Geriatric Rehabilitation PDF 2023-2024

By:Dr. Tareq ElSayed Kamal Lecturer of Physical Therapy Faculty of Physical Therapy Sphinx University 2023 - 2024  Outline the symptoms of hypotension.  Name the causes of hypotension.  Define orthostatic hypotension.  List the exercises suitable f...

By:Dr. Tareq ElSayed Kamal Lecturer of Physical Therapy Faculty of Physical Therapy Sphinx University 2023 - 2024  Outline the symptoms of hypotension.  Name the causes of hypotension.  Define orthostatic hypotension.  List the exercises suitable for hypotension patients. Hypotension  Low blood pressure, means that the pressure of blood circulating around the body is lower than normal.  Category Systolic Diastolic (normal) 110-129 70-84 Grade I (Mild) 90-109 60-69 Hypotension Grade II (Moderate) 70-89 50-59 Hypotension Grade III (Severe) 40-49 50-69 Hypotension Extremely Severe < 40 Hypotension < 50 There are three major types of low blood pressure: 1- Orthostatic hypotension. 2- Postprandial hypotension. Postprandial hypotension (PPH) is a significant drop in blood pressure after eating. 3- Neural mediated hypotension (neurogenic orthostatic hypotension or vasovagal syncope). Definition Systolic blood pressure decreases by at least 20 mmHg or diastolic blood pressure decrease by at least 10 mmHg within three minutes of standing. Most common symptoms Feeling light-headed - dizzy or faint soon after arising – blurred (tunnel) vision – Sweating.  Causes 1. Nervous system diseases, such as neuropathy (neurogenic orthostatic hypotension). 2. Prolonged bed rest (decrease sensitivity of the carotid bodies baroreceptors (stretch receptors) and aortic sinus). 3. Dehydration. 4. Irregular heart beat (heart arrhythmia). Management of Orthostatic hypotension Assessment and treatment  Nonpharmacologic management To avoid falling Slow changes in position. Stockings: to increase venous return. Avoid extremes of temperature. Activities: Before rather than after a meal. Afternoon rather than morning. Avoid heavy lifting.  Moving from the supine to standing position in gradual stages (including continuous changing of the position throughout the day. e.g.: half-lying position using pillows, semi-sitting, and sitting at the edge of the bed). Breathing Exercises (that improve venous return so cardiac output increases). Isometric lower-extremity exercise in the bed as an ankle pump.  Water exercises are particularly helpful because of the improvement in venous return produced by the pressure of the water. Reclining exercises (recumbent biking or rowing) are preferable. Compression (elastic) Garment (stocking): used to decrease venous pooling on standing. It is best to use thigh or waist high stockings that produce at least 15 to 20 mmHg pressure. N.B: During a PT session, it will be important to monitor a patient's BP before, during, and after exercise.  Getting plenty of fluids. Keeping hydrated helps prevent symptoms of low blood pressure. Drink plenty of water before long periods of standing, or any activities that tend to trigger symptoms.  Avoiding alcohol. Alcohol can worsen orthostatic hypotension, so limit or avoid it completely.  Increasing salt in the diet. This must be done carefully and only after discussing it with a health care provider. Too much salt can cause blood pressure to increase beyond a healthy level, creating new health risks.  Eating small meals: If blood pressure drops after eating, having small, low-carbohydrate meals might help.  Exercising. Regular cardiovascular and strengthening exercises might help reduce symptoms of orthostatic hypotension. Avoid exercising in very hot, humid weather.  Raising the head of the bed. Sleeping with the head of the bed slightly raised can help fight the effects of gravity.  Postprandial hypotension (PPH) is a significant drop in blood pressure after eating.  PPH is common in elderly patients with autonomic system dysfunction. It occurs in roughly 1/3 of patients with diabetes mellitus and the majority of patients with Parkinson’s disease (PD). It is also seen in patients with paraplegia and Alzheimer’s disease.  Patients with heart failure and hypertension have also been noted to have postprandial blood pressure drops. Diuretics like furosemide can potentiate the postprandial blood pressure drop.  Education regarding the risk of falling 15–90 minutes after eating.  Remaining in a supine position following a meal.  Avoiding alcoholic beverages with large meals.  Ensuring adequate hydration with eating.  Encouraging frequent small meals instead of infrequent large meals.  Decreasing the amount of carbohydrates in a meal and serving at colder temperatures.  Coffee drinking with a meal.  Exercise and walking gradually after meals. As with lung sounds, superficial topographical landmarks assist the therapist in auscultation of heart sounds and murmurs.  Aortic: Second ICS, at right sternal border (RSB)  Pulmonic: Second ICS, at left sternal border(LSB)  Tricuspid: Fourth and fifth ICS, LSB  Mitral: cardiac apex fifth ICS, MCL.