Open lower extremity fractures in the geriatric population

Falls present a large danger to the geriatric population, with one in three individuals over the age of 65 experiencing at least one fall annually. With most falls occurring while walking, the relationship between inclined walking and fall risk has not been fully explored. In this study, 16 healthy young participants (age: 26.8 ±5.4 years, height: 175.0±11.0 cm, weight: 68.2 ±19.9 kg) walked on a treadmill with level surface and 10 degrees incline/decline in a virtual environment laboratory. We found that gait parameters and lower extremity joint moments were affected by surface inclination. These observed changes in joint moments and gait parameters may present challenges to the older population especially with musculoskeletal disorders and thereby increase the risk of falls. This study offers new information on the effects of incline and decline surface walking compared to normal flat ground surface walking.

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Normal Swallowing in the Geriatric Population

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd10.1.14 ◽

2001 ◽

Vol 10 (1) ◽

pp. 14-18 ◽

Cited By ~ 2

Author(s):

Gary H. McCullough

Keyword(s):

Geriatric Population ◽

Normal Swallowing

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The Interaction of Pulmonary Physiology and Swallowing: A Juggling Act for the Physician and Speech-Language Pathologist

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd18.1.34 ◽

2009 ◽

Vol 18 (1) ◽

pp. 34-40

Author(s):

Karen J. Dikeman ◽

Marta S. Kazandjian ◽

Elbert Tun ◽

Panina Niyazova ◽

Tien-Tsai Tsai ◽

...

Keyword(s):

Health Care Providers ◽

Medical Condition ◽

Team Approach ◽

Care Providers ◽

Geriatric Population ◽

Pulmonary Physiology ◽

Speech Language Pathologist ◽

Ventilator Dependence ◽

Clinical Case Studies ◽

Single Disease Entity

Abstract Patients who are dependent upon tracheostomy and/or ventilator use present a particular challenge to health-care providers. The interaction of pulmonary physiology and deglutition is complex, as illustrated in the course of patients who are in the weaning process. Speech language pathologists (SLPs) should work closely with their physician colleagues to understand the influence of multiple medical co-morbidities on intervention. In traditional medicine, the clinician's objective is to connect a patient's many symptoms and complaints to a single disease entity. However, in caring for the ventilator dependent geriatric population, a symptom such as dysphagia typically results from the interplay of various, multi-organ symptoms, and conditions. This article strives to demonstrate the “juggling act” that the physician and SLP must balance between the patient's current medical condition, pulmonary dysfunction, and disordered swallowing. Clinical case studies illustrate the benefit of swallowing intervention on quality of life. While the care of patients with tracheostomy and ventilator dependence requires a team approach, with respiratory therapy and nursing vital members, this article emphasizes the roles of the SLP and physician.

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Combining Values

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2002.marapr01 ◽

2002 ◽

Vol 7 (2) ◽

pp. 1-4, 12 ◽

Cited By ~ 1

Author(s):

Christopher R. Brigham

Keyword(s):

Lower Extremity ◽

Upper Extremity ◽

Evaluation Method ◽

Proximal Phalanx ◽

Common Error ◽

The Third ◽

Whole Person ◽

Impairment Ratings ◽

Upper Extremity Impairment ◽

The Individual

Abstract To account for the effects of multiple impairments, evaluating physicians must provide a summary value that combines multiple impairments so the whole person impairment is equal to or less than the sum of all the individual impairment values. A common error is to add values that should be combined and typically results in an inflated rating. The Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, includes instructions that guide physicians about combining impairment ratings. For example, impairment values within a region generally are combined and converted to a whole person permanent impairment before combination with the results from other regions (exceptions include certain impairments of the spine and extremities). When they combine three or more values, physicians should select and combine the two lowest values; this value is combined with the third value to yield the total value. Upper extremity impairment ratings are combined based on the principle that a second and each succeeding impairment applies not to the whole unit (eg, whole finger) but only to the part that remains (eg, proximal phalanx). Physicians who combine lower extremity impairments usually use only one evaluation method, but, if more than one method is used, the physician should use the Combined Values Chart.

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Quick Reference: Chapter 3: The Musculoskeletal System and Chapter 4: The Nervous System

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2000.mayjun03 ◽

2000 ◽

Vol 5 (3) ◽

pp. 4-4

Keyword(s):

Nervous System ◽

Lower Extremity ◽

Musculoskeletal System ◽

Multistep Method ◽

Manual Muscle Testing ◽

Motor Deficits ◽

Lower Extremity Weakness ◽

Residual Symptoms ◽

Muscle Testing ◽

Almost All

Abstract Lesions of the peripheral nervous system (PNS), whether due to injury or illness, commonly result in residual symptoms and signs and, hence, permanent impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, divides PNS deficits into sensory and motor and includes pain in the former. This article, which regards rating sensory and motor deficits of the lower extremities, is continued from the March/April 2000 issue of The Guides Newsletter. Procedures for rating extremity neural deficits are described in Chapter 3, The Musculoskeletal System, section 3.1k for the upper extremity and sections 3.2k and 3.2l for the lower limb. Sensory deficits and dysesthesia are both disorders of sensation, but the former can be interpreted to mean diminished or absent sensation (hypesthesia or anesthesia) Dysesthesia implies abnormal sensation in the absence of a stimulus or unpleasant sensation elicited by normal touch. Sections 3.2k and 3.2d indicate that almost all partial motor loss in the lower extremity can be rated using Table 39. In addition, Section 4.4b and Table 21 indicate the multistep method used for spinal and some additional nerves and be used alternatively to rate lower extremity weakness in general. Partial motor loss in the lower extremity is rated by manual muscle testing, which is described in the AMA Guides in Section 3.2d.

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Q&A: Multiple Lower Extremity Impairments and AMA Guides, Third Edition, Revised

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2017.marapr05 ◽

2017 ◽

Vol 22 (2) ◽

pp. 15-16

Author(s):

Christopher R. Brigham ◽

Kathryn Mueller ◽

Steven Demeter ◽

Randolph Soo Hoo

Keyword(s):

Lower Extremity

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Spinal Impairment Evaluation: Fifth Edition Changes

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2001.janfeb01 ◽

2001 ◽

Vol 6 (1) ◽

pp. 1-3

Author(s):

Robert H. Haralson

Keyword(s):

Spinal Cord ◽

Lower Extremity ◽

Range Of Motion ◽

Upper Extremity ◽

Spinal Cord Injuries ◽

Clinical Findings ◽

Fourth Edition ◽

Treatment Results ◽

Standard Terminology ◽

Made In

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, was published in November 2000 and contains major changes from its predecessor. In the Fourth Edition, all musculoskeletal evaluation and rating was described in a single chapter. In the Fifth Edition, this information has been divided into three separate chapters: Upper Extremity (13), Lower Extremity (14), and Spine (15). This article discusses changes in the spine chapter. The Models for rating spinal impairment now are called Methods. The AMA Guides, Fifth Edition, has reverted to standard terminology for spinal regions in the Diagnosis-related estimates (DRE) Method, and both it and the Range of Motion (ROM) Method now reference cervical, thoracic, and lumbar. Also, the language requiring the use of the DRE, rather than the ROM Method has been strengthened. The biggest change in the DRE Method is that evaluation should include the treatment results. Unfortunately, the Fourth Edition's philosophy regarding when and how to rate impairment using the DRE Model led to a number of problems, including the same rating of all patients with radiculopathy despite some true differences in outcomes. The term differentiator was abandoned and replaced with clinical findings. Significant changes were made in evaluation of patients with spinal cord injuries, and evaluators should become familiar with these and other changes in the Fifth Edition.

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