Kinesitherapie bij ouderen
KINESITHERAPIE BIJ OUDEREN .................................................................................................................................... 1
1. HEALTHY AGING – FRAILTY (KWETSBAARHEID) ...................................................................................................................... 5
Inleiding ..................................................................................................................................................................... 5
Why specialise in PT with older adults .....................................................................................................................................5
Evidence-based Clinical decision Making .................................................................................................................................5
Methodisch handelen: .............................................................................................................................................................6
Diagnose: .................................................................................................................................................................................6
Leeftijd ................................................................................................................................................................................7
Geriatrische Therapie ..............................................................................................................................................................7
Healthy Ageing (from concept to handbook) .....................................................................................................................9
Geriatrie .............................................................................................................................................................................9
Medisch model ........................................................................................................................................................ 10
Kwetsbaarheid (Frailty) ........................................................................................................................................... 11
Modellen om frailty te beschrijven ........................................................................................................................................12
1. HET FENOTYPE MODEL; ................................................................................................................................................12
2. cumulatieve deficiet model (= ROCKWOOD) ................................................................................................................13
Interventies voor kwetsbaarheid ...........................................................................................................................................15
2. SLAAPDISFUNCTIE, DIABETES/ VASCULAIRE PATHOLOGIE & DECUBITUS ..................................................................................... 16
Slaap ........................................................................................................................................................................ 16
Slaappatronen........................................................................................................................................................................16
1. Evolutie van totale slaaptijd (TST) en slaapstadia met de leeftijd .................................................................................16
2. Hypnogram bij jonge persoon in vergelijking met ouder persoon ................................................................................16
3. veranderingen van de slaap op oudere leeftijd ............................................................................................................17
Slaapdisfunctie .......................................................................................................................................................................17
Aandoeningen van de slaap ...................................................................................................................................................18
1. Slaapapneu ...................................................................................................................................................................18
2. Periodieke beenbewegingen ........................................................................................................................................19
3. vervroegde slaapfase syndroom ...................................................................................................................................19
4. REM slaap gedragsstoornis ...........................................................................................................................................19
5. Medische aandoeningen ..............................................................................................................................................19
6. Psychiatrische aandoeningen .......................................................................................................................................19
7. Organische hersensyndroom ........................................................................................................................................20
Onderzoek slaap ....................................................................................................................................................................20
Behandeling ...........................................................................................................................................................................20
1. SLAAPHYGIËNE..............................................................................................................................................................20
2. RELAXATIE- EN ADEMHALINGSTHERAPIE......................................................................................................................20
3. COGNITIEVE GEDRAGSTHERAPIE ..................................................................................................................................20
Diabetes .................................................................................................................................................................. 21
Ouderdomsdiabetes (Type 2).................................................................................................................................................21
Oorzaak ..................................................................................................................................................................................21
Klinische symptomen .............................................................................................................................................................21
Acute verwikkelingen .............................................................................................................................................................21
Chronische verwikkelingen ....................................................................................................................................................21
Therapeutische behandeling .................................................................................................................................................22
Vasculaire pathologie .............................................................................................................................................. 22
Veneuze insufficiëntie ............................................................................................................................................................22
Arteriële insufficiëntie: perifeer .............................................................................................................................................23
Decubitus (doorligwonden) => zie praktijkles.......................................................................................................... 25
Graad 1: niet-wegdrukbare roodheid ....................................................................................................................................25
Graad 2 ..................................................................................................................................................................................25
Graad 3 ..................................................................................................................................................................................25
Graad 4 ..................................................................................................................................................................................25
Ontstaan ................................................................................................................................................................................25
Bradenschaal .........................................................................................................................................................................25
Preventie ................................................................................................................................................................................25
3. PSYCHOGERIATRIE.......................................................................................................................................................... 27
Normale veroudering .............................................................................................................................................. 27
Anatomische en fysiologische veranderingen ........................................................................................................................27
Cognitieve en gedragsmatige veranderingen .........................................................................................................................27
Dementie ................................................................................................................................................................. 28
Mini mental State Examination (MMSE) ................................................................................................................................29
1
, Montreal Cognitive Assesment (MOCA) ................................................................................................................................29
Klinische kenmerken: .............................................................................................................................................................29
Risicofactoren: .......................................................................................................................................................................30
Verschillende vormen van dementie .....................................................................................................................................31
1. Ziekte van Alzheimer ....................................................................................................................................................31
2. Frontotemporale dementie ..........................................................................................................................................31
3. Lewy body dementie ....................................................................................................................................................32
4. Ziekte van Parkinson .....................................................................................................................................................32
5. Vasculaire dementie .....................................................................................................................................................33
6. Korsakov dementie .......................................................................................................................................................33
7. mengvormen ................................................................................................................................................................33
Verloop volgens etiologie.......................................................................................................................................................34
Corticale en subcorticale vormen van dementie ...................................................................................................................34
Stadia van dementie ..............................................................................................................................................................34
Belevingsgerichte zorg ......................................................................................................................................................35
Differentiaal diagnose dementie ............................................................................................................................................36
Motoriek en dementie ...........................................................................................................................................................38
Pijn en dementie ....................................................................................................................................................................39
Behandeling ...........................................................................................................................................................................40
Kinesitherapeuthische interventeis .......................................................................................................................................40
Foetale houding – paratonie.............................................................................................................................................40
Aanvullende behandeling ......................................................................................................................................................41
Omgaan met personen met dementie ...................................................................................................................................41
Ageism (Praktijk) ..................................................................................................................................................... 41
Communicatie (praktijk) .......................................................................................................................................... 41
4. SARCOPENIE ................................................................................................................................................................. 42
Inleiding ................................................................................................................................................................... 42
Richtlijnen ................................................................................................................................................................ 43
1. Handknijpkracht .................................................................................................................................................................44
2. Gangsnelheid .....................................................................................................................................................................45
3. Oefentherapie: spierkracht ................................................................................................................................................45
Internationale richtlijnen om fysieke activiteit te stimuleren (65+) .......................................................................................45
5. FARMACOTHERAPIE ....................................................................................................................................................... 47
Met de leeftijd neemt het gebruik van geneesmiddelen toe ................................................................................... 47
Bijwerkingen kunnen zeer sterk verschillen tussen ouderen ................................................................................... 47
Polyfarmacie verhoogt de kans op bijwerkingen ..................................................................................................... 47
Farmacokinetiek verschilt tussen ouderen en jongvolwassenen ............................................................................. 47
De rol van kinesitherapeut ...................................................................................................................................... 48
Aandoeningen & medicatie ..................................................................................................................................... 48
Artrose ...................................................................................................................................................................................48
Paracetamol......................................................................................................................................................................48
Niet-narcotische analgetica (NSAID) .................................................................................................................................49
Beroerte .................................................................................................................................................................................49
Medicatie ter secundaire preventie van atherosclerose a. carotis ...................................................................................49
Osteoporose ..........................................................................................................................................................................50
Botontkalking kan ontstaan door menopause en/of medicatiegebruik ...........................................................................50
Botontkalking wordt vermeden en behandeld met beweging en medicatie ....................................................................50
Cataract & glaucoom .............................................................................................................................................................50
Cataract ............................................................................................................................................................................51
Glaucoom .........................................................................................................................................................................51
Herpes zoster .........................................................................................................................................................................51
Postherpetische neuralgie ................................................................................................................................................52
Prostaathyperplasie ...............................................................................................................................................................53
Urine-incontinentie ................................................................................................................................................................53
Ziekte van Parkinson ..............................................................................................................................................................54
Pijn .........................................................................................................................................................................................54
6. ARTROSE ..................................................................................................................................................................... 56
Osteoarthritis (OA) .................................................................................................................................................. 56
Epidemiologie ........................................................................................................................................................................56
Definitie knie osteoarthritis ...................................................................................................................................................56
Pathologie (Kraakbeen) ....................................................................................................................................................57
OA-gerelateerde weefselafwijkingen (remodellering) ...........................................................................................................57
Pathogenese of knie-ostheoartrose .......................................................................................................................................59
Top-down bemiddeling van pijn vanuit de hersenen ........................................................................................................60
Centrale sensitisatie (bij artrose) ......................................................................................................................................61
2
, TAKE HOME MESSAGES..........................................................................................................................................................63
Mechanismen die het effect van lichaamsbeweging verklaren ............................................................................... 63
Bewegen wordt aanbevolen door internationale richtlijnen .................................................................................................63
Exercise-induced hypoalgesia ...........................................................................................................................................65
Exercise-induced hypoalgesia in osteoarthritis.................................................................................................................65
TAKE HOME MESSAGES..........................................................................................................................................................66
Behandeling van OA pijn ......................................................................................................................................... 66
Exercise-induced hypoalgesia in osteoarthritis ......................................................................................................................66
Top-down behandeling OA pijn..............................................................................................................................................67
Maladaptieve pijn cognities & houdingen .............................................................................................................................67
Stress management ...............................................................................................................................................................67
7. HOUDING .................................................................................................................................................................... 68
Houding ................................................................................................................................................................... 68
Inleiding .................................................................................................................................................................................68
Anatomische en fysiologische veranderingen ........................................................................................................................68
Momentwerking heup ...........................................................................................................................................................69
Voornaamste veranderingen in houding................................................................................................................................69
Parkinson ...............................................................................................................................................................................70
Hyperkyfose ............................................................................................................................................................. 70
Definitie & prevalentie ...........................................................................................................................................................70
Oorzaak & Pathologie ............................................................................................................................................................71
Geassocieerde gezondheidsrisico’s ........................................................................................................................................71
Evaluatie ................................................................................................................................................................................72
Observatie ........................................................................................................................................................................72
Cobb hoek ........................................................................................................................................................................72
Evaluatie Debrunner Kyphometer ....................................................................................................................................72
Flexicurve Ruler ................................................................................................................................................................73
Spinal mouse ....................................................................................................................................................................73
Inclinometer .....................................................................................................................................................................73
Occiput-to-wall .................................................................................................................................................................73
Betrouwbaarheid & validiteit ...........................................................................................................................................73
Functionele testing ...........................................................................................................................................................73
Behandeling ......................................................................................................................................................................74
Manuele mobilisatie .........................................................................................................................................................74
Oefentherapie - mobilisatie ..............................................................................................................................................74
Stretching .........................................................................................................................................................................75
Progressieve weerstandstraining ......................................................................................................................................75
Stabilisatietraining ............................................................................................................................................................75
Oefentherapie ..................................................................................................................................................................75
Proprioceptie/ postural alignement .................................................................................................................................75
Postural taping ..................................................................................................................................................................75
Spinale orthese .................................................................................................................................................................75
8. UITHOUDING ................................................................................................................................................................ 76
Uithoudingsvermogen ............................................................................................................................................. 76
Uithoudingsvermogen meten .................................................................................................................................. 78
Uithoudingsvermogen trainen ................................................................................................................................ 79
9. VALPREVENTIE .............................................................................................................................................................. 82
Inleiding ................................................................................................................................................................... 82
Incidentie thuiswonende ouderen .........................................................................................................................................82
Incidentie ziekenhuizen en WZC ............................................................................................................................................82
Waar en wanneer vallen ouderen? ........................................................................................................................................82
Etiologie................................................................................................................................................................... 82
Biologische factoren ..............................................................................................................................................................83
Evenwichtsmechanisme .......................................................................................................................................... 83
Sensorisch systeem ................................................................................................................................................................83
Somatosensorisch systeem ....................................................................................................................................................83
Visueel systeem .....................................................................................................................................................................83
Vestibulair systeem ................................................................................................................................................................84
CZS .........................................................................................................................................................................................84
Motorisch systeem.................................................................................................................................................................84
Leeftijdsgebonden veranderingen .........................................................................................................................................86
Gevolgen van valincident ........................................................................................................................................ 86
Fysieke letsel ..........................................................................................................................................................................86
Psychologische impact ...........................................................................................................................................................86
Economische impact ..............................................................................................................................................................87
3
, Verhoogde mortaliteit ...........................................................................................................................................................87
Valpreventie ............................................................................................................................................................ 87
Primaire valpreventie .............................................................................................................................................................88
Secundaire valpreventie ........................................................................................................................................................88
Klinische vragen ................................................................................................................................................................89
Oefenprogramma’s ......................................................................................................................................................93
Sleutelelementen van een goed oefenprogramma .....................................................................................................94
Doorverwijzen: ............................................................................................................................................................95
F-pathologie sinds maart 2007 ....................................................................................................................................95
Informatie en advies/WZC ...........................................................................................................................................96
Preventie van breuken ...........................................................................................................................................................96
10. LONGREVALIDATIE ....................................................................................................................................................... 97
Fysiologie ................................................................................................................................................................. 97
Normale veroudering .............................................................................................................................................. 98
Veel voorkomende aandoeningen ......................................................................................................................... 100
Pneumonie...........................................................................................................................................................................100
Atelectase ............................................................................................................................................................................101
COPD ....................................................................................................................................................................................102
Respiratoire kinesitherapie .................................................................................................................................... 103
Klinisch onderzoek ...............................................................................................................................................................103
Behandeling .........................................................................................................................................................................105
1. Pulmonaal ventilatie: ...........................................................................................................................................105
2. Pulmonaal: sputummobilisatie ...................................................................................................................................105
3. Pulmonaal: hulpmiddelen...........................................................................................................................................106
4. Pulmonaal: zuurstoftoedoening .................................................................................................................................106
5. Oefentherapie.............................................................................................................................................................106
Behandeling veel voorkomende pathologieën ...................................................................................................... 108
Pneumonie...........................................................................................................................................................................108
Atlectase ..............................................................................................................................................................................108
COPD ....................................................................................................................................................................................108
11. ORGANISATIE OUDEREN ZORG ...................................................................................................................................... 110
Toename nood residentiële zorg............................................................................................................................ 110
Residentiele opvang .............................................................................................................................................................110
Belangrijkste diensten van langdurige zorg..........................................................................................................................110
Tewerkstelling kinesitherapeuten in residentiële zorg ........................................................................................... 110
Woonzorgcentra ..................................................................................................................................................................110
Hulpbehoevendheid als maatstaf .......................................................................................................................... 112
Categorieën van zorgbehoevendheid ..................................................................................................................................112
Nomenclatuur ....................................................................................................................................................... 113
Zelfstandige kine ..................................................................................................................................................................113
M-nomenclatuur ..................................................................................................................................................................113
K-nomenclatuur ...................................................................................................................................................................114
F-pathologie .........................................................................................................................................................................114
Gangrevalidatie bij patiënten .........................................................................................................................................114
Voorzieningen ........................................................................................................................................................ 115
Woonzorgcentra (en rust- en verzorgingstehuizen) .............................................................................................................115
Centra voor kortverblijf (CKV) ..............................................................................................................................................115
Dagverzorgingscentra ..........................................................................................................................................................115
Dagverzorgingscentra voor palliatieve verzorging ...............................................................................................................115
Centra voor herstelverblijf ...................................................................................................................................................115
Serviceflats en assistentiewoningen ....................................................................................................................................115
Dienst geriatrie in een algemeen ziekenhuis (G-dienst) ......................................................................................................116
Interne liaison ......................................................................................................................................................................116
Kwaliteitszorg ........................................................................................................................................................ 117
Referentiekader voor de woonzorgcentra ...........................................................................................................................117
BELRAI ..................................................................................................................................................................................117
Sectorspecifieke minimale kwaliteitseisen ..........................................................................................................................118
Taak kinesitherapeut in de ouderenzorg ............................................................................................................... 118
Hoofddoel ............................................................................................................................................................................118
Wet op de uitvoering van de kinesitherapie (WUK) .............................................................................................................118
Specifieke opdrachten kine ..................................................................................................................................................118
Taken binnen het multidisciplinaire team ............................................................................................................................119
Interdisciplinair overleg .......................................................................................................................................................119
Taken ....................................................................................................................................................................................119
4
KINESITHERAPIE BIJ OUDEREN .................................................................................................................................... 1
1. HEALTHY AGING – FRAILTY (KWETSBAARHEID) ...................................................................................................................... 5
Inleiding ..................................................................................................................................................................... 5
Why specialise in PT with older adults .....................................................................................................................................5
Evidence-based Clinical decision Making .................................................................................................................................5
Methodisch handelen: .............................................................................................................................................................6
Diagnose: .................................................................................................................................................................................6
Leeftijd ................................................................................................................................................................................7
Geriatrische Therapie ..............................................................................................................................................................7
Healthy Ageing (from concept to handbook) .....................................................................................................................9
Geriatrie .............................................................................................................................................................................9
Medisch model ........................................................................................................................................................ 10
Kwetsbaarheid (Frailty) ........................................................................................................................................... 11
Modellen om frailty te beschrijven ........................................................................................................................................12
1. HET FENOTYPE MODEL; ................................................................................................................................................12
2. cumulatieve deficiet model (= ROCKWOOD) ................................................................................................................13
Interventies voor kwetsbaarheid ...........................................................................................................................................15
2. SLAAPDISFUNCTIE, DIABETES/ VASCULAIRE PATHOLOGIE & DECUBITUS ..................................................................................... 16
Slaap ........................................................................................................................................................................ 16
Slaappatronen........................................................................................................................................................................16
1. Evolutie van totale slaaptijd (TST) en slaapstadia met de leeftijd .................................................................................16
2. Hypnogram bij jonge persoon in vergelijking met ouder persoon ................................................................................16
3. veranderingen van de slaap op oudere leeftijd ............................................................................................................17
Slaapdisfunctie .......................................................................................................................................................................17
Aandoeningen van de slaap ...................................................................................................................................................18
1. Slaapapneu ...................................................................................................................................................................18
2. Periodieke beenbewegingen ........................................................................................................................................19
3. vervroegde slaapfase syndroom ...................................................................................................................................19
4. REM slaap gedragsstoornis ...........................................................................................................................................19
5. Medische aandoeningen ..............................................................................................................................................19
6. Psychiatrische aandoeningen .......................................................................................................................................19
7. Organische hersensyndroom ........................................................................................................................................20
Onderzoek slaap ....................................................................................................................................................................20
Behandeling ...........................................................................................................................................................................20
1. SLAAPHYGIËNE..............................................................................................................................................................20
2. RELAXATIE- EN ADEMHALINGSTHERAPIE......................................................................................................................20
3. COGNITIEVE GEDRAGSTHERAPIE ..................................................................................................................................20
Diabetes .................................................................................................................................................................. 21
Ouderdomsdiabetes (Type 2).................................................................................................................................................21
Oorzaak ..................................................................................................................................................................................21
Klinische symptomen .............................................................................................................................................................21
Acute verwikkelingen .............................................................................................................................................................21
Chronische verwikkelingen ....................................................................................................................................................21
Therapeutische behandeling .................................................................................................................................................22
Vasculaire pathologie .............................................................................................................................................. 22
Veneuze insufficiëntie ............................................................................................................................................................22
Arteriële insufficiëntie: perifeer .............................................................................................................................................23
Decubitus (doorligwonden) => zie praktijkles.......................................................................................................... 25
Graad 1: niet-wegdrukbare roodheid ....................................................................................................................................25
Graad 2 ..................................................................................................................................................................................25
Graad 3 ..................................................................................................................................................................................25
Graad 4 ..................................................................................................................................................................................25
Ontstaan ................................................................................................................................................................................25
Bradenschaal .........................................................................................................................................................................25
Preventie ................................................................................................................................................................................25
3. PSYCHOGERIATRIE.......................................................................................................................................................... 27
Normale veroudering .............................................................................................................................................. 27
Anatomische en fysiologische veranderingen ........................................................................................................................27
Cognitieve en gedragsmatige veranderingen .........................................................................................................................27
Dementie ................................................................................................................................................................. 28
Mini mental State Examination (MMSE) ................................................................................................................................29
1
, Montreal Cognitive Assesment (MOCA) ................................................................................................................................29
Klinische kenmerken: .............................................................................................................................................................29
Risicofactoren: .......................................................................................................................................................................30
Verschillende vormen van dementie .....................................................................................................................................31
1. Ziekte van Alzheimer ....................................................................................................................................................31
2. Frontotemporale dementie ..........................................................................................................................................31
3. Lewy body dementie ....................................................................................................................................................32
4. Ziekte van Parkinson .....................................................................................................................................................32
5. Vasculaire dementie .....................................................................................................................................................33
6. Korsakov dementie .......................................................................................................................................................33
7. mengvormen ................................................................................................................................................................33
Verloop volgens etiologie.......................................................................................................................................................34
Corticale en subcorticale vormen van dementie ...................................................................................................................34
Stadia van dementie ..............................................................................................................................................................34
Belevingsgerichte zorg ......................................................................................................................................................35
Differentiaal diagnose dementie ............................................................................................................................................36
Motoriek en dementie ...........................................................................................................................................................38
Pijn en dementie ....................................................................................................................................................................39
Behandeling ...........................................................................................................................................................................40
Kinesitherapeuthische interventeis .......................................................................................................................................40
Foetale houding – paratonie.............................................................................................................................................40
Aanvullende behandeling ......................................................................................................................................................41
Omgaan met personen met dementie ...................................................................................................................................41
Ageism (Praktijk) ..................................................................................................................................................... 41
Communicatie (praktijk) .......................................................................................................................................... 41
4. SARCOPENIE ................................................................................................................................................................. 42
Inleiding ................................................................................................................................................................... 42
Richtlijnen ................................................................................................................................................................ 43
1. Handknijpkracht .................................................................................................................................................................44
2. Gangsnelheid .....................................................................................................................................................................45
3. Oefentherapie: spierkracht ................................................................................................................................................45
Internationale richtlijnen om fysieke activiteit te stimuleren (65+) .......................................................................................45
5. FARMACOTHERAPIE ....................................................................................................................................................... 47
Met de leeftijd neemt het gebruik van geneesmiddelen toe ................................................................................... 47
Bijwerkingen kunnen zeer sterk verschillen tussen ouderen ................................................................................... 47
Polyfarmacie verhoogt de kans op bijwerkingen ..................................................................................................... 47
Farmacokinetiek verschilt tussen ouderen en jongvolwassenen ............................................................................. 47
De rol van kinesitherapeut ...................................................................................................................................... 48
Aandoeningen & medicatie ..................................................................................................................................... 48
Artrose ...................................................................................................................................................................................48
Paracetamol......................................................................................................................................................................48
Niet-narcotische analgetica (NSAID) .................................................................................................................................49
Beroerte .................................................................................................................................................................................49
Medicatie ter secundaire preventie van atherosclerose a. carotis ...................................................................................49
Osteoporose ..........................................................................................................................................................................50
Botontkalking kan ontstaan door menopause en/of medicatiegebruik ...........................................................................50
Botontkalking wordt vermeden en behandeld met beweging en medicatie ....................................................................50
Cataract & glaucoom .............................................................................................................................................................50
Cataract ............................................................................................................................................................................51
Glaucoom .........................................................................................................................................................................51
Herpes zoster .........................................................................................................................................................................51
Postherpetische neuralgie ................................................................................................................................................52
Prostaathyperplasie ...............................................................................................................................................................53
Urine-incontinentie ................................................................................................................................................................53
Ziekte van Parkinson ..............................................................................................................................................................54
Pijn .........................................................................................................................................................................................54
6. ARTROSE ..................................................................................................................................................................... 56
Osteoarthritis (OA) .................................................................................................................................................. 56
Epidemiologie ........................................................................................................................................................................56
Definitie knie osteoarthritis ...................................................................................................................................................56
Pathologie (Kraakbeen) ....................................................................................................................................................57
OA-gerelateerde weefselafwijkingen (remodellering) ...........................................................................................................57
Pathogenese of knie-ostheoartrose .......................................................................................................................................59
Top-down bemiddeling van pijn vanuit de hersenen ........................................................................................................60
Centrale sensitisatie (bij artrose) ......................................................................................................................................61
2
, TAKE HOME MESSAGES..........................................................................................................................................................63
Mechanismen die het effect van lichaamsbeweging verklaren ............................................................................... 63
Bewegen wordt aanbevolen door internationale richtlijnen .................................................................................................63
Exercise-induced hypoalgesia ...........................................................................................................................................65
Exercise-induced hypoalgesia in osteoarthritis.................................................................................................................65
TAKE HOME MESSAGES..........................................................................................................................................................66
Behandeling van OA pijn ......................................................................................................................................... 66
Exercise-induced hypoalgesia in osteoarthritis ......................................................................................................................66
Top-down behandeling OA pijn..............................................................................................................................................67
Maladaptieve pijn cognities & houdingen .............................................................................................................................67
Stress management ...............................................................................................................................................................67
7. HOUDING .................................................................................................................................................................... 68
Houding ................................................................................................................................................................... 68
Inleiding .................................................................................................................................................................................68
Anatomische en fysiologische veranderingen ........................................................................................................................68
Momentwerking heup ...........................................................................................................................................................69
Voornaamste veranderingen in houding................................................................................................................................69
Parkinson ...............................................................................................................................................................................70
Hyperkyfose ............................................................................................................................................................. 70
Definitie & prevalentie ...........................................................................................................................................................70
Oorzaak & Pathologie ............................................................................................................................................................71
Geassocieerde gezondheidsrisico’s ........................................................................................................................................71
Evaluatie ................................................................................................................................................................................72
Observatie ........................................................................................................................................................................72
Cobb hoek ........................................................................................................................................................................72
Evaluatie Debrunner Kyphometer ....................................................................................................................................72
Flexicurve Ruler ................................................................................................................................................................73
Spinal mouse ....................................................................................................................................................................73
Inclinometer .....................................................................................................................................................................73
Occiput-to-wall .................................................................................................................................................................73
Betrouwbaarheid & validiteit ...........................................................................................................................................73
Functionele testing ...........................................................................................................................................................73
Behandeling ......................................................................................................................................................................74
Manuele mobilisatie .........................................................................................................................................................74
Oefentherapie - mobilisatie ..............................................................................................................................................74
Stretching .........................................................................................................................................................................75
Progressieve weerstandstraining ......................................................................................................................................75
Stabilisatietraining ............................................................................................................................................................75
Oefentherapie ..................................................................................................................................................................75
Proprioceptie/ postural alignement .................................................................................................................................75
Postural taping ..................................................................................................................................................................75
Spinale orthese .................................................................................................................................................................75
8. UITHOUDING ................................................................................................................................................................ 76
Uithoudingsvermogen ............................................................................................................................................. 76
Uithoudingsvermogen meten .................................................................................................................................. 78
Uithoudingsvermogen trainen ................................................................................................................................ 79
9. VALPREVENTIE .............................................................................................................................................................. 82
Inleiding ................................................................................................................................................................... 82
Incidentie thuiswonende ouderen .........................................................................................................................................82
Incidentie ziekenhuizen en WZC ............................................................................................................................................82
Waar en wanneer vallen ouderen? ........................................................................................................................................82
Etiologie................................................................................................................................................................... 82
Biologische factoren ..............................................................................................................................................................83
Evenwichtsmechanisme .......................................................................................................................................... 83
Sensorisch systeem ................................................................................................................................................................83
Somatosensorisch systeem ....................................................................................................................................................83
Visueel systeem .....................................................................................................................................................................83
Vestibulair systeem ................................................................................................................................................................84
CZS .........................................................................................................................................................................................84
Motorisch systeem.................................................................................................................................................................84
Leeftijdsgebonden veranderingen .........................................................................................................................................86
Gevolgen van valincident ........................................................................................................................................ 86
Fysieke letsel ..........................................................................................................................................................................86
Psychologische impact ...........................................................................................................................................................86
Economische impact ..............................................................................................................................................................87
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, Verhoogde mortaliteit ...........................................................................................................................................................87
Valpreventie ............................................................................................................................................................ 87
Primaire valpreventie .............................................................................................................................................................88
Secundaire valpreventie ........................................................................................................................................................88
Klinische vragen ................................................................................................................................................................89
Oefenprogramma’s ......................................................................................................................................................93
Sleutelelementen van een goed oefenprogramma .....................................................................................................94
Doorverwijzen: ............................................................................................................................................................95
F-pathologie sinds maart 2007 ....................................................................................................................................95
Informatie en advies/WZC ...........................................................................................................................................96
Preventie van breuken ...........................................................................................................................................................96
10. LONGREVALIDATIE ....................................................................................................................................................... 97
Fysiologie ................................................................................................................................................................. 97
Normale veroudering .............................................................................................................................................. 98
Veel voorkomende aandoeningen ......................................................................................................................... 100
Pneumonie...........................................................................................................................................................................100
Atelectase ............................................................................................................................................................................101
COPD ....................................................................................................................................................................................102
Respiratoire kinesitherapie .................................................................................................................................... 103
Klinisch onderzoek ...............................................................................................................................................................103
Behandeling .........................................................................................................................................................................105
1. Pulmonaal ventilatie: ...........................................................................................................................................105
2. Pulmonaal: sputummobilisatie ...................................................................................................................................105
3. Pulmonaal: hulpmiddelen...........................................................................................................................................106
4. Pulmonaal: zuurstoftoedoening .................................................................................................................................106
5. Oefentherapie.............................................................................................................................................................106
Behandeling veel voorkomende pathologieën ...................................................................................................... 108
Pneumonie...........................................................................................................................................................................108
Atlectase ..............................................................................................................................................................................108
COPD ....................................................................................................................................................................................108
11. ORGANISATIE OUDEREN ZORG ...................................................................................................................................... 110
Toename nood residentiële zorg............................................................................................................................ 110
Residentiele opvang .............................................................................................................................................................110
Belangrijkste diensten van langdurige zorg..........................................................................................................................110
Tewerkstelling kinesitherapeuten in residentiële zorg ........................................................................................... 110
Woonzorgcentra ..................................................................................................................................................................110
Hulpbehoevendheid als maatstaf .......................................................................................................................... 112
Categorieën van zorgbehoevendheid ..................................................................................................................................112
Nomenclatuur ....................................................................................................................................................... 113
Zelfstandige kine ..................................................................................................................................................................113
M-nomenclatuur ..................................................................................................................................................................113
K-nomenclatuur ...................................................................................................................................................................114
F-pathologie .........................................................................................................................................................................114
Gangrevalidatie bij patiënten .........................................................................................................................................114
Voorzieningen ........................................................................................................................................................ 115
Woonzorgcentra (en rust- en verzorgingstehuizen) .............................................................................................................115
Centra voor kortverblijf (CKV) ..............................................................................................................................................115
Dagverzorgingscentra ..........................................................................................................................................................115
Dagverzorgingscentra voor palliatieve verzorging ...............................................................................................................115
Centra voor herstelverblijf ...................................................................................................................................................115
Serviceflats en assistentiewoningen ....................................................................................................................................115
Dienst geriatrie in een algemeen ziekenhuis (G-dienst) ......................................................................................................116
Interne liaison ......................................................................................................................................................................116
Kwaliteitszorg ........................................................................................................................................................ 117
Referentiekader voor de woonzorgcentra ...........................................................................................................................117
BELRAI ..................................................................................................................................................................................117
Sectorspecifieke minimale kwaliteitseisen ..........................................................................................................................118
Taak kinesitherapeut in de ouderenzorg ............................................................................................................... 118
Hoofddoel ............................................................................................................................................................................118
Wet op de uitvoering van de kinesitherapie (WUK) .............................................................................................................118
Specifieke opdrachten kine ..................................................................................................................................................118
Taken binnen het multidisciplinaire team ............................................................................................................................119
Interdisciplinair overleg .......................................................................................................................................................119
Taken ....................................................................................................................................................................................119
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