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A Functional Testing Approach to Geriatric RehabDesigning Test-Driven Rehab Programs to Safely Improve

Function and Mobility in Older Adults

Seminar Manual 1852IMPORTANT:Customer Service is available weekdays between 6AM-6PM Central time at 800-433-9570 Option 1. For weekend calls, contact Customer Service on the following Monday.

John B. Perry, PT, CSCS, FAFS, CAFS, 3D MAPS, is an APTA Licensed Physical Therapist with over 20 years of experience in clinical, outpatient, and home settings. The author of ‘Hip To Be Fit’, Mr. Perry has developed and presented programs across the country on lower extremity injuries, propriobility, motor development and Applied Functional Science principals for patients and clients of all types and purposes.

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John B. Perry, PT, CSCS, FAFS, CAFS, 3D MAPS, is an APTA Licensed Physical Therapist with over 20 years of experience in sports/fitness, out patient, hospital, home and skilled settings. The author of ‘Hip To Be Fit’, Mr. Perry has developed and presented programs nationally and internationally on lower extremity injuries, proprioception, movement awareness and Applied Functional Science principals for patients and clients of all types and purposes. An NSCA Certified Strength and Conditioning Specialist, Fellow of Applied Functional Science and Certified in AFS as well as 3D MAPS functional testing system, Mr. Perry utilizes his background in orthopedic injury rehab, functional lower extremity anatomy, and movement awareness to bring a unique and comprehensive approach to gait analysis.Mr. Perry has worked in many different environments throughout his physical therapy career which gives him insight into gait biomechanics and assessments from a variety of therapeutic settings. Mr. Perry’s well-rounded clinical skills have allowed him to serve a diverse patient population. Co-Owner of Inner Circle Management in Ohio, a faculty member and Director of Live events and Education for the Gray Institute, Mr. Perry received his Bachelors of Science in Physical Therapy from The Ohio State University.

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INSTRUCTOR

CONTENT

OBJECTIVES

____ Teaching ability ____ Organization of material ____ Knowledge base ____ Effectiveness

Yes No

1

2

3After attending the program, how well do you feel you are able to:

(fill in the blank)

(fill in the blank)

(fill in the blank)

(fill in the blank)

Name: Professional Title: Setting/Population:

____ Relevance/value of information for your work____ Content matched the stated objectives____ Completeness of coverage of materials

____ Usefulness of hand-outs/visuals____ Meeting facility & accommodations____ Convenience of meeting facility location

Instructor Name: Cindy Lee, M.S.Ed Location Attended: Date:

__ Identify early warning signs of potential autism spectrum disorders in preschool children.__ Select appropriate treatment approaches for preschool children.__ Identify the difference between atypical and typical developmental patterns.__ Select instructional strategies/interventions that are appropriate for the presenting characteristics

(behavioral, cognitive, social, emotional, sensory).__ Plan for structured and organized facilitation of play and socialization.__ Describe ways to support families through the period of diagnosis and throughout early development.

Preschoolers & AutismKeeping Calm When They’re Carrying On

John B. Perry, PT, CSCS, FAFS, CAFS, 3D MAPS

ѩ Describe the anatomical changes in the aging adult in order to provide an optimum treatment plan with respect to strength, flexibility, and balance.

ѩ Perform patient-appropriate, research-based functional tests.

ѩ Recognize the key assessment tools and treatment concepts involved in fall prevention.

ѩ Incorporate the most appropriate rehab program to improve functional progression.

ѩ Implement evidence-based strategies for post-operative rehab in the geriatric patient.

ѩ Design functional home exercise programs to increase continuous progression in the geriatric patient.

A Functional Testing Approach to Geriatric RehabDesigning Test-Driven Rehab Programs to Safely Improve Function and Mobility in Older Adults

JOHN B. PERRY, PT, CSCS, FAFS,

CAFS,

3D MAPS

• Consultants- ICM, Inc.

• Sports Med, Acute, Swing Bed, Inpatient, SNF, LTC, HH settings

• Author, Speaker, Blogger and Creative Thinker :)

JOHN B PERRY, PT, CSCS,

FAFS, CAFS, 3D MAPS

(FELLOW OF APPLIED

FUNCTIONAL SCIENCE)• Right Brain Thinking

• Einstein’s Theory of Insanity

• Gary Gray(www.grayinstitute.com)

• Wayne Dyer

• Tim Ferriss

7

WHO’S HERE?

• Specialties

• Settings

Same Landscape ...different set of eyes..

OVERVIEW

•T------F-----A-------R

8

COMMON DISORDERS

• http://www.rightdiagnosis.com/symptoms/gait_disorders/causes.htm

• Ms

• Stroke

• Parkinson’s

• Injury

The moment we want to believe

something, we suddenly see all

the arguments for it, and become

blind to the arguments against it.George Bernard Shaw

9

MAIN THEME

• We are using gait to problem solve

• The test is the exercise and the exercise is the test

• We are using movement to find solutions for

assessment and treatment

• We are positioning our clients for success

• It’s all about...

•The ability of the body to move and react

in 3 planes, with and against gravity,

while efficiently and effectively loading

and unloading producing the proper

amount of speed.

Movement Awareness

10

Proprioception

The ability to sense the position and location and orientation and movement of

the body and its parts

The ability to use the nervous system and its proprioceptors correctly. Creating movement awareness within a constant changing environment.

PROPRIOBILITY

11

• 3 planes

• Gravity /ground reaction

• Transformational zone-Load and Unload

• Speed/Reaction

Principles

• Place in transformational zones

• Move body in all 3 planes concurrently

• Train for ideal load to unload

• Speed

STRATEGIES

12

• Proximal and distal attachment

• Uniplaner

• NonWeight Bearing

• Segmental

• Attack what Hurts

• Gravity/Ground

Reaction

• 3 Planes

• Load/Unload

• Attack the Culprit

• Chain Reaction

PST

What We Learned

- Change the Way You Look at Things

- Stride, Arm Swing, Transverse Plane Motion

- What is not smooth or fluid (fluidity)

Gait- Big Picture

13

WHERE TO FOCUS

• Where to put the “X”

• Dancing Monkeys

GAIT: WHAT SHOULD IT LOOK

LIKE?

• Load and Unload in 3 Planes Of Motion

14

NORMAL GAIT

• Calcaneal Eversion

• STJ Pronation

• Ankle Dorsiflexion

• Tibial IR

• Adduction of Knee with IR and Flexion

• Hip Adduction with Flexion and IR

NORMAL GAIT

• Opposite Ankle Dorsiflexion

• Knee Extension with ER and Abduction

• Hip Extension, Abduction and IR

15

NORMAL GAIT

• Lumbar and Thoracic opposite rotation to pelvis

• Opposite arm swing to leg that is forward

• Cervical spine rotation same as pelvis

Constant balance between both sides of body

We are reciprocal beings

Multi-planar

Fluid

16

More focus on Fluidity- Less on Rigidity

Systematic....with Functional Eye

VIDEO ANALYSIS

• Videos

• Lab

17

FUNCTIONAL

ANATOMY

• Muscle Function During Locomotion

• Synergistic Approach

18

MUSCLE FUNCTION

DURING LOCOMOTION

• Muscles are Reactors

• Everyone Is Different

• Muscles control loading then synergistically help

produce unloading utilizing gravity, ground reaction and

momentum (speed)

SYNERGISTIC

APPROACH

• How to Network

• Full Body Approach

• Chain Reaction

19

"Loading" improves " Mostability" or Stability

(Networking)

“Unloading” is more of challenge ( taking friends away)

BIOMECHANICAL

EVALUATION• Mindset

• Subjective/Listen

• Posture

• ROM

• MMT

• Palpation

• Movement Awareness/Balance

20

Hip Flexors Gastroc HIP

Ilio Sol ITB Adductors Rotators

Saggital Plane: ACTIONLE

Persuasion Long Stride x x

Short Stride x

UE Persuasion Arm Swing x x x

Elbows Bent x x

Frontal Plane:LE

Persuasion Wide Gait x x

Narrow Gait x x

UE Persuasion OH Same x opp x opp x opp

OH Opposite x same x same x opp

Transverse Plane

LE Persuasion Toes In x x x x

Toes Out x x

UE Persuasion Arms Same Side x opp x opp x both x same

Arms Opposite x same x same x both x

Verbally

Physically Demonstrate

Hands On

Goal is Subconscious Reaction

Change One Thing At A Time

How Do We “Drive” Our Patients?

21

• Start With Success

• Begin with the End in Mind

• 1-2 Tasks per Visit

• 3 exercises

• 1 gait change

Initiating The Plan

Put Them In The "Garage" and Influence Your "X"

( Muscle or Movement)

This Will Confirm Your "Hunch"

22

FUNCTIONAL

EXERCISES

• Strategies andTechniques based on

our Principles we used with our Gait

and biomechanical eval.

XXX

LXX

RXX

23

3 Plane Pelvic Drives

3 Plane Arm Reaches

24

3 Plane Leg Drivers

Narrow

Wide

Stagger/Narrow

25

Toe In and Out

Squats

26

Squats with Reaches

27

Lunge with Reaches

3 D Exercise

28

BUTTERFLY

EFFECT

• In chaos theory, the butterfly effect is the sensitive

dependence on initial conditions, where a small change at

one place in a deterministic nonlinear system can result in

large differences to a later state. The name of the effect, coined by Edward Lorenz, is derived from the theoretical

example of a hurricane's formation being contingent on whether or not a distant butterfly had flapped its wings

several weeks before.

BUTTERFLY

EFFECT• Make One Change... See Chain Reaction

29

Butterfly Effect

3-5 Exercises Day One

30 Seconds ea.

3 Times/Day

Start With Success

PUTTING SYSTEMS

IN PLACE

• Start Globally

• Choose a Direction

• Drive

• Analyze

• Repeat

30

See Systems Sheet, See Pics

PelvisArmsLegs

Movement

Drivers

Lengthen in one plane,

Drive in other two

What Is Our Focus ?

31

RE-EVALUATION

• Your Work is Never Finished

• Marathon not a Sprint

• It’s the Process not the Outcome

Second Visit:

Gait

Review ExercisesModalities

ManualAdd Exercise?

Gait

Notes

*** Did Plan/ Goals Change?***

32

Exercise Progressions

Stance

Squats

Lunges

Step ups

( Reaches with all movements)

Matrices

Documentation

Test Is Exercise And Exercise Is Test (FAFS)

33

PROBLEM SOLVING

• Locate Potential Culprit

• What would not allow the painful or restricted

area to load/unload as it should?

• What is solution for today?

The people who get on in this world

are the people who get up and look

for the circumstances they want and

if they can't find them, make them.

George Bernard Shaw

34

GERIATRIC GAIT

EVALUATION

• Antalgic

• Cautious

• Cerebellar/Ataxia

• Choreic

• Dystonic

• Frontal Gait Disorder (Apraxia)

• Hemiparetic

• Paraparetic

• Parkinsonian

• Psychogenic

• Sensory Ataxia

• Steppage

• Vestibular Ataxia

• Waddling

35

BIG

ROCKS• Story

• What is the list for your setting?

BIG ROCKS

• Posture

• Weakness

• Dormant Butts

• Health related issues

• Environment

• Communication

36

FLUIDITY WITH

PROPRIOBILITY

• Improving propriobility (one’s ability to use proprioceptors to gain functional mobility and fluidity)

• There is no reception without proprioception

TECHNIQUES

• Persuading

• Driving

• Exercise

• Movement Awareness

• Listening

• Communicating

• Learning

• Improving

• Teaching

• Positioning for Success

• Feeling

• Understanding

37

• Use what you have available to work with-

Strengths/Success

• If Based on Applied Functional Science, You

are NOT Wrong...Know your “Why”

• “Influence” the chain reaction and build on

success

• Influencing the body’s proprioceptors-

consciously and subconsciously

THE ART OF PERSUASION

T-F-A-

R• YOU are in Control

• YOU drive the movement based on your

observations.

• BE in the moment

38

• Start With Success

• Begin with the End in Mind

• 1-2 Tasks per Visit

• Don’t overwhelm patient

• Keep it simple

ADJUSTMENTS AND

TIMING

ONGOING ANALYSIS

Gravity

Ground Reaction

3 planes

load/unload

Chain Reaction within the

Transformational Zone

Work with what is available to you

39

HOMEWORK• One task /goal to work on or staff/family to

assist with for that day or week

• To be done when you are not there

• Looking for carryover from work you have

done

40

MUSCLE FUNCTION DURING ADL

• Ideal Gait muscle function

• Visible body APP

• Muscles control loading then synergistically

help produce unloading utilizing gravity,

ground reaction and momentum (speed)

ADL’S AND MUSCLE FUNCTION

• Sit to Stand

• Lat Lunge and Reach

• Pick up slipper

• Reach into Cabinet (high and low)

• Opening a door

41

MOVEMENT AWARENESS LAB

• Crawling

• Kneeling

• getting up from floor

• standing

• Lunges

• walking

MOVEMENT AWARENESS LAB

• Jogging

• Hopping

• Skipping

• Starts and Stops

42

GERIATRIC GAIT

EVALUATION

• Supine

• Sitting

• Standing

• Ambulation

43

GARAGE VS.

TRACK

• Bed mobility level?

• Transfer Level?

• Can they ambulate and at what level?

• Garage= supine, sit or wt. bearing

• Track = actual ambulation

TAKING THE NEXT STEP

• Reassessments performed Daily by all staff

• What needs/issues to be progressed/changed/modified today?

• and Why?

44

FUNCTIONAL

MEASURES• Berg Balance Scale

• 5 Rep STS

• Timed Get Up and Go

• Falls Efficacy Scale

• Four Square Step Test

• Dynamic Gait Index

• 3D MAPS

FUNCTIONAL

MEASURES• Scores from Standardized Testing

should improve based upon our ability to enhance proprioception

• Using Applied Functional Science

• Training Movements not Muscles

45

HH/ASSISTED LIVING

• 84 y/o male, Pneumonia, General Debilitation,

HTN, decreased balance, rollator for

ambulation with Min A-CGA

• Lives at Home with 3 hours passport daily

• 3 stairs enter/exit home for medical appts

• step down into living room

ACUTE/INPATIEN

T• 68 y/o B knee replacement with CHF, DM and

HTN

• Lives with Elderly Husband and Daughter to

assist daily

• Day 1 and 2

46

SNF / ECF / LTC

• 91 year female with senile dementia, depression with

mood disorder, DM, HTN, frequent falls, UTI’s

• Min A with bathing and dressing;Feeds self

• ambulates without device

• 2 falls in last week/Prior PT and OT

OUTPATIENT

CLINIC• 74 y/o female, Frozen R shoulder following fall

resulting in Humerus Fx , Immobilized 8

weeks, may begin gentle ROM, B Knee OA,

fairly good health otherwise

• Son assists during day, Pt alone at night and

that is how she prefers it

• Uses cane and furniture walks,

47

LAB

• Assessment-Garage vs Track or both

• 3 possible exercises~ 1 task for homework (

What would you do currently?)

• Focus on functional muscle function

• What is missing? What is available to work

with?

48

What are Your BIG Rocks?

Know Your “Why”

Teach your “Why”

WHAT DID WE

SEE?

SIMILARITIES?

STRATEGIC ADJUSTMENTS

AND TIMING• Begin where Pt is successful

• Begin with Garage work(Pelvis,UE,LE)

• 3 planes of motion

• Emphasizing Load/Unload with full body

synergistic approach

• Progress to transfers and gait, applying same

principles

49

EXERCISE

PROGRESSIONS• Supine >>Rolling>>Side Lying >> Sitting>>

Dynamic Sitting>> Partial Standing >> Standing>> Stepping >> Squats >> Lunges >> Pivots >> Ambulation >> Stairs >> Stooping >> Dynamic Reaches with Gait

• All focusing on 3 plane proprioceptive driven movements

EXERCISE

PROGRESSIONS• Positioning

• Repetitions

• Duration

• Speed

• Loads

• Feedback, manual or verbal

50

DOCUMENTATION• A Necessary Evil

• Makes us “Skilled”

• Gets us “Paid”

• Enhances communication between disciplines

• Makes us “Authors” within our craft

51

DOCUMENTATION:

SKILLED

• Patient ambulated 100’ with wheeled walker with 6

verbal cues to increase heel strike. Tactile cues given

x’s 2 for safe maneuvering of walker.

• Patient performed upper body dressing with SBA.

Moderate verbal cueing needed for finding shirt front

and modified technique to get T-shirt over head.

• Patient presents to PT after recent hospitalization for CHF. Exacerbation of CHF has caused decreased exercise tolerance due to skeletal muscle maladaptations that have affected the patient’s functional strength. Patient presents with balance deficits, inability to ambulate safely and decreased ability to transfer as evidenced by specialized testing. Patient will benefit from skilled progressive resistive exercises, and mobility and balance retraining to return safely to independent living in home environment.

DOCUMENTATION:

Assessment

52

DOCUMENTATION:

MEDICAL

NECESSITY• Patient will continue to benefit from skilled PT to increase

balance and decrease fall risk as patient completed 4 square step test in 17 seconds indicating they are at high risk for falls. Patient remains at risk for falls and falls with injury due to complicating factor of osteoporosis, but has demonstrated good progress over past week by decreasing 4 square step test by 4 seconds.

DOCUMENTATION: GOALS

• STG x 2 weeks: Patient will achieve 120

degrees of shoulder flexion to reach into upper

cabinets independently at home to allow for

safe food preparation.

• LTG x 4 weeks: Patient will independently

ambulate 1.2 m/sec with walker without loss of

balance on outside surfaces to allow patient to

safely cross the road at home to get mail from

mailbox.

53

DOCUMENTATION:

DISCHARGE

• Patient was seen for 12 visits of PT services. Patient has made excellent progress towards heel strike goal. The patient is now able heel strike 100% of time with no verbal cues compared to needing verbal cues every 10 feet on eval. Patient showed great benefit from estim program combined with PRE for ankle dorsiflexors and neuromuscular reeducation. Patient to return home with no adaptive equipment and no further PT needed. Patient is I in home exercise program to maintain goals and continue at a lower risk for fall.

• Pt amb min A of 1 with gait belt using RW. Trunk flexed

posturing, fwd head, kyphotic posture with flexion of knees

B. Step-to gait with LLE, shuffle step pattern with decreased

stride length. mod VC for proper gait pattern and RW use.

Proprioceptive deficits in LE and trunk musculature

including strength and flexibilty issues are contributing to

above pattern. When combined with bed mobility, sitting

posture and MMT , it is felt pt could benefit from skilled P.T.

consisting of 3 plane pelvic UE and LE driven exercises in

supine, sitting,modified standing and standing. Focus on

Strengthening, flexibility, proprioception, gait, transfers,

safety awareness (etc.)........for improved functional

mobility, transfers, safety, improved functional

independence, return to PLOF and or Decrease BOC on

staff....then will list goals.

Example

54

WORDS TO LIVE BY:

• Proprioceptive enhancement with focus on...

• Loading and unloading of trunk, UE and LE

• Functional mobility

• Safety awareness

• Skilled, PLOF

• 3 planes, driven

• Trunk Disassociation from pelvis

• Step-though pattern

• Heel toe pattern

• Adequate arm swing

• proper posturing

• environment awareness

WORDS TO LIVE BY:

55

FALLS RISK ASSESSMENT

Musculoskeletal disorders

Cervical spondylosis

Gout

Lumbar spinal stenosis

Muscle weakness or atrophy

Osteoarthritis

Osteoporosis

Podiatric conditions

Sensory abnormalities

Hearing impairment

Peripheral neuropathy

Visual impairment

Neurologic disorders

Cerebellar dysfunction or

degeneration

Delirium

Dementia

Multiple sclerosis

Myelopathy

Normal-pressure hydrocephalus

Parkinson disease

Stroke

Vertebrobasilar insufficiency

Vestibular disorders

FALLS

PREVENTION• Screening Protocol

• Communication with Disciplines

• History

• Medication Review

• Physical Exam

• Gait and Balance Performance Testing

• Presence of Environmental Hazards

56

FALLS

PREVENTION

• Enhance Propriobility through the Art of

Persuasion using Applied Functional Science

Principles, Strategies and Techniques.

• Communicate!

• Focus on “homework” tasks

• 3 plane dynamic movements in sitting and

standing

SUMMARY

• What did we learn? BIG ROCKS

57

• Summary

• Questions

• Contact Info

WRAP UP AND

EVALUATIONS

john.imovebetter@gmail.com

www.youtube.comPropriobility

REFERENCES

• www.grayinstitute.com

• www.imovebetter.com

58

THANKS FOR PLAYING!

59

Gait Biomechanics and Analysis-Article Bibliography

Biomechanical and Neuromuscular Characteristics of Male Athletes: Implications for the Development of

Anterior Cruciate Ligament Injury Prevention Programs. Sugimoto D, Alentorn-Geli E, Mendiguchía J,

Samuelsson K, Karlsson J, Myer GD. Sports Med. 2015 Feb 7.

Pivoting neuromuscular control and proprioception in females and males. Lee SJ, Ren Y, Kang SH, Geiger

F, Zhang LQ. Eur J Appl Physiol. 2014 Nov 28.

Improvement in upper leg muscle strength underlies beneficial effects of exercise therapy in knee

osteoarthritis: secondary analysis from a randomised controlled trial. Knoop J, Steultjens MP, Roorda LD,

Lems WF, van der Esch M, Thorstensson CA, Twisk JW, Bierma-Zeinstra SM, van der Leeden M, Dekker

Physiotherapy. 2014 Aug 13.

Principles of postoperative anterior cruciate ligament rehabilitation. Saka T. World J Orthop. 2014 Sep

18;

Discriminant analysis of neuromuscular variables in chronic low back pain. Rossi DM, Morcelli MH,

Cardozo AC, Denadai BS, Gonçalves M, Navega MT. J Back Musculoskelet Rehabil. 2014 Aug 28. [Epub

ahead of print]

Progress in sensorimotor rehabilitative physical therapy programs for stroke patients.

Chen JC, Shaw FZ. World J Clin Cases. 2014 Aug 16;2(8):316-26. doi: 10.12998/wjcc.v2.i8.316. Review.

Complex muscle vibration patterns to induce gait-like lower-limb movements: proof of concept.

Duclos C, Kemlin C, Lazert D, Gagnon D, Dyer JO, Forget R. J Rehabil Res Dev. 2014;51(2):245-51. doi:

10.1682/JRRD.2013.04.0079.

Exercise for reducing fear of falling in older people living in the community. Kendrick D, Kumar A,

Carpenter H, Zijlstra GA, Skelton DA, Cook JR, Stevens Z, Belcher CM, Haworth D, Gawler SJ, Gage H,

Masud T, Bowling A, Pearl M, Morris RW, Iliffe S, Delbaere K. Cochrane Database Syst Rev. 2014 Nov

28;11:CD009848. doi: 10.1002/14651858.CD009848.pub2. Review.

Effect of light and vigorous physical activity on balance and gait of older adults. Pau M, Leban B, Collu G,

Migliaccio GM. Arch Gerontol Geriatr. 2014 Nov-Dec;59(3):568-73. doi: 10.1016/j.archger.2014.07.008.

Epub 2014 Aug 2.

Functional benefits of tai chi training in senior housing facilities. Manor B, Lough M, Gagnon MM,

Cupples A, Wayne PM, Lipsitz LA. J Am Geriatr Soc. 2014 Aug;62(8):1484-9. doi: 10.1111/jgs.12946.

Erratum in: J Am Geriatr Soc. 2014 Nov;62(11):2233.

Improvements in gait characteristics after intensive resistance and functional training in people with

dementia: a randomised controlled trial. Schwenk M, Zieschang T, Englert S, Grewal G, Najafi B, Hauer K.

BMC Geriatr. 2014 Jun 12;14:73. doi: 10.1186/1471-2318-14-73.

60

Upper limb contributions to frontal plane balance control in rollator-assisted walking. Tung JY, Gage WH,

Poupart P, McIlroy WE. Assist Technol. 2014 Spring;26(1):15-21; quiz 22-3.

Creaby MW, Bennell KL, Hunt MA. Gait Differs Between Unilateral and Bilateral Knee Osteoarthritis.

Arch Phys Med Rehabil. 2012 Feb 29. [Epub ahead of print] PubMed PMID: 22385873.

Simonsen EB, Tegner H, Alkjær T, Larsen PK, Kristensen JH, Jensen BR, Remvig L, Juul-Kristensen B. Gait

analysis of adults with generalised joint hypermobility. Clin Biomech (Bristol, Avon). 2012 Feb 22. [Epub

ahead of print] PubMed PMID: 22364778.

Cimolin V, Galli M, Albertini G, Crivellini M, Romkes J, Brunner R. Quantitative analysis of upper limbs

during gait: a marker set protocol. J Appl Biomater Biomech. 2012 Feb 15:0. doi:

10.5301/JABB.2012.9040. [Epub ahead of print] PubMed PMID: 22367686.

Hamacher D, Bertram D, Fölsch C, Schega L. Evaluation of a visual feedback system in gait retraining: A

pilot study. Gait Posture. 2012 Mar 15. [Epub ahead of print] PubMed PMID: 22425191.

Bradley M, Sabatier JM. Acoustically-observable properties of adult gait. J Acoust Soc Am. 2012

Mar;131(3):EL210-5. PubMed PMID: 22423810.

Barthuly AM, Bohannon RW, Gorack W. Gait speed is a responsive measure of physical performance for

patients undergoing short-term rehabilitation. Gait Posture. 2012 Mar 7. [Epub ahead of print] PubMed

PMID: 22406292.

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References

1. Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls. A prospective

study. JAMA. 1989;261(18):2663–2668.

2. Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr

Med. 2002;18(2):141–158.

3. Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence

show? Med Clin North Am. 2006;90(5):807–824.

4. Rubenstein LZ, Powers CM, MacLean CH. Quality indicators for the management and prevention of

falls and mobility problems in vulnerable elders. Ann Intern Med. 2001;135(8 pt 2):686–693.

5. Thurman DJ, Stevens JA, Rao JK. Practice parameter: assessing patients in a neurology practice for

risk of falls (an evidence-based review): report of the Quality Standards Subcommittee of the American

Academy of Neurology. Neurology. 2008;70(6):473–479.

6. Sudarsky L. Gait disorders: prevalence, morbidity, and etiology. Adv Neurol. 2001;87111–117.

7. Chu LW, Chi I, Chiu AY. Incidence and predictors of falls in the Chinese elderly [published correction

appears in Ann Acad Med Singapore. 2005;34(7):469]. Ann Acad Med Singapore. 2005;34(1):60–72.

8. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the

community. N Engl J Med. 1988;319(26):1701–1707.

9. Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med. 2003;348(1):42–49.

10. Alexander NB. Gait disorders in older adults. J Am Geriatr Soc. 1996;44(4):434–451.

11. Alexander NB. Differential diagnosis of gait disorders in older adults. Clin Geriatr

Med. 1996;12(4):689–703.

12. Verghese J, LeValley A, Hall CB, Katz MJ, Ambrose AF, Lipton RB. Epidemiology of gait disorders in

community-residing older adults. J Am Geriatr Soc. 2006;54(2):255–261.

13. Bloem BR, Haan J, Lagaay AM, van Beek W, Wintzen AR, Roos RA. Investigation of gait in elderly

subjects over 88 years of age. J Geriatr Psychiatry Neurol. 1992;5(2):78–84.

14. Hough JC, McHenry MP, Kammer LM. Gait disorders in the elderly. Am Fam

Physician. 1987;35(6):191–196.

15. Sudarsky L. Clinical approach to gait disorders of aging: an overview. In: Masdeu JC, Sudarsky L,

Wolfson L, eds. Gait Disorders of Aging: Falls and Therapeutic Strategies. Philadelphia, Pa.: Lippincott-

Raven; 1997:147–157.

62

16. Centers for Disease Control and Prevention. Prevalence and most common causes of disability

among adults—United States, 2005. MMWR Morb Mortal Wkly Rep. 2009;58(16):421–426.

17. Bloem BR, Gussekloo J, Lagaay AM, Remarque EJ, Haan J, Westendorp RG. Idiopathic senile gait

disorders are signs of subclinical disease. J Am Geriatr Soc. 2000;48(9):1098–1101.

18. Winter DA, Patla AE, Frank JS, Walt SE. Biomechanical walking pattern changes in the fit and

healthy elderly. Phys Ther. 1990;70(6):340–347.

19. Elble RJ, Thomas SS, Higgins C, Colliver J. Stride-dependent changes in gait of older people. J

Neurol. 1991;238(1):1–5.

20. Snijders AH, van de Warrenburg BP, Giladi N, Bloem BR. Neurological gait disorders in elderly

people: clinical approach and classification. Lancet Neurol. 2007;6(1):63–74.

21. Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ, Buschke H. Abnormality of gait as a

predictor of non-Alzheimer's dementia. N Engl J Med. 2002;347(22):1761–1768.

22. Moylan KC, Binder EF. Falls in older adults: risk assessment, management and prevention. Am J

Med. 2007;120(6):493.e1–493.e6.

23. Alexander NB, Goldberg A. Gait disorders: search for multiple causes. Cleve Clin J

Med. 2005;72(7):586, 589–590592–594passim.

24. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and

meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc. 1999;47(1):40–50.

25. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and

meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc. 1999;47(1):30–39.

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