presented by Julie Ries
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.
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.
A small physiological change can manifest as a huge change in function and independence, as is represented in the classic idea of declining down the slippery slope of aging. As PTs we recognize that this can be represented in both directions... a small improvement in physiology can move someone who is frail or pre-frail to a more functional level. Activity is the key to moving back up the slope and progressive walking challenges are a perfect cornerstone to treatment.
Gait and cognition, especially executive function, are intricately related. Evidence demonstrating this relationship in recent rehabilitation literature is presented. The relevance of this relationship and the need for dual task training are discussed.
The 3 primary tasks of gait are reviewed to provide a paradigm within which to perform observational gait analysis. Treatment interventions are discussed with tips for ensuring success and a special emphasis on ideas for dual task training.