According to the CDC, more than one in four older adults fall each year. Falls may lead to fear of falling, decreased mobility, dependence, increased risk of future falls, and even death. The goal of a fall prevention and balance program is to decrease future falls and improve functional mobility, safety, and quality of life. Rehabilitation for those at risk of falling may include training for static and dynamic balance, gait, dual-task (DT) activity, and cognition which may be accomplished with virtual reality.
According to the CDC, in the U.S. there have been more than 33.9 million cases since January 2020. As many as 1 in 10 of those who develop COVID-19 exhibit new and prolonged symptoms lasting 12 weeks or longer. This is known as long COVID and occurs regardless of the severity of the acute illness. These individuals may have multisystem involvement with the most common symptoms after 6 months being fatigue, post-exertional symptom exacerbation (PESE), and problems with memory and concentration (brain fog). Therapists should screen for PESE, a worsening of symptoms typically 12 to 48 hours following even minimal cognitive, physical, emotional, or social activity that may last for days or weeks. (World Physiotherapy, 2021)
In a recent CDC Morbidity and Mortality Weekly Report, Moreland & Lee (2021) analyzed 2018 U.S. data which revealed individuals 65 and older had 2.4 million emergency department visits and more than 700,000 hospitalizations due to unintentional injuries. Greater than 90% of these injuries were related to falls. This shows the importance of an effective interdisciplinary fall prevention and balance program for the geriatric population.
According to the CDC, each year in the United States more than 795,000 people suffer a stroke and it is the leading cause of serious long-term disability. Individuals who suffer a stroke may have muscle weakness throughout the body including muscles of respiration and swallowing. They also may have compromised endurance, poor balance, and increased dependency with mobility and activities of daily living which greatly impact their quality of life.
According to the CDC, 78% of adults over 55 in the U.S. have one or more chronic conditions. The ability to perform activities of daily living (ADLs) such as transfers, dressing, and bathing along with instrumental activities of daily living (IADLs) such as shopping, cooking, and cleaning informs healthcare professionals regarding the individual’s level of independence. With chronic conditions such as COPD, chronic heart failure, stroke, and diabetes, individuals may have dyspnea, weakness, and poor aerobic capacity which in turn may lead to impaired ability to perform ADLs and IADLs.
Respiratory diseases are among the leading causes of death and disability in the United States. In 2019, chronic lower respiratory disease including asthma, but predominately chronic obstructive pulmonary disease (COPD), was the 4th leading cause of death and influenza and pneumonia the 9th leading cause of death (Kochanek et al., 2020). The ranking for 2020 will likely change due to COVID-19-related deaths at greater than 500,000.
Heart disease is the leading cause of death for both men and women in the United States with greater than 600,000 deaths attributed each year. Along with other conditions such as diabetes and obesity, heart disease may lead to heart failure which affects 6.2 million Americans per year (CDC, 2020).
Muscle strength decline is associated with normal aging and may be accelerated by illness, disease, or injury. Decreased physical activity resulting from COVID-19 mitigation efforts is exacerbating the incidence of muscle disuse atrophy in older adults. Strength declines may lead to functional and mobility deficits with increased risk of falls, injury, or death. According to the CDC, each year three million adults are treated in emergency departments for injuries related to falls. By 2030 fall deaths are anticipated to rise to seven per hour. Accurate assessment of strength using validated tests and objective measures is crucial to creating an appropriate treatment plan and achieving outcomes that reduce fall risk.
Physical and occupational therapists treat many individuals who present with impaired coordination, motor control, balance and tone. These individuals may have a wide range of diagnoses, from neurologically involved, such as cerebral vascular accident (CVA) and Parkinson’s disease, to orthopedic involvement such as post-total knee replacement (TKR). The common goal of improving functional mobility and outcomes may be achieved by the addition of research-supported cycling and biophysical agents.
The rehabilitation of patients with and recovering from COVID-19 is evolving and will be an integral part of therapy for the foreseeable future. The American Physical Therapy Association (APTA) developed a task force representing all academies and sections to identify core outcome measures to be used with all patients diagnosed with COVID-19 throughout care, across all settings. These outcome measures are to be used with patients having goals associated with five constructs; function, strength, endurance, cognition, and quality of life. (APTA, 2020)