CONTRIBUTORS .T,MS PT.PhD Cory Christiar Andre A Cu ione,PT,PhD University of Pittsburgh Physical Therapy Program ty Directo Physical Therapy Department Department of Physical Medicine Health Services Research Pittsburgh,Pennsylvania Sch Reh Development Service Dale Avers,PT,DPT,PhD Director Post Professional dpt Greg W.Hartley,PT,DPT,GCS Program CharD.Cicone,PT,PhD, Director of Rehabilitation Dep f Physical Therapy APTA Hospita College of Health Professions Department of Physical Therapy SUNY Upstate Medical University Ithaca College Director Syracuse,New York Ithaca.New York Katherine Beissner,PT,PhD Rhea Cohn PT DPT Hospitals Professor Health Care Consultant Miami, Department of Physical Therapy Washington,DC metro area Adiunct Assistant Professor Ithaca College Ithaca,New E.Edelstein,PT,MA,FISPO, ysical Therapy Diane Borello-France,PT,PhD Spe cial Lecturer Associate professor Program in Physical Therapy Columbia University New York,New York Associate Cathy S.Elrod.PT.PhD ical Thera Associate Professor Richard Briggs,MA,PT Department of Physical Therapy Grand Rapids,Michigan M spice and Catherine E.Lang PT,PhD Chico,California Christine E.Fordyce,PT,DPT Program in Physical Therapy Rehab Director Program in Occupational Marybeth Brown,PT,PhD,FAPTA Therapy ical Ther f Neurology Claire Gold,MSPT,MBA,COS-C, Saint Louis.Missouri University of Missour CPHQ Columbia,Missouri Home Health Age lhdniniuaor Tanya LaPier,PT,PhD,CCS Sabrina Camilo,PT,MSPT,GCS Private Practitione on University Sao Paulo.Brazil
Alia A. Alghwiri, PT, MS PhD candidate University of Pittsburgh Physical Therapy Department Pittsburgh, Pennsylvania Dale Avers, PT, DPT, PhD Associate Professor Director, Post Professional DPT Program Department of Physical Therapy Education College of Health Professions SUNY Upstate Medical University Syracuse, New York Katherine Beissner, PT, PhD Professor Department of Physical Therapy Ithaca College Ithaca, New York Diane Borello-France, PT, PhD Associate Professor Department of Physical Therapy Rangos School of Health Sciences Duquesne University Pittsburgh, Pennsylvania Richard Briggs, MA, PT Hospice Physical Therapist Enloe Medical Center, Hospice and HomeCare Chico, California Marybeth Brown, PT, PhD, FAPTA Professor Physical Therapy Program, Biomedical Sciences University of Missouri Columbia, Missouri Sabrina Camilo, PT, MSPT, GCS Private Practitioner São Paulo, Brazil C O N T R I B U T O R S Cory Christiansen, PT, PhD Assistant Professor Physical Therapy Program Department of Physical Medicine & Rehabilitation School of Medicine University of Colorado Aurora, Colorado Charles D. Ciccone, PT, PhD, FAPTA Professor Department of Physical Therapy Ithaca College Ithaca, New York Rhea Cohn, PT, DPT Health Care Consultant Washington, DC metro area Joan E. Edelstein, PT, MA, FISPO, CPed Special Lecturer Program in Physical Therapy Columbia University New York, New York Cathy S. Elrod, PT, PhD Associate Professor Department of Physical Therapy Marymount University Arlington, Virginia Christine E. Fordyce, PT, DPT Rehab Director Gentiva Health Services Auburn, New York Claire Gold, MSPT, MBA, COS-C, CPHQ Home Health Agency Administrator Gentiva® Home Health San Diego, California Andrew A. Guccione, PT, PhD, DPT, FAPTA Deputy Director Health Services Research & Development Service Department of Veterans Affairs Washington, DC Greg W. Hartley, PT, DPT, GCS Director of Rehabilitation & Assistant Hospital Administrator, Geriatric Residency Program Director St. Catherine’s Rehabilitation Hospitals and Villa Maria Nursing Centers Miami, Florida; Adjunct Assistant Professor University of Miami Miller School of Medicine Department of Physical Therapy Coral Gables, Florida Barbara J. Hoogenboom, PT, EdD, SCS, ATC Associate Professor Program in Physical Therapy Grand Valley State University Grand Rapids, Michigan Catherine E. Lang PT, PhD Assistant Professor Program in Physical Therapy Program in Occupational Therapy Department of Neurology Washington University Saint Louis, Missouri Tanya LaPier, PT, PhD, CCS Professor Eastern Washington University Cheney, Washington vii
vi CONTRIBUTORS nOIAnTMH,wD ycal Therapy Dep ant Profe Salt lake city.utah Rehabilitation Scien and Rehabilitation Sciences- Carleen Lindsey,PT,MScAH,GCs argen Boston,Massachusetts College Park,Maryland Backs Balance Bristol.Connecticut John Rabbia,PT,DPT,MS,GCS, Karin Westlen-Boyer,DPT,MPH Toby M.L 匹PhD,FAPTA CWS Intermountain Health Fitness ation of Hospital Pediatrics City,U Director of Training Barbara Resnick,PhD,CRNP, Mary Ann Wharton,PT,MS Center for Child and Human AAN,FAANP Associate Professor and Prof Curriculum Co igo.DC orkin Gershowitz Chair in ie I Therapy University of Maryland School of Michelle M.Lusardi,PT,DPT,PhD Adjunct Associate Professor Physical Therapist Assistant College of Education and Health Julie D.Ries,PT,PhD Associate Professor College of Allegheny County,Boyce Campus Professions Program in Physical Therapy Monroeville,Pennsylvania Marymount University Arlington,Virginia .AT PT,DPT,PhD Robin L.Marcus,PT,PhD,OCS Kathleen Toscano.MHS.PT.PCS Associate professor Assistant Professor Program in Physical Therapy and Olne rgh Carol A.Miller,PT,PhD,GCS Patrick J.VanBeveren,PT,DPT, Ann K.Williams,PT,PhD MA,O e Program in Physica Health erapy Services ege of H Professions and North Ge orgia college state on Center The University of Montana University Syracuse,New York Missoula.Montana Dahlonega,Georgia ART ment and Profe Payment Advocac School of Physical Therapy Professor of Physical Therapy American Physical Th erapy dr(A Martha Walker.PT.DPT Karen Mueller,PT,PhD Clinical Instructor Professor Physical Therapy and Rehabilitation of marvland Department of Physical Therapy Baltimore.Maryland Northern Arizona University Flagstaff.Arizona
viii CONTRIBUTORS Paul LaStayo, PT, PhD, CHT Associate Professor Department of Physical Therapy University of Utah Salt Lake City, Utah Carleen Lindsey, PT, MScAH, GCS Physical Therapist Bones, Backs & Balance Bristol, Connecticut Toby M. Long, PT, PhD, FAPTA Associate Professor Department of Pediatrics Director of Training Center for Child and Human Development Georgetown University Washington, DC Michelle M. Lusardi, PT, DPT, PhD Professor Emerita Department of Physical Therapy and Human Movement Science College of Education and Health Professions Sacred Heart University Fairfield, Connecticut Robin L. Marcus, PT, PhD, OCS Assistant Professor Department of Physical Therapy University of Utah Salt Lake City, Utah Carol A. Miller, PT, PhD, GCS Professor Doctorate Program in Physical Therapy North Georgia College & State University Dahlonega, Georgia Justin Moore, PT, DPT Vice President, Government and Payment Advocacy American Physical Therapy Association (APTA) Alexandria, Virginia Karen Mueller, PT, PhD Professor College of Health and Human Services Department of Physical Therapy Northern Arizona University Flagstaff, Arizona Jean Oulund Peteet, PT, MPH, PhD Clinical Assistant Professor Department of Physical Therapy and Athletic Training Boston University College of Health and Rehabilitation Sciences– Sargent Boston, Massachusetts John Rabbia, PT, DPT, MS, GCS, CWS Visiting Nurse Association of Central New York Barbara Resnick, PhD, CRNP, FAAN, FAANP Professor Sonya Ziporkin Gershowitz Chair in Gerontology University of Maryland School of Nursing College Park, Maryland Julie D. Ries, PT, PhD Associate Professor Program in Physical Therapy Marymount University Arlington, Virginia Kathleen Toscano, MHS, PT, PCS Pediatric Physical Therapist Montgomery County Infant and Toddler Program Olney, Maryland Patrick J. VanBeveren, PT, DPT, MA, OCS, GCS, CSCS Director of Physical Therapy Services St. Camillus Health and Rehabilitation Center Syracuse, New York Michael Voight, PT, SCS, OCS, ATC, CSCS Professor School of Physical Therapy Belmont University Nashville, Tennessee Martha Walker, PT, DPT Clinical Instructor Physical Therapy and Rehabilitation Science University of Maryland Baltimore, Maryland Chris L. Wells, PhD, PT, CCS, ATC Assistant Professor–Part Time, Department of Physical Therapy & Rehabilitation Science University of Maryland School of Medicine College Park, Maryland Karin Westlen-Boyer, DPT, MPH Intermountain Health & Fitness Institute at LDS Hospital Salt Lake City, Utah Mary Ann Wharton, PT, MS Associate Professor and Curriculum Coordinator Department of Physical Therapy Saint Francis University Loretto, Pennsylvania; Adjunct Associate Professor Physical Therapist Assistant Program Community College of Allegheny County, Boyce Campus Monroeville, Pennsylvania Susan L. Whitney, PT, DPT, PhD, NCS, ATC, FAPTA Associate Professor Program in Physical Therapy and Otolaryngology University of Pittsburgh Pittsburgh, Pennsylvania Ann K. Williams, PT, PhD Adjunct Professor College of Health Professions and Biomedical Sciences The University of Montana Missoula, Montana Rita A. Wong, EdD, PT Physical Therapy Department Chairperson Professor of Physical Therapy Marymount University Arlington, Virginia
PREFACE e of this textbook has not changed since the first provide nuance to examination findings or modulate the edition 18 years ago.The editors'intent for undertaking outcomes of intervention.Part IlI provides the scientific andaicnrpPrableeate em ematic o tools to integrate health and functional status informa comes.In the tion with examination data,formulate an accurate diag. next section,the chapters cover some health conditions nosis,and that care settings adults but represent points of of phy informed advocate for older adults.What has changed Thehercapis in rppic ication of rha the original pubication for ened t in Part Finally, section g for the exar ce that can pel or obstruct the ofession's abil to be certified as geriatric clinical specialist as well as ityothe efradph health of the nation:reimbursement and advocacy. mos t gratifyin Geriatri What started as an attempt to update a w nd t ceive th of c ertified the cha atric physical therapyand the area all attest to the fact that physical therapist practice 20 vears The goals which we first described in 1993 and oriented toward ol dults is no onger a ne velty,con epeated the secon edition remain:to denne the sc sis population.On the contrar.griatris physical physical therapist practice in general;and to promote the ion in practice and cuing adoption of evidence-based principles of clinical care e physical therapists to exer hat advanc geriatric physical therapist practice.It is oug from primary prevention to end-of-life care. that we have contributed to this phenomenon. The new edition of Geriatric Physical Therapy has organize cphys Andrew A.Guccione,ThD.DT vers,PT,DPT.PhD ology of disease and disability.Next,our contributors
P R E F A C E Although the content of previous editions has been substantially revised, it is remarkable that the overall purpose of this textbook has not changed since the first edition 18 years ago. The editors’ intent for undertaking the third edition of Geriatric Physical Therapy is to assist the development of reflective physical therapists who can use the available scientific evidence and objective tools to integrate health and functional status information with examination data, formulate an accurate diagnosis, and design effective treatment plans that can be implemented at all levels of care and across all settings to produce optimal outcomes. We further believe that this practitioner can serve both patients and society as an informed advocate for older adults. What has changed throughout the years is that the original publication was intended only as a textbook for entry-level students. In the intervening years we have expanded the vision of this text to include individuals studying for the examination to be certified as geriatric clinical specialist as well as practicing clinicians. The last group is perhaps the most surprising and the most gratifying. Geriatric physical therapy has come into its own in the last two decades. The emergence of the specialty, the growth of certified specialists, and the number of practicing clinicians in the area all attest to the fact that physical therapist practice oriented toward older adults is no longer a novelty, confined to a few physical therapists whose good hearts and intentions led them to concerns about America’s aging population. On the contrary, geriatric physical therapy is bursting with innovation in practice and cutting edge research that will enable physical therapists to exercise the full range of their education, experience, and expertise across the full continuum of the health care system from primary prevention to end-of-life care. The new edition of Geriatric Physical Therapy has been arranged in six parts. In Part I, we organize the foundational sciences of geriatric physical therapy, which range from basic physiology of aging to clinical epidemiology of disease and disability. Next, our contributors explore the personal and environmental contexts of examination and intervention, particularly as these factors provide nuance to examination findings or modulate the outcomes of intervention. Part III provides the scientific basis for evaluation and diagnosis of prototypical health conditions and patient problems that are emblematic of geriatric physical therapy as well as the design of plans of care for effective treatment and optimal outcomes. In the next section, the chapters cover some health conditions that are not common to the entire population of older adults but represent points of substantial health impact requiring specific expertise to be addressed effectively. The practice of physical therapists in our application of specific education, experience, and expertise in the health problems of older adults across spectrum of healthcare delivery is presented in Part V. Finally, the last section tackles the societal issues affecting physical therapist practice that can propel or obstruct the profession’s ability to address the health of older adults and optimize the health of the nation: reimbursement and advocacy. What started as an attempt to update a well-received resource was infused with a new vision and turned into a substantial revision to reflect the changes in geriatric physical therapy and the profession itself in the last 20 years. The goals which we first described in 1993 and repeated in the second edition remain: to define the scientific basis of physical therapy; to describe how physical therapist practice with older adults differs from physical therapist practice in general; and to promote the adoption of evidence-based principles of clinical care that advance geriatric physical therapist practice. It is clear now that the best scientific thoughts are being translated into clinical actions. We are pleased to think that we have contributed to this phenomenon. Andrew A. Guccione, PT, PhD, DPT, FAPTA Rita A. Wong, EdD, PT Dale Avers, PT, DPT, PhD ix
ACKNOWLEDGMENTS This is truly a textbook that reunites an old team with to find each other then;we know now we were blessed some long-t rm colleagues, ces a sub with an exciting intellectual partnership and profes. stantial nu of new ted to christie Hart for encouragin to undertake a third edition.While the response to the of geriatric physical therapist practice had of collab he team at orative practice in g geriatric physical therapy.As it hap Ultimately,we recognize that whatever we might out geriatric physical therapy is the summation is,a prot the tists,clinicians Du EEA品 aryb Andrew A.Guccione,T DT uted he expert the
x CHAPTER 12 Chapter Title Goes Here x A C K N O W L E D G M E N T S This is truly a textbook that reunites an old team with some long-term colleagues, but also introduces a substantial number of new contributors that allows us to appreciate the vitality of geriatric physical therapy and the profession itself. Their vibrant contributions, joined with cutting-edge expertise, have expanded the horizons of this text and enriched us as professionals committed to practice with older adults. The editorial team exemplifies the essence of collaborative practice in geriatric physical therapy. As it happens, we had worked together before on what was, and still is, a professional career highlight for all of us: the development of the geriatric specialty examination. During that venture, our special contributor and friend, Marybeth Brown, was a full member of the team. For this venture, our “silent” partner in developing the examination, Dale Avers, switched places with Marybeth, taking the on-stage role while Marybeth contributed her singular expertise from the wings. It seemed fortuitous to find each other then; we know now we were blessed with an exciting intellectual partnership and professional friendship. We are indebted to Christie Hart for encouraging us to undertake a third edition. While the response to the previous editions was very positive, we knew the scope of geriatric physical therapist practice had evolved substantially necessitating a global revision. The team at Mosby/Elsevier has supported us each step of the way. Ultimately, we recognize that whatever we might know about geriatric physical therapy is the summation of countless interactions with scientists, clinicians, educators and students, but most of all our patients. It is in recognition of their primary role in teaching us as well as our families in supporting us that this work is dedicated. Andrew A. Guccione, PT, PhD, DPT, FAPTA Rita A. Wong, EdD, PT Dale Avers, PT, DPT, PhD
PA RT Foundations
1 P A R T Foundations I