Orthoses in Older Patients
16.6 Physical Therapy in Patients Who Use Orthotic Devices The orthoses should be evaluated by the attending practitioner, orthotist, and phys-
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16.6 Physical Therapy in Patients Who Use Orthotic Devices
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utmost importance. Trunk and upper-extremity flexibility exercises allow more efficient performances in daily activities.
Upper-extremity strength is important for transfers in bed mobility, donning and doffing of orthotic devices, and ambulation activities. Patients using orthoses show greater energy expenditure than normal individuals; therefore, aerobic training is fundamental, provided there are no medical contraindications. Moreover, strength- ening exercises of the trunk musculature improve stability, and training of the lower extremities improves gait pattern, allowing, in this way, an efficient ambulation.
It is also important to improve balance of disabled elderly in order to prevent falls and maintain independence in daily functional activities. Patients who use orthotic devices usually experience loss of balance and stability. The presence of environ- mental barriers, such as soft, uneven or unstable surfaces and the gait instability may increase the risk of fall injuries. Ambulation training aims to improve patient’s walk on even or uneven surfaces (i.e., carpet, grass, sidewalks), from short to longer dis- tances, using the appropriate devices. Any deviation and asymmetry in gait pattern should be promptly evaluated and corrected.
Functional training for independence in daily activities such as personal hygiene or independent transfer is part of the exercise program (e.g., from bed to wheelchair, from wheelchair to toilet, from seated to standing position, with or without the assistive devices, and vice versa).
The purpose of the stair exercises is to teach patients how to safely ascend and descend stairs using orthoses. Stair negotiation is one of the most difficult tasks for older people, and stair falls cause more than 10% of fatal fall accidents. Walking stairs requires attention, balance, and coordination. Proprioception, somatosensory, visual, and vestibular systems often deteriorate with aging; therefore, stair descent and ascent can be very difficult for older patients using orthoses [14–17]. Supervised physical therapy, mobility, and balance exercises, with or without the use of stair rail- ings or assistive devices, can be helpful in accomplishing this very hard task [18].
From all the above, we can conclude that education and a multicomponent, pro- gressive, personalized training program should be considered as part of the manage- ment of elderly patients who use orthotic devices.
Key Points
• The orthoses are used, usually within a rehabilitation program, to correct the impaired functions of the upper/lower limbs or of the spine.
• The correct choice of an orthotic device should be based on the clinical situation, the individual functional assessment, and the social context, focusing on patient’s and caregiver’s needs.
• Association of an orthotic usage with a multicomponent individualized training program improves patient’s functionality.
• A periodic checkup is also necessary to control the fit of the orthosis and avoid unnecessary complications secondary to its usage.
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S. Masiero, U. Carraro (eds.), Rehabilitation Medicine for Elderly Patients, Practical Issues in Geriatrics, DOI 10.1007/978-3-319-57406-6_17 M. Traballesi (*) • G. Morone • S. Brunelli
Santa Lucia Hospital, Neurorehabilitation Unit, Rome, Italy
e-mail: [email protected]; [email protected]; [email protected]