This interactive New York Physical Therapy Ebook contains 36 hours of continuing education. To complete click the Complete Your CE button at the top right of the screen.
NEW YORK Physical Therapy Continuing Education
Elite Learning
This book satisfies all continuing education requirements for your license renewal.
ELITELEARNING.COM/BOOK Complete this book online with book code: PTNY3622B 36-hour Continuing Education Package $236
WHAT’S INSIDE
Chapter 1: Alzheimer’s Disease and Other Dementias: Medical Overview and Rehabilitation Management, 2nd Edition [4 Contact Hours] The purpose of this course is to provide useful, pragmatic information to rehabilitation therapists to facilitate successful rehabilitation for individuals with Alzheimer’s and other dementias. Too often, those with dementia are excluded from rehabilitation opportunities based on the assumption that they will not benefit, or they are given a brief trial of rehabilitation that does not take into consideration the special needs of this population and, as a result, they do not make gains. This course will provide an overview of Alzheimer’s disease and its medical management, practical information on optimal interactions with individuals who have Alzheimer’s disease, research findings related to motor learning in this population, existing evidence on rehabilitation with individuals with dementia, and strategies to facilitate successful outcomes. Chapter 2: Common Chronic Health Conditions Associated with Aging [3 Contact Hours] This course is designed to assist healthcare professionals in encouraging, teaching, and guiding older adults with chronic conditions to practice healthy lifestyles. This course explores common chronic conditions associated with aging, and discusses how healthcare professionals can help older adults manage these conditions and enhance health. Included is a look at the emotional effects of coping with loss, disability, and chronic conditions. Depression and bereavement are described, along with the stages of grief and methods of distinguishing among them. Because the incidence of cancer increases with age, preventive cancer screening and prevention guidelines for older adults are presented. Prevention, treatment of, and coping with such common problems as hearing loss, hypertension, and incontinence are also discussed. Because stroke, arthritis, and osteoporosis all have the potential to negatively affect functional status, these conditions are also reviewed to help promote healthy aging. Chapter 3: Evidence-Based Management of Knee Osteoarthritis [4 Contact Hours] The purpose of this course is to provide physical therapists and physical therapist assistants with up-to-date, evidence-based information pertaining to the diagnosis, treatment and prevention of knee OA. Although this course will be most applicable to physical therapists and physical therapist assistants who work with older individuals in outpatient settings, the increased incidence of OA makes the information in this course relevant to therapists in a variety of settings. Even therapists who specialize and treat patients in areas other than orthopaedic settings will likely encounter individuals whose OA affects their participation, mobility, or function. Chapter 4: Examination and Management of the Client With Parkinson’s Disease, 2nd Edition [5 Contact Hours] This course is designed to provide physical therapists and physical therapist assistants with the information needed to appropriately examine and treat the client with Parkinson’s disease (PD), including differential diagnosis of individuals who exhibit signs and symptoms indicative of PD. In addition, the learner will be able to manage clients with PD by designing a comprehensive treatment program based on the use of appropriate outcome measures. Equipped with the most current evidence, the learner will be able to discuss and critically evaluate interventions directed at the specific body structure and function, activity, and participation deficits associated with PD. Chapter 5: Exercise and Older Adults [2 Contact Hours] Worldwide, an estimated 424,000 people die each year from falls; the vast majority are from low- and middle- income countries. Additionally, an estimated 37.3 million falls require medical attention. Physical and occupational therapists also play an important role in decreasing the risk of falls in the elderly population. They can effectively develop exercise programs for the aging population and for special populations with specific diseases or conditions. These prescribed programs can improve an aging person’s functional activity levels, which can be seriously impacted by a fall, causing serious health consequences. Fall-prevention strategies can help decrease the risk of falls and improve overall health and functional ability in the aging population.
1
26
41
59
80
COURSE LIST CONTINUED ON NEXT PAGE ►
i
PHYSICAL THERAPY CONTINUING EDUCATION
Book Code: PTNY3622B
Chapter 6: Preventing Falls in Older Adults
89
[5 Contact Hours] An older adult falls every second of every day, with more than 29 million falls occurring in 2014, resulting in more than 7 million injuries. This intermediate-level course provides healthcare professionals in the areas of physical and occupational therapy with the knowledge they need to successfully identify those at risk for falls, assess individuals, and develop interventions targeted at reducing fall risk in older adults. Although therapists may be aware of the need to assess and treat older adults for risk for falls, they may not be fully abreast of approaches that are supported by evidence and are proven to truly reduce the incidence of falls. Chapter 7: Supporting Aging in Place: A Physical Therapist’s Toolkit [5 Contact Hours] This intermediate level course is designed to assist physical therapists and physical therapy assistants in evaluating, planning, and preparing their older adult clients to age in place. This toolkit will highlight the role physical therapy plays in enhancing the quality of life for older adults and to allow them to participate in meaningful activities while remaining in their homes as they age and make the necessary modifications to do so. Chapter 8: Telehealth for Physical and Occupational Therapy [1 Contact Hour] This course will teach practitioners how to set up and complete telehealth sessions for a physical or occupational therapy practice, primarily focusing on how to evaluate, monitor, and treat patients remotely. Chapter 9: Total Hip Arthroplasty: Current Concepts in Pre- and Postsurgical Physical Therapy [4 Contact Hours] This intermediate-level course provides physical therapists and physical therapy assistants with a comprehensive overview of total hip arthroplasty (THA). At the end of this course the learner will be able to identify the anatomy of the hip as it pertains to THA, describe the most recent advances in surgical approaches for THA, and gain an improved understanding of how different types of prosthetic implants, methods of fixation, and surgical techniques influence the ability of patients to participate in rehabilitation and achieve the desired clinical goals for functional independence. Additionally the learner will be able to describe the role of PT both in the preoperative and postoperative phases for the patient undergoing THA and be able to describe an optimal rehabilitation program for these time periods based on current research. Clinical cases presented will facilitate the learner being able to select appropriate rehabilitative strategies following THA. Chapter 10: Total Knee Arthroplasty: Current Concepts in Physical Therapy Management [3 Contact Hours] The purpose of this intermediate level course is to provide physical therapists and physical therapist assistants with a comprehensive overview of the many considerations surrounding knee replacement surgery, including the relevant anatomy, epidemiology, patient selection criteria, surgical considerations, common postoperative complications, and rehabilitation strategies. This course discusses the pre and postoperative patient management, rehabilitation goals and treatment in the acute, post-acute, and functional recovery stages. This course, which is relevant for physical therapists and physical therapy assistants, provides evidence-based research that supports rehabilitation treatment methods and outcomes following total knee arthroplasty while highlighting the areas in need of further study.
112
133
138
157
©2022: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.
ii
Book Code: PTNY3622B
PHYSICAL THERAPY CONTINUING EDUCATION
FREQUENTLY ASKED QUESTIONS
What are the requirements for license renewal? License Expires
Contact Hours
Mandatory Subjects
36 (All hours are allowed through home-study)
Licenses expire the end of the licensee’s birth month every 3 years.
None.
How much will it cost?
Contact Hours
Course Title
Price
Chapter 1: Alzheimer’s Disease and Other Dementias: Medical Overview and Rehabilitation Management, 2nd Edition
4
$32.00
Chapter 2: Common Chronic Health Conditions Associated with Aging
3
$24.00
Chapter 3: Evidence-Based Management of Knee Osteoarthritis
4
$32.00
Chapter 4: Examination and Management of the Client With Parkinson’s Disease, 2nd Edition
5
$40.00
Chapter 5: Exercise and Older Adults
2
$16.00
Chapter 6: Preventing Falls in Older Adults
5
$40.00
Chapter 7: Supporting Aging in Place: A Physical Therapist’s Toolkit
5
$40.00
Chapter 8: Telehealth for Physical and Occupational Therapy
1
$8.00
Chapter 9: Total Hip Arthroplasty: Current Concepts in Pre- and Postsurgical Physical Therapy
4
$32.00
Chapter 10: Total Knee Arthroplasty: Current Concepts in Physical Therapy Management
3
$24.00
Best Value - Save $52.00 - All 36 Hours
36
$236.00
How do I complete this course and receive my certificate of completion? See the following page for step by step instructions to complete and receive your certificate. Are you a New York board-approved provider? Colibri Healthcare, LLC is recognized by the New York State Education Department’s State Board for Physical Therapy as an approved sponsor of continuing education for Physical Therapists and Physical Therapy Assistants. Are my credit hours reported to the New York board? No. The board performs random audits at which time proof of continuing education must be provided. What information do I need to provide for course completion and certificate issuance? Please provide your license number on the test sheet to receive course credit. Your state may require additional information such as date of birth and/or last 4 of Social Security number; please provide these, if applicable. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Physical-Therapy you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 1-888-857-6920, Monday - Friday 9:00 am - 6:00 pm, EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory subjects (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file.
Licensing board contact information: New York State Education Department | Office of the Professions | State Board for Physical Therapy 89 Washington Avenue, 2nd Floor West | Albany, NY 12234 Phone (518) 474-3817, ext. 180 | Fax (518) 402-5944 Website: http://www.op.nysed.gov/prof/pt/
iii
PHYSICAL THERAPY CONTINUING EDUCATION
Book Code: PTNY3622B
Please read these instructions before proceeding. Read and study the enclosed courses and answer the final examination questions. To receive credit for your courses, you must provide your customer information and complete the evaluation. Follow the instructions below to receive credit and your certificate of completion. How to complete continuing education
Fastest way to receive your certificate of completion
Online • Go to EliteLearning.com/Book. If you wish to complete all courses in this book, enter code: PTNY3622B in the example box then click GO . If you are not completing all courses in this book, the individual course codes are shown in the table below. You will need to enter the course code into the example box and complete each course individually. • If you already have an account created, sign in to your account with your username and password. If you do not have an account already created, you will need to create one now. • Follow the online instructions to complete your final exam. Complete the purchase process to receive course credit and your certificate of completion. Please remember to complete the online survey.
Elite Learning
Enter book code
Example: ANCCFL2422
GO
If you need help finding your code, Browse Book Code FAQs
Your profession
Course Name
Course Code
All 36 Hours in the book
PTNY3622B
Alzheimer’s Disease and Other Dementias: Medical Overview and Rehabilitation Management, 2nd Edition
PTNY04AD
Common Chronic Health Conditions Associated with Aging
PTNY03CC
Evidence-Based Management of Knee Osteoarthritis
PTNY04KN
Examination and Management of the Client With Parkinson’s Disease, 2nd Edition
PTNY05PD
Exercise and Older Adults
PTNY02OA
Preventing Falls in Older Adults
PTNY05PF
Supporting Aging in Place: A Physical Therapist’s Toolkit
PTNY05SA
Telehealth for Physical and Occupational Therapy
PTNY01TH
Total Hip Arthroplasty: Current Concepts in Pre- and Postsurgical Physical Therapy
PTNY04TH
Total Knee Arthroplasty: Current Concepts in Physical Therapy Management
PTNY03TK
iv
Book Code: PTNY3622B
PHYSICAL THERAPY CONTINUING EDUCATION
WHAT’S INSIDE
Chapter 1: Alzheimer’s Disease and Other Dementias: Medical Overview and Rehabilitation Management, 2nd Edition [4 Contact Hours] The purpose of this course is to provide useful, pragmatic information to rehabilitation therapists to facilitate successful rehabilitation for individuals with Alzheimer’s and other dementias. Too often, those with dementia are excluded from rehabilitation opportunities based on the assumption that they will not benefit, or they are given a brief trial of rehabilitation that does not take into consideration the special needs of this population and, as a result, they do not make gains. This course will provide an overview of Alzheimer’s disease and its medical management, practical information on optimal interactions with individuals who have Alzheimer’s disease, research findings related to motor learning in this population, existing evidence on rehabilitation with individuals with dementia, and strategies to facilitate successful outcomes. Chapter 2: Common Chronic Health Conditions Associated with Aging [3 Contact Hours] This course is designed to assist healthcare professionals in encouraging, teaching, and guiding older adults with chronic conditions to practice healthy lifestyles. This course explores common chronic conditions associated with aging, and discusses how healthcare professionals can help older adults manage these conditions and enhance health. Included is a look at the emotional effects of coping with loss, disability, and chronic conditions. Depression and bereavement are described, along with the stages of grief and methods of distinguishing among them. Because the incidence of cancer increases with age, preventive cancer screening and prevention guidelines for older adults are presented. Prevention, treatment of, and coping with such common problems as hearing loss, hypertension, and incontinence are also discussed. Because stroke, arthritis, and osteoporosis all have the potential to negatively affect functional status, these conditions are also reviewed to help promote healthy aging. Chapter 3: Evidence-Based Management of Knee Osteoarthritis [4 Contact Hours] The purpose of this course is to provide physical therapists and physical therapist assistants with up-to-date, evidence-based information pertaining to the diagnosis, treatment and prevention of knee OA. Although this course will be most applicable to physical therapists and physical therapist assistants who work with older individuals in outpatient settings, the increased incidence of OA makes the information in this course relevant to therapists in a variety of settings. Even therapists who specialize and treat patients in areas other than orthopaedic settings will likely encounter individuals whose OA affects their participation, mobility, or function. Chapter 4: Examination and Management of the Client With Parkinson’s Disease, 2nd Edition [5 Contact Hours] This course is designed to provide physical therapists and physical therapist assistants with the information needed to appropriately examine and treat the client with Parkinson’s disease (PD), including differential diagnosis of individuals who exhibit signs and symptoms indicative of PD. In addition, the learner will be able to manage clients with PD by designing a comprehensive treatment program based on the use of appropriate outcome measures. Equipped with the most current evidence, the learner will be able to discuss and critically evaluate interventions directed at the specific body structure and function, activity, and participation deficits associated with PD. Chapter 5: Exercise and Older Adults [2 Contact Hours] Worldwide, an estimated 424,000 people die each year from falls; the vast majority are from low- and middle- income countries. Additionally, an estimated 37.3 million falls require medical attention. Physical and occupational therapists also play an important role in decreasing the risk of falls in the elderly population. They can effectively develop exercise programs for the aging population and for special populations with specific diseases or conditions. These prescribed programs can improve an aging person’s functional activity levels, which can be seriously impacted by a fall, causing serious health consequences. Fall-prevention strategies can help decrease the risk of falls and improve overall health and functional ability in the aging population.
1
26
41
59
80
COURSE LIST CONTINUED ON NEXT PAGE ►
i
PHYSICAL THERAPY CONTINUING EDUCATION
Book Code: PTNY3622B
Chapter 6: Preventing Falls in Older Adults
89
[5 Contact Hours] An older adult falls every second of every day, with more than 29 million falls occurring in 2014, resulting in more than 7 million injuries. This intermediate-level course provides healthcare professionals in the areas of physical and occupational therapy with the knowledge they need to successfully identify those at risk for falls, assess individuals, and develop interventions targeted at reducing fall risk in older adults. Although therapists may be aware of the need to assess and treat older adults for risk for falls, they may not be fully abreast of approaches that are supported by evidence and are proven to truly reduce the incidence of falls. Chapter 7: Supporting Aging in Place: A Physical Therapist’s Toolkit [5 Contact Hours] This intermediate level course is designed to assist physical therapists and physical therapy assistants in evaluating, planning, and preparing their older adult clients to age in place. This toolkit will highlight the role physical therapy plays in enhancing the quality of life for older adults and to allow them to participate in meaningful activities while remaining in their homes as they age and make the necessary modifications to do so. Chapter 8: Telehealth for Physical and Occupational Therapy [1 Contact Hour] This course will teach practitioners how to set up and complete telehealth sessions for a physical or occupational therapy practice, primarily focusing on how to evaluate, monitor, and treat patients remotely. Chapter 9: Total Hip Arthroplasty: Current Concepts in Pre- and Postsurgical Physical Therapy [4 Contact Hours] This intermediate-level course provides physical therapists and physical therapy assistants with a comprehensive overview of total hip arthroplasty (THA). At the end of this course the learner will be able to identify the anatomy of the hip as it pertains to THA, describe the most recent advances in surgical approaches for THA, and gain an improved understanding of how different types of prosthetic implants, methods of fixation, and surgical techniques influence the ability of patients to participate in rehabilitation and achieve the desired clinical goals for functional independence. Additionally the learner will be able to describe the role of PT both in the preoperative and postoperative phases for the patient undergoing THA and be able to describe an optimal rehabilitation program for these time periods based on current research. Clinical cases presented will facilitate the learner being able to select appropriate rehabilitative strategies following THA. Chapter 10: Total Knee Arthroplasty: Current Concepts in Physical Therapy Management [3 Contact Hours] The purpose of this intermediate level course is to provide physical therapists and physical therapist assistants with a comprehensive overview of the many considerations surrounding knee replacement surgery, including the relevant anatomy, epidemiology, patient selection criteria, surgical considerations, common postoperative complications, and rehabilitation strategies. This course discusses the pre and postoperative patient management, rehabilitation goals and treatment in the acute, post-acute, and functional recovery stages. This course, which is relevant for physical therapists and physical therapy assistants, provides evidence-based research that supports rehabilitation treatment methods and outcomes following total knee arthroplasty while highlighting the areas in need of further study.
112
133
138
157
©2022: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.
ii
Book Code: PTNY3622B
PHYSICAL THERAPY CONTINUING EDUCATION
FREQUENTLY ASKED QUESTIONS
What are the requirements for license renewal? License Expires
Contact Hours
Mandatory Subjects
36 (All hours are allowed through home-study)
Licenses expire the end of the licensee’s birth month every 3 years.
None.
How much will it cost?
Contact Hours
Course Title
Price
Chapter 1: Alzheimer’s Disease and Other Dementias: Medical Overview and Rehabilitation Management, 2nd Edition
4
$32.00
Chapter 2: Common Chronic Health Conditions Associated with Aging
3
$24.00
Chapter 3: Evidence-Based Management of Knee Osteoarthritis
4
$32.00
Chapter 4: Examination and Management of the Client With Parkinson’s Disease, 2nd Edition
5
$40.00
Chapter 5: Exercise and Older Adults
2
$16.00
Chapter 6: Preventing Falls in Older Adults
5
$40.00
Chapter 7: Supporting Aging in Place: A Physical Therapist’s Toolkit
5
$40.00
Chapter 8: Telehealth for Physical and Occupational Therapy
1
$8.00
Chapter 9: Total Hip Arthroplasty: Current Concepts in Pre- and Postsurgical Physical Therapy
4
$32.00
Chapter 10: Total Knee Arthroplasty: Current Concepts in Physical Therapy Management
3
$24.00
Best Value - Save $52.00 - All 36 Hours
36
$236.00
How do I complete this course and receive my certificate of completion? See the following page for step by step instructions to complete and receive your certificate. Are you a New York board-approved provider? Colibri Healthcare, LLC is recognized by the New York State Education Department’s State Board for Physical Therapy as an approved sponsor of continuing education for Physical Therapists and Physical Therapy Assistants. Are my credit hours reported to the New York board? No. The board performs random audits at which time proof of continuing education must be provided. What information do I need to provide for course completion and certificate issuance? Please provide your license number on the test sheet to receive course credit. Your state may require additional information such as date of birth and/or last 4 of Social Security number; please provide these, if applicable. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Physical-Therapy you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 1-888-857-6920, Monday - Friday 9:00 am - 6:00 pm, EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory subjects (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file.
Licensing board contact information: New York State Education Department | Office of the Professions | State Board for Physical Therapy 89 Washington Avenue, 2nd Floor West | Albany, NY 12234 Phone (518) 474-3817, ext. 180 | Fax (518) 402-5944 Website: http://www.op.nysed.gov/prof/pt/
iii
PHYSICAL THERAPY CONTINUING EDUCATION
Book Code: PTNY3622B
Please read these instructions before proceeding. Read and study the enclosed courses and answer the final examination questions. To receive credit for your courses, you must provide your customer information and complete the evaluation. Follow the instructions below to receive credit and your certificate of completion. How to complete continuing education
Fastest way to receive your certificate of completion
Online • Go to EliteLearning.com/Book. If you wish to complete all courses in this book, enter code: PTNY3622B in the example box then click GO . If you are not completing all courses in this book, the individual course codes are shown in the table below. You will need to enter the course code into the example box and complete each course individually. • If you already have an account created, sign in to your account with your username and password. If you do not have an account already created, you will need to create one now. • Follow the online instructions to complete your final exam. Complete the purchase process to receive course credit and your certificate of completion. Please remember to complete the online survey.
Elite Learning
Enter book code
Example: ANCCFL2422
GO
If you need help finding your code, Browse Book Code FAQs
Your profession
Course Name
Course Code
All 36 Hours in the book
PTNY3622B
Alzheimer’s Disease and Other Dementias: Medical Overview and Rehabilitation Management, 2nd Edition
PTNY04AD
Common Chronic Health Conditions Associated with Aging
PTNY03CC
Evidence-Based Management of Knee Osteoarthritis
PTNY04KN
Examination and Management of the Client With Parkinson’s Disease, 2nd Edition
PTNY05PD
Exercise and Older Adults
PTNY02OA
Preventing Falls in Older Adults
PTNY05PF
Supporting Aging in Place: A Physical Therapist’s Toolkit
PTNY05SA
Telehealth for Physical and Occupational Therapy
PTNY01TH
Total Hip Arthroplasty: Current Concepts in Pre- and Postsurgical Physical Therapy
PTNY04TH
Total Knee Arthroplasty: Current Concepts in Physical Therapy Management
PTNY03TK
iv
Book Code: PTNY3622B
PHYSICAL THERAPY CONTINUING EDUCATION
Chapter 1: Alzheimer’s Disease and Other Dementias: Medical Overview and Rehabilitation Management, 2nd Edition 4 Contact Hours
By: Julie D. Ries, PhD, PT Learning objectives
After completing this course, the learner will be able to: Define Alzheimer’s disease and other neurocognitive disorders. Describe the brain changes, stages, etiology, and risk factors of Alzheimer’s disease. Identify diagnostic methods and pharmacological interventions used with individuals who have Alzheimer’s disease. Course overview Alzheimer’s disease is the most prevalent cause of dementia, accounting for 60% to 80% of all cases with current estimates suggesting that 5.5 million older adults in the United States are living with Alzheimer’s dementia (Alzheimer’s Association, 2018a). According to the Alzheimer’s Association (2018a), one in 10 older Americans has Alzheimer’s dementia, and almost two-thirds of them are women, likely due to the fact that women live longer than men. According to the U.S. Census Bureau, currently more than 48 million adults aged 65 years and older make up 15% of the population; by 2050, the older population is expected to exceed 88 million, comprising more than 22% of Americans (He, Goodkind, & Kowal, 2016). Because age is the primary risk factor for Alzheimer’s disease, the number of people with Alzheimer’s disease is projected to nearly triple by 2050, reaching 14 million. The incidence of Alzheimer’s disease is expected to climb sharply around 2030, when all baby boomers (people born between 1946 and 1964) will be older than 65 years. The likelihood of rehabilitation professionals treating individuals with Alzheimer’s disease increases year by year. The purpose of this course is to provide useful, pragmatic information to rehabilitation therapists to facilitate successful rehabilitation for individuals with Alzheimer’s and other dementias. Too often, those with dementia are excluded from rehabilitation opportunities based on the assumption that they will not benefit, or they are given a brief trial of rehabilitation that does not take into consideration the special needs of this population and, as a result, they do not make gains. This course will provide an overview of Alzheimer’s disease and its medical management, practical information on optimal interactions with individuals who have Alzheimer’s disease, research findings related to motor learning in this population, existing evidence on rehabilitation with individuals with dementia, and strategies to facilitate successful outcomes. This is an intermediate-level course for rehabilitation professionals working with the geriatric population. Physical and occupational therapists who have limited knowledge of Alzheimer’s disease and other dementias often manage these individuals within the same theoretical framework and strategies with which they approach their cognitively intact clients, which may result in limited success. Staples & Killian (2012) surveyed physical therapists in skilled nursing facilities and found that these professionals felt they would benefit from increased training and resources to effectively manage older adults with dementia, particularly those with late-stage disease. Negative beliefs and attitudes related to working with individuals who have advanced dementia were revealed in their study, suggesting the presence of therapeutic nihilism (disbelief in any benefit of therapy). In a survey of physical and occupational
Describe movement disorders associated with Alzheimer’s disease and the principles for facilitating motor learning and optimizing interactions with individuals who have Alzheimer’s disease. Describe evidence-based rehabilitation interventions for individuals with Alzheimer’s disease and appropriate outcome measures. Implement strategies to facilitate optimal therapeutic success with individuals with Alzheimer’s disease. therapists working with individuals in long-term care settings who have dementia, Buddingh et al. (2013) identified patients’ dementia-related cognitive, emotional, and motor issues and the facility’s time and staffing constraints as the top perceived barriers to providing the best care. Both studies identified the therapists’ perceived need for further education related to working with older adults who have dementia. Existing evidence shows that the needs of individuals with Alzheimer’s disease are different from the needs of those without cognitive deficits. Observation of and respect for special considerations related to personal interaction, communication, cueing, and motor learning can substantially impact the success of rehabilitation with this population. Given the prevalence of Alzheimer’s disease in those older than age 65, any rehabilitation professional working with older adults is likely to work with patients who have dementia, including those working in the typical orthopedic outpatient setting. Physical and occupational therapists who address the unique needs of this population will have greater success in their rehabilitation efforts, and their patients will reap the benefits of their knowledge and skill. Each of the following scenarios presents unique challenges. This course should provide the knowledge and confidence to address these scenarios and facilitate the best possible outcome: A physical therapist is consulting with a local adult daycare program for individuals with Alzheimer’s disease. The therapist has been hired to implement and oversee an ongoing exercise program with the primary goals of increasing balance and decreasing falls. How should the therapist proceed? A staff occupational therapist at a subacute facility is working with an 83-year-old woman with a diagnosis of Alzheimer’s disease who is 3 days post-op for open reduction internal fixation of hip fracture secondary to a fall. The primary occupational therapist who has been following her for the two previous visits writes, “Patient is confused and unable to follow commands or actively participate in therapy. Low priority.” How should the staff occupational therapist proceed? A physical therapist at a skilled nursing facility is interested in developing a program of regular physical activity for a group of residents on the memory unit. The medical director of the facility is not convinced of the value of the program. How should the therapist proceed?
EliteLearning.com/Physical-Therapy
Book Code: PTNY3622B
Page 1
A home care physical therapist evaluates a 78-year-old woman with Alzheimer’s disease, who lives with her loving husband. Prior to a recent hospital admission, she was independently ambulatory. She had a recent bout with pneumonia but she is bouncing back, and her husband is motivated to oversee a home exercise program that will help her regain her prior level of functioning or perhaps even exceed it. How should the therapist proceed?
A home care occupational therapist evaluates an 80-year-old man with Alzheimer’s disease who was recently discharged from the hospital after a brief stay for lower extremity cellulitis. His medical status is stable, but his wife notes that he is struggling with self-care and activities of daily living that he was able to do independently prior to admission. How should the therapist proceed?
DEFINING DEMENTIAS AND RELATED NEUROCOGNITIVE DISORDERS
Dementia is an umbrella term that refers to a variety of diseases and conditions that impact cognition and behavior to the extent of interfering with daily functioning. All dementias result from nerve cell damage and death in the central nervous system. To varying degrees, they alter memory and cognition to the point of negatively affecting personal, social, occupational, and functional status. Although true dementia is chronic and irreversible, dementia- like symptoms can also be seen in conditions that are reversible or treatable. Clinical observation and neuropsychological testing provide the basis for a diagnosis of dementia. Careful observation and synthesis of information about specific symptomatology, the characteristics of onset, and the progression of symptoms can contribute to an accurate diagnosis of dementia type. Increasingly, certain dementias can Alzheimer’s disease Alzheimer’s disease is the sixth leading cause of death in the United States and the fifth leading cause of death among persons aged 65 and older (Alzheimer’s Association, 2018a). While other top causes of death (such as cancer and cardiovascular-related deaths) are decreasing, deaths related to AD are on the rise; and after age 74, AD death rates rise steeply. Death from AD is admittedly difficult to accurately measure. The sequelae of AD include problems with mobility that can lead to pneumonia, falls, and problems with swallowing that can lead to malnutrition. A cascade of events, initiated because of dementia, can lead to death, however documenting the cause of death is not always clear: Is AD the cause of death when an individual dies from sepsis due to pneumonia that results from immobility due to dementia? Or is AD incidental to the cause of death? The clarity of whether someone dies with or from AD continues to be hazy. Nevertheless, deaths from AD are on the rise, and this cannot be entirely explained by the increasing age of the population. It is likely that decreasing death rates from other causes (e.g., heart disease, stroke), increased and earlier diagnosis of AD, and better reporting of AD on death certificates are combined contributors to this rise. Death by age 80 is twice as likely in those who have AD compared to the general population (Alzheimer’s Association, 2018a). Alzheimer’s disease progresses gradually. Most noticeable in the early stages is memory impairment. Friends and family begin to Vascular dementia Vascular dementia, in the form of multi-infarct or post-stroke dementia, is considered the second most common type of dementia, and it can be seen in combination with AD or other dementias. Vascular dementia develops when blood flow is impaired, depriving areas within the brain of necessary oxygen and nutrients. The damage can result from widespread small vessel disease (multi-infarct) or from blockage of a major artery (cerebrovascular accident or stroke). A hallmark of vascular dementia is the sudden onset of symptoms (e.g., after a single major infarct blocks the blood supply to a significant portion of the brain) and/or a stepwise progression of symptoms over time (e.g., following a series of mini-strokes or infarcts in small vessels). This feature differentiates vascular dementia from AD, in which the progression of symptoms is subtle and gradual. Because the pathology underlying this type of dementia is not unique to the vessels of the brain, but is systemic, individuals
be more definitively diagnosed using biochemical and genetic markers. Mounting evidence from long-term observational and autopsy studies suggests that many people have brain abnormalities associated with dementias of more than one type (Alzheimer’s Association, 2018a; National Institute on Aging [NIA], 2018). Data from 2014 Medicare claims suggests that one-third of Medicare beneficiaries who die in a given year have been diagnosed with Alzheimer’s disease (AD) or another dementia (Alzheimer’s Association, 2018a). The following information on various types of dementia is compiled from multiple sources (Alzheimer’s Association, 2018a; NIA, 2018). Although the focus of this course is AD, practitioners will benefit from a basic understanding of other types of dementia. notice deficiencies as the disease progresses. Visuospatial and language problems, along with problems with abstract thinking, become increasingly prevalent, interfering with the ability to manage such instrumental activities of daily living (IADLs) as planning a meal or balancing a checkbook. Many people in the early stages of AD demonstrate some awareness of their growing mental deficiencies, but as the disease progresses, insight into one’s own disability diminishes, and major gaps in memory and cognition become apparent. Functional declines in activities of daily living (ADLs) and self-care skills follow and, eventually, individuals with AD require constant supervision and help with all ADLs. As the disease enters the late stages, individuals with AD lose the ability to communicate, control movement, and interact with their environment. The hallmark neuropathology of AD includes (a) plaques made up of beta-amyloid proteins that impact neuron-to-neuron transmission and communication and (b) neurofibrillary tangles made up of abnormal tau protein that negatively impact the cell microtubule transport system, preventing the import of essential nutrients into the cell. An inflammatory response in the midst of neuron damage and decreased neuron connectivity also contribute to AD pathology. Because AD is the focus of this course, more specific information about the etiology, pathology, risk factors, and diagnosis of AD will follow the discussion of the types of dementia. with vascular dementia also have a high risk of cardiovascular conditions (e.g., coronary artery disease, myocardial infarction, high blood pressure, high cholesterol) and peripheral vascular disease, a relevant fact to keep in mind when working with this population. Symptoms of vascular dementia vary depending on the specific area or areas of brain involvement. Whereas the first noticeable symptom in AD is almost always memory loss, individuals with vascular dementia may not present with early memory loss, but instead with impaired executive functions (e.g., poor judgment, inability to make plans), depending on the location of vascular lesions. Individuals who experience major vessel stroke and resulting vascular dementia may also present with typical physical impairment (i.e., hemiparesis or hemiplegia) and/or language deficits (i.e., expressive, receptive, or global aphasia).
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Book Code: PTNY3622B
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A diagnosis of vascular dementia is made based on clinical presentation, neurocognitive testing, and brain imaging studies. Magnetic resonance imaging (MRI) of the brain may show characteristic abnormalities associated with vascular damage, but it may not be conclusive. Some changes in the brain that are consistent with vascular dementia can coexist with the distinct brain changes seen in AD, leading to a diagnosis of mixed dementia (i.e., evidence of any two or more dementias
are present). Because vascular dementia is closely tied to other cardiovascular conditions, managing risk factors associated with heart disease can play a role in preventing later cognitive decline. Preventive treatment may include monitoring blood pressure, weight, blood sugar, and cholesterol and maintaining a high level of physical activity. Active management of risk factors, even after diagnosis, is essential to comprehensive care. The progressive courses of the three most common types of dementia are distinctly different and are depicted in Figure 1. Alzheimer’s dementia shows a slow, somewhat steady progression, vascular dementia progresses in a stepwise fashion, and LBD often shows significant fluctuations over time. Figure 1: Progressive Course of the Most Common Dementias
Dementia with Lewy bodies and Parkinson’s disease dementia Dementia with Lewy bodies is the third most common cause of dementia and is often considered to include two types of presentations: Lewy body dementia (LBD) and Parkinson’s disease dementia (PDD). The pathology and clinical picture of these two dementias are similar, and their diagnoses are generally related to the timing of the onset of symptoms. If parkinsonian motor symptoms precede cognitive symptoms by 1 year or more, the dementia is classified as PDD, but if cognitive symptoms precede or are concurrent with Parkinson’s motor symptoms, LBD is diagnosed. Lewy bodies are abnormal deposits of the protein alpha- synuclein that form inside nerve cells within the brain. Alpha- synuclein is normally present in a healthy brain, but abnormal clumps of this protein in central nervous system neurons are a hallmark of LBD and PDD. A definitive differentiation among AD, LBD, and PDD can be difficult because the neuropathology of AD can coexist with Lewy bodies. Lewy body pathology leads to patterns of decline similar to those seen in AD, including problems with memory, judgment, and behavior changes; although memory impairment is the hallmark symptom of AD, it may not be the first symptom to appear in LBD. Daily fluctuations in cognitive symptoms (e.g., level of arousal, attention, facility of speech) may be apparent in LBD, but they are not as common in AD. People with LBD may also experience visual hallucinations, sleep disorders, and autonomic dysregulation. Finally, parkinsonian motor symptoms of tremor, bradykinesia, rigidity, and postural instability are seen with PDD and can develop with LBD.
Note. From Western Schools, 2020.
Mixed dementias More common than previously thought, mixed dementias present with pathology and symptoms of two or more types of dementia – most commonly Alzheimer’s and vascular dementia, but sometimes LBD or other dementias. Patients with mixed dementias often present with the classic memory Frontotemporal dementia Frontotemporal dementias (FTDs) are a group of conditions affecting the nerve cells in the frontal and temporal lobes of the brain with hallmark symptoms related to personality, behavior, and emotional and language disorders. FTD is the most common type of dementia in individuals younger than age 60. The early onset and the usual relative sparing of memory until late in the disease can result in a misdiagnosis of a psychiatric disorder prior to an accurate diagnosis of FTD. FTD is characterized by the early and rapid onset of severe personality and behavior disturbances, including impairments in personal interactions, Less common types of dementia There are other less common types of dementia, some of which present with unique clinical characteristics. HIV-associated dementia HIV can cause an encephalopathy (also called AIDS dementia complex ), which presents as widespread destruction of the brain’s white matter. Unlike other sequelae of HIV, this condition is related to the presence of the virus itself, as opposed to being the result of an opportunistic infection. Individuals with HIV-associated dementias present with memory and learning impairment, confusion, and difficulty with executive functions. Over time, they may develop motor problems as well.
and cognitive impairment seen with AD, but they may have a stepwise progression of clinical deterioration (as seen in vascular dementia) or more fluctuation of cognitive impairment (as seen in LBD).
judgment, planning, and social functioning. Inappropriate comments to others and irrational decision making regarding finances or personal matters are common. Individuals with FTD may present as disconnected from a situation and appear either apathetic and disinterested or manic. The microscopic brain changes in FTD appear to be related to accumulation of abnormal tau protein (tauopathy) and scarring (gliosis). There are several subtypes, including variant FTD, primary progressive aphasia, progressive supranuclear palsy (PSP), and Pick’s disease. Huntington’s disease dementia Huntington’s disease is a fatal brain disorder caused by a faulty gene for the protein huntingtin. The gene destroys nerve cells, beginning in the basal ganglia, causing a typical triad of symptoms: motor, cognitive, and psychiatric. Huntington’s disease is an autosomal dominant trait, so anyone with a parent who has Huntington’s disease has a 50% chance of inheriting the gene and a 100% chance of developing Huntington’s disease if he or she inherits the gene. Symptoms typically surface between age 30 and 50 years, with progressive and significant disability. Death usually occurs 15 to 25 years after symptom onset. Motor symptoms of Huntington’s disease include involuntary choreiform (rapid, jerky, dyskinetic) movements of the trunk
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Book Code: PTNY3622B
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