Physical therapists play a unique role in the health care system: as experts in task analysis, we are the professionals who examine problems that individuals encounter in their mobility and daily function, whether due to injury, illness, surgery, or deconditioning. A solid understanding of anatomy and kinesiology is certainly the foundation for our skill set. We also incorporate knowledge of typical development and of age-related changes across multiple systems: the ability to “data collect and data process” of the sensory and perceptual systems, the ability to interpret, analyze, remember, and learn of the many association areas of the brain; the ability to plan and initiate appropriate movement responses of the various components of the motor system, and the challenges that may be encountered in enacting responses by an aging or deconditioned musculoskeletal or cardiopulmonary/ cardiovascular system. When working with an aging adult, we determine which of the potential contributors to movement dysfunction are remediable with intervention, or when adaptation of the task or environment may instead be necessary. We depend on our knowledge of measurement to select and interpret the most appropriate tools to use in our examination. After we have gathered information from our older patient's history and physical examination, our process of evaluation leads to a physical therapy diagnosis that is movement- or function-centered, rather than disease-centered. We determine a movement-oriented prognosis that takes into account the older adult's goals and expectations, health and cognitive status, support network, and living environment, as well as the affordance and constraints of the health care setting in which care will be provided. We develop and implement an outcome-oriented and prioritized plan of care and track progression toward the goals of improved mobility and functional status.
The process we use to guide our clinical decision making is certainly complex; to be effective, we must continually seek new knowledge to keep “current” with developments in the fields of exercise, motor learning and motor control, health and wellness, and management of many diseases and conditions that contribute to movement difficulties. The Associate Editors and I strive to present clinically useful “evidence” from researchers whose work focuses on the problems that we face and address in everyday practice. The first 4 articles in this issue address contributors to, examination of, and interventions for impairments of postural control and balance. The systematic review by Liu and Frank on tai chi as intervention for older adults with balance dysfunction provides best current evidence of efficacy and effectiveness. Weirich and colleagues describe how strength, flexibility, and body composition contribute to dynamic postural control in young, midlife, and older adults. Coleman and Clifft explore the impact of restriction of shoulder motion on balance performance and risk of falling using the Berg Balance Scale. To round out the set of articles focused on postural control, Goldberg and colleagues present evidence about clinometric properties of a dynamic measure of balance: the maximal step test. The next article, by Andrews and colleagues, reexamines the definition of community ambulation, presenting useful information on the distances required to access community resources necessary for instrumental activities of daily living, as well as walking speeds for safe navigation across intersections with timed crosswalk signals. LaStayo and colleagues challenge our thinking about exercise for cancer survivors, providing evidence of the efficacy and energy costs of eccentric strengthening for older patients with cancer-related fatigue and weakness. Finally, the case report by Peplinski and Irwin provides a solid model of clinical reasoning for effective patient-client management, detailing the examination, evaluation, plan of care, and outcome assessment for an older woman with chronic plantar fasciitis. The editorial team would welcome your thoughts and suggestions about the quality and “applicability” of information in this issue of the Journal!
ON OUR COVER
This trio of friends is a testament to the power of friendship over time! Gertrude, Eulalie, and Gertrude first met 20 years ago in a summer community when, on retirement of their husbands, they began to spend summers together as neighbors “at the lake.” During that time, they shared the joys and challenges of life as grandchildren grew up, went off to college, married, and began the fourth generation for their families. They jokingly coped with changes in eyesight, hearing, and memory associated with advancing age, supported each other through the advent of various health problems of their own, grieved together on the passing of their husbands, and reinvented themselves as family matriarchs. Now in their late 80s, they continue to gather at the lake and celebrate enduring friendship, a positive model for us all!
Michelle M. Lusardi