Prior to administering any standard test of muscular strength, endurance or flexibility, it is prudent to ascertain total body active range of motion or mobility. Begin with single-joint movements (shoulder flexion, extension, abduction and adduction) and progress through multijoint actions (shoulder flexion simultaneous to internal rotation and scapular elevation). By observing the movement, you can identify discomfort, immobility and perhaps muscle weakness within these ranges of motion.
Next, you can hand the client a very light weight, such as a one-pound dumbbell, and ask her or him to repeat the above movements. Gradually increase the resistance, and observe carefully. You may observe a number of things:
1. If there is a limit to the range of motion, it may indicate joint intolerance (Hyatt 1994). There can be so much intolerance that the muscle can't overcome it and range of motion will be stopped. If you suspect joint intolerance (possibly due to an arthritic condition), refer the client to an appropriate medical professional for further evaluation.
2. If the client can move through a full range of motion without pain, but has difficulty raising the arm with a specific resistance (indicated by the muscle "quivering"), the problem is more likely muscle weakness. Observation will help you determine what level of resistance to begin with. The weight of the body part alone may be sufficient to begin the training program.
3. The client may feel strain or discomfort, which you can identify by her or his facial expression. Or the client may
move the joints through the range of motion without discomfort, but then the following day she or he may feel pain (a classic symptom of people who do too much too soon). To determine if this is the case, you can ask, "After what we did yesterday, do you feel any discomfort?" Be conservative with your progression.
It makes sense to determine what issues of motor performance may actually hinder the desired objective of a given test. The priority should be to train the "weak links of the chain" first-and test later.
Disabilities relating to functional instability can range from multisensory deficits (for example, in vision, touch, spatial awareness or hearing) and decreasing proprioception (balance) to diseases such as arthritis, apraxia and pseudobulbar palsy (Tinetti 1986). Parkinson's disease can also affect a variety of functions, including rising from a chair and stepping. Cerebellar disease can be responsible for instability when turning. Buchner and Larson (1987) relate functional impairments in patients with Alzheimer-type dementia (ATD). Abnormal gait and balance have also been observed in ambulatory patients with ATD (Visser 1983).
Issues In Program Planning
Because assessing individual function is the primary component of program design for older adults, you should immediately eliminate chronological stereotypes. Discriminatory assumptions-such as those that lump older adults between 60 and 70 years old as recreationally active and those over 80 years old as happy just to be able to get off a bus-put an automatic ceiling on potential ability.
Evans and Rosenburg (1991) state that the measurement of biological age is a calculation that must be done one person at a time, since chronology offers few clues. It is unduly restrictive to make generalizations regarding the older population. Consider the following generalizations: