Sunday, November 27, 2011

Runner's Feet Seminar Presentation

Just today, I had the opportunity to share my insights on a seminar conducted in San Juan De Dios Hospital in Pasay. The topic is Runner's Feet. I was given the task to share about the anatomy of the shoe as well as the biomechanics of the foot that affect an individual during running. It also included some history of the running shoe as well as the evolution of the shoe.
So as promised to the attendees, I am providing a link to the presentation slides for your own personal use. As I have mentioned, with so much paper used, I went the paperless route and hopefully you just place this in your electronic device, (ipad,computer,smartphone) and minimize the unnecessary use of paper if you can store it digitally and electronically.
By the way, I will make this available for download for only the month of December 2011. After which I will remove it already. So make sure you get it and save it before the end of the year. It is in pdf file already.
Enjoy and here is the link. Just click on it. Does the shoe "feet"? presentation

Friday, October 14, 2011

Falls in the elderly: Exercises done at home

Your patients or love ones who have been not so  active at home will succumb sooner or later to the what we call deconditioning. Due to their condition such as poor balance or affected by other ailments, they become confined in bed, or wheelchair or chair. Definitely such situations will leave their upper and lower limbs weaker. As the saying goes, "Use it or lose it."

So here are some simple exercises that you can ask your patient or love one to do at home. We will start with some exercises for the upper limbs done during sitting.

1. Forward Arm lift
While the patient is sitted. Make the patient do an arms forward position. Then let the patient lift the arms alternately beyond the head level or as high as they can go. Just make sure the patient breathes in and out while doing the exercise. Do not make them hold their breath.

Do this without or with weights being held on the hand depending on the patients capability.

2. Backward pull exercise

Again patient in an arms forward position and then let the person imagine as if pulling a stick backward. This can be done with or without weights or even holding a stick. Remind the person to just breath in on starting position and breath out during pull position. Do not make them hold their breath.

Arms forward starting position
Backward pull position

3. Shoulder shrugs

Let the person keep the arms and hands on the side (with or without weights) and then let the person shrug the shoulders. Breath in during starting position and breath out on shrug position.

Shoulder shrug starting position

Shoulder Shrug up position

Reasons of doing this?

1. To keep the upper limb in good condition or at the least not deteriorate its strength.
2. Keep the joints moving and not become stiff
3. Strengthen the muscles that help the person stand during pull up to stand as well as keep the tone of the upper back muscles.
4. Prevent stooping forward during sitting.

How many times to be done?

Depending on the condition of the patient, you can start at 10 counts per exercise and progress accordingly.
It is advised to do it 3 times a day, morning, afternoon and early evening.

Extra Tip:

The simpliest weight you can use are just plastic water bottles. A 250ml water bottle is equivalent to 1/4th kg. (100ml water is equivalent to 100gms) So no need to buy gym weights.

The next set will be standing exercises.

Special Thanks to Mr. Jayson Javier, PTRP. Upon this blog post, he is  a PT faculty instructor in The College of Physical Therapy of San Juan De Dios Educational Foundation, Incorporated, Pasay City.

Sunday, September 25, 2011

Falls in the elderly: Prevention

Now we will deal with simple things in the household to prevent accidents that may lead the elderly people to lose balance. Also included are some things to consider to do when you have them checked by their physician.

Here in the Philippines, it usually have an extended type of family structure which of course consists of the grandparents or older population. So what are those simple steps to consider.

1. Keep the wires off the floor.
Tangled wires
Usually extension cords, phone wires or internet wires, appliance wires criss-cross all over our houshold. It is thus obvious that the foot of an individual may be snagged while crossing over these wires.

2. Make sure rugs or floor mats will not cause snagging of the foot. If this is not kept flat off the floor then again catching the foot while crossing over it is very highly likely.

3. Make sure the floors are not slippery. We should reconsider if waxing and making the floor too shiny is not a potential fall factor for the elderly.

4. Use of non-skid shoes/slippers.

5. Use of night light in bedroom, stair lights. For some general "phenomenon" the elderly usually do not want to open lights going to the bathroom when they wake up at night. Again this is a potential risk for falls due to a) less ability to see in the dark b)balance and equilibrum problems c)weaker lower/upper limbs

6. Use of bedside commode instead of going to the bathroom during night time.

7. As for stairs, make sure there is contrasting colors of the steps and wall in order for them to discern the steps and not get confused or have a misstep.

8. Have their eyes checked. If only 1 eye is really able to see. i.e. cataract on 1 eye causing less vision, the depth perception of the individual is compromised.

9. Polypharmacy: Elderly individuals usually have a LOT of meds to take in the morning, lunch, evening and even in between. So try to visit their physician and ask what can be reduced or removed if possible. The potential for cross interactions is very high for multiple medicine intake that may affect their balance.

Alright, now the next blog will be some exercises that can help out the elderly. Stay tuned.
Picture c/o MS online clipart from Fotolia

Tuesday, September 20, 2011

Falls in the elderly: The Facts

As I have discussed in the past 2 blogs regarding falls in the elderly that are focused mainly on simple ways to assess if they have a tendency to fall. Now you may be wondering, what is the big deal with falling?

Short answer. A LOT!

Long Answer: As one ages, just like a mechanical equipment, the body undergoes "wear and tear" if I may simply it. Anatomically and physiologically, the body may not be able to handle circumstances as compared to when it was younger. Thus any trauma or accidents such as a fall may be too much to handle.

So now with the facts.

1. Elderly falls that resulted in fractures usually affect the wrist, spine and hip. 90% of those occur in the hip. The effect of course will be immobility leading more to physical deterioration. *

2. Elderly falls is 10x more likely to be hospitalized and 8x more likely to die as compared to children. *

3. 2x longer hospitalization  with increased risk for home care. *

3. Increasing age also has increasing mortality (death) due to falls. *

4. Common injuries that occur in elderly falls, Head trauma, fractures as mentioned above, dislocations or soft tissue injuries. *

* Statistics and facts taken from article of George Fuller, COL, MC, USA in his article in American Family Physician.

So now that the facts are stated, one can now understand why elderly falls can be devastating to the one affected and to their love ones. Is this preventable. The short answer is "Yes". That will be the next set of topics. Stay tuned.

Monday, September 12, 2011

Falls in the elderly: How to assess their balance Part 2

The next part of these series of blogs for the elderly is another type of test that does not involve walking.

It is called the Four Test Balance Scale. A study done by Melinda Gardner, David Buchner, M. Clare Robertson and A. John Campbell from the Journal Age and Ageing 2001: 30: 77-83, Titled Practical implementation of an exercise-based falls prevention programme, showed how to do this test.

It requires an individual to stand on 4 different foot positions of increasing difficulty without an assistive device. The one being assessed can be helped out to assume the position but no help can be provided once the test starts per position.

The sequence of the tests are:
1. Standing Feet together
2. Standing Semi-tandem (one foot is halfway in front of the other but still close together)
3. Standing Tandem position (one foot is in front of the other with the heel of the front foot touching the toe of the back foot)
4. One leg standing (One tested chooses which leg to stand on)

Picture reference was taken from the Journal mentioned above. Click on the link. (PDF file)
Each test should be completed for at least 10 seconds. Inability to assume or maintain that position is equivalent to a failed test stage. The one being tested should also be on bare feet.

Unlike the initial Timed "Up and Go" test which includes walking, this test is only done in a standing position. Again this give you an idea if your elderly love one already has possible problems in balance that need to be assessed by your family physician or your Physical Medicine and Rehabilitation Specialist.

For those who like to view a video of this test, it can be seen at Vimeo. However I believe it is in German language but at least you know how it is done.

Friday, September 9, 2011

Falls in the Elderly: How to Assess their Balance Part 1

Last August 2011, I was asked to give a short seminar on fall prevention in the elderly by Home Health Care. It gave me a chance to provide information on helping the allied medical and medical audience together with caregivers on taking care of the elderly. So to start this set of blogs, I initially asked myself, if I am taking care of someone in this age group, how can I know if he or she has problems in balance or mobility?

George F. Fuller, COL, MC, USA from White House Medical Clinic, Washington D.C. provided an article under American Family Physician that one way to screen the elderly is by noting if they have a history of fall within the last 6 months. If an elderly has more than 2x of occurrence of fall within 6 months an evaluation is warranted for any possible underlying problem. This may already denote a declining physical and physiological status.

Now if you like to test the mobility of an elderly, an easy way to do it is the Timed "Up and Go" Test. Wherein an individual is timed from doing this test. The patient s
its on a standard armchair, stands up and walks for 3 meters (10 feet), turns around and return to a sitting position.

The individual is freely mobile if done in < 10 s
econds; mostly independent if done within 11 to 20 seconds; Variable mobility if within 20 to 30 seconds and Impaired mobility if > 30 seconds. This will help you gauge if your elderly patient or love one has impaired mobility already.

Reference for Timed "Up and Go" Test is found on Table 6 of the link from Sir George Fuller's article under American Family Physician. (Click on the link above)

Next topic will be another way to test standing balance.