Gold-standard Strength and ROM Analysis for Frailty Reversal
Even in older adults by monitoring carefully muscular strength and ROM, specialised exercise programs can be prescribed that reverse frailty and that engender fitness, older adults will remain physically independent and non-frail throughout a longer period of their life. Exercise is the medicine that can prevent frailty as well as reverse it.
Guided joint motion, can be great pain lotion
1.
Dynamometer Testing
The physical changes due to aging or neurological conditions can be subtle and occur over a long period of time. Physical activity improves quality of life and has been promoted“to not only add years to your life but to add life to your years” by the American Heart Association (2015, p. 1). Despite the evidence of the benefits of physical activity, the decline in physical activity with age may be the most consistent finding in physical activity epidemiology.
The electronic technology we use can help accurately detect changes in strength, movement and balance and monitor over time. We also use the power of our normative data to benchmark patient results to enhance shared decision-making of their care.
As a result of the strength and ROM assessments is a powerful motivational tool to help patients live their best lives with specific programs while demonstrating the effectiveness of tailored treatment plan to patients, their families, care team and regulators.
We can interpret results by benchmarking patients against age and gender, built from 20 million + musculoskeletal data points.
Other Associated Benefits Apart from Accuracy and Objectivity:
Improved compliance: 99% compliance rates with patients and exercise programs as they are aware the review consult will include hands on retesting and comparing to last consult results.
Improved communication and understanding: Incorporating VALD has made [patient education] a very easy process as education is the key to a successful rehabilitation.
Improved outcomes: Patient understanding, motivation, and compliance all can dramatically increase, leading to improved patient outcomes.
2.
Data-informed Decision Making
With novel objective measurement tools, intuitive data collection and actionable insights, VALD technology helps us clinicians measure patients' progress and make more accurate, data-informed treatment decisions.
The list of joint variables we can test include :
(Ankle and Toe)
Strength + ROM for Inversion, eversion, dorsiflexion, plantar flexion,
(Elbow)
Strength + ROM for Flexion, extension
(Hand and Wrist)
Strength + ROM for Supination, Pronation, Extension, Flexion, Ulna Deviation , Radial Deviation
(Hip)
Strength + ROM for Extension, flexion external/internal rotation, abduction, adduction.
(Knee and Neck)
Strength + ROM for Extension, flexion, (Neck lateral flexion, rotation)
(Scapula and Shoulder)
Strength + ROM for protraction, retraction, scaption, (shoulder external/internal rotation, extension, flexion, abduction. adduction).
(Trunk)
Strength + ROM for extension, flexion, lateral flexion, rotation.
3.
Examples of Use
Joint Motion to Help Maintain Physical Activity as Frailty is Bidirectional
Two common assessment tools used to determine frailty status include the Clinical Frailty Scale [1] and the Cardiovascular Health Study-Frailty Phenotype [2]. Exercise interventions aimed at ultimately reversing the frailty phenotype have a positive functional impact on frail older adults, joint motion via physical activity can assist with pain and functional fitness [3; 4].
Pre-frail vs Frail
Pre-frail individuals are at a critical time point, where the training goal is to reverse the frailty phenotype. Thus, the proportion of exercise directed to strength and balance training in pre-frail is higher relative to the frail group to promote the return to robust health as well as train elements of function that would reduce the risk for falls. When pre-frail individuals do not take preventative exercise measures to regain strength, they may transgress to become frailer and begin a downward spiral of accumulating morbidity.
Solution
By monitoring strength and ROM, tailored exercise programs can be assigned to individuals that are critical to health and wellness of frail and pre-frail older adults. For example similar to balance exercise, flexibility training can be integrated with other modalities of exercise or it can be performed separately as part of the cool-down. Research has demonstrated increases in cadence (steps/min), walking speed (m/s), stride length, and passive hip extension range of motion after having frail older adults complete a 10-week hip flexor stretching routine [5].
Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D.B., McDowell, I., and Mitnitski, A. 2005. A global clinical measure of fitness and frailty in elderly people. CMAJ. 173(5): 489–495. doi:10.1503/cmaj.050051. PMID:16129869.
Fried, L.P., Tangen, C.M., Walston, J., Newman, A.B., Hirsch, C., Gottdiener, J.,et al. 2001. Frailty in older adults: evidence for a phenotype. J. Gerentol. A. Biol. Med. Sci. 56A(3): M146–M156. PMID:11253156.
Roland, K.P., Theou, O., Jakobi, J.M., Swan, L., and Jones, G.R. 2014. How do community and occupational therapists classify frailty? A pilot study. J. Frailty Aging, 3(4): 247–250. PMID:27048865.
Theou, O., Stathokostas, L., Roland, K.P., Jakobi, J.M., Patterson, C., Vandervoort, A.A., et al. 2011. The effectiveness of exercise interventions for the management of frailty: a systematic review. J. Ageing Res.: 569194. doi:10.4061/2011/569194. PMID:21584244.
Watt, J.R., Jackson, K., Franz, J.R., Dicharry, J., Evans, J., and Kerrigan, D.C. 2011. Effect of a supervised hip flexor stretching program on gait in frail elderly patients. PM&R. 3(4): 330–335. doi:10.1016/j.pmrj.2011.01.006. PMID:21497319.
ROM Assessment Example
Multiple studies have shown that upward of 30% of people older than 65 years may suffer from one of several different shoulder conditions including rotator cuff pathology or arthritis.[1–3] These conditions often lead to reduced shoulder function [4]. However, even when individuals in this population experience notable shoulder symptoms, fewer than 50% seek treatment for them. [1]. Yet it has been clinically observed that patients who complained of lower extremity orthopaedic conditions also have upper extremity dysfunction about which little complaint was made. It has also been observed that fewer shoulder complaints are registered by older and less mobile individuals.
Given the fact that the elderly patients are often unknowingly frail, it has been suggested that their musculoskeletal concerns are addressed with a focus that is sensitive to frailty as well as to a more traditional problem- or extremity-focused approach [5-6]. Due to the numerous challenges of a busy clinic (over booking, short visit time, decreased time for documentation/charting, decreased staffing and decreased patient function due to dementia, and decreased physical strength and range of motion), it is not always possible to administer and score formal shoulder function assessments for example and to assess for frailty, that the Fried frailty phenotype assessment offers. An effective frailty screening option of an orthopedic or exercise physiology clinic might better be able to focus on assessing ROMs and to inquire about the use of an assistive device an refer this back to the GP for follow-up [7].
References
Chard MD, Hazleman R, Hazleman BL, King RH, ReissBBShoulder disorders in the elderly: a community survey. Arthritis Rheum. 1991;34(6):766-769.
Chakravarty KK, Webley M. Disorders of the shoulder: an often unrecognised cause of disability in elderly people. BMJ. 1990; 300(6728):848-849.
Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotatorcuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8(4):296-299.
Sallay PI, Reed L. The measurement of normative American Shoulder and Elbow Surgeons scores. J Shoulder Elbow Surg. 2003;12(6):622-627.
Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictorof surgical outcomes in older patients. J Am Coll Surg. 2010; 210(6):901-908.
Penrod JD, Litke A, Hawkes WG, et al. Heterogeneity in hipfracture patients: age, functional status, and comorbidity. J Am Geriatr Soc. 2007;55(3):407-413.
Kinnucan, E., Molcjan, M. T., Wright, D. M., & Switzer, J. A. (2018). A Prospective Look at the Link Between Frailty and Shoulder Function in Asymptomatic Elderly Individuals. Geriatr Orthop Surg Rehabil, 9, 2151459318777583.