke, hip fx.)
• Preventive gerontology by promoting structured
  physical fitness (wellness) programs (??)
• Early rehabilitation for common minor
  musculoskeletal disorders to avoid progression to
  disability.(??)

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Cascade effect
Patient with osteoporosis osteoarthritis
Joint stiffness hampered mobility lead to a
fall with femur fracture
Greatly reduced mobility prevents patient from
reaching bathroom in time, resulting in
incontinence
Incontinence leads to depression
Depression interpreted as pseudodementia
18
????????????

• ?????82?10??, 65????? gt7,??????????????
• 2004?????65????????????9.2 ??????????,????2021?,
  ???????????,????????380?,?????15,????????????????

19
?????????????

• 37? ????
• 59? ??????????
• 4.63? ????,??????? 85?,??????15??

20
??96?????????????????

• ??????
• ??????
• ??????????????
• ????????????

21
??96?????????????????

• ??????
• ??????
• ??????
• ??

22
??96????????????????

• ????
• ?????
• ????
• ???

23
????????????????????

• ?????????
• ??????
• ??/??/??????????
• ????????????????????????????????
• ??????????????????,????????????????????

24
???????

• ?????????,??????????????????,?????????????
• ?????????????????????????????????????,????????????
  ???
• ????????? ? ????

25
?????????

• ??????????????????????????????,???????????????????
  ????,?????????????????????????????????????????????
  ??????????????????????????????????????????
• ?????????,????????????,??????????????????????????
  ???????????????????AIDS????????(???????????)??????
  ????

26
????????????????????
27
?????????

• ?????????????,????????????
• ???????????,?????????????,??????????coordination??
  ??motor problem solving ability?
• ????????????????,???????????immobility?
• ???????????????????,????????,???????????????

28
?????????

• ??????????????????????????
• Cardio-vascular Fitness
• Strength, Flexibility Bone Density
• Balance
• Psychologic Benefits

29
???????????

• ????????????????
• ?????,???????stretching exercises??????????????
• ???????????(?????????)??????
• ?????,???????????(hyperthermia)???(dehydration)???
  ??????,???????????????(hypothermia)???(frostbite)
  ?
• ???????????COPD,???????????????????
• ?????????????????,??????????????

30
??????(?)

• ????????????,??????????????
• ???????????
• ?????????????????
• ????????????????????????,????????????????,????????
  ??
• ????????????????(???????????????)

31
??????(?)

• ??????????????????????????????????????????????????
  ????????????
• ??????????????,????? (40-60? VO2max)??????(???????
  ????)
• ????????????
• ?????????????

32
????

• ??????
• ????(??)???????
• ??????????(functional capacity)
• ????????????????
• ????????????
• ???????????
• ??????????
• ????????functional capacity?????

33
Stop Sign???????????????

• ????????????
• ?????????????
• ?????
• ???????(dyspnea)
• ????????
• ??(nausea) ???(vomiting)
• ??????(decreased coordination)
• ?????????(fatigue)
• ????(confusion)
• ????(lightheadedness or dizziness)

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??(aerobic)????

• Variable ????????? ???????
• ??,????,??, ??????,
• Mode ??,?? ??,????, ???,????
• Muscle groups Large Large
• Frequency 3-5 times/wk 3-4 times/wk
• Duration 20-60 min 20-60 min
• Intensity 60-80?of max. HR 40-60 of max.
  HR
• Warm-up
• flexibility ex./ 10-15 min/10min ???
• Cool-down ex.

35
?????????

• Variable ????????? ???????
• Dynamic(free-weights or
• Mode variable resistance) ??
• Close-chain ex.
• Type of m. Isometric, Isotonic, ??isometric???
• contraction isokinetic Valsava maneuver
• Muscle groups Any ??????? ??????? ?
  ???????Frequency 2-3 times/wk 2-3 times/wk
• Duration 9s/contraction(3s each for
• concentric, state, eccentric phase) ??
• Intensity 60-80?of 1RM Circuit weight training
• programs low resistance
• (40-60 of 1RM)
• Sets repetitions 1-3 sets of 8-12
  repetitions 1-3 sets of 15-30 repetitions
• Rest periods 2-3s between repetitions, 2 min
  between sets ??

36
???????????

• ???(Diabetes Mellitus,DM)?????
• ??????????????
• ?????????????????(insulin)????

37
????

• 5-7 times per week
• Promotes weight loss and sustained increase in
  insulin sensitivity
• Low-intensity exercise
• (50 VO2max)
• Same improvement in
• insulin sensitivity as
• higher intensities

38
?????????

• ??????????????,?????
• ??????,???????
• ?????
• ??gt140mg/dL??gt200300mg/dL?????????,????????????
  ?
• hyperglycemia????????????????????????????????????
  ???????(acetone)???????????
• ??12hrs??????insulin????????????,?????insulin??,?
  ?????
• ???????????????????
• ??????????????,??????????

39
???????????

1. ????? (physical fitness)
2. ?????? (metabolic control)
3. ??????? (obesity)
4. ??????(blood lipid profile)
5. ????????(coronary heart disease)
6. ???????(psychosocial benefits)

40
??????????

• ???????????????????,??????????????
• ?????????????????????????????

41
?????????

• ??4 ?/?,3050min/?,??7085HRmax?
• ?????4560min/?,57?/??
• ????
• ???????????????(???)???????(????)
• ?????????HR ??????,???C.O.???
• ???????????????????/?(???)? ß-blockerCa2
  blocker???HR,HR?????????,???RPE?METs????
• ??????(Valsava maneuver)isometric
  stabilization exercise
• ?? sysBP/diaBP?1020mmHg in resting sysBP?in
  exercising (?sympathetic tone)

42
????

• ????????(RPE)
• ??620???HR 60200 bpm
• HR?VO2?RPE???????????

43
???????????

• ????
• ??????????????????(PNF patterns)
• ?????????????(motor learning)??
• Mind-body interventionsrelaxation
• Deep breathing exercises improve cardiopulmonary
  function

44
???????????( Proprioceptive Neuromuscular
Facilitation, PNF)

• PNF ??????????????????????????????????????,??????
  ???????????????

45
PNF patterns

• ??????????
• ???????????????,??????????????????????
• ????????????,??????????????????????????
• ???????????????????????????,????????????????
• ?????????????,????????????
• ??????????????????,?????????????????

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Motor Control Learning

• Motor Learning
• Stage1 gain voluntary control of the stabilizing
  m. build up patients holding capacity
  (10repetitions, each hold for 10s)
• Stage2 dynamic work
• Stage3 proprioceptive training?automatic nature
  of stabilization

• Stage of Motor Control
• Stage 1Conscious perception kinesthetic
  awareness
• Stage 2Volitional control produce movement
• Stage 3Coordination control movement
• Stage 4Engram formation automatization of
  movement

47
???????

• ????static
• ??
• ????dynamic coordination
• ??
• ????strength, coordination, balance
• ??

48
Thanks for your attention!
49
??????????
50
?????

• ???????
• ?????????,?????????
• ??????????????????,??????????
• ??????????????
• ?????????,??????
• ?????????????,?????????
• ??????????20???,?????????????

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Bed Exercises
52
Bed Exercises
53
Bed Exercises
54
Bed Exercises
55
Sitting Exercises
56
Sitting Exercises
57
Sitting Exercises
58
Standing Exercises
59
Standing Exercises
60
Standing Exercises
61
Standing Exercises
62
Standing Exercises
63
Coordination Quick Reflex
64
Range of motion
Place wand at back of neck. Gently rub wand over
neck. Rub sides of the neck. Extend down the
shoulders. Place stick in both hands at lap
level. Push stick out to side push to other
side (L)
Place the stick in the Rt hand. Turn hand to
face up, then face down, still holding the stick.
Repeat with the Lt hand
65
Strengthening
66
Strengthening
67
Strengthening
68
Stretching
69
Thanks for your attention!