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Terms in this set (120)

-Age: 0-3 months(held in sitting) - Gross motor skill: 1) head bobs in sitting 2) back is rounded 3) hips are apart, turned out, and bent 4) head is steady 5) chin tucks; able to gaze at floor 6) sits with less support 7) hips are bent and shoulders are in front of hips

-Age: 5-6 months (supports self in sitting) - Gross motor skill: 1) sits alone momentarily 2) increased extension in back 3) sits by propping forward on arms 4) wide base, legs are bent 5) periodic use of "high guard" position 6) protective responses present when falling to the front

-Age: 5-10 months (sits alone) - Gross motor skill: 1) sits alone steadily, initially with wide base of support 2) able to play with toys in sitting position

-Age: 6-11 months - Gross motor skill: gets to sitting position from prone position

-Age: 7-8 months - Gross motor skill: 1) equilibrium reactions are present 2) able to rotate upper body while lower body remains stationary 3) protective responses are present when falling to the side

-Age: 8-10 months - Gross motor skill: 1) sits will without support 2) legs are closer; full upright position, knees straight 3) increased variety of sitting positions, including "w" sit and side sit 4) difficult fine motor tasks may prompt return to wide base of support

-Age: 9-18 months - Gross motor skill: rises from supine position by first rolling over to stomach then pushing up into four-point position

-Age: 10-12 months - Gross motor skill: 1) protective extension backwards, first with bent elbows then straight elbows 2) able to move in and out of sitting position into other position

-Age: 11-12 months - Gross motor skill: 1) trunk control and equilibrium responses are fully developed in sitting position 2) further increase in variety of positions possible

-Age: 11-24 months + - Gross motor skill: rises from supine by first rolling to side then pushing up into sitting position
-Ego adaptation is the adaptive response of the ego in the development of the personality
-Eight stages of man are identified and include a critical personal-social crisis that when resolved by the individual gives the individual a sense of mastery and results in the acquisition of a personality quality
-Basic trust vs mistrust: the infant/baby realizes that survival and comfort needs will be met; hope is integrated into the personality (birth to 18 months)
-Autonomy vs doubt and shame: the child realizes that he/she can control bodily functions; self-controlled will is integrated into the personality (2 to 4 years)
-Initiative vs. guilt: the child gains social skills and gender role identity; a sense of purpose is integrated into the personality (preschool age)
-Industry vs inferiority: the child gains a sense of security through peers and gains mastery over activities of his/her age group; a feeling of competency is integrated into the personality (elementary school age)
-Self-identity vs. role diffusion: the teenager begins to make choices about adult roles, and with the resolution of this identity crisis a sense of fidelity or membership with society is integrated into the personality (teenage years)
-Intimacy and solidarity vs isolation: the young adult establishes an intimate relationship with a partner and family; the capacity to love is achieved (young adulthood)
-Generativity vs self-absorption: the adult finds security in the contribution of his/her chosen personal/professional roles; the capacity to care is achieved (middle adulthood)
-Integrity vs despair: the mature adult reflects on his/her own value, and shares with the younger generation the knowledge gained; wisdom is acquired (maturity)
-Sensorimotor period (ages birth to 2 years): 1) reflexive stage - schemes begin in response to reflexes (1 month) 2) primary circular reacting - child learns about cause and effect as a result of reflexive sensorimotor patterns that are repeated for enjoyment (2 to 4 months) 3) secondary circular reaction - voluntary movement patterns emerge due to coordination of vision and hand function, and an early awareness of cause and effect develops (5 to 8 months) 4) coordination of secondary schemata - voluntary movement in response to stimuli that cannot be seen as in object permanence, and early development of decentered thought (9 to 12 months) 5) tertiary circular reactions - the child seeks out new schemes, with improved gross and fine motor abilities; tool use begins (12 to 18 months) 6) purposeful tool use, explores problem solving options.

-Preoperational period (ages 2 to 7 years): 1) classification - categorizing objects according to similarities and differences 2) seriation - the relationship of one object or classification of objects to another 3) conservation - the end product of the preoperational period. The child is able to recognize the continuities of an object or class of objects in spite of apparent changes 4) the preoperational period is divided into two phases - preconceptual the child expands vocabulary and symbolic representations ( 2 to 4 years) and intuitive thought phase, the child imitates, copies or repeats what is seen or heard and bases conclusions on what he/she believes to be true rather than on logic. Inductive reasoning denotes a transition to the next stage (4 to 7 years) 5) Child progresses from dependence on perception, as opposed to logic, and egocentric orientation to logical thought, for solving problems.

-Concrete operations (ages 7 to 11 years): 1) reversibility - an expansion of conservation, leads to increased spatial awareness 2) rules - as rules are better understood, they are also applied 3) Empirico-inductive thinking - the child solves problems with the information that is obvious and present 4) child uses logical thinking on observed or mentally represented objects, enjoying games with rules which help the child adjust to social demands

-Formal operations, (ages 11 through the teen years): 1) hypothetico-deductive thinking, the ability to analyze and plan 2) child uses logic to hypothesize many ways to solve problems, and can draw from past and present experiences to imagine what can have an effect on future situations
-6-9 months: 1) child finds object after watching it disappear, eg. toy covered by cloth 2) child uses movement as a means to an end, eg. rolling to secure joy 3) child anticipates movement of objects in space, eg. looking toward trajectory of object circling his/her head 4) child attends to consequences of actions, eg. banging toy and realizing it makes noise 5) child repeats actions to repeat consequences, eg. banging toy to hear noise

-9-12 months: 1) child is able to use a tool after demonstration, eg. using a stick to secure a toy that is out of reach 2) child's behavior becomes more goal directed 3) child performs an action to produce a response

-12-15 months: 1) child recruits the help of an adult to achieve a goal 2) child attempts to activate a simple mechanism 3) child turns and inspects objects 4) child uses a trial and error approach to new challenges
-18-21 months: 1) child attends to shapes of things and uses them appropriately 2) child begins to think before acting 3) child uses tool to obtain a favored object 4) child begins to replace trial and error with a thought process in order to attain a goal 5) child can operate a mechanical toy, eg. an on-off switch 6) child can predict effects or presume causes

-21-24 months: 1) child recognizes operations of several mechanisms 2) child matches circles, squares, triangles, and manipulates objects into small openings, eg. shape sorters

-24-27 months: child discriminates sizes

-24-30 months: child can build with blocks horizontally and vertically

-27-30 months: 1) child begins to relate experiences to one another, based on logic and knowledge of previous experiences 2) child can make a mental plan of actions without acting it out 3) child can see relationships between experiences, eg. if the balloon is popped, it will make a loud noise

-36-38 months: 1) child can build a tower of nine cubes, demonstrating balance and coordination 2) child can organize objects by size, and builds a structure from a mental image

-48-60 months: 1) child can build involved structures combining various planes, along with symmetrical designs 2) child is able to utilize spatial awareness, cause-and-effect, and mental images in problem solving
-Appropriate positioning to allow for neutral pelvic alignment and trunk stability either in caregiver's lap or chair (infant seat or wheelchair); avoid head extension to prevent asphyxiation as a result of closing of the airway
-Hand positioning of the caregiver; place the index finger longitudinally under the child's lip, middle finger under the jaw, and place the thumb on the lateral end of the mandible
-Facilitate lip closure by applying slight upward pressure of the index finger under the child's lip
-Hand positioning of the index and middle fingers to assist in inhibiting tongue thrust (press bowl of spoon downward and hold on tongue)
-Facilitate swallow by lip closure, and by placement and slight downward pressure of the spoon on the middle aspect of the tongue
-Facilitate chewing by placement of foods such as long soft cooked vegetables, between the gum and teeth
-Integrate preventive measures to work out of abnormal patterns: 1) provide firm downward pressure, using a spoon, on the middle aspect of the tongue in presence of a tonic bite reflex 2) prevent tongue retraction to avoid choking 3) facilitate lip closure for a tongue thrust that can result in loss of liquids and food, drooling, and failure to thrive 4) decrease tactile sensitivity prior to feeding as well as at other times, by providing firm pressure; encourage sucking/chewing on a cloth; rub gums, palate, tongue; promote oral exploration of toys; use a NUK toothbrush; and vary texture of foods, gradually introducing mashed potatoes mixed with other vegetables and soft meats
-Consider and utilize the appropriate texture of foods as related to the child's feeding problems. Thick foods are easier to swallow and manage, especially if a tongue thrust is present
-A major role of the therapist is to assist the caregiver in considering and promoting a pleasant social atmosphere for feeding by utilizing positioning and handling techniques to promote eye contact and bonding in a relaxed environment
-Consider the developmental sequence of feeding skills
-Focus: a standardized norm referenced assessment which evaluates visual motor integration and visual perceptual skills of preschoolers, including perception in space, awareness of spatial relationships, color and space discrimination, matching two attributes simultaneously and the ability to reproduce what is seen and interpreted
-Method: two performance subtests and two behavioral observation checklists: 1) the Drawing subtest requires the child to recognize and reproduce lines and shapes that increase in level of complexity 2) the Block Patterns subtest requires the child to recognize color and shape and reproduce block patterns and match block pictures using 3 dimensional blocks 3) it has a section that first predetermines that the child has the requisite skills to continue with the test items 4) the behavioral observation checklists are completed during testing by the administrator to document observed behaviors in an orderly manner to be used in test interpretation
-Scoring and interpretation: 1) the child's fine motor skills and visual perceptual abilities are examined separately, to the extent possible 2) each task has specific criteria listed on the score sheet 3) to attain the precision needed to accurately score the child's final products, templates and a ruler are provided to be used when scoring each subtest 4) raw scores are converted to standard scores and percentile ranges for both subtests and for the total test (impairments indicated by standards scores below 80 and percentile scores below 25) 5) administrator's recorded behavioral observations of the child during the testing are not included in the score. These observations are used in test interpretation and subsequent intervention planning 6) interpretation of the child's performance and current emerging abilities are made based upon the combination of numerical scores, behavioral observations, and error analysis
-Population: preschoolers aged 3 1/2 to 5 1/2 years old
-Tasks of infancy and childhood: 1) walk 2) take solid food 3) talk 4) control elimination of body wastes 5) develop sex differences and sexual modesty 6) develop physiologic stability 7) understand concepts of social and physical reality 8) develop emotional ties with parents, siblings, and others 9) understand right from wrong, conscience evolves

-Tasks of middle childhood: 1) develop physical skills needed for games 2) establish health self-concept 3) make friends with children of the same age 4) read, write, and calculate 5) acquire a fund of information necessary for everyday life 6) develop morality and values 7) formulate opinions about social groups and institutions

-Tasks of adolescence: 1) establish relationships with male and female friends of same age, increasing in quantity and quality 2) develop masculine/feminine social role 3) become comfortable with and respect one's changing body 4) decrease emotional reliance on parents/other adults 5) prepare for marriage and family life 6) prepare for economic career 7) develop a value system to shape behavior or develop one's own philosophy 8) behave in a socially responsible manner

-Tasks of early adulthood: 1) choose a partner 2) adjust to a partner 3) start a family 4) raise children 5) manage a home 6) pursue an occupation 7) develop civic responsibility 8) join/form a compatible social group

-Tasks of middle adulthood: 1) guide adolescents toward becoming responsible and well adjusted adults 2) engage in adult civic and social responsibility 3) progress in an occupational career 4) pursue leisure-time activities 5) relate to partner as a person 6) deal with and accept physiologic changes of middle age 7) accept aging parents

-Tasks of later adulthood: 1) cope with decreasing physical strength and health 2) adjust to retirement and reduced income 3) adjust to death of spouse/partner 4) affiliate with one's age-group 5) change social roles 6) arrange for the most appropriate and appealing living environment
-Sensory integration of vestibular, proprioceptive, and tactile information for functional use: 1) integration of the tactile subsystems (0-3 months) 2) integration of primitive postural reflexes (3-9 months) 3) maturation of righting and equilibrium reactions (9-12 months) 4) integration of two sides of the body, awareness of body parts and their relationship, and motor plan gross movements (1-2 years) 5) motor plan fine movements (2-3 years)

-Cognitive skill: the ability to perceive, represent and organize sensory information to think and problem solve; 1) utilization of inborn behavioral patterns for environmental interactions (0-1 months) 2) interrelation of visual, manual, auditory, and oral responses (1-4 months) 3) early exploration of the environment and interest in outcomes of actions: remembers action responses, believes that own actions cause responses, and has an awareness of the relation of these actions and events (4-9 months) 4) utilization of deliberate actions to achieve a goal: object permanence begins, anticipation of familiar events, imitation, interest in sizes/shapes, and perception of other objects as partially causal (9-12 months) 5) utilization of a trial and error approach to problem solving: tool use, begins to realize that alternate routes can be used, remembers the order of a simple sequence, and realizes that others can cause events to happen (12-18 months) 6) formulation of mental pictures: pretends, early cause and effect, manipulates objects in space, has a clearer understanding that others can manipulate the environment (18 months - 2 years) 7) representation of objects in terms of felt experiences: understands that there are consequences to actions that others cannot read his/her mind, and recognizes that events have causes (2-5 years) 8) representation of objects by name: begins to understand that other people may have differing opinions (6-7 years) 9) comprehension that different labels can be used for the same object, use of formal logic and speculation (11-13 years)

-Dyadic interaction skill: the ability to participate in a variety of dyadic relationships; 1) family relationships (8-10 months) 2) playmate relationships (3-5 years) 3) superior/authority relationship interactions (5-7 years) 4) friend relationships (10-14 years) 5) peer-superior relationships (15-17 years) 6) intimate/sharing/committed relationships (18-25 years) 7) caring/unselfish relationships (20-30 years)

-Group interaction skill: the ability to engage in a variety of primary groups: 1) parallel group - minimal awareness of or interaction with others (18 months -2 years) 2) project group - limited in duration, cooperation, and sharing (2-4 years) 3) egocentric group - cooperation, competition, longer in duration, build self-esteem (9-12 years) 4) cooperative group - compatible group, members concerned with meeting the needs of fellow members (9-12 years) 5) mature group - differing roles, concerned with completion of task as well as meeting the needs of fellow members (15-18 years)

-Self-identity skills: the ability to perceive the self as a relatively autonomous, holistic, and acceptable person who has permanence and continuity over time; 1) self as a valued person (9-12 months) 2) assets and limitations of the self (11-15 years) 3) self as self-directed (20-25 years) 4) self as a productive, contributing member of a society (30-35 years) 5) self identity as an independent individual (35-50 years) 6) understanding the aging process of one's self and eventual death as part of the life cycle (45-60 years)

-Sexual identity skill: the ability to feel comfortable about one's sexual nature and to engage in continued sexual relationship that takes into account mutual satisfaction of sexual needs; 1) act on the basis of one's pregenital sexual nature (4-5 years) 2) sexually mature as a positive growth experience (12-16 years) 3) give and receive sexual gratification (18-25 years) 4) sustain sexual relationship with mutual satisfaction of sexual needs (20-30 years) 5) accept sex-related physiological changes that occur as a natural part of the aging process (40-60 years)
-Older adults experience a loss of function of the senses: 1) may lead to sensory deprivation, isolation, disorientation, confusion, appearance of senility and depression 2) may strain social interactions and decrease ability to interact socially and with the environment 3) may lead to decreased functional mobility and increased risk of injury 4) alters quality of life
-Vision: there is a general decline in visual acuity; gradual prior to sixth decade, rapid decline between ages 60 and 90; visual loss may be as much as 80% by age 90
-Hearing: occur as early as fourth decade; affects a significant number of elderly (23% of individuals aged 65-74 have hearing impairments and 40% over age 75 have hearing loss; rate of loss in men is twice the rate of women, also starts earlier
-Vestibular/balance control: degenerative changes in otoconia of utricle and saccule; loss of vestibular hair-cell receptors; decreased number of vestibular neurons; VOR gain decreases; begins at age 30, accelerating decline at ages 55-60 resulting in diminished vestibular sensation
-Somatosensory: 1) decreased sensitivity of touch associated with decline of peripheral receptors, atrophy of afferent fibers- lower extremities more affected than upper 2) proprioceptive losses, increased thresholds in vibratory sensibility, beginning around age 50 - greater in lower extremities than upper extremities, greater in distal extremities than proximal 3) loss of joint receptor sensitivity; losses in lower extremities, cervical joints may contribute to loss of balance 4) cutaneous pain thresholds increased; greater changes in upper body areas (upper extremities, face) than for lower extremities
-Taste and smell: 1) gradual decrease in taste sensitivity 2) decreased smell sensitivity
-Aging changes include: 1) presbyopia - visual loss in middle and older ages characterized by inability to focus properly and blurred images, due to loss of accommodation, elasticity of lens 2) decreased ability to adapt to dark and light 3) increased sensitivity to light and glare 4) loss of color discrimination, especially for blues and greens 5) decreased pupillary responses, size of resting pupil increases 6) decreased sensitivity of corneal reflex - less sensitivity to eye injury or infection 7) oculomotor responses diminished - restricted upward gaze, reduced pursuit eye movements; ptosis may develop
-Additional vision loss with pathology:
1) cataracts - opacity, clouding of lens due to changes in lens proteins - results in gradual loss of vision, central first then peripheral; increased problems with glare; general darkening of vision; loss of acuity, distortion (surgery is an effective treatment)
2) glaucoma - increased intraocular pressure, with degeneration of optic disc, atrophy of optic nerve; results in early loss of peripheral vision (tunnel vision) (if untreated, it can progress to total blindness; if diagnosis is made early, surgery and/or medication are effective treatments)
3) macular degeneration - loss of central vision associated with age-related degeneration of the macula compromised by decreased blood supply or abnormal growth of blood vessels under the retina; typically individuals retain some peripheral vision; increased sensitivity to glare, and difficulty adjusting to light change; may progress to total blindness
4) diabetic retinopathy - damage to retinal capillaries, growth of abnormal blood vessels and hemorrhage leads to retinal scarring and finally retinal detachment; central vision is impaired, vision is blurred; complete blindness is rare (a complication of diabetes mellitus)
5) CVA, homonymous hemianopsia - loss of 1/2 visual field in each eye (nasal half of one eye and temporal half of other eye); produces the inability to receive information from right or left side; corresponds to side of sensorimotor deficit
6) medications - impaired or fuzzy vision may result with antihistamines, anti-psychotics, anti-depressants, steroids
-Aging changes: 1) diminished acuity, delayed reaction times, longer response times 2) reduced function of vestibular ocular reflex (VOR); affects retinal image stability with head movements, produces blurred vision 3) altered sensory organization - older adults more dependent upon somatosensory inputs for balance 4) less able to resolve sensory conflicts when presented with inappropriate visual or proprioceptive inputs due to vestibular losses 4) postural response patterns for balance are disorganized - characterized by diminished ankle torque, increased hip torque, increased postural sway
-Additional loss of vestibular sensitivity with pathology: 1) Meniere's disease - episodic attacks characterized by tinnitus, dizziness, and a sensation of fullness or pressure in the ears; may also experience sensorimotor hearing loss 2) Benign paroxysmal positional vertigo (BPPV) - brief episodes of vertigo (less than 1 minute) associated with position change; the result of degeneration of the utricular otoconia that settle on the cupula of the posterior semicircular canal; common in older adults 3) medications - antihypertensives (postural hypotension); anticonvulsants; tranquilizers, sleeping pills, aspirin, NSAIDS 4) cerebrovascular disease - verterbrobasilar artery insufficiency (TIAs, strokes); cerebellar artery stroke, lateral medullary stroke 5) ceregellar dysfunction - hemorrhage, tumors (acoustic neuroma, meningioma); degenerative disease of brain stem and cerebellum; progressive supranuclear palsy 6) migraine 7) cardiac disease
-Vision: 1) assess for visual deficits - acuity, peripheral vision, light and dark adaptation, depth perception; diplopia, eye fatigue, eye pain 2) maximize visual function - assess for use of glasses, need for environmental adaptations 3) sensory thresholds are increased - allow extra time for visual discrimination and response 4) work in adequate light, increase intensity, reduce glare; avoid abrupt changes in light, eg. light to dark 5) use large, high contrast print for written materials 6) provide magnifying glasses (either portable or attached to a stand/work table) to view objects and complete tasks 7) provide an eye patch for diplopia 8) decreased peripheral vision may limit social interactions; therefore, stand directly in front of the person at eye level when communicating with him/her 9) assist in color discrimination - use warm colors (yellow, orange, red) for identification and color coding 10) provide other sensory cues when vision is limited, eg. verbal descriptions to new environments, touching to communicate you are listening, "talking" clocks and watches 11) provide safety education; reduce fall risk
-Hearing: 1) assess for hearing - acuity, speech discrimination/comprehension; tinnitus, dizziness, vertigo, pain 2) assess for use of hearing aids; check for proper functioning 3) minimize auditory distractions, work in quiet environment 4) speak slowly and clearly, directly in front of person at eye level 5) use nonverbal communication to reinforce your message, eg. gesture, demonstration 6) provide written and demonstrated directions/guidelines for activities 7) orient person to topics of conversation he/she cannot hear to reduce paranoia, isolation 8) provide assistive devices to compensate for functional effects of hearing loss and to ensure person's safety, eg. vibrating and flashing smoke alarms, telephones, doorbells, and clocks
-Vestibular/balance control: 1) increased incidence of falls in older adults 2) fall prevention
-Somatosensory: 1) assess carefully - check for increased thresholds to stimulation, sensory loss by modality, area of body 2) allow extra time for responses with increased thresholds 3) use touch to communicate - maximize physical contact, eg. rubbing, stroking, and tapping 4) provide augmented feedback through appropriate sensory channels, eg. using kitchen utensils with wide textured grips may be easier than narrow smooth handles 5) teach compensatory strategies to prevent injury to anesthetic limbs 6) provide assistive devices and environmental modifications as needed for fall prevention 7) provide feedback devices as appropriate (eg. limb load monitor)
-Taste and smell: 1) assess for identification of odors, tastes (sweet, sour, bitter, salty); somatic sensations (temperature, touch) 2) decreased taste, enjoyment of food leads to poor diet and nutrition 3) older adults frequently increase use of taste enhancers, eg. salt or sugar 4) decreased home safety, eg. gas leaks, smoke
-Cardiovascular age-related changes: 1) changes due more to inactivity and disease than aging 2) degeneration of heart muscle with accumulation of lipofuscins (characteristic brown heart); mild cardiac hypertrophy left ventricular wall 3) decreased coronary blood flow 4) cardiac valves thicken and stiffen 5) changes in conduction system - loss of pace maker cells in SA node 6) changes in blood vessels - arteries thicken, less distensible; slowed exchange capillary walls; increased peripheral resistance 7) resting blood pressures rise - systolic greater than diastolic 8) decline in neurohumoral control - decreased responsiveness of end-organs to beta-adrenergic stimulation of baroreceptors 9) decreased blood volume, hemopoietic activity of bone 10) increased blood coagulability
-Pulmonary system age-related changes: 1) chest wall stiffness, declining strength of respiratory muscles results in increased work of breathing 2) loss of lung elastic recoil in increased work of breathing 3) changes in lung parenchyma: alveoli enlarge, become thinner; fewer capillaries for delivery of blood 4) changes in pulmonary blood vessels: thicken, less distensible 5) decline in total lung capacity - residual volume increases, vital capacity decreases 6) forced expiratory volume (air flow) decreases 7) altered pulmonary gas exchange - oxygen tension falls with age (at a rate of 4mmHg/decade; PaO2 at age 70 is 75, versus 90 at age 20) 8) blunted ventilatory responses of chemoreceptors in response to respiratory acidosis - decreased homeostatic responses 9) blunted defense/immune responses - decreased ciliary action to clear secretions, decreased secretory immunoglobulins, alveolar phagocytic function
-For cardiovascular changes: 1) changes at rest are minor - resting heart rate and cardiac output relatively unchanged; resting blood pressures increase 2) cardiovascular responses to exercise - blunted, decreased heart rate acceleration, decreased maximal oxygen uptake and heart rate; reduced exercise capacity, increased recovery time 3) decreased stroke volume due to decreased myocardial contractility 4) maximum heart rate declines with age 5) cardiac output decreases, 1% per year after age 20 - due to decreased heart rate and stroke volume 6) orthostatic hypotension - common problem in elderly due to reduced baroreceptor sensitivity and vascular elasticity 7) increased fatigue; anemia common in elderly 8) systolic ejection murmur common in elderly 9) possible ECG changes - loss of normal sinus rhythm; longer PR and QT intervals; wider QRS; increased arrhythmias
-For pulmonary changes: 1) respiratory responses to exercise - similar to younger adult at low and moderate intensities; at higher intensities, responses include increased ventilatory cost of work, greater blood acidosis, increased likelihood of breathlessness, and increased perceived exertion 2) clinical signs of hypoxia are blunted; changes in mentation and affect may provide important cues 3) cough mechanism is impaired 4) gag reflex is decreased, increased risk of aspiration 5) recovery from respiratory illness - prolonged in the elderly 6) significant changes in function with chronic smoking, exposure to environmental toxic inhalants
-Complete a cardiopulmonary assessment prior to commencing an exercise program: 1) this is essential in older adults due to the high incidence of cardiopulmonary pathologies 2) select an appropriate graded exercise testing protocol 3) standardized test batteries and norms for elderly are not available 4) many elderly cannot tolerate maximal testing; submaximal testing commonly used 5) testing and training modes should be similar
-Individualized exercise prescription is essential: 1) choice of training program based on - fitness level, presence or absence of cardiovascular disease, musculoskeletal limitations, individual's goals, roles, and activity interest 2) prescriptive elements (frequency, intensity, duration, and mode) are the same as for younger adults 3) walking, chair and floor exercises, Yoga, Tai-Chi, and modified strength/flexibility calisthenics are well-tolerated by most elderly 4) consider pool programs (exercises, Tai-Chi, walking, swimming) for persons with musculoskeletal and neurological impairments 5) consider multiple modes of exercise on alternate days to maintain interest and reduce likelihood of muscle injury, joint overuse, pain, fatigue, and boredom
-Aerobic training programs can significantly improve cardiopulmonary function in the elderly: 1) decreases heart rate at a given submaximal power output 2) improves maximal oxygen uptake (VO2max) 3) greater improvements in peripheral adaptation, muscle oxidative capacity then central changes 4) improves recovery heart rates 5) decreases systolic blood pressure, may produce a small decrease in diastolic blood pressure 6) increases maximum ventilatory capacity - vital capacity 7) reduces breathlessness, lowers perceived exertion 8) psychological gains, improves sense of well-being, self-image 9) improves functional capacity
-Improve overall daily activity levels for independent living: 1) lack of exercise/activity is an important risk factor in the development of cardiopulmonary disease 2) lack of exercise/activity contributes to problems of immobility and disability in the elderly