Page 20 - Mobility Management, May/June 2021

ATP Series
Aging with Cerebral Palsy
pattern to help them stand up or walk. It’s not going to be a tradi- tional gait pattern, but they might use that tightness and that tone to have a form of ambulation. That’s when we have to look at it and say, cost/benefit wise, how is this going to impact you over time? How is this impacting your hips and knee joints? Do we need to look at managing some of that spasticity, but we don’t want to take all of it away?”
How Aging Impacts CP in Adolescence
Once kids hit puberty, physical, emotional and social changes begin, Kiger noted. “You start to see weight gain for a number of reasons. When kids are little, they are naturally cute, and people take them out of their chairs and play with them. It’s much easier to transfer them, so they’re in their stander, they’re in their gait trainer. They’re possibly burning more calories.
“As they hit middle school, the demands of classes can be higher. A kid might say, ‘I have six periods, I don’t have time to be in a stander.’ Especially if they’re eating by mouth, they’re teenagers, and they want to go where their friends want to go. There’s junk [food] available. Just because a kiddo has CP doesn’t mean they’re going to want to watch their weight.”
Parents and therapists must now work with a teen who has stronger opinions. “Compliance changes,” Kiger said. “When a child is little, you can kind of force them to go to therapy. For pre-teens and teens, it’s natural to rebel against your family. So if you’re being told you have to go to PT or this PT is telling you you’ve got to do your home exercises: ‘Yeah, whatever.’ Parents are going to do what all parents do: Choose their battles.”
How Aging Impacts CP in Middle Age
Kiger added that changes don’t stop once the client reaches adulthood. “As someone who worked primarily in pediatrics before joining Sunrise, we used to preach ‘developmental milestones,’” she said. “Why do people stop focusing on developmental milestones once people are out of adolescence? What are the developmental milestones as an adult that you go through?”
“I am an occupational therapist so I worked in in-patient neurological rehab primarily with adults,” Chesney said. “I worked with clients with spinal cord injuries, some adults with CP or neurodegenerative diseases. No matter what your diag- nosis is, the phenomenon of tone and spasticity comes from that neurological impact. What’s so hard is it’s so unique to each person. One form of managing spasticity isn’t necessarily going to work for everybody.”
Chesney said she views spasticity as an indication to look closer: “Spasticity is dynamic, it is velocity dependent. It’s the body’s way of telling you something’s wrong. When we see some- body that we’ve been working with, and their spasticity today is just really terrible — it’s hard to move them and they’re tighter than they usually are — there’s a lot of questions.
“Did you not sleep well, did you miss taking your medication? Have you had a bowel movement? When somebody is consti- pated, or maybe their bladder is full, their body is going to have higher spasticity and tone. It’s like your body’s way of saying,
‘I have to focus on something that’s not right. I can’t focus on relaxing these muscles.’ If somebody is in pain, you’re going to
All Grown Up: The Many Milestones of Middle Age
The Merck Manual [Changes in the Body with Aging] says, “Most bodily functions peak shortly before age 30 and then begin a gradual but continuous decline.”
Bones become less dense, Merck Manual says, which raises the risk of fractures. Changes in the vertebrae at the top of the spine “cause the head to tip forward, compressing the throat.” That makes swallowing more difficult, thus raising the risk of choking.
Cartilage thins, often leading to osteoarthritis, Merck says. Muscle tissue and strength start to decrease early in
the aging process — at around age 30. Presbyopia, the stiffening of the lens in the eyes, typically begins at age 40: That’s when people notice a loss of “near vision,” or objects less than two feet away. And, Merck says, as we age, we need more
light to see, our color perceptions change (which can make text written in certain colors harder to read), and our depth perception becomes less acute.
Noise exposure over a lifetime causes hearing loss: It’s harder to hear higher pitches, and speech (including high- pitched sounds such as T, S, and P in English) is harder to understand. Our senses of taste and smell become less acute. And skin becomes thinner, less elastic, and drier.
The Mayo Clinic notes that our bladders often become less elastic with age, which leads to more frequent urination and potentially a raised risk for incontinence.
But aging isn’t all bad news. In a
2016 study published in the Journal of Clinical Psychiatry and reported by Time, researchers at the University of California,
San Diego found that happiness changed throughout life, and they found a “dipping down” in middle age.
Then happiness rebounded. Said Time, “People in their 20s and 30s reported the highest levels of depression, anxiety and stress, plus the lowest levels of happiness, satisfaction and well-being. Older people, surprisingly, were the happiest.” m
20 MAY-JUNE 2021 | MOBILITY MANAGEMENT MobilityMgmt.com
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