Multiple Body System Analysis Across the Lifespan
Original Editor - Ewa Jaraczewska based on the course by Eena Kapoor
Top Contributors - Ewa Jaraczewska, Jess Bell and Kim Jackson
Introduction[edit | edit source]
Throughout the lifespan, the body experiences many changes in its cells, tissues, and organs, which can impact the functioning of all body systems. Everyone ages differently, and healthcare providers must be able to recognise these differences. This article explores multi-system characteristics, impairments, and interventions for children, adolescents, adults, and older adults.
Musculoskeletal System[edit | edit source]
A full musculoskeletal examination should be performed to assess the musculoskeletal system. Functional tests are an important part of this assessment.
The functional capacity of the musculoskeletal system should be assessed within the context of a person's school, play, work, daily activities, and sports. Because functional tests vary in terms of their reliability and validity, using a combination of a questionnaire and a functional test appears to be the most effective means to evaluate the functional capacity of the musculoskeletal system.[1] The following questionnaires are recommended:[1]
- Oswestry Disability Index
- Pain Disability Index
- Roland-Morris Disability Questionnaire
- Upper Extremity Functional Scale
Table 1 provides examples of functional tests that can be used in the musculoskeletal system assessment for children/adolescents, adults and older adults. It also identifies conditions and changes that can occur in the system across the lifespan.
Children/Adolescents | Adults | Older Adults | |
---|---|---|---|
Muscle strength
(functional assessment to include sit-to-stand and stairs) |
|
1MSTST: norm values range from 8.1 in individuals with stroke to 24 in individuals with advanced lung disease[6] or 50 in healthy adult males.[7] |
|
Flexibility / range of motion
(spinal and chest wall mobility) |
Chest wall mobility:
Age 3 years through to adulthood: Chest wall mobility measurements for tidal volume excursion(quiet breathing):[12]
Paediatric:
Chest wall measurement for vital capacity(big breath):[12]
Spinal mobility:
|
Chest wall mobility:
Spinal mobility: Measured in standing using the inclinometer technique:[14]
|
Chest wall mobility:
Spinal mobility: Measurement as for adults.
|
Pain |
|
|
|
Bone mineral density |
|
||
Core stability |
|
Same as in children/adolescents. | Same as in children/adolescents. |
Neurological System[edit | edit source]
"Neurons that fire together, wire together."[10]
"Each time we practise that certain type of movement or certain type of action, we are laying down those pathways in our brain."[10] -- Eena Kapoor
A neurological assessment includes many elements. For a detailed discussion of how to screen the neurological system, please see: Neurological Screen. This section discusses key functional tests that can be included in a neurological system assessment.
It is important to consider the following components in a neurological systems assessment:
- proprioception
- ability to determine a body segment's position and movement in space[23]
- vestibular system
- ability to coordinate movement with balance (static and dynamic)
- contributes to spatial orientation, postural control, and gaze stabilisation
- interoception
- ability to detect/perceive internal body states, including heart rate, respiration, hunger, and digestion[24]
- our perception of internal body signals influences our emotions, decision-making, and sense of self
- please watch the following optional video if you want to learn more about interoception
Table 2 provides examples of functional tests that can be part of the neurological system assessment for children/adolescents, adults and older adults. It also identifies conditions and changes that occur in the neurological system across the lifespan.
Children/Adolescents | Adults | Older Adults | |
---|---|---|---|
Proprioception |
|
There are three main testing techniques for assessing proprioception in adults: |
|
Vestibular system |
|
|
|
Integumentary System[edit | edit source]
Adequate mobility of the skin and other connective tissues is needed for free movement of the underlying structures to provide postural support and assure proper ventilation.[12] Multiple impairments can be associated with fascial restrictions.
The skin is one of the largest organs of the body. It has many functions, including [32]
- structural barrier
- thermoregulation
- contributes to sensation for neuromuscular control
- provides fascial mobility to allow a joint range of motion
Skin diseases such as atopic dermatitis, psoriasis, and allergic or irritant contact dermatitis affect skin transepidermal water loss (TEWL) (i.e. the amount of water lost through the epidermis from evaporation), hydration, and acidity.[33]
Table 3 provides examples of conditions and changes that can occur in the integumentary system across the lifespan.
Children/Adolesents | Adults | Older Adults |
---|---|---|
|
|
|
If you would like to learn more about this system, please see: Integumetary System.
Gastrointestinal System[edit | edit source]
- The gastrointestinal (GI) system occupies the majority of the space in the abdominal compartment
- The following structures surround the abdominal compartment:
- diaphragm superiorly
- abdominal wall anteriorly
- spine posteriorly
- costal arch on both sides
- pelvis inferiorly
- The abdominal compartment contains multiple solid and hollow organs, adipose tissue, and major blood vessels. It is located intra- and/ or retro-peritoneally
- The healthy functioning of the GI system depends on the body's ability to generate intra-abdominal pressure
Table 4 provides examples of conditions and changes in the gastrointestinal system that can occur across the lifespan and should be considered in a multiple systems analysis.
Children/Adolesents | Adults | Older Adults |
---|---|---|
|
|
|
Cardiopulmonary System[edit | edit source]
The following functions of the cardiopulmonary system should be considered in a multiple systems analysis:
- breathing mechanics and patterns
- sleep quality
- oxygen saturation and blood pressure
Children/Adolescents | Adults | Older Adults | |
---|---|---|---|
Breathing mechanics and patterns |
|
|
|
Sleep quality |
|
||
Oxygen saturation and blood pressure |
|
Mental Health System[edit | edit source]
“Without mental health there can be no true physical health” -- Dr Brock Chisholm, the first Director-General of the World Health Organization (WHO)
The World Health Organization defines mental health as comprehensive physical, psychological and social well-being.[58] Economic and social circumstances significantly influence complete mental health, resilience and social support across the lifespan.[59] Older adults often score lower in mental health-related quality of life (MHRQoL) scores.[60] Kang et al.[60] also found that older adults report the highest stress and depression. Stress, depression, and subjective health status influence mental health-related quality of life in adolescents and adults.[60]
The role of physiotherapists in mental health can include:[61]
- promoting health, including mental health
- providing education about mental health
- providing referrals to mental health specialists when necessary
- providing a person-centred approach for children, adolescents, adults, and older adults to enhance physical and emotional well-being through improving posture, respiration and concentration
- the following low-impact activities may be useful for patients:
- Yoga (mind-body therapy)
- Pilates method (balancing of the body and mind)
- Feldenkrais method (using movement to improve self-awareness and function[62])
- Tai-Chi
- Mindfulness-based therapies
- Breathing therapies
- the following low-impact activities may be useful for patients:
Resources[edit | edit source]
- Schenkman M, Butler RB. A model for multisystem evaluation treatment of individuals with Parkinson's disease. Phys Ther. 1989 Nov;69(11):932-43. doi: 10.1093/ptj/69.11.932. PMID: 2813521.
- Massery M, Magee CL. Asthma: multisystem implications. In: Campbell S, Palisano R, Vander Linden D, editors. Physical Therapy for Children. 3 ed. Philadelphia, PA: Elsevier Health Science, 2006. p851-79.
References[edit | edit source]
- ↑ 1.0 1.1 Wind H, Gouttebarge V, Kuijer PP, Frings-Dresen MH. Assessment of the functional capacity of the musculoskeletal system in the context of work, daily living, and sport: a systematic review. J Occup Rehabil. 2005 Jun;15(2):253-72.
- ↑ Falk B, Dotan R. Child-adult differences in the recovery from high-intensity exercise. Exerc Sport Sci Rev. 2006 Jul;34(3):107-12.
- ↑ Haile SR, Fühner T, Granacher U, Stocker J, Radtke T, Kriemler S. Reference values and validation of the 1-minute sit-to-stand test in healthy 5-16-year-old youth: a cross-sectional study. BMJ Open. 2021 May 7;11(5):e049143.
- ↑ 4.0 4.1 Mall MP, Wander J, Lentz A, Jakob A, Oberhoffer FS, Mandilaras G, et al. Step by step: evaluation of cardiorespiratory fitness in healthy children, young adults, and patients with congenital heart disease using a simple standardized stair climbing test. Children (Basel). 2024 Feb 12;11(2):236.
- ↑ Schorling DC, Rawer R, Kuhlmann I, Müller C, Pechmann A, Kirschner J. Mechanographic analysis of the timed 4 stair climb test - methodology and reference data of healthy children and adolescents. J Musculoskelet Neuronal Interact. 2023 Mar 1;23(1):4-25.
- ↑ Watson K, Winship P, Cavalheri V, Vicary C, Stray S, Bear N, Hill K. In adults with advanced lung disease, the 1-minute sit-to-stand test underestimates exertional desaturation compared with the 6-minute walk test: an observational study. J Physiother. 2023 Apr;69(2):108-113.
- ↑ Bohannon RW, Crouch R. 1-Minute Sit-to-Stand Test: Systematic review of procedures, performance and clinimetric properties. J Cardiopulm Rehabil Prev. 2019 Jan;39(1):2-8.
- ↑ Strassmann A, Steurer-Stey C, Lana KD, Zoller M, Turk AJ, Suter P, Puhan MA. Population-based reference values for the 1-min sit-to-stand test. Int J Public Health. 2013 Dec;58(6):949-53.
- ↑ Gagliano-Jucá T, Li Z, Pencina KM, Traustadóttir T, Travison TG, Woodhouse L, Basaria S, Tsitouras PD, Harman SM, Bhasin S, Storer TW. The Stair Climb Power Test as an Efficacy Outcome in Randomized Trials of Function Promoting Therapies in Older Men. J Gerontol A Biol Sci Med Sci. 2020 May 22;75(6):1167-1175.
- ↑ 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 Kapoor E. Multiple Body System Analysis Across the Lifespan Course. Plus, 2024.
- ↑ Brodowski H, Andres N, Gumny M, Eicher C, Steinhagen-Thiessen E, Tannen A, Kiselev J.Reliability of stair-climbing speed in two cohorts of older adults.International Journal of Therapy and Rehabilitation 2021; 28(11):1-15.
- ↑ 12.0 12.1 12.2 Massery, M. "If You Can't Breathe, You Can't Function" continuing education class 20 hrs. 2008, Chicago, IL. USA www.MasseryPT.com
- ↑ 13.0 13.1 Kondratek M, Krauss J, Stiller C, Olson R. Normative values for active lumbar range of motion in children. Pediatr Phys Ther. 2007 Fall;19(3):236-44.
- ↑ Waddell G, Somerville D, Henderson I, Newton M. Objective clinical evaluation of physical impairment in chronic low back pain. Spine 1992;17:617–28.
- ↑ Saidu IA, Maduagwu SM, Abbas AD, Adetunji OO, Jajere AM. Lumbar spinal mobility changes among adults with advancing age. J Midlife Health. 2011 Jul;2(2):65-71.
- ↑ Sansone L, Gentile C, Grasso EA, Di Ludovico A, La Bella S, Chiarelli F, Breda L. Pain Evaluation and Treatment in Children: A Practical Approach. Children (Basel). 2023 Jul 13;10(7):1212.
- ↑ Adeboye A, Hart R, Senapathi SH, Ali N, Holman L, Thomas HW. Assessment of Functional Pain Score by Comparing to Traditional Pain Scores. Cureus. 2021 Aug 3;13(8):e16847.
- ↑ BioPsychoSocial Assessment Tools for the Elderly - Assessment Summary Sheet. Available from https://instruct.uwo.ca/kinesiology/9641/Assessments/Biological/FPS.html [last access 22.03.2024]
- ↑ 19.0 19.1 McVey MK, Geraghty AA, O'Brien EC, McKenna MJ, Kilbane MT, Crowley RK, Twomey PJ, McAuliffe FM. The impact of diet, body composition, and physical activity on child bone mineral density at five years of age-findings from the ROLO Kids Study. Eur J Pediatr. 2020 Jan;179(1):121-131.
- ↑ Padilla Colón CJ, Molina-Vicenty IL, Frontera-Rodríguez M, García-Ferré A, Rivera BP, Cintrón-Vélez G, Frontera-Rodríguez S. Muscle and Bone Mass Loss in the Elderly Population: Advances in diagnosis and treatment. J Biomed (Syd). 2018;3:40-49.
- ↑ Liu CK, Leng X, Hsu FC, et al. The impact of sarcopenia on a physical activity intervention: the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P) J Nutr Health Aging. 2014;18(1):59–64.
- ↑ Johnston AP, De Lisio M, Parise G. Resistance training, sarcopenia, and the mitochondrial theory of ageing. Appl Physiol Nutr Metab. 2008 Feb;33(1):191-9.
- ↑ Han J, Waddington G, Adams R, Anson J, Liu Y. Assessing proprioception: A critical review of methods. J Sport Health Sci. 2016 Mar;5(1):80-90.
- ↑ Camarata S, Miller LJ, Wallace MT. Evaluating Sensory Integration/Sensory Processing Treatment: Issues and Analysis. Front Integr Neurosci. 2020 Nov 26;14:556660.
- ↑ Neuroscience News. Exploring Interoception: The Neuroscience of Internal Body Signals - Neuroscience News. Available from: https://www.youtube.com/watch?v=rms5I02Rzg0&t=39s [last accessed 23/3/2024]
- ↑ 26.0 26.1 26.2 26.3 26.4 Chu VWT. Assessing Proprioception in Children: A Review. J Mot Behav. 2017 Jul-Aug;49(4):458-466.
- ↑ 27.0 27.1 Yang N, Waddington G, Adams R, Han J. Joint position reproduction and joint position discrimination at the ankle are not related. Somatosens Mot Res. 2020 Jun;37(2):97-105.
- ↑ 28.0 28.1 28.2 28.3 Ferlinc A, Fabiani E, Velnar T, Gradisnik L. The Importance and Role of Proprioception in the Elderly: a Short Review. Mater Sociomed. 2019 Sep;31(3):219-221.
- ↑ 29.0 29.1 Yanovich E, Bar-Shalom S. Static and Dynamic Balance Indices among Kindergarten Children: A Short-Term Intervention Program during COVID-19 Lockdowns. Children (Basel). 2022 Jun 22;9(7):939.
- ↑ Coto J, Alvarez CL, Cejas I, Colbert BM, Levin BE, Huppert J, Rundek T, Balaban C, Blanton SH, Lee DJ, Loewenstein D, Hoffer M, Liu XZ. Peripheral vestibular system: Age-related vestibular loss and associated deficits. J Otol. 2021 Oct;16(4):258-265.
- ↑ 31.0 31.1 31.2 Nnodim JO, Yung RL. Balance and its Clinical Assessment in Older Adults - A Review. J Geriatr Med Gerontol. 2015;1(1):003.
- ↑ Lucas K, Todd P, Ness BM. A Multi-Systems Approach to Human Movement after ACL Reconstruction: The Integumentary System. Int J Sports Phys Ther. 2021 Dec 1;17(1):74-80.
- ↑ 33.0 33.1 33.2 33.3 King A, Balaji S, Keswani SG. Biology and function of fetal and pediatric skin. Facial Plast Surg Clin North Am. 2013 Feb;21(1):1-6.
- ↑ Fluhr JW, Darlenski R, Lachmann N, Baudouin C, Msika P, De Belilovsky C, Hachem JP. Infant epidermal skin physiology: adaptation after birth. Br J Dermatol. 2012 Mar;166(3):483-90.
- ↑ Giusti F, Martella A, Bertoni L, Seidenari S. Skin barrier, hydration, and pH of the skin of infants under 2 years of age. Pediatr Dermatol. 2001 Mar-Apr;18(2):93-6.
- ↑ 36.0 36.1 36.2 36.3 Knaggs H, Lephart ED. Enhancing skin anti-aging through healthy lifestyle factors. Cosmetics. 2023; 10(5):142.
- ↑ 37.0 37.1 37.2 37.3 37.4 37.5 Russell-Goldman E, Murphy GF. The Pathobiology of Skin Aging: New Insights into an Old Dilemma. Am J Pathol. 2020 Jul;190(7):1356-1369.
- ↑ Arlen AM, Nawaf C, Kirsch AJ. Prune belly syndrome: current perspectives. Pediatric Health Med Ther. 2019 Aug 6;10:75-81.
- ↑ Cerebral Palsy Digestive Issues and Health. Available from https://www.cerebralpalsyguidance.com/cerebral-palsy/associated-disorders/digestive-issues-and-health/ [last access 24.03.2024]
- ↑ Cresswell AG, Blake PL, Thorstensson A. The effect of an abdominal muscle training program on intra-abdominal pressure. Scand J Rehabil Med. 1994 Jun;26(2):79-86.
- ↑ 41.0 41.1 41.2 41.3 Bajaj JS, Long M. Exploring GI Diseases Across the Lifespan. The American Journal of Gastroenterology 118(3):p 381-382, March 2023.
- ↑ 42.0 42.1 Trachsel D, Erb TO, Hammer J, von Ungern-Sternberg BS. Developmental respiratory physiology. Paediatr Anaesth. 2022 Feb;32(2):108-117.
- ↑ How are children different? Available from https://www.rch.org.au/trauma-service/manual/how-are-children-different/ [last access 25.3.2024]
- ↑ Romei M, Mauro AL, D’Angelo MG, Turconi AC, Bresolin N, Pedotti A, Aliverti A. Effects of gender and posture on thoraco-abdominal kinematics during quiet breathing in healthy adults. Respiratory physiology & neurobiology. 2010 Jul 31;172(3):184-91.
- ↑ 45.0 45.1 Sikora M, Mikołajczyk R, Łakomy O, Karpiński J, Zebrowska A, Kostorz-Nosal S, Jastrzębski D. Influence of the breathing pattern on the pulmonary function of endurance-trained athletes. Sci Rep 2024;14 (1113 ).
- ↑ Matthews KA, Pantesco EJ. Sleep characteristics and cardiovascular risk in children and adolescents: an enumerative review. Sleep Med. 2016 Feb;18:36-49.
- ↑ Michels N, Clays E, De Buyzere M, Vanaelst B, De Henauw S, Sioen I. Children's sleep and autonomic function: low sleep quality has an impact on heart rate variability. Sleep. 2013 Dec 1;36(12):1939-46.
- ↑ Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion. J Clin Sleep Med. 2016 Nov 15;12(11):1549-1561
- ↑ Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011;32:1484-1492.
- ↑ 50.0 50.1 Wang Z, Yang W, Li X, Qi X, Pan KY, Xu W. Association of Sleep Duration, Napping, and Sleep Patterns With Risk of Cardiovascular Diseases: A Nationwide Twin Study. J Am Heart Assoc. 2022 Aug 2;11(15):e025969.
- ↑ Zhong X, Hilton HJ, Gates GJ, Jelic S, Stern Y, Bartels MN, Demeersman RE, Basner RC. Increased sympathetic and decreased parasympathetic cardiovascular modulation in normal humans with acute sleep deprivation. J Appl Physiol (1985). 2005 Jun;98(6):2024-32.
- ↑ A Good Night's Sleep. Available from https://www.nia.nih.gov/health/sleep/good-nights-sleep [last access 26.03.2024]
- ↑ Rosner B, Cook N, Portman R, Daniels S, Falkner B. Blood pressure differences by ethnic group among United States children and adolescents. Hypertension. 2009;54:502–508.
- ↑ Rademacher ER, Jacobs DR, Jr, Moran A, Steinberger J, Prineas RJ, Sinaiko A. Relation of blood pressure and body mass index during childhood to cardiovascular risk factor levels in young adults. J Hypertens. 2009;27:1766–1774.
- ↑ 55.0 55.1 New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension. Available from https://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017 [last access 26.03.2024]
- ↑ Vold ML, Aasebø U, Wilsgaard T, Melbye H. Low oxygen saturation and mortality in an adult cohort: the Tromsø study. BMC Pulm Med. 2015 Feb 12;15:9.
- ↑ 57.0 57.1 Rodríguez-Molinero A, Narvaiza L, Ruiz J, Gálvez-Barrón C. Normal respiratory rate and peripheral blood oxygen saturation in the elderly population. J Am Geriatr Soc. 2013 Dec;61(12):2238-2240.
- ↑ World Health Organization, WHO. Geneva; World Health Organization: 2001. Strengthening Mental Health Promotion.
- ↑ Schönfeld P, Brailovskaia J, Margraf J. Positive and negative mental health across the lifespan: A cross-cultural comparison. Int J Clin Health Psychol. 2017 Sep-Dec;17(3):197-206.
- ↑ 60.0 60.1 60.2 Kang MK, Kim MS, Gang M, Oh K, Kwon JS, Lee SH. Factors affecting the mental health-related quality of life in adults across the lifespan. The Korean Journal of Rehabilitation Nursing. 2012;15(2):73-82.
- ↑ Probst M. Physiotherapy and mental health. Chapter 9.Clinical physical therapy. 2017 May 31;230:59-68.
- ↑ International Feldenkrais Federation. The Feldenkrais method. Available from: https://feldenkrais-method.org/archive/feldenkrais-method/ (last accessed 8/4/2024).