Chapter 10: Neuromuscular and Movement Function: Muscle, Bone, and Joints

LEARNING OUTCOMES

By the end of this chapter, readers will be able to:

1. Describe the typical age-related muscular, skeletal, and nervous system structural changes that may lead to impairments and affect functional abilities.

2. Discuss the effects of aging on muscle strength, muscle power, and joint range.

3. Explain assessment considerations for the older adult and the specific procedures used for assessing range of motion, flexibility, and strength.

4. Describe the types of exercise and activity programs that may be used to increase range of motion, flexibility, and strength in the older adult.

5. Discuss the relationship between older adult function and muscle strength and power.

6. Identify interventions that may be used to prevent or lessen age-related neuromusculoskeletal changes in older adults.

Clinical Vignette

Mrs. Fran Smithson is a 78-year-old woman who lives with her husband of 56 years in a two-story home. There are five steps up into the house with a railing on both sides of the steps. There are eight steps (no railing) from the main floor to the second floor, where Mr. and Mrs. Smithson's bedroom is located.

Mrs. Smithson was diagnosed with osteoarthritis 10 years ago. She has severe pain in her hands that causes problems with dressing, primarily with the fine motor dexterity needed for buttons and clasps. In addition, food preparation is difficult (e.g., cutting food and opening containers). Mrs. Smithson has identified pain in her right hip and has been having difficulty negotiating stairs. She must climb one step at a time and often has to hold onto her husband to negotiate the stairs, especially since there is no railing. Mrs. Smithson was previously a very active woman. She volunteered at the local hospital visiting with patients twice a week. However, she is now only able to volunteer once every other week because her hip is too sore to visit the hospital more frequently. She is unhappy she can no longer knit, as she greatly enjoyed making socks, mittens, and sweaters for her 13 grandchildren. Mrs. Smithson loves to garden but, because of the pain in her hip and hands, she minimizes the work by maintaining only the flower boxes in the front of her house

1. What changes has Mrs. Smithson experienced that would be considered "normal" age-related changes? What changes would be considered "abnormal"?

2. How have meaningful daily activities been affected by the diagnosis of osteoarthritis and the subsequent symptoms?

3. On the basis of the information provided about Mrs. Smithson, what would be the main focus of your intervention(s)?