When a person gets injured or has a prolonged illness, doctors often recommend physical therapy. In the case of older people, though, sometimes this is seen as just something to "try." This could not be further from the truth. Physical therapy is "A-quality" therapy for many conditions affecting older people, from Alzheimer's to urinary incontinence. In fact, one researcher did a study in which you had to be 100 years of age to even participate!
According to Jennifer M. Bottomley, PhD, MS, PT, president of the geriatrics section of the American Physical Therapy Association (APTA) and adviser to the surgeon general, one of the main things that brings older people to the physical therapist is a fall. "They want and need to maintain their independence," she says.
"It's important to look at each individual," stresses Tim Kauffman, PT, PhD, professor of physical therapy at the Hahnemann campus of Drexel University in Philadelphia. "Every person of any age has an individual background, say an auto accident, football injury, genetic predispositions. No two 'old' people are the same."
According to APTA, physical therapy can restore or increase strength, range of motion, flexibility, coordination, and endurance -- as well as reduce pain. Another important role is to retrain the patient to do everyday tasks.
Guy Davidson, of Tempe, Ariz., was 70 when he had a stroke following bypass surgery. The formerly busy minister could not speak, his right leg would not support him, and his right arm hung straight down. He went into rehab for three months. At first he could only sing, which uses a different portion of the brain than speaking, but gradually he began to speak. After many stressful sessions ("I would be sweating," he admits), he regained much use of both his arm and leg and can dress himself, drive (he took lessons), and work full time. Now he's back in the hospital every day -- visiting sick parishioners.
Conditions Helped by Therapy
Physical therapy referrals are appropriate and helpful for many problems thought of as affecting older people.
Take arthritis, for example. By 65, almost everyone has it in their spine, Kauffman says, though not everyone has symptoms. Besides taking a pill, suffers can avail themselves of many types of physical therapy -- aquatic, hot packs, electrical stimulation, ice to reduce swelling, there is a long list. "We emphasize strength, range of motion, balance, and coordination," Kauffman says.
"We get a lot of referrals for osteoporosis," Bottomley notes. "We try to make people more stable in relation to gravity, doing extension exercises to keep posture erect. Osteoporosis can lead to falls and bones can be injured." (Weight-bearing exercise earlier in life can also prevent osteoporosis, studies show.)
Physical therapy can also help alleviate some of the pain associated with cancer. "We want to maintain the highest functionality," Bottomley says. "The correct exercises after mastectomy can reduce swelling and improve range of motion," Kauffman says. "The therapist has to determine the right exercise and right amount based on clinical judgment (rather than patients just moving around as much as they can stand to at home)."
How about that old favorite, incontinence? "This is an exercise in locating the muscles that control that and operating them at will," Kauffman says. Social timing is also important -- knowing how soon after drinking something you will need to use the restroom and planning for that. A physical therapist can help establish such patterns.
Strokes, as Davidson's experience illustrates, definitely require physical therapy. "We use something called proprioceptive neuromuscular facilitation," Bottomley says, explaining that this is a purposeful movement pattern that can stimulate and retrain the brain. Another technique -- which Davidson says greatly helped him -- is constraint therapy, in which the stroke sufferer's "good" limb is restrained and the weak or paralyzed one used 85% of the day. Speech retraining also can be an issue. "If the person is in pain, we can treat that electrically," Kauffman says.
Parkinson's is an "exciting" area, Kauffman says. "We have learned that physical intervention early -- before stage 4, when the therapist is often summoned -- can almost always prevent the severe symptoms of stage 4." He explains that the goal is to keep the Parkinson's patient's trunk flexible to avoid "robotic" movements. (Parkinson's disease is a chronic disease of the nervous system that results in a gradual decrease of muscle control.) Sometimes he has people lie on the floor and move their head and trunk in opposite directions. He even puts patients on horseback sometimes, which increases trunk strength and flexibility.
How can physical therapy help dementia and Alzheimer's patients? "We try to maintain function," Bottomley says, adding that the types of movement the patient remembers from the past is most effective, such as dancing or gardening. "This also prevents falls."
Balance is another issue with older people. "Balance is very complicated," Kauffman says. "It requires many systems in the body -- nutrition, oxygenation of blood, muscle strength, joint receptors, vision, inner ear. Physical therapy can tune up all of these areas. In one case, peripheral vision, patients are asked to throw and catch a weighted beachball that curves and wobbles through the air unpredictably, like a knuckleball.
Therapy is almost always prescribed for hip fracture and replacement patients, amputees, and those with joint aches and pains. "I call the latter 'grandparenting injuries,'" smiles Bottomley. "The grandkids come over and the grandparents take extra walks or climb on the playground equipment. Come Monday morning, ouch."
Role of Family
Even though an older person may have had a hospital stay or required extra attention, family members should be positive and supportive of more trips -- this time to therapy, Kauffman says. Relatives also need to understand the loss of mobility and independence. "It was a frightening experience to go home and be dependent," Davidson says. "They put up some grab bars, but I could not do things for myself.
Kauffman urges that family members never be dictatorial or expect a certain level of progress. Davidson adds, however, that you should find a therapist with goals and not one who is letting the insurance run out "hoping" you will improve.
Families should participate rather than nag, according to Bottomley. "When you come over, say, 'Mom, are you up to a walk?'" It is also important to be sure the patient is eating correctly -- bring microwaveable meals, or else your loved one may be living on crackers and cheese.
Above all, physical therapy is an ongoing process -- a journey. And as with all journeys, there will be ups and downs. Realistic expectations and a sense of humor help. In one case, a stroke victim had a little trouble with splatters in the bathroom, so he threw water all over his pants and came out warning others about the rogue faucet that had drenched him.
Star Lawrence is a medical journalist based in the Phoenix area.