Stefano Masiero Ugo Carraro Editors

It is our honor and privilege to provide this preface to the first edition of the book Rehabilitation Medicine for Elderly Patients, published by Springer in Practical Issues in Geriatrics, a series whose editor-in-chief is Prof. The idea of writing this book came primarily to help junior doctors entering their studies and PM&R residents learn the basic concepts of rehabilitation of older adults.

Contributors

Antonio Frizziero, MD, PhD Department of Physical Medicine and Rehabilitation, University of Padua, Padua, Italy. Stefano Masiero Department of Neuroscience, Physical Medicine and Rehabilitation Unit, University of Padua, Padua, Italy.

Physical Activity and Rehabilitation in Elderly

Aging Demographics
Functional Chang es in Elderly
Physical Activity vs. Exercise
Measuring Physical Activity
The Importance of Physical Activity in the Prevention of Chronic Disease
Level of Regular Physical Activity in Older Men and Women
Determinants of Levels of Physical Activity
Benefits of Increasing Physical Activity During Rehabilitation
Concluding Remarks

More objective measures of physical activity include doubly labeled water (considered by many to be the gold standard for measuring energy expenditure over time), metabolic chambers (expensive facilities available only in very few specialized research centers), and accelerometers (devices). that measures acceleration and estimates the total amount of activity). In most, if not all, circumstances the rehabilitation process includes an increase in the daily level of physical activity.

Table 1.1 At 86 years, Japan’s life expectancy is the longest in the world followed by the 13 countries listed in the table with a life expec-tancy of 85 years

Aging Brain and Neurological Changes

Introduction
The Aging Brain: Structural Changes in Normal Aging .1 Basic Anatomy

Basic Physiology
Synaptic Plasticity
Structural Changes
Neuroplasticity

The Aging Brain: Functional Changes .1 Cognitive Decline

Dementia Is Not Part of the Normal Aging

Conclusions

Preserve Brain Health!

There is a growing body of evidence regarding the benefit of exercise in terms of neuroplasticity and the ability of the brain to repair itself. Alzheimer's disease (AD) is considered a disease and not part of normal aging.

Fig. 2.1 Anatomic parts of the neuron and their function

Age-Related Changes in Body

Composition and Energy Metabolism

Introduction
Body Composition and Aging
Changes in Resting Energy Rate
Maximal Aerobic Capacity and Metabolic Equivalent in Aging
Approaches to Rehabilitation for Elderly Patients

RMR gradually decreases with aging, mainly due to changes in body composition (and especially reduction in fat-free mass), but also due to changes in tissue energy metabolism [14]. Age-related changes in body composition and energy metabolism should be considered when planning rehabilitation programs for the elderly.

Fig. 3.1 Age-related changes in body composition and energy metabolism

Sarcopenia and Aging

Aging
Sarcopenia: Definition, Etiology, and Staging
The Pathophysiology of Sarcopenia
Sarcopenia Assessment

Muscle Mass
Muscle Strength

Sarcopenia: Epidemiology and Outcomes
Sarcopenia and Frailty

Sarcopenia has since been defined as the loss of skeletal muscle mass and strength that occurs with advanced age [3]. As previously described, sarcopenia determines functional and phenotypic modifications leading to loss of muscle mass and strength.

Table 4.1 Summary of sarcopenia definitions and diagnostic criteria

Physical Exercise and Aging

Introduction
Physical Exercise Is Multifaceted
PE Frequency
PE Duration
PE Exercises
Number of Repetitions and Sets and Derived Variables The number of repetition is linked mainly to the load and the aim of exercise. Higher
Intensity

Many studies in recent years, from the seminal paper of Frontera et al. Both endurance training and resistance training are fundamental to maintaining and improving the elderly's quality of life.

Table 5.1 Effects of aerobic and resistance exercise on different variables Aerobic/

Safe Antiaging Full-Body In-Bed Gym and FES for Lazy Persons: Home In-Bed

Introduction
Suggested Exercises
Conclusions
Antiaging Total-Body In-Bed Gym

Safe Full Body Anti-Aging Gym in Bed and FES for Lazy People: At Home in Bed. When full-body bed exercise is not indicated or people are reluctant to do it, functional electrical stimulation may be an alternative.

Fig. 6.1 (a, b) Flexion and extension of the ankles

Motivation and Rehabilitation in Older Patients

As a positive consequence, rehabilitation interventions can be adapted immediately according to the mental and physical state of the patient. After more than a decade of clinical practice in geriatric rehabilitation, our overall experience is that gaining knowledge of the patient's preferences before the critical health event and the patient's personality (eg, through family contacts) is helpful in determining tailored intervention program. We conclude that exploring the construct of motivation is essential in working with older adults and should therefore be systematically considered in geriatric rehabilitation units, as it appears as a key mediator of the success or failure of a rehabilitation program.

Bed Rest Syndrome

Scarponi and M. Zampolini

Introduction

Effects of Bed Rest

Prevention of Bed Rest Syndrome

Intensive care unit (ICU) patients could be the paradigm of bed rest management via mobilization. Probably the most effective strategy to mitigate the impact of bed rest on the development of sarcopenia is adequate nutrition and/or the use of resistance exercises [13]. Ikezoe T et al (2012) Effects of age and inactivity due to prolonged bed rest on trunk muscle atrophy.

Table 8.1 summarizes the fundamental aspects for the principal body systems.

Exercise for Frail Older Adults

Introduction
Balance and Gait in Frail Older People
Frailty Measurement
Physiotherapy in Frail Older Adult
Strength Training and Aerobic Exercise
Balance
Promotion to Participation

Social or communication factors can also limit participation (e.g. the need to dress in a certain way or difficulties with verbal expression). The most important patient characteristics that greatly influence the caregiver's life are the risk of falls, depressive symptoms, and behavioral problems. The role of the caregiver is very important in promoting and maintaining a physically active lifestyle in older adults.

Fig. 9.1 This figure shows the imbalance between the gravity center and the supporting base in older adults

Physical Therapy Modalities for Older Persons

Introduction
Thermotherapy

Heat
Cold

Laser Therapy

Low-Level Laser Therapy (LLLT)
High Dose: High Power Laser Therapy

Therapeutic Ultrasound
Extracorporeal Shockwave Therapy (ESWT)
Whole Body Vibration (WBV)
Magnetotherapy
Electrotherapy

Iontophoresis
Neuromuscular Electrostimulation (NMES)
Transcutaneous Electrical Nerve Stimulation (TENS)
Interferential Current (IC)

NIR delivers energy to the cells causing vasodilation, an increase in skin blood flow and local heating. The effectiveness of IFC in the management of acute and chronic pain is explained with activation of the. Perret D, Rim J, Adrian C (2006) A geriatrician's guide to the use of physical modalities in the treatment of pain and dysfunction.

Table 10.1 Tissue absorption according to different PM treatment (Adapted from www.electro- www.electro-therapy.org/modality/ultrasound-therapy)

Functional Electrical Stimulation of Skeletal Muscles in Aging

Structural and Molecular Markers of Muscle Weakness and of Recovery Induced by h-b FES

The left and right thigh electrode pairs were connected to the two channels of the stimulator. This allowed independent activation of the left and right thigh muscles, which were alternately stimulated. The result was an increase in muscle strength, associated with an increase in fast-twitch fibers, which are the first to respond to ES and are related to skeletal muscle power [14, 15].

FES for Partially Denervated Muscle and FES Protocols for Training of Denervated–Degenerated Skeletal

Stimulation Devices and Electrodes
Training Protocol

Kern H, Boncompagni S, Rossini K, Mayr W et al (2004) Long-term denervation in humans causes degeneration of both contractile and excitation-contraction coupling apparatuses reversible by functional electrical stimulation (FES). Kern H, Hofer C, Moedlin M et al (2002) Denervated muscle in humans: limitations and problems of currently used functional electrical stimulation training protocols. Boncompagni S, Kern H, Rossini K et al (2007) Structural differentiation of skeletal muscle fibers in the absence of innervation in humans.

Table 11.1 FES training of relatively short-term denervated (1–2 years) human muscles (Adapted from Kern et al

The Contribution of Occupational Therapy: A Profession in Support

Background
Introduction
The Salutogenic Model and Occupational Therapy
The Role of Occupational Therapy in Elderly Care
The Scope of Occupational Therapy Assessment and Intervention

Occupational therapists emphasize the expectations on the part of the family, society and the elderly themselves, about what their reality in aging is. In this way, the elderly client can engage in and maintain their roles and responsibilities, which in OT is referred to as their "occupational performance". The professional skills of OT also include the ability to measure results in terms of satisfaction in their participation. Yann Bertholom is an OT at the rehabilitation center of "Il Paese di Oz - ANFFAS" in Trento, Italy, and is the president of the Italian Scientific Society of Occupational Therapy (SITO).

The Hand and the Occupational Therapy

Romagnoli and S. Tocco

Hand Therapy

This client-centered approach is based on a graded meaningful activity that will address functional problems of the upper limb, whether it is a limitation of joint movement (Fig. 13.1a, b); reduced strength (Figure 13.2); mismatch. The patient later moves on to more complex activities, such as assembling a simple piece of furniture (Figure 13.3) to baking a cake, finally simulating real work or leisure activities that are important to the patient. In some cases, when it comes to a temporary (so-called sports injury) (Fig. 13.6a, b) or permanent impairment, for example in the case of degenerative diseases or amputees, the occupational therapist can also decide on an adaptive solution.

Fig. 13.1 Wrist exercises for flexion-extension (a) and prono-supination (b) with a ball

Frail Elderly Persons and Smart Home Technologies

Johnson and P. Ianes

Introduction
Clinical Cases

Her two adult daughters live in the same town not far from her. At home, she often wakes up in the middle of the night to go to the bathroom. Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among community-dwelling older persons.

Fig. 14.1 AUSILIA: Assisted unit for simulating independent living activities, collaboration between the University of Trento and Azienda Provinciale per i Servizi Sanitari Provincia Autonoma di Trento, Italy, www.ausilia.tn.it

Thermal Rehabilitation of Geriatric Patients

Crotti and U. Solimene

Introduction
Crenotherapy
Hydrotherapy

Physiological Actions
Treatment

The thermal waters can also be used to treat chronic irritations and inflammations of the upper and lower respiratory tract. Balneotherapy uses water and the mineral properties of the salts dissolved in it to treat certain medical conditions, such as osteoarticular diseases. However, in some cases, this difference is not so sharp (eg, in osteoarthritis, a functional recovery and a reduced progression of the disease can be achieved), due to the fact that hydrotherapy also works to stimulate the immune system; .

Orthoses in Older Patients

Introduction
Upper Limb Orthoses
Shoes and Shoe Modifications
Lower Limb Orthoses (LLO)
Spinal Orthoses (SO)
Physical Therapy in Patients Who Use Orthotic Devices The orthoses should be evaluated by the attending practitioner, orthotist, and phys-

Leather is one of the best materials to avoid this inconvenience, as it is durable and breathable, adapts to the shape of the patient's foot and can be easily reshaped. FO can also correct midfoot hyperpronation by acting on the longitudinal axis of the foot. Patients using orthotics are instructed in lower extremity desensitization activities such as friction massage and tapping to reduce hypersensitivity and become more tolerant of the pressure of the orthosis.

Fig. 16.1 Upper limb rigid (right) and semirigid static orthoses

Taking Charge of the Lower Limb

Amputee Patient: Evaluation Measures, Scales, and the Clinical Approach

Taking Charge of the Patient
Clinical Evaluation
Pre-prosthetic Training
Prosthetic Rehabilitation .1 The Approach to the Patient

Development of Balance and Coordination with the Prosthesis

Return to Walking After Amputation .1 Exercises Preparatory to Walking

The Rehabilitation of the Gait Pattern
The Use of a Walking Aid
Use of Stairs

Functional Evaluation

The goal of the pre-prosthetic phase is to prepare the remaining limb and the whole body to support movement abilities in the prosthetic phase. Prosthetic rehabilitation represents a key moment in the recovery of patients after amputation of the lower limbs. Further development of the load on the prosthesis on the bed - Development of the equilibrium state on the prosthesis itself.

Prosthetic Treatment in Elderly Population

The choice of a foot with a solid ankle cushion (SACH), specifically designed for geriatric amputees, can further support the reduction of the weight of the prosthesis, thanks to its low weight (350 g) compared to commonly used prosthetic feet (around 550 g) [11]. . In this case, the patient perceives the weight of the prosthesis as heavier, even if it is objectively light. The system stabilizes the volume of the remaining limb, and the high adhesion facilitates control over the prosthesis.

Gerontechnology, Domotics, and Robotics

Introduction
Gerontechnology
Domotics
Rehabilitation Robotics

One of the current and future challenges of managing health and chronic diseases is the active participation of citizens and patients themselves in the process of health care management. One of the driving factors behind the current electronic revolution is the vision that computing will permeate our environment. Various hand motor impairments can be viewed as consequences of either motor execution or motor planning/learning.

Fig. 19.1 A conceptual schema of the system and the interaction among all the subsystems included in the platfv

Telemedicine and Physical Medicine

Rumeau

Relevance
Definitions

Health: For WHA “…eHealth is the cost-effective and secure use of informa- tion and communications technologies in support of health and health-related fields,

Legal and Ethical Issues
Telemedicine Acts in Geriatric Rehabilitation
The Process of a Telemedicine Act
Case 1: Physical Medicine in Palliative Care
Case 2: Electric Wheelchair Prescription for a Patient Living at Home with a Cognitive and Motor
Case 3: Pressure Sore Healing and Beyond
Implementation

We do not examine the patient, the diagnosis or therapeutic decisions are discussed in the medical documentation. The applicant receives the result of the TMR and adds it to the patient's file. The patient is referred by the occupational therapist (OT) of the dementia rehabilitation team at home.

Table 20.1Showing the different types of telemedicine relevant to geriatric rehabilitation Applicant’s sideConsultant’s sideActivityExampleName of act Patient ± medical ± paramedical staffMedical staff ± paramedical staffExaminationStroke diagnosisConsulta

The Role of Nutrition in Rehabilitation of Older Adults

Introduction

Sarcopenia, Frailty, and Cachexia .1 Sarcopenia

Nutrition and Fluid Demands .1 Nutritional Demands

Fluid Demands

Assessment of Malnutrition and Fluid Intake .1 Overall

Mini Nutritional Assessment (MNA R ) and Nutritional Risk Screening (NRS 2002)

Interventions

Normal Nutritional Intake
Postdischarge Management of Nutritional Intake

Goisser S, Schrader E, Singler K et al (2015) Malnutrition according to the Mini Nutritional Assessment (MNA) is associated with severe functional impairment in geriatric patients before and up to 6 months after hip fracture. Bartali B, Frongillo EA, Bandinelli S et al (2006) Low nutrient intake is a major component of frailty in older persons. Goisser S, Schrader E, Singler K et al (2015) Low postoperative intake is associated with poorer functional outcome in geriatric patients up to 6 months after hip fracture.

Table 21.3 Checklist to diagnose potential insufficient food or fluid intake and malnutrition [28]

Elderly Rehabilitation: A Clinical and Drug-Related Approach

Introduction

Department of Neuroscience, Rehabilitation Unit, University of Padua, Padua, Italy e-mail: [email protected]. Department of Medicine, Division of Geriatrics, University of Padua, Padua, Italy e-mail: [email protected].

Features of the Elderly Admitted to Rehabilitation Wards