Front Matter

Chapter 18 Rehabilitation for Geriatric Patients 475

Hydrotherapy

Hydrotherapy provides buoyancy, decreasing
concussive forces on potentially painful or
arthritic joints (see Chapter  9). Prior screening
for medical conditions is important to ensure
that the geriatric patient will be able to tolerate
the warmth and moisture of the water as well
as the stress and exertion encountered with
hydrotherapy. Providing shorter hydrotherapy
sessions with more breaks may be beneficial for
a weakened geriatric patient. The buoyancy of
the water may allow the therapist to perform
standing therapeutic exercises such as rhythmic
stabilization, joint compressions, and pattern­

ing for patients that are too weak to stand inde­

pendently or those with severely compromised

mobility (Figure 18.17).

Neuromuscular electrical stimulation

Targeted muscle strengthening with neuromus­

cular electrical stimulation (NMES) can assist

patients with severe muscle atrophy. In weakened

patients, NMES activates muscles that can be tar­

geted later with therapeutic exercise. NMES can

be done two to three times a week at the clinic for

patients with mild to moderate muscle atrophy,

or taught to capable clients so that it can be done

three to five times a week at home for patients

with neurogenic or severe muscle atrophy.

Bedding and decubital ulcers

Patients with muscle atrophy as well as recum­

bent patients with thin body condition and

poor muscle mass are at greatest risk for pres­

sure sores or decubital ulcers. Comfortable

padding helps keep these patients warm and

protects their skin (Figure 18.18). Frequent

turning (every 2–4 hours) should be employed

if patients are unable or unwilling to do so on

their own so as to prevent atelectasis and exces­

sive pressure on bony points.

Patients with decubital ulcers should not

enter the underwater treadmill or therapy

pool without a waterproof seal over the wound.

Figure 18.16 A geriatric pelvic limb amputee with a
prosthetic enjoys a rest period during a therapeutic
exercise session.

Figure 18.17 Geriatric patients benefit from the hydrostatic and cardiovascular benefits of aerobic exercise in a lower
impact hydrotherapy environment.