Geriatric Rehabilitation A Textbook For The Physical Therapist Assistant 1st Edition Jennifer Bottomley
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BOTTOMLEY
Geriatric Rehabilitation
A Textbook for the Physical Therapist Assistant
As the aging population continues to increase, so does the need
for a text specific to the specialized care of the elderly patient as Each pathological area
it applies to the physical therapist assistant student, faculty, and covered includes:
clinician. • Screening, assessment, and
evaluation
slackbooks.com
SLACK Incorporated
Jennifer M. Bottomley PT, MS, PhD2
Geriatric Rehabilitation Consultant & Educator
Boston, Massachusetts
PTA Advisors:
ISBN: 978-1-55642-816-6
All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher, except for brief quota-
tions embodied in critical articles and reviews.
The procedures and practices described in this book should be implemented in a manner consistent with the professional standards
set for the circumstances that apply in each specific situation. Every effort has been made to confirm the accuracy of the information
presented and to correctly relate generally accepted practices. The authors, editor, and publisher cannot accept responsibility for
errors or exclusions or for the outcome of the material presented herein. There is no expressed or implied warranty of this book or
information imparted by it. Care has been taken to ensure that drug selection and dosages are in accordance with currently accepted/
recommended practice. Due to continuing research, changes in government policy and regulations, and various effects of drug reac-
tions and interactions, it is recommended that the reader carefully review all materials and literature provided for each drug, especially
those that are new or not frequently used. Any review or mention of specific companies or products is not intended as an endorsement
by the author or publisher.
SLACK Incorporated uses a review process to evaluate submitted material. Prior to publication, educators or clinicians provide impor-
tant feedback on the content that we publish. We welcome feedback on this work.
Contact SLACK Incorporated for more information about other books in this field or about the availability of our books from distribu-
tors outside the United States.
Bottomley, Jennifer M.
Geriatric rehabilitation : a textbook for the physical therapist assistant / Jennifer Bottomley.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-55642-816-6 (alk. paper)
1. Physical therapy for older people. 2. Older people--Rehabilitation. I. Title.
[DNLM: 1. Physical Therapy Modalities. 2. Aged. 3. Aging--physiology. 4. Allied Health Personnel. 5. Geriatric Assessment--methods.
6. Rehabilitation--methods. WB 460 B751g 2010]
RC953.8.P58B68 2010
615.8’20846--dc22
2010005295
For permission to reprint material in another publication, contact SLACK Incorporated. Authorization to photocopy items for internal,
personal, or academic use is granted by SLACK Incorporated provided that the appropriate fee is paid directly to Copyright Clearance
Center. Prior to photocopying items, please contact the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA 01923 USA;
phone: 978-750-8400; web site: www.copyright.com; email: [email protected]
DEDICATION
To Senator Ted Kennedy (1932–2009), whose inspiring life and service in the US Senate has made the path
for aging Americans so much easier. What happens to the people you touch and never really know? Thanks
to your work, Senator Kennedy, you’ve touched and inspired many lives. If there are only 5 people for each
of us to meet in heaven, I will hope that one of them will be you.
z 1965: supported the creation of Medicare and Medicaid, programs he fought to strengthen and expand
for decades
z 1966: expanding the Economic Opportunity Act of 1964 to create a national health centered system
z 1972: Women, Infants and Children program, providing nutrition assistance to low-income mothers and
their children
z 1975: Education for All Handicapped Children Act, guaranteeing free and equal public education for
disabled children
z 1977: offered his first National Healthcare Plan, meant to cover all Americans
z 1985: Consolidated Omnibus Budget Reconciliation Act (COBRA), the Kennedy-sponsored law that
allows workers to get stop-gap health insurance while between jobs
z 1992: Mammography Quality Standards Act, improving the safety and accuracy of mammograms
z 1994: Family and Medical Leave Act, guaranteeing employees unpaid time off for illness and to care for
a family member
z 1996: Health Insurance Portability and Accountability Act, installing privacy standards for health infor-
mation and protecting workers from losing their health insurance when they change or lose their jobs
z 1997: State Children’s Health Insurance Program, helping states provide health coverage to low-income
uninsured children
z 2000: Minority Health and Health Disparities Research and Education Act, increasing research and data
collection on minority health
z 2006: Family Opportunity Act, expanding Medicaid to include funds to children with special needs
z 2010: Health care reform passed the House and Senate in March
Note: This only includes the bills Senator Kennedy inspired and help to write in the area of health. Of the
more than 2,500 bills written in his 46-year career in the US Senate, these highlights do not touch foreign
affairs, civil rights, or education, to name a few. These highlights are only some of the measures Senator
Kennedy sponsored, cosponsored, or negotiated in the area of health.
CONTENTS
Dedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
About the PT & PTA Advisors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii
About the Cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
My Gratitude to All,
Jennifer M. Bottomley
ABOUT THE AUTHOR
Jennifer M. Bottomley, PT, MS, PhD2, has a bachelor’s degree in
Physical Therapy from the University of Wisconsin–Madison and an
advanced master’s degree in Physical Therapy from the MGH Institute
of Health Professionals in Boston, MA. She also has a combined
intercollegiate doctoral degree in Gerontology (University of
Massachusetts) and Health Science and Service Administration (Union
Institute), as well as a second doctoral degree in Health Service
Administration, Legislation, and Policy Management with a specialty in
Gerontology (Union Institute).
Dr. Bottomley has been clinically practicing since 1974 in acute
care, home care, outpatient clinics, nursing homes and long-term care
facilities. Currently, she serves as an academic and clinical educator in
Geriatric Physical Therapy internationally and throughout the United
States in numerous university programs. In addition to teaching, Dr.
Bottomley is a rehabilitation consultant for Amedisys Home Health and Hospice, Inc. She practices clinically
in the Boston area in homeless shelters and has orchestrated free screening and intervention projects for the
homeless elderly of Massachusetts, obtaining federal grants to provide free screening and care for low-income
elders in 14 central Massachusetts cities and towns.
Dr. Bottomley has served on advisory boards for the Office of the Surgeon General and the Office of
Women’s Health for the Department of Health and Human Services, and was appointed to a White House
Interdisciplinary Medicare Reform Advisory Panel for rehabilitation in home care and long-term care settings.
She continues to serve in that capacity.
Dr. Bottomley is a nationally renowned speaker, author, and educator. She has contributed chapters to
many texts, published numerous articles and co-authored a geriatric text, now in its 3rd edition, with Carole
B. Lewis entitled Geriatric Rehabilitation: A Clinical Approach published in 2008. She has also edited the Quick
Reference Dictionary for Physical Therapy, now in its 2nd edition, published by SLACK Incorporated in 2004.
In 2006, MGH Institute of Health Professions recognized Dr. Bottomley with the 2nd annual Most
Distinguished Alumni Award. The Massachusetts chapter of the APTA also awarded her the Mary MacDonald
Distinguished Service Award in 2008.
ABOUT THE PT & PTA ADVISORS
Peggy DeCelle, Newman PT, MHR has practiced as a physical therapist for 27 years in a variety of settings
including acute care, outpatient orthopedics, institutional long-term care, and home health. Additionally, she
has managed allied health professionals in all of these settings. Currently, she continues to work with patients
in an outpatient setting, 2 afternoons per week.
Ms. Newman served as PTA Program Director at the Oklahoma City Community College from 1995-2006.
She also served as Academic Coordinator of Clinical Education (ACCE) at the University of Oklahoma
from 1988-1993. After leaving OCCC, she practiced clinically for a year, in a variety of settings, and
returned to the University of Oklahoma’s Department of Rehabilitation Sciences in 2007. She is currently
serving as the Director of Clinical Education, in addition to Director of the Faculty Continuing Education
Program and Assistant Professor.
Ms. Newman has served the OPTA in many roles including Chapter President and Chief Delegate, and she
currently serves as Chief Delegate and Membership Committee Co-Chair. She was appointed to the Oversight
Panel for the Analysis of Practice for the PT and PTA licensure examination by the Federation of State Boards
of Physical Therapy from 2005-2007.
She has presented locally and nationally on topics including “Vision 2020,” “Using Support Personnel
Effectively,” “The Guide to PT Practice: An Introduction,” “Let’s Talk Ethics,” and “Ethical and Legal Challenges
for Therapists in Today’s Health Care Environment.” She presented “Enhancing the Therapist: Therapist
Assistant Partnership” at the APTA Annual Conference in Boston in 2010.
Ms. Newman is the co-author of The PTA Handbook: Keys to Success in School and Career for the Physical
Therapist Assistant, published by SLACK in 2005. She recently authored the chapter “Standards of Practice” in
the Study Guide for the Physical Therapist Assistant’s Examination.
Karen Ryan, PTA has been an educator, author and physical therapist assistant clinician for over 20 years.
She received her associate in applied science degree as a PTA from St. Catherine’s College in Minneapolis, MN
and is currently completing her bachelor’s degree in Health Administration and Public Education at Metro
State College in Denver, CO. As a clinician, Ms. Ryan has worked in a multitude of practice settings and is
currently the administrator for a private physical therapy clinic, Back to Motion Physical Therapy, in Denver,
where she continues to keep her hand in direct client care every week. Ms. Ryan is also the editor and
contributing author for a national PTA licensure review and study guide, and teaches courses for PTA
graduates preparing for their licensure examination. In her spare time she takes full advantage of living in
Colorado, snowshoeing and hiking as often as possible.
Stacy Potvin, PTA, BA, BS received a bachelor of arts degree in English from Niagara University in 1986,
and a bachelor of science degree in Physical Education in 1990 from Canisius College. She worked as a physical
education teacher and athletic director before beginning her career as a physical therapist assistant.
She received an associate of science degree in Physical Therapy from Bay State College in 1996 and has
been working as a physical therapist assistant in the outpatient rehabilitation department at Beth Israel
Deaconess Medical Center since graduating. She is a PTA III, the senior PTA on staff, and treats patients with
a wide range of musculoskeletal problems, with a special interest in aquatic therapy, geriatrics, and sports
medicine. Ms. Potvin has been very involved in clinical education for physical therapist assistants, and is an
APTA credentialed clinical instructor who supervises students from Bay State College, North Shore College,
and Hesser College. She has also served on the advisory board for the clinical education program at Bay State
College.
ABOUT THE COVER
The cover portrait, “Newton,” by artist Deborah L. Bottomley, is of the author’s and artist’s grandfather.
Ms. Bottomley has captured the essence of Grandpa Newton in this beautifully detailed drawing, one in a
series of drawings of elders’ faces, reflecting life’s many challenges and joys in lines that go from the face
right to the heart.
Fundamental Concepts in
Geriatric Rehabilitation
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CHAPTER III
And in the narrow bed built within the wall in the tiny room, wherein
a tallow candle placed on a central table threw only very feeble rays,
the girl Rose Marie lay dreaming.
She—Rose Marie—the daughter of Papa Legros—as he was
uniformly called in the neighbourhood—she was now a great lady, by
the will of God and the decree of the Holy Father himself. She would
have a glass coach like the ladies whom she had so often seen
driving about in Versailles, and sit in it, dressed in the latest fashion
and holding a fan in her hand, which would be encased in a lace
mitten.
At this point in her dreams Rose Marie sat up in bed, very straight
and dignified, with her little hands folded over the cotton coverlet,
and she bent her young head to right and to left, like one saluting a
number of passers-by. A nod accompanied by an encouraging smile
indicated the greeting to a supposed friend, whilst a condescending
nod and a haughty stare suggested the presence of an acquaintance
of somewhat low degree.
Thus Rose Marie had seen the ladies behave in their coaches in
Versailles. She had seen Maria Mancini bow serenely to her admirers,
and the Queen Mother bestow the stony stare on her detractors. She
had watched, wondered and admired, but never had she tried to
imitate until now—now that her smile would be appreciated by
many, her frown be of consequence to others.
Up to now it had not mattered. Though her father was reputed to be
wealthy, he was only a tailor, who had to bow and scrape and wallow
before the great gentlemen of the Court. Aye! and had more than
once been soundly thrashed because of the misfit of a pair of Court
breeches.
And Rose Marie had oft sighed for greatness, for the gilded coach
and a seat at the opera, for silken dresses, flowers, patches and
rouge. She was only a child with an acutely developed sense of
sympathy for everything that was dainty and refined, everything that
smelt sweetly and was soft and tender to the touch.
Thus she went on dreaming her dream in content, never doubting
for a moment that happiness lay closely linked with this sudden
accession to grandeur. The fact that her lawful lord and husband had
shown a desire to break his marriage vows, and to take unto himself
some other wife more equal to him in rank and breeding than the
humble tailor's daughter, troubled Rose Marie not at all. With
sublime faith in the workings of Providence, she put her husband's
reluctance to acknowledge her down to his ignorance of herself.
He had never seen her since the day of the ceremony, eighteen
years ago. She was a baby in arms then, whilst now—
Rose Marie drew in her breath and listened. Maman was evidently
not yet coming up. All was still on this upper floor of the house. Rose
Marie put her feet to the ground and rose from her bed. She picked
up the candle from the table and tripped across the room to where—
on the whitewashed wall opposite—there hung a small gilt-framed
mirror.
Into this she peeped, holding the candle well above her head. Her
face wore neither the look of vanity, nor even that of satisfaction:
rather was it a look of the closest possible scrutiny. Rose Marie
turned her head to right and left again, but not—this time—in order
to enact a private comedy, but in order to convince herself in her
own mind that her cheeks had indeed that peach-like bloom, which
her overfond father had so oft proclaimed, and that her hair was
sufficiently brilliant in colour to be called golden, and yet not too
vivid to be called "roux."
We may take it that this scrutiny, which lasted nearly twenty
minutes, was of a satisfactory character, for presently, with a happy
little sigh, and heaving breast, Rose Marie tripped lightly back to her
narrow bed in the wall, and squeezed herself well within the further
dark angle, to which the flickering light of the tallow candle had no
access.
This she did because she had heard maman's step on the stairs, and
because her own cheeks now were of a flaming red.
PART II
CHAPTER IV
Mistress Julia Peyton waited for a few moments until the opening
and shutting of the outer door proclaimed the fact that young Lord
Stowmaries had really and definitely gone.
Then she went to the little secrétaire which stood in an angle of the
room, drew forth a sheet of paper, took a heavy quill pen in her
hand, and feverishly—though very laboriously—began to write.
It was a difficult task which the fair lady had set herself to do, for
neither writing nor spelling were among her accomplishments, being
deemed unnecessary and not pertaining to the arts of pleasing. But
still she worked away, with hand cramped round the rebellious quill,
dainty fingers stained with the evil-smelling black liquid, and her
brow puckered with the intensity of mental effort, until she had
succeeded in putting on paper just what she wished to say: