Upon completion of this lecture student will
be able to:
• Explain the purpose of geriatric
rehabilitation.
•
Describe major principles influencing
geriatric rehabilitation.
•
Understand the goals for adapting an
environment for the older person.
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The purpose of geriatric rehabilitation is to
assist the disabled aged in recovering lost
physical, psychological or social skills to
make them more independent.
The decline in muscle strength and mass,
respiratory reserve and cardiovascular
functioning ,kyphotic postural changes and
many other physiological and psychological
changes associated with inactivity and
ageing.
Three major principles :
 Variability.
 Hypokinetics.
 Optimal health.
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Variability of the aged must be considered in
rehabilitation principles and practices of aged.
 Variability of capabilities within an aged group is
more pronounced than younger.
 Optimum health is directly related to optimum
functional ability.
 In acute situations, rehabilitation must be
directed toward:
 Stabilizing the primary problems.
 Preventing secondary complications such as bed
sores & contractures
 Restoring lost functions

Hypokinetics describes the physiology of
inactivity
 Most common reason for losses in functional
capabilities in aged is inactivity or immobility.
 There are many reasons for immobilizing the
aged.
 Deconditioning is defined as multiple changes in
multiple organ system physiology
that are induced by inactivity and reversed by
activity(exercise)
 The degree of deconditioning depends on degree
of superimposed inactivity and prior level of
physical fitness

Two major categories of inactivity or
hypokinetics :
 The acute hypokinetics of bed rest
 Chronic inactivity induced by a sedentary
lifestyle or chronic disease.
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Neurosensory:
Decreased
 Decreased
 Decreased
 Decreased
 Decreased
 Decreased

EEG
thermoregulation
cognition
in reaction time
balance
postural sway
Cardiovascular:
 Decreased output.
 Increased heart rate.
 Decreased oxygen uptake.
 Decreased blood volume.
 Decreased aerobic capacity.
 Delayed post activity recovery time

Respiratory:
 Atelectais.
 Hypoxemia.
 Increased risk of pneumonia.
 Decreased chest wall compliance.
 Decreased intercoastal muscle strength.
 Decreased vital capacity.
 Impaired gas exchange

Musculoskeletal
 Decreased muscle strength.
 Decreased aerobic capacity.
 Bone loss
 Joint contractures
 Osteoarthritis
 Decreased glycoproteins

Genitourinary :
 Urinary tract infection.
 Urinary incontinence.
 Skin- pressure sores
 Gastrointestinal – constipation.
 Functional
 Decreased activities of daily living.
 Increased risk of falls

Psychological
 Anxiety
 Fear
 Depression
 Mood changes
 Hallucinations
 Sleep disturbances

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B- bladder and bowel incontinence retention,
bed sores
E- emotional trauma
D- deconditioning of muscles& nerves,
depression, demineralization of bone
R- ROM loss & contractures, restlessness,
renal dysfunction
E- energy depletion, EEG activity decrease
S- sensory deprivation,sleep disorders, skin
problems
T- trouble
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The last principle in geriatric rehabilitation is
of optimal health.
WHO defines health as a state of complete
physical, mental and social well being.
The existence of complete physical health
refers to absence of pathology, impairment or
disability.
WHO , mental health include cognitive and
intellectual intactness as well as emotional
well being.
There are some cumulative effects :
 Biological
 Physiological
 Anatomical
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Preventing impairment and disability is a key
principle in geriatric rehabilitation.
Rehabilitation should be directed at preventing
premature disability.
 Rehabilitation efforts should focus medically on :
 Reducing the inflammation through drugs or ice.
 Maintaining joint mobility during the acute
phase(by modalities, assist in reducing oedema
or physical therapy)
 Joint protection techniques and prescription of
adaptive devices such as walker to protect the
joint.

 Provision
for proper nutrition in light of
medication and also vitamin C is crucial
component in health.
 Social and psychological support to provide
emotional and motivational support.
Health Awareness and Beliefs
 Exercise programming :
 Exercises have potential for improving physical fitness,
agility and speed of response.
 They also serve to improve muscle strength, flexibility,
bone health and cardiovascular response.
 Exercise has been shown to provide social and
psychological benefits affecting the quality of life and
social well being.
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Pain management :
 Pain management is very important factor in geriatric
rehabilitation.
 Pain is human perception or recognition of a noxious
stimulus.
 In geriatric 2 types of pain : acute & chronic.
 Treatment of acute pain may include medications to
reduce inflammation, ice, heat and gentle mobility
exercises.
 Chronic pain is more frequently observed and difficult
to control
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Assistive devices such as cane, a quad or walker
can be prescribed to improve stability during
ambulation and reduce stresses on the joint.
Wheel chair prescription may be necessary for
longer distances.
Proper positioning and seating for individual who
must sit for extended periods is required to
decrease discomfort and keep pressures off of
bony prominences, provide adequate postural
support, facilitate feeding and prevent
progression of joint contractures and
deformities.
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The use of physical restraints in an attempt to
keep patients safe, continiues to be practised
despite evidence that they often increase the
incidence of falls.
Decreasing the use of physical restraints
continues to be a challenge for the health
care team.
Restraints are used to prevent injury to self,
control of agitated or restless behavior,
management of a resident’s cognitive deficit
and poor judgement.
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Prevention/protection from falls and other
injuries.
Allows medical treatment to proceed without
patient interference.
Maintenance of body alignment.
Increases patient’s feeling of security and
safety.
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Injury from falls.
Accidental death by strangulation
Skin abrasions and breakdown.
Immobilization sequelae (deconditioning,
muscle atrophy, contractures, deep vein
thrombosis)
Decline in ADLs, functional mobility.
Cardiac stress.
Increased mortality.
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Falls are not part of normal ageing process,
but are due to interaction of underlying
physical dysfunction, medications and
environmental hazards.
Poor health status, impaired mobility from
inactivity or chronic illness, postural
instability.
Medical conditions are often a cause of
falling.
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The fear of falling is often a cause for
inactivity and is commonly seen an individual
who has sustained a previous fall.
Limitations of range of motion, decreased
muscle strength and joint mobility,
coordination problems can predispose an
elderly individual to falling.
Specific strengthening and gait training
programs assist in preventing falls by
improving overall strength and coordination
and balance time.
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Gait evaluation is one of the most important
components in fall prevention. The ‘Get-up
and Go” test is a method used often to test
functional strength, balance, coordination
and safety during gait.
Balance exercises can be incorporated into
functional activities for the aged.
Moving from sit to stand and from stand to
sit are examples of controlled voluntary
weight shifting
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Shifting the trunk forward and back and from
side to side while sitting are examples of
voluntary weight shifting.
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Remain calm and assess your situation.
Roll over slowly.Locate the nearest sturdy
chair.
Crawl or shuffle to the chair.
Kneel, then stand up using the chair.
Then turn and sit down.
Call or wait for help.
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The process of adapting to the environment
or adapting environment to aged person is
very important.
Evaluation of the environment is more
difficult than task analysis because the
environment of concern is the one in which
individual actually lives and has to function.