Electronic Strength & ROM Analysis for Frailty Prevention
Even in older adults by monitoring carefully muscular strength and ROM, specialised exercise programs can be prescribed that halt frailty and that engender fitness. Exercise is “the medicine” that can prevent accelerated frailty & health burdens.
The strength of outcomes can be only as good as your tools, dynamometry helps increase it.
-
Objective muscle strength (dynamometer) and joint ROM to expose weak links in the kinetic chain & stiffness affecting movement, functional fitness and activities of daily living.
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.
-
Standardised positions & cues; short sets with rests; hand-grip dynamometry; goniometer/functional ROM with dynamometry.
Strength testing using electronic force gauges for all major joints and muscle groups (upper and lower body representative).
Prep: clothing to move in; bring usual aid if use
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.
-
Sarcopenia risk; rehab progression; job/role capacity; pairing with gait deficits.
-
Identifies weak links in muscle and flexibility in particular joint stiffness affecting stair climbing, transfers, balance.
Gives targeted strength & mobility progressions; shows measurable change.
Prevents risk of ligament and muscle tears associated with aging that can affect mobility and functional living.
-
Peak force/hand-grip, side-to-side symmetry, ROM degrees; traffic-light flags vs age/sex references where available.
Plan: “step-ups and downs” or progressions; re-test 6–8 weeks.
Delivery: Clinician PDF in 2–3 business days (priority 24 h); CSV on request.
Electronic logging, graphing and tracking over time (cloud accessible reporting - reports and weaknesses/improvements available in reports for clinical assessment.
-
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].
-
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.[6–8] These conditions often lead to reduced shoulder function [9]. However, even when individuals in this population experience notable shoulder symptoms, fewer than 50% seek treatment for them. [6]. 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 [9-11]. 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 orthopaedic or exercise physiology clinic might better be able to focus on assessing ROMs and to inquire about the use of an assistive device and refer this back to the GP for follow-up [12]
-
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. Gerontol. 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:21497319Description text goes here.
Chard MD, Hazleman R, Hazleman BL, King RH, Reiss BB. Shoulder 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 rotator cuff 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 predictor of surgical outcomes in older patients. J Am Coll Surg. 2010; 210(6):901-908.
Penrod JD, Litke A, Hawkes WG, et al. Heterogeneity in hip fracture 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.