AGING

CHANGES WITH
SENSORY AND
MOTOR
SYSTEMS

PRESENTER: SNEHA MANDAR

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 AGING
• A continuous and cumulative process taking
place in human from conception to death

• It is generally agreed that the first two

decades of human life is the phase of the
productive aging process and that the
degenerative aging process commences in
the third decade of life

Jackson, Osal 2nd edition: Physical therapy of the geriatric patient

• an intrinsic and progressive decline in an organisms survival due to internal
physiological deterioration a complex process that converts physiologically
and cognitively fit healthy adults into less fit older individuals .

• takes place in a cell an organ or the total organism with the passage of time
it is a process that goes over the entire adult life span of any living thing.

• results from accumulation of a wide variety of molecular and cellular

damage over time leading to gradual decrease in physical and mental
capacity and increase in the risk of disease and ultimately death.
• Capacity to respond to external stress and capacity to function in normal
all day activities decreases with aging and hence the effective capabilities
of the individuals gradually deteriorates with time .

• Disease does not result from aging but rather from the vulnerability that
aging causes in lowering the resistance threshold for the development of
disease.
 Aging is defined as the time-sequential deterioration that occurs in most
living beings, including weakness, increased susceptibility to disease and adverse
environmental conditions, loss of mobility and agility, and age-related
physiological changes

Goldsmith, 2006

WHO definition:
At the biological level, ageing results from the impact of the accumulation of
wide variety of molecular and cellular damage over time. This leads to gradual
decrease in physical, mental capacity, a growing risk of disease, and ultimately
death
-5th February 2018
Stages of Aging

o Newborn/infancy : 0–2 yrs 

o Toddler : 2–5 yrs
o School-age : 5–12 yrs
o Adolescence : 13–19 yrs
o Adulthood : 20–35 yrs
o Midlife : 35–55 yrs
o Senior citizen : 55–80 yrs
o Old age : 80+ yrs
 Classification Of Aging
S. NO. AGE-GROUP (Years) Category

1. 60-74 Yrs Young-Old

2. 75-84 Yrs Old-Old

3. 85-99 Yrs Oldest-Old

4. 100+ Yrs Centenarians

-Jackson, Osal 2nd edition : Physical therapy of the geriatric patient

TYPES OF Primary aging (healthy aging
AGING or disease free)

Secondary aging (disease

related aging)

Tertiary terminal drop aging

 • Primary aging is the gradual - and presently
inevitable - process of bodily deterioration that
takes place throughout life: the accumulation
of biochemical damage that leads to slowed
Primary movements, fading vision, impaired hearing,
reduced ability to adapt to stress, decreased
Aging resistance to infections, and so forth.

• Examples include the loss of melanin, which

causes gray hair, and decreased skin elasticity.
 • Secondary aging processes result from disease
and poor health practices (e.g. no exercise,
Secondary Aging smoking, excess fat and other forms of self-
damage) and are often preventable, whether
through lifestyle choice or modern medicine.
 • Refers to the increase in cognitive and
Tertiary Aging physical deterioration of a person in the
short time before death.
 • Age associated changes that involve the physical structures and
functioning of the body and that affect a person's ability to
function survive is refer to biological aging.

BIOLOGICAL • Developmental changes are irreversible normal changes in a

AGING living organism that occur as the time passes, the changes that
occur with Development are neither accidental nor a result of
abuse, inactivity or disease.

• Developmental changes can be divided into three

1)Development
2) Maturation
3) Aging
• Development
It refers to changes that occur before birth or during
childhood.

• Maturation
It concerns the changes that result in the transformation of a
child into an adult.

• Aging
It refers to the group of developmental changes that occur in
the later stages.
EFFECTS OF AGING ON
SENSORY SYSTEM
• The normal aging process causes gradual losses to the sensory system.
Generally, these changes begin around the age of 50 years.

• As we age, the way our senses (hearing, vision, taste, smell, touch) give us
information about the world changes. Our senses becomes less sharp, and
this can make it harder to notice details.

• Sensory changes can affect our lifestyle. We may have problems

communicating, enjoying activities, and staying involved with people.
Sensory changes can lead to isolation.
• Our senses receive information from the environment. This information can
be in the form of sound, light, smells, tastes, and touch. Sensory
information is converted into nerve signals that are carried to the brain.
There, the signals are turned into meaningful sensations.

• A certain amount of stimulation is required to become aware of a sensation.

This minimum level of sensation is called the threshold. Aging raises this
threshold. We need more stimulation to be aware of the sensation.

• Aging can affect all of the senses, but usually hearing and vision are most
affected. Devices such as glasses and hearing aids, or lifestyle changes can
improve your ability to hear and see.
VISION
• Vision occurs when light is processed by your eye and interpreted by your
brain. Light passes through the transparent eye surface (cornea).

• It continues through the pupil, the opening to the inside of the eye.

• The pupil becomes larger or smaller to control the amount of light that enters
the eye. The colored part of the eye is called the iris. It is a muscle that
controls pupil size. After light passes through your pupil, it reaches the lens.
The lens focuses light on your retina (the back of the eye). The retina
converts light energy into a nerve signal that the optic nerve carries to the
brain, where it is interpreted.
• Vision is important in identifying environmental cues and distinguishing
environmental hazards. As people age, changes in vision and visual
perception may lead to misinterpretation of visual cues and result in
functional dependence.
Vision slows:
• Generally, beginning around the age of 50, the lens of the eye
becomes less elastic, causing slowed vision. It will take longer for the
eye to focus on close objects, and blurring may be bothersome. Older
adults need more time to recognize objects or to focus on objects at
different distances.

Visual scanning becomes difficult:

• Because it takes longer for the older eyes to focus, many older adults
find it hard to scan an area and find a particular object. For example,
at the grocery store older people will have trouble picking out specific
items on a shelf. Likewise, moving objects are harder to see so it may
be impossible to read the credits at the end of a movie.
The cornea becomes less sensitive

The pupil gets smaller:

• When the pupil gets smaller, the lens gets thicker and less transparent,
resulting in less light reaching the retina. Many older adults have
trouble seeing at dusk, making out objects in low-lighted areas, or
telling one dark color from another. Thus, an older person needs more
light to see well. In fact, a person aged 65 or older needs twice as
much light as does a 20-year-old.
Visual acuity declines:
• the capacity of the eye to discriminate fine
details of objects in the visual field, generally
declines with age. Factors responsible for
decreased visual acuity include increased
thickness of the lens, which affects the amount
of light allowed to reach the retina, and the loss
of elasticity of the lens. These changes result in
decreased ability to see clearly and particularly
affect near objects.

• Visual aids can like glasses and contact lenses

can enhance vision when worn properly,
especially in the early stages of vision loss.
Hand-held magnifiers are adequate for use
over short periods, for example, when reading
a telephone book.
Visual field:
• decrease in both peripheral and upper visual
fields accelerates with aging. Decreased pupil
size, resulting in admittance of less light to
the peripheral retina, may be responsible for
early changes. Later changes may result from
decreased retinal metabolism.
• Within the environment, this decrease in
upper visual field may cause older individuals
to miss cues above head level.
• Common examples of cues found above head
level may include traffic and street signs,
direction or information signs in public
buildings, hanging light fixtures, and
environmental hazards such as hanging tree
limbs.
Illumination decreases
• Due to optical and neural changes, it has been
estimated that older individuals require as
much as two to four times more light than their
younger counterparts.
• Lighting that focuses directly on the task,
rather than overhead lighting, is recommended
to meet the needs of older individuals for
reading, task performance, and other close
work.
• Gooseneck lamps or small, high-intensity
lamps with three-way switches are also helpful
in achieving the proper ratio of background-to-
task lighting.
Glare:
• When illumination is increased, care must be exercised to avoid excessive
and intensive illumination, which can create a hazard for older persons in
the form of glare. Glare results from diffuse light scattering on the retina as
it passes through mildly opaque refractive media, inhibiting clear vision.
• A primary cause of glare sensitivity is the increasing opacity of the lens,
which diffuses the incoming light. Degenerative changes that take place in
the cornea also contribute to glare.
• Glare can be lessened by modifying light sources.
• Diffuse, soft lighting is preferable to single-light sources. Lamp shades
should be used to soften the light. Glare from windows can be minimized
by use of sheer curtains, venetian blinds, tinted-glass windows, or drapes.
Dark Adaptation:
• Dark adaptation, or the ability of the eye to become more visually
sensitive after remaining in darkness for a period of time, is delayed in
older persons.
• One reason for this visual change is the smaller, miotic pupil, which limits
the amount of light reaching the periphery of the retina.
• Reading glasses are initially indicated. Later, bifocals are needed to
compensate for the inability of the lens to change shape and focus on
objects of varying distances.
Accommodation:
• Accommodation, the ability of the eye to focus images on the retina
independent of object distances, is impaired with aging.
• this results in the inability to focus clearly over a range of distances.
• The decrease in this ability, referred to as presbyopia, occurs
gradually and affects near vision first.
Color:
• The ability to perceive, differentiate, and distinguish colors declines
with aging as a result of changes in retinal cones, the retinal bipolar and
ganglion cells, the visual pathways that terminate in the occipital cortex,
and the lens.
• Both warm and cool colors can be included in a color scheme when
living environments are designed for aging individuals.
Contrast:
• ability to discriminate between degrees of
brightness appears to decrease in individual’s age
60 years and older. In particular,
• contrast sensitivity to medium and high spatial
frequencies declines progressively with age, and
contrast sensitivity to low spatial frequencies
remains unchanged.
• older individuals have difficulty seeing objects that
have low contrast, especially with a bright
background. Older persons require greater than two
times as much light to see low contrasting objects
with the same degree of clarity as younger people.
• Bright detail on dark backgrounds is easier to
distinguish than low contrast or dark detail on light
background.
• Aging eyes also may not produce enough
tears which leads to dry eyes which may
be uncomfortable.
• When dry eyes are not treated, infection,
inflammation, and scarring of the cornea
can occur.
• relieve dry eyes by using eye drops or
artificial tears.
• Common eye disorders that cause vision changes that are NOT normal include:

Cataracts: clouding of the lens of the eye

Glaucoma: rise in fluid pressure in the eye

Macular degeneration: disease in the macula (responsible for central vision)

that causes vision loss
Retinopathy: disease in the retina often caused by diabetes or high blood
pressure
Cataracts
• are very common in older people which causes blurred vision in the center of the
eye.
• A person has a cataract when the center of the lens gets hard and cloudy.
• A person with a cataract might say that they feel like they are looking through water
on glass or trying to see through a car windshield in the rain when the windshield
wipers are not turned on.
• will be sensitive to glare, say that colors look dull, and have a hard time driving at
night.
• When a cataract is in its early stages, bright lights make it hard to see. Sunglasses
may improve vision.
• can be removed surgically on an outpatient basis and with little discomfort.
Glaucoma
• sometimes called “the sneak thief of
sight” because it comes on slowly
without warning.
• occurs when pressure builds up in the
eyeball from an excess of fluid. The
excess fluid may be from either faulty
drainage or an overproduction of fluid.
• A person with glaucoma may notice
colored rings around lights and only be
able to see objects straight ahead.
• If not treated in the early stages,
glaucoma will cause blindness.
Macular degeneration
• is a deterioration of nerve cells of the
macula, which is a small area in the retina.
• most common cause of blindness in older
people.
• can occur quickly and affects center or
straight-ahead vision.
• Objects may appear blurred, distorted, or
completely gone.
• Anyone with a macular degeneration has
trouble recognizing faces, reading, watching
television, or doing close work.
• The peripheral vision is unaffected.
Diabetic Retinopathy
• common complication of diabetes.
• Poor blood circulation causes the
eye to produce small, weak-walled
blood vessels. These vessels can
easily hemorrhage causing blurred
vision or severe loss of eyesight in
the affected eye.
• the retina may become detached
from the back of the eye.
• If untreated, this condition can
cause blindness.
 Poor coordination (i.e. difficulties buttoning).

Tunnel vision (can only see objects straight ahead).

Features of Squinting.

Poor Vision
Poor depth perception (tendency to spill food and drink
when setting it down, by either dropping it or setting it
down very hard).

A tendency to select bright colors over dull colors.

 Sit or stand where the person can best see
you.

Make sure there is good light.

Vision loss

Control glare.

Stand still to give the person time to focus

on you.
 Make sure the room has good light without
shadows or glare.

suggestions If you darken the room to show slides, videos,

transparencies, etc., allow a minute or two for
talking with a the audience to adjust to less light in the room.

group
Hold meetings during the daytime rather than
at night.

Keep walkways free of cords, chairs, or other

objects.
HEARING
• Hearing provides a primary link that allows individuals to identify with the
environment and communicate effectively.

• Hearing occurs after sound vibrations cross the eardrum to the inner ear. The
vibrations are changed into nerve signals in the inner ear and are carried to the brain
by the auditory nerve.

• Balance (equilibrium) is controlled in the inner ear. Fluid and small hair in the inner
ear stimulate the auditory nerve. This helps the brain maintain balance.
• Hearing loss often begins at a young age and progresses slowly during the 20s, 30s, and
40s. Most people do not notice hearing loss until they are in their 50s or 60s, when they
begin to have a hard time hearing high frequency sounds.

• For example, the consonants s, z, t, f, and g are high frequency sounds and hard to hear. The
low pitched vowels a, e, i, o, and u are easier to hear.

• It may be hard to distinguish between words that sound alike. For example, dead may sound
like “bed” or names like “Park” may sound like Clark.
 Types of hearing Loss

Conductive hearing loss occurs when

something blocks the sound waves from
Central nerve loss, sometimes called
the outer and middle ear. Early childhood
“nerve deafness”. Nerve loss is a
infections, current infections, a simple
permanent hearing loss. The cause can be
build up of wax, or a foreign object in the
allergies, auditory nerve tumors, noise, or
ear often causes this type of hearing loss.
the natural aging process. Nerve deafness
Fortunately, this kind of hearing loss can
cannot be cured.
usually be cured by surgery, removing wax,
or taking antibiotics.
Causes of Hearing 1. Noise
loss
2. Injuries

3. Medications

4. Diseases

5. Ear Infections

6. Heredity

7. Aging
 Hearing loss and quality of life

Family caregiver service providers and health care professionals often feel
frustrated when trying to communicate with an older person who cannot
hear well. Poor hearing can lead to many misunderstandings, hurt feelings,
blame, and guilt. Perhaps if care providers better understand how old age
affects hearing, and ways to compensate for hearing loss, families could
enjoy better relationships and a higher quality of life.
Following are some common ways that an older person with hearing loss
may react.

• Relationships/Isolation: Hearing is a “social sense”. Significant loss of

hearing can cause older adults to feel cut off from friends and family.
Carrying on a conversation may be so difficult that they prefer to withdraw
and be isolated.

• Mental Health: Persons with hearing loss often become isolated and
depressed.

• Safety: A person may not hear warning sounds or alarms.

• Misunderstood Conversation: Poor hearing can lead to suspiciousness,
paranoia, alienation, and frequent disagreements with others.

• Labeled as Confused or Demented: When older persons fail to answer when

spoken too or if they give inappropriate answers to questions, they are
sometimes considered confused or demented.

• Paranoid Behavior: Inappropriate actions based upon missed information can

lead to a feeling of paranoia. For example, when everyone is laughing at a
joke that was not heard by an older person with poor hearing, the older person
may mistakenly feel that he/she is being laughed at by members of the group.

• Fatigue: Listening and following a conversation is tiring for someone with

poor hearing.
 • Talk loudly
• Turn their head so that the best ear is toward a
How to sound.
recognize if • Eyes focus on a speaker’s lips (lip reading).

someone • Ask people to repeat what was said.

• A blank look.
cannot hear • Withdrawal from social events.
well? • Increased impatience in conversation.
• Respond inappropriately during a conversation.
• Not reacting to a loud noise.
 • Get the person’s attention before speaking to them.
• Use a normal tone of voice. Do not shout.
• Talk face-to-face so that the person can see your lips
• Speak clearly and distinctly.
• Cut out the background noise; turn off the radio and
television.

Dealing with • Reduce building noises such as a furnace, fans, appliances,

etc.
poor hearing • Move to a quieter or less distracting area
• Use gestures with hands, facial expressions, and visual aids.
• Allow adequate time for person to respond
• Do not chew, smoke, or cover your month when speaking.
• Stay still so that the person can see you and your lips.
• Do not speak directly into the person’s ear.
• Watch for an indication that the person understood your
message.
 • Use a microphone
• Do not write on a blackboard and talk while your
When back is to the audience.
• Remember that if you use slides or transparencies in
speaking to a darkened room, the audience will not be able to
lip-read.
groups of • Stand still. Do not pace the room because the
older people audience will have difficulty reading your lips. The
older person may also have a slowed ability to keep
re-focusing their vision to see you.
• Use visuals that reinforce your spoken word.
• Repeat questions from the audience before
answering the question.
 • resist using a hearing aid because they perceive
hearing aids as a symbol of old age.
Why do older • rather miss out on hearing sounds rather than risk
people resist being considered old.
• use of a microphone amplifier to enhance hearing
using a • some people find hearing aids unacceptable because
hearing aid? the device amplifies background noises making it
difficult to hear spoken words.
• some people may have hearing problems that a
hearing aid cannot overcome.
 TASTE AND SMELL
• The senses of taste and smell work together. Most tastes are linked with odors. The
sense of smell begins at the nerve endings high in the lining of the nose.

• You have about 10,000 taste buds. Your taste buds' sense sweet, salty, sour, bitter, and
umami flavors. Umami is a taste linked with foods that contain glutamate, such as the
seasoning monosodium glutamate(MSG).

• Smell and taste play a role in food enjoyment and safety. A delicious meal or pleasant
aroma can improve social interaction and enjoyment of life. Smell and taste also allow
you to detect danger, such as spoiled food, gases, and smoke.
• It is natural for older people to lose some of their ability to taste.

• most can still identify sweet, sour, bitter, or salty foods, especially when these
flavors are concentrated. For example, older persons may add large amounts of
salt to enhance the flavor and make foods more palatable.

• The number of taste buds decreases as you age. Each remaining taste bud also
begins to shrink. Sensitivity to the five tastes often declines after age 60.

• In addition, your mouth produces less saliva as you age. This can cause dry
mouth, which can affect your sense of taste.
 • Increase or decrease of appetite.
• Weight loss or weight gain.
How can loss • Complaints that foods taste badly or have
of taste be no taste.
recognized? • Complaints about food tasting bitter or
sour.
• Unable to identify foods by taste.
• Excessive use of seasonings.
 SMELL
• Lack of smell can affect the pleasure and satisfaction that older people
obtain from food.
• Anyone who cannot smell food will, likewise, not be able to taste
food. Changes in the ability to smell, also have implications for safety,
personal hygiene, and enjoyment of life.
• Loss of smell can put an older person at risk to the dangers associated
with eating spoiled food or not responding to smoke or leaking gas.
• Some medical conditions such as Alzheimer’s Disease or head trauma
can cause loss of smell or the inability to understand or distinguish
smells.
 TOUCH, PAIN AND VIBRATION
• The sense of touch makes you aware of pain, temperature, pressure, vibration,
and body position.
• Skin, muscles, tendons, joints, and internal organs have nerve endings
(receptors) that detect these sensations.
• Some receptors give the brain information about the position and condition of
internal organs. Though you may not be aware of this information, it helps to
identify changes (for example, the pain of appendicitis).
• Brain interprets the type and amount of touch sensation. It also interprets the
sensation as pleasant(such as being comfortably warm), unpleasant (such as
being very hot), or neutral (such as being aware that you are touching
something).
• The skin is the largest organ of the body and has millions of nerve endings.
• People thrive on stimulation through touch; without it, humans often feel a
longing or aching. Touching doesn’t have to involve hugging. Just a simple pat
on the shoulder or arm can communicate that someone cares.
• Those caring for older adults can communicate love through the sense of touch
by giving a gentle back rub, rubbing lotions to dry skin, or brushing the hair.
• Offering your arm to help someone who may be a bit unsteady walking helps to
satisfy the need for touch. Even a pet that might sit on the lap or rub around the
legs can fulfill the need for touch.
• The sense of touch may be the most important of the senses, yet the most
neglected.
• We can survive without sight, hearing, taste, or smell, but without touch, we are
at great risk of mental breakdown.
How can I tell if a person has a poor sense
of touch?
Withdrawal or avoidance Extremes in feeling pain,
of activities usually either not feeling pain or
enjoyed, such as sewing overreacting to slight
or playing with a pet. pain.

Showing no response to
Grasping objects tightly.
pressure.
Causes

• Parkinson’s Disease.
• Mini-strokes.
• Lack of blood flow to the hands because of swelling.
• Arthritis.
• Not using limbs or muscles (bedridden or continuous sitting).
EFFECTS OF AGING ON
MOTOR SYSTEM
 MOTOR SYSTEM
• The CNS is the central component of the motor system; its
function is to program and implement the execution of
movements. The CNS works both consciously (cortical areas)
and unconsciously (subcortical structures).

• The motor cortex is composed of three main areas (primary

motor cortex, the premotor cortex, and the supplementary
motor area) all three located in the frontal lobe. To design a
motor plan, the system uses information from the outside
world as well as from the inner body.

• This information is processed in two areas of the brain

associated with conscious processes, the primary
somatosensory cortex, and the posterior parietal cortex, both
located in the parietal lobe, and is integrated and transmitted
to different parts of the system through different pathways.
• The main path of the conscious or voluntary component of the
motor system is the pyramidal tract. The pyramidal tract crosses
the midline; the pathway that controls the right part of the body
is in the left cerebral hemisphere and vice versa.

• This is important, because if there is a lesion above the

decussation of the pyramids the deficit will be contralateral, but
if it is under the decussation, the deficit will be on the same side
as the lesion.

• Neurons of the pyramidal tract synapse with the inferior or

lower motor neurons located in the spinal cord or medulla
oblongata, these neurons connect with the muscles through the
neuromuscular junction.
• The unconscious or involuntary component
of the motor system is called the
extrapyramidal system; it is composed of
nuclei in the base of the brain, called basal
ganglia (striatum, globus pallidus, substantia
nigra, and subthalamic nucleus) and tracts
that interconnect the cortex, the basal
ganglia, the thalamus, and the cerebellum.

• The extrapyramidal system specializes in

the control and coordination of movements.
Alterations of movement control can be seen
in diseases, such as Parkinson’s disease,
where rigidity, tremor, and other movement
disorders may appear.
• The PNS receives input from the CNS and is the
final executor of the motor act. The PNS consists
of the peripheral nerves, the muscles, and the
junction between these two, called the
neuromuscular junction.

• The nerves are fascicular structures that carry three

different types of fibers, motor, sensory, and
autonomic (related to visceral functions).

• The muscles are the contractile apparatus and final

effector of the motor system. Muscles have fixed
sites and by performing a contraction they produce
movement.
 • THE MOTOR UNIT IS THE BASIC functional unit in the
neuromuscular system that allows production of force and
movement. The motor unit consists of the alpha motor
neuron and the muscle fibers it innervates.

AGING AND
MOTOR UNIT • Age-related changes to the neuromuscular system and the
resulting motor performance, however, do not appear to be
uniform among old adults.

• Some old adults have much greater impairments in motor

function compared with others of the same age and sex, so
between-subject variability is typically greater than young
adults.
Aging and Motor Unit
• The motor neuron is the final common pathway through which
all synaptic inputs are translated to motor function by the
musculoskeletal system.

• Aging is accompanied by a net loss of motor units, changes to

the morphology and properties of existing motor units, and
altered inputs from peripheral, spinal, and supraspinal centers.

• Ultimately, motor performance is impaired, and its variability is

greater with advanced age.
 • Motor performance including
strength
Age related
changes in power
Motor contraction velocity
Performance
fatigability
force steadiness
Strength

• The age-related reduction in maximal isometric strength largely

parallels the loss of muscle mass.

• Based on cross-sectional studies of lower limb muscles, strength is

usually reduced by 10% per decade with reductions starting at
approximately 40–50 years of age, with evidence of accelerated
declines in very old age so that the average strength of an 80-yr-old
can be by 40% that of a same-sex 20- to 30-yr-old.
Power
• Age-related reductions in maximal power are greater in magnitude than for
maximal isometric strength.

• Power is also more strongly associated with functional performance tasks

such as stair climbing, ambulation, and rising time from a chair, than age-
associated reductions in isometric strength.

• Increasing physical activity, in particular with resistance and power training

of the lower limbs, can have large effects on increasing power and
decreasing risk of disability in old adults
Contraction velocity and rate of force development

• The slowing of whole muscle with aging contributes to the reduced power in older
adults.

• The whole muscles of older adults exhibit lower rates of force development and
slower relaxation rates than young during voluntary contractions and evoked
contractions (independent of voluntary activation) in both upper and lower limbs.

• Age-related slowing of whole muscle is accompanied by a reduced proportional

area of MHC II fibers and lower maximal shortening velocity of single muscle
fibers even in MHC I fibers of very old active and inactive old adults.
Voluntary activation

• During a maximal-effort isometric contraction and with adequate practice,

old adults can achieve high levels of activation, although this may vary with
the muscle group involved, velocity of contraction, physical activity level,
and age of the old adult.

• Inadequate activation of the surviving motor units in old adults may

contribute to age-related losses of strength and power.
Fatigability
• Performance fatigability is the reduction in force or power of a muscle in
response to exercise.

• The consequences of greater fatigability with aging are significant because

fatigability further exacerbates the age-related loss of strength and power in
old adults observed before exercise.

• fatigue-induced variability of force or power, which is greater with aging,

may further impair performance of daily activities.
Force steadiness

• Age-related changes in motor unit behavior affect the control of force

among old adults.

• Typically, old adults are less steady than young adults, especially during
light-load tasks that are often required during activities of daily living.
 • With advanced age comes a decline in sensorimotor
control and functioning. These declines in fine motor
Motor control, gait and balance affect the ability of older
performance adults to perform activities of daily living and
deficits in older maintain their independence
adults

• The causes of these motor deficits are multi-factorial,

with central nervous system declines and changes in
sensory receptors, muscles and peripheral nerves
• Motor performance deficits for older adults appear to be due to
dysfunction of the central and peripheral nervous systems as well as
the neuromuscular system.

• Motor performance deficits include coordination difficulty, increased

variability of movement, slowing of movement, and difficulties with
balance and gait in comparison to young adults.

• These deficits have a negative impact on the ability of older adults to

perform functional activities of daily living.
• Movement slows with age by as much as 15– 30% . This slowing
appears in part to be strategic in that older adults emphasize
movement accuracy at the cost of movement speed.
Diggles-Buckles, 1993

• Older adults show deficits in coordination of bimanual and multi-

joint movements. For example, movements become slower and less
smooth when older adults move their shoulder and elbow joints
simultaneously as opposed to performing single joint actions.

• Cerebellar patients exhibit similar deficits, suggesting that age-

related degeneration of the cerebellum and the proprioceptive
system may contribute to deficits in multi-joint coordination for
older adults.
MOTOR CHANGES

• POSTURE
• GAIT
• BALANCE
POSTURE AND MOVEMENT

• Posture or “station” (the bearing of one’s body that provides a stable background for
movement) and movement (the ability to change posture and position) are regulated
by a number of structures and functions within and without the nervous system.

• With aging, skilled motor movements are slowed, and gross movements, particularly
those related to maintenance of posture and gait (i.e., manner or style of walking),
are altered.

• These changes affect the speed of movement, which may be accelerated or slowed.
Alternatively, these changes may affect the contraction of specific muscles, resulting
in abnormal movements (as in dyskinesias) or in abnormal posture (as in dystonias).
• Alterations of movement and posture lead to imbalance and thus, to a high
incidence of falls, one of the most frequent and life-threatening accidents
of old age

• With advancing age, the typical adult gait changes to a hesitant, broad-
based, small-stepped gait with many of the characteristics of early
parkinsonism, often including stooped posture, diminished arm swinging
• Typical gait in normal individual is characterized by:
head that is erect (without spinal curvature)
Arms that swing reciprocally (without grabbing at furniture)
Stepping without staggering or stumbling movements and
Feet that clear the ground at each step
•Typical gait changes in older adults includes

Decreased gait speed

Decreased step or stride length
Increased stance time and double-limb support time
Increased variability of gait (variability in step or stride time, length,
width, frequency, or velocity)
Decreased excursion of movement at hip, knee, and ankle
• Measurements of a subject’s gait, such as speed and length of stride are not
obtrusive and can provide useful information on the degree of competence
or damage of the central and peripheral nervous system.

• Impairment of gait and balance may also indicate disturbances of the

vascular and mental status as well as the conditions of the skeleton and
joints and orthopedic disorders.
• Gait changes may be useful in providing additional clinical insights:
Gait asymmetry gives a clue to hemiplegia or arthritis (both of which
negatively affect movement)
Impairment of shoulder movements in walking suggests parkinsonism
Increase in stride width relates to cerebellar disease and arthritis and
Trunk flexion (due to unstable balance) suggests impaired visual,
vestibular, and proprioceptive controls
• Motor performance impairments with aging are likely due in part to changes in
peripheral structures such as sensory receptors, muscles, peripheral nerves, joints,
etc. as well as central nervous system changes.

• A greater understanding of age-related motor system changes is an important

precursor to designing appropriate rehabilitation strategies.
 1. Guccione AA, Avers D, Wong R. Geriatric physical therapy-
ebook. Elsevier Health Sciences; 2011 Mar 7.
2. Hunter SK, Pereira HM, Keenan KG. The aging neuromuscular
system and motor performance. Journal of applied physiology.
2016 Oct 26.
3. Schieber F. Aging and the senses. InHandbook of mental health
and aging 1992 Jan 1 (pp. 251-306). Academic Press.
REFERENCES 4. Zapparoli L, Mariano M, Paulesu E. How the motor system
copes with aging: a quantitative meta-analysis of the effect of
aging on motor function control. Communications biology.
2022 Jan 20;5(1):1-5.
5. Seidler RD, Bernard JA, Burutolu TB, Fling BW, Gordon MT,
Gwin JT, Kwak Y, Lipps DB. Motor control and aging: links to
age-related brain structural, functional, and biochemical
effects. Neuroscience & Biobehavioral Reviews. 2010 Apr
1;34(5):721-33.
6. Siewe YJ. Understanding the effects of aging on the sensory
system. Oklahoma Cooperative Extension Service; 2004.
VISION
HEARING
 Principles of hearing
Units for measuring sound exposure
• Sound pressure level (SPL)
• Expressed in Pa
• Range from 20 pa (hearing threshold) till 20 Pa
• Decibel db of sound pressure level
• defined as: 20 log10 p1/p0 where p1 is actually measured sound pressure level
of a given sound, and p0 is a reference value of 20μPa, which corresponds to
the lowest hearing threshold of the young, healthy ear.
• In the logarithmic scale the range of human ear’s audible sounds is from 0 dB
SPL (hearing threshold) to 120-140 dB SPL (pain threshold)
• Examples of sound pressure levels in relation to hearing threshold and
pain threshold (in dB SPL)The range of human ear’s audible sounds
goes from 0 dB SPL (hearing threshold) to 120-140 dB SPL (pain
threshold) 
Hearing threshold: o dB

Leaves fluttering: 20 dB

Whisper in an ear: 30 dB

Normal speech conversation: 60 dB

Cars/vehicles for a close observer: 60-100 dB

Airplane taking off for a close observer: 120 dB

Pain threshold: 120-140 dB

 Types of hearing loss
1. Conductive hearing loss
2. Sensorineural hearing loss
3. Mixed hearing loss
4. Central hearing loss
 Severity of Hearing loss

• Table shows one of the more commonly used classification systems. The
numbers are representative of the patient’s hearing loss range in decibels.
• The American Academy of Ophthalmology and Otolaryngology
(AA00) guidelines (Revised in 1979) states:
“ the ability to understand normal everyday speech at a distance of about 5 feet
does not noticeably deteriorate as long as the hearing loss does not exceed an
average value of 25 dB at 500, 1000 and 2000 Hz”
 Hearing loss causes
• Age: tiny hairs get damaged and are less able to respond to sound waves
• Noise: exposure to loud noises damage the hair cells in the cochlea
• Infections: fluid can build up in the middle ear
• Perforated eardrum: depending on the size of perforation, there may be a
mild or moderate hearing loss
• Tumors: eg acoustic neuroma and meningioma
• Trauma: injuries such as skull fracture or a punctured eardrum
• Medications: aminoglycoside class of antibiotics
• Genes: genetic hearing loss often begins with hearing loss diagnosed at birth
 Assessment of hearing
1. Initial otoscopic examination
2. Speech test (loud, whisper)
3. Tuning fork test (weber, rinne and schwabach)
4. Audiometry
5. Tympanometry
6. OAE (Otacoustic Emission)
7. EChocG
8. BERA
1. Initial Otoscopic examination
• Performed with hand a held otoscope
• Ear canal and tympanic membrane
are observed
• Tympanic membrane is seen for:
Light reflection

Differentiation of its part

mobility
 2. Speech Test
• Simplest of all
• Involves testing ability to hear words without
using any visual information
• Patient should repeat 5 words spoken loudly at
a distance of approximately 5 meter
• The whispered voice test involves the tester
blocking one of patients ears and testing
hearing by whispering words at varying
volumes

Ball point click test

3. Tuning fork test
• Used to differentiate between
conductive and sensorineural
hearing loss
• Larger forks vibrate at slower
frequency
• Tuning forks with frequency 256
or 512 Hz are used
Principle of tuning fork test
CHL (OE or ME Disorder)
• Sounds delivered to the ear via AC will be attenuated
• If the sound is delivered to the ear via BC, bypassing the OE and ME
then the sound will be heard normally assuming there is no disorder
• SNHL (OE and ME are free from disorders)
• Sounds delivered to the ear via BC will also be attenuated.
 Weber’s Test
• Vibrating tuning fork is placed on the patient’s
forehead (or in the middle)
• The vibrations are transmitted by bone
conduction to cochlea
• The patient should state if the tone is heard in
the left ear, right ear or both ears
• If the sound lateralizes, the patient may have
either an ipsilateral conductive hearing loss or
a contralateral sensorineural hearing loss
 Rinne’s Test
• Compares the level of air and bone
conduction of same ear
• Base of a tuning fork is placed to the
mastoid area (bone conduction) and then
after the sound is no longer appreciated, the
vibrating top is placed near the external ear
canal (air conduction)
 Schwabach’s Test
• Compares the patient’s bone conduction
of the examiner’s
• If the patient stops hearing before the
examiner, their suggests a sensorineural
loss
• If the patient hears it longer than the
examiner, this suggests a conductive loss
4. Audiometry
• Audiometry is a branch of audiology
and is the science of measuring
hearing acuity for variations in sound
intensity and frequency
• An audiometer is the device used to
produce sound of varying intensity
and frequency
Pure tone audiometry
• A pure tone is a tone having a single specific frequency. The frequency
of the tone is determined by the rate or speed at which the sound
source vibrates
• Pure tone audiometry is the use of pure tones to assess an individuals
hearing
• The results of this testing are plotted on the audiogram
• Pure tones are generated by an audiometer and presented to the patient
via headphones or in some cases, through loudspeakers
• Can be air conduction audiometry or bone conduction audiometry
Pure tone air audiometry procedure
• The audiologist present pure tones of one frequency to the patient,
initially at an intensity level that is assumed they can hear quite well
• The intensity (loudness) of the tone is decreased in 10 to 15 dB steps
• This is continued, with tones being presented for one to two seconds,
until the patient no longer responds
• The intensity is then raised in 5 dB steps until the patient responds,
decreased again and increased again in 5dB steps until the patient
responds
• This lowest audible intensity is defined as the patients threshold for the
particular frequency and is marked as such on the audiogram
• Interaural attenuation and masking
• At certain intensity levels, the signal
presented to the test ear will cross over
and be heard in the non-test ear. The inter-
aural attenuation rate, or the intensity
difference at which a sound will be heard
in the non-test ear, is approximately 40 dB
for air conduction signals presented
through circumaural earphones
• The masking noise used for pure tone
audiometry is narrow-band noise,
generally the same frequency as the pure
tone being presented to the test ear.
5. Tympanometry
• examination used to test the condition
of the middle ear and mobility of the
eardrum (tympanic membrane) and the
conduction bones by creating variations
of air pressure in the ear canal
• In evaluating hearing loss,
tympanometry permits a distinction
between sensorineural and conductive
hearing loss, when evaluation is not
apparent via Weber and Rinne testing
Principles of Tympanometry
• Introduces a pure tone into ear canal through 3 function probe tip
• Manometer (pump) varies air pressure against TM (controls mobility)
• Speaker produces 220 Hz probe tone
• Microphone measures loudness in ear canal
 6. Otoacoustic Emission
• They are low intensity sounds produced by the outer
hair cells of a normal cochlea
• Can be elicited by a very sensitive microphone placed
in EAC (External Ear Canal)
• Absent when OHC are damaged
• Thus serve to test cochlear functioning
• Uses
As a screening test for neonates
Distinguish cochlear from retrocochlear HL
To test hearing n mentally challenged and
uncooperative individuals after sedation
7. ElectroCochleoGraphy (EChocG)
• It measures electrical potentials arising in
the cochlea and VIII nerve in response to
auditory stimuli within first 5 millisec
• Response is in the form of
Cochlear microphonics (CM)
Summation potential (SM)
Action potentials(AP)
• Two methods are widely used
Transtympanic
Extratympanic
8. BERA
• Hearing loss in children is difficult to
know from the beginning.
• Hearing loss can cause speech, language,
cognitive, social and emotional problems.
Therefore, it will be better if the hearing
test in children is done early.
• Healthy hearing is when the auditory
nerve is able to transmit sound impulses
from the ear to the brain at a certain
speed.
• The BERA test can provide information on whether nerves convey
sound impulses to the brain and whether the speed of sound delivery is
within normal limits.
• This hearing examination can determine the type of abnormality
(conductive or sensor neural), severity (hearing threshold), and
hearing loss (inner ear or other parts) of the child.
• In addition, in determining the hearing threshold, BERA is also used in
otoneurologic diagnosis. This is useful for patients with unilateral or
asymmetrical hearing loss (hearing nerve tumors, brain tumors, other
nerve disorders, multiple sclerosis, etc.)
 BERA Procedure
• BERA can be done without the patient needing to
do anything. Patients only need to lie down and
preferably in a calm attitude or while sleeping.
• Electrodes will be placed on the patient’s head and
behind the ear during the BERA test procedure.
• When the examination is done, the patient will be
heard various sounds through headphones. This
examination measures changes in brain electrical
activity (EEG) in the provision of acoustic stimuli.
• This examination has no risk of complications, is
painless, and does not require special preparation
for the BERA test