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OUTCOME MEASURES:

1. Balance and Mobility Tests:

a. BERG BALANCE SCALE


i. Equipment: stopwatch, ruler
ii. Scoring:
1. Each component is scored from 0-4
2. Total score is out of 56
3. 45 = cut off score for fall risk
iii. Abilities
1. Attention/ sequencing/executive functions
iv. Postural control
1. Anticipatory, steady state
v. Components:
1. Sitting unsupported
2. Sitting to standing
3. Standing unsupported
4. Standing to sitting
5. Transfers
- From chair with arm rests to chair
6. Standing with eyes closed
7. Standing with feet together
8. Reaching forward with outstretched arm
9. Retrieving object
10. Turning to look behind
11. Turning 360 degrees
12. Placing alternate ft n stool
13. Standing with one foot in front
14. Standing on one foot

b. Performance Oriented Mobility Assessment (POMA)


i. Time: 10-15 minutes
ii. 16 items
1. 9 balance (sitting/sit-stand/standing/nudged/turning/eyes closed)
2. 7 gait (initiation/step length and height/ symmetry/ continuity/ path/
trunk/ walking stance)
iii. Scoring: 3 point ordinal0,1,2highest score = independence
1. Gait score (out of 12) + Balance score( out of 16) = total of 28
possible
2. Score < 19 = FALL RISK, 19-24 = medium Fall Risk, 25-28 = LOW
risk
iv. Populations: elderly, ALS, PD, Stroke
v. Postural Control:
1. Anticipatory and reactive postural control
2. Steady state standing and sitting balance

c. Dynamic Gait Index (DGI)


i. Purpose: Assess Gait/attention/ command following
ii. Time: 6- 30 minutes
iii. Postural Control:
1. Anticipatory and reactive postural control
iv. Marked distance of 20 feet ( can be w/ or w/out AD)
1. Steady state walking
2. Walking with changing speeds
3. Walking with head turns (horizontal/vertical)
4. Walking while stepping over & around obstacles
5. Pivoting while walking
6. Stair climbing
v. Scoring: 4 point scale (3= no gait deviation, 2 = minimal impairment, 1 =
moderate impairment, 0 = severe impairment)
1. Highest score = 24 score < 19 = FALL RISK
vi. Populations: elderly, TBI, MS, PD, stroke, vestibular

d. Functional Gait Assessment (FGA)


i. Purpose: Assess Gait/ anticipatory and reactive postural control/ attention/
command following
ii. Time: 5-10 minutes
iii. 10 item test
1. Gait level surface/ change in speed/ horizontal & vertical head turns/
pivots/ step over obstacle/ narrow BOS/ eyes closed/ backwards/
stairs
iv. Scoring: each task scored 0-3 (0= severe impairmt, 1 = mod, 2= mild, 3 =
norm)
1. Highest score = 30, score < 22 = FALL RISK
v. Populations: elderly (40-80), PD, SCI, Stroke, vestibular dx.

e. Four Square Step Test (FSST)


i. Purpose: dynamic balance that clinically assesses the persons ability to step
over objects forward, sideways, and backwards
ii. Time: < 5 minutes
iii. Pt. steps over 4 canes set up like a cross on the floor stepping both feet in
1. Stepping clockwisesquare , square 2, square 4, square 3, (back to 1)

2. Stepping counterclockwise square 3, square 4, square 2, end at 1
iv. Populations: elderly, PD, Stroke, vestibular, fall risketc
v. Scoring: the best time of 2 FSST trials is the scorestart time when 1st foot
contacts square 2 and stop when last foot comes back to square 1
1. Geriatric population/stroke > 15 sec at RISK for Falls
2. PD >10 sec at risk for falls, vestibular >12 seconds

f. Timed Up and Go (TUG)


i. Purpose: assess mobility, balance, walking ability, fall risk
ii. Time: < 3 minutes
iii. Patient sits in chairgopt. stands & walks 3 m. turns and comes back to
sit
iv. Postural control:
1. Anticipatory postural control
v. Population: elderly adult/PD/SCI/Stroke/ vestibular/MS/LBP/CP/Alzheimers
vi. Scoring: by time >12 sec indicating fall risk (varies among populations)

g. Functional Reach Test (FR)


i. Purpose: measure of postural stability (limits of stability)
ii. Stand near a wall, 90 degrees shoulder flexion, reach as far as possible, 2
trials
iii. Time: 5 minutes
iv. Scoring:
1. Community dwelling elderly-- < 7 inched = unable to leave
neighborhood w/out help, limited in mobility and ADLs
v. Populations: elderly, PD, SCI, vestibular, stroke
h. Gait Speed (GS) - normal pace10 m walk test..etc
i. Purpose: assess walking speed over a set duration
ii. Time: < 5 minutes
iii. Have 2 m buffer zone and 4 m test/timed path
iv. Scoring: based on time
v. Postural Control:
1. Anticipatory
vi. Populations: TBI, orthopedic, PD, SCI, stroke, Vestibular, elderly

i. Mini-Best test (MB)


i. Purpose: balance/ anticipatory/reactive postural control/gait
ii. Time : 10-15 minutes
iii. 14 items
1. Sit-stand, rise to toes, SLB, sompensatory stepping: fwd/bkwd/lateral,
balance feet together firm surface/foam surface, incline eyes closed
2. Change in gait speed, head turns (horiz), pivoting, step over obstacles,
TUG & TUG with dual task
iv. Scoring: 0,1,20 = lowest, 2 = highest
v. Populations: elderly, PD, stroke, TBI, MS, ataxia/balance disorders

j. Modified Clinical Test of Sensory Interaction in Balance (mCTSIB)


i. Purpose: assess patients balance under a variety of conditions to infer the
source of instability
ii. Patient performance is timed for 30 seconds/ provided with 3 trials
1. Stand on a firm surface, eyes open
2. Stand on a firm surface eyes closed
3. Stand on a foam surface eyes open
4. Stand on a foam surface eyes closed
iii. Scoring: Average score of 3 trails
iv. Time: less than 10 minutes
v. Composite score <260 seconds has specificity of 90% and sensitivity of 44%

k. 4-stage Balance Test


i. Purpose: to assess static balance
ii. Should not use AD/ keep eyes open
1. Stand with feet side by side
2. Place instep of one foot so it is touching the big toe of the other foot
3. Place one foot in front of the other, heel touching toe
4. Stand on one foot
iii. Scoring: if pt. can hold a position for 10 seconds without moving his/her feet
go to the next positionif not stop the test (record all times for items able to
do)
1. An older adult who cannot hold tandem stance at least 10 seconds is
at increased RISK for falls

l. 30-second Chair Stands


i. Purpose: assess functional LE strength
ii. Using folding chair without arms/arms crossed, complete as many full stands
as possible within 30 seconds/ sit fully between stands
iii. Scoring: total number of (correct) stands within 30 seconds
iv. Time: 30 seconds
v. Patients: geriatrics/movement disorders

2. For each of the following components of postural control, describe a recommended test or
measure. Be able to describe how you could make each test/measure more challenging as
needed so as not to miss subtle balance problems in relatively healthier people.
a. Steady-state standing
b. Functional limits of stability in standing
c. Ankle, hip, stepping, and arm (reach/grasp) reactive strategies
d. Sensory re-weighting (ability to adapt senses to different environmental conditions)
e. Anticipatory postural control
f. Cognitive contributions to postural control

3. Physical Performance and Mobility Examinations:


a. Physical Performance and Mobility Examination
i. Purpose/usage:
1. Grossly assess function/mobility without fatiguing out a patient
2. Has some higher and lower level tasks
3. Anticipatory postural control/cognitive abilities
ii. Bed Mobility: sit up in bed from lying down
1. Assessing need for assistance and time to complete
iii. Transfers: stand up from sitting (on bed) move to chair, sit down, stand up
from chair once
1. Assessing need for assistance and use of arms
iv. Multiple chair stands: stand up from chair 5x
1. Assessing need for assistance, use of arms, time to complete
v. Standing balance: ability to hold 4 positions for 10 sec. (feet apart, feet
together, semi-tandem, tandem)
1. Assess need for assistance/time
vi. Step up: step up one step with handrail
1. Assessing need for assistance/ use of handrail
vii. Ambulation: walk 5m2 trials
1. Assessing time at usual pace --- number of steps

b. High Level Mobility Assessment


i. Purpose/Usage
1. To overcome ceiling effects seen in other mobility measures
ii. Time: 6-30 minutes
iii. Scoring: set criteria for each score based on time, 0-5 point scale0 unable
to complete task/ needs assist5= normal
1. Total score out of 54
iv. Items:
1. Walk
2. Walk backward
3. Walk on toes
4. Walk over obstacle
5. Run
6. Skip
7. Hop forward (affected)
8. Bound (affected)3 trials
9. Bound (less affected)--- 3 trials
10. Up stairs independent (no rail and reciprocal)
11. Up stairs dependent (rail or not reciprocal)
12. Down stairs independent (no rail and reciprocal)
13. Down stairs dependent (rail or not reciprocal)
v. Population: TBI

4. Distinguish between the categories of the following mobility function classification schemes

a. Functional Walking Categories (J. Perry; OS Box 15.6, p. 676)


i. Physiological Walker:
1. Walks only for exercise only at home or in parallel bars at therapy
ii. Household Walker
1. Limited Household Walker
- Relies on walking for some extent for household activities
- Requires assistance for some walking activities, uses a
wheelchair, or is unable to perform certain walking activities
2. Unlimited Household Walker
- Ability to use a walking aid for all household activities
without any reliance on a wheelchair
- Encounters difficulty with stairs and uneven terrain
- May not be able to enter or leave the house independently
3. Community Walker
- Can enter and leave the home independently
- Can ascend and descend the curb independently
- Can manage stairs to some degree
- Independent in at least one moderate and community activity
and needs assistance or is unable in no more than one other
low-challenge activity
4. Least Limited Community Walker
- Demonstrates independent stair management
- Independent in all moderate community activities without
assistance of a wheel chair
- Independent in either local stores or uncrowded shopping
centers
- Independent in at least two other moderate community
activities
5. Community Walker
- Independent in all home and community activities
- Can accept crowds and uneven terrain
- Demonstrates complete independence in shopping centers
-
*Patients in each higher category can perform all of the activities in the previous groups as well as
the additional level of challenge they are classified under

b. Functional Ambulation Classification Scale (SCW p. 426)


i. 6 functional levels ranging from 0-5
0 = non-ambulation
absolute walking incapacity even with external help
1 = non-functional ambulation
Dependent walking that requires permanent help of others =
Patient must be firmly supported by 1-2 people and/or walking is
possible only within a therapy session at home or at the hospital in //
bars
2 = Household Ambulation
Walking is only possible indoors on flat, horizontal surfaces, usually
within a known and controlled are, such as in the home
3 = Neighborhood ambulation
Patients are able to walk indoors and outdoors on uneven surfaces and
they are able to climb an occasional step or stair
Able to wlak in the street within a limited and restricted distance
4 = Independent community ambulation
Patients are able to walk on all types of irregular surfaces
They can ascend and descend steps/stairs/ramps/curbs
Have considerable, even unrestricted walking distance so that they are
capable of shopping for food and accomplishing other basic chores
Not considered normal walkers b/c they have aesthetic/physical
abnormalities i.e. walk with a limb
5 = Normal Ambulation
Walking is completely normal in both distance and appearance both
at home and outside with unlimited distance
There is no anomaly or limb/ can tiptoe walk on heels and in tandem

5. UE Tests:

a. Chedoke Arm Hand Inventory


i. Purpose: evaluate the functional ability of the paretic arm/hand to perform
tasks
1. B/L UE involvement
2. Standardized (training video)
ii. Original has 13 items, also versions with 7,8,9
iii. Time: 30 minutes
iv. Scoring: 7 point activity scale
1. 1 total assistance 7 complete independence (FIM scale)
2. Higher score = better performance
v. Populations: stroke/ other UE paralysis
b. Motor Activity Log
i. Purpose: assess arm functionself report measure
1. Amount of use, quality of movement
2. Evaluate use of affected UE pre/post utilization of constraint therapy
to force use of UE
ii. Questions: rate quality of movement and amount of movement for 30, 28, or
14 daily functional tasks
1. Include object manipulation (pen, fork, comb, cup) and gross motor
(transferring to a car, steadying during standing, pull chair into a
table)
iii. Time: about 20 minutes
iv. Scoring: amount of use scale and quality of movement scale
1. 0= weaker arm not used at all 5= ability to use weaker arm was
normal
2. Higher score = better performance
v. Population: Stroke patients/ adult/elderly/ CIMT
1. Need to have cognitive function to answer questions appropriately
c. Minnesota Manual Dexterity Test
i. Purpose: ability to move small objects various distances/ gross + fine control
1. Eye-hand coordination, dexterity
ii. Components:
1. Placing, turning, displacing
2. One hand turning and placing, two hands placing and turning
iii. Scoring: timed/ standardized
1. Norm referenced for 3 trials
- low placing times= 160-174 seconds
- low turning times = 130- 142 seconds
iv. Populations/minimum abilities:
1. Attention, sequencing
2. geriatrics/ UE impairments
d. Nine hole peg test
i. Purpose: measures finger dexterity/ fine motor coordination, eye hand
control, following directions
ii. Asking pt. to take pegs from container and place into holes on board as quick
as possible
iii. Scoring: based on time (or based on # of pegs placed in 50 or 100 seconds)
iv. Time: < 1 minute
v. Population: TBI, stroke, PD, elderly
1. Minimum abilities: attention/sequencing
e. Wolf Motor Function Test
i. Purpose: quantitative measure of UE motor ability through timed and
functional tasks
1. Tests both arms
2. Looks at quality of movementtailoring assessment to client
3. Can be utilized with different ranges of impairmentfunctional
4. Cant be used in cases of spasticity
5. Not hierarchal in nature continue even if a person doesnt pass one
subtest
ii. 21 item3 parts: time, functional ability, strength
1. Grasp, grip, pinch, gross movement
iii. 30 minutes- each subtask has a 2 minute limit
1. Time can vary based on clients ability
iv. Scoring: 6 point ordinal scale0 = doesnt attempt w/involved arm, 5 =arm
participates normally
1. Max score = 75
2. Higher score = better performance
v. Population: TBI, stroke
f. Action Research Arm Test
i. Purpose: assess UE functional using observational methods
ii. 19 items 4 subtests: grasp, grip, pinch, gross motor
1. Hierachal designeach task will get more challengingif you fail to
perform the lower level task you wont have the performance to
complete the upper level tasks
iii. Scoring: 4 point scale
1. 0= performs normally, 2 = completes but takes abnormally long, 1 =
performs partially, 0= cannot perform any of test
2. Higher score = better performance
iv. Time: 10 minutes time dependent on patient ability
v. Population: MS, stroke, TBI
1. Cortical damage resulting in hemiplegia
g. Jebsen-Taylor Hand Function Test
i. Purpose: assess uni-manual hand functions required for ADLs
1. Standardizedneed coffee can/beans/spoon/soup cans
2. Fine motor, weighted functional tasks, non-weighted functional tasks
ii. 7 subtests performed on both non-dominant and dominant hand
1. Writing a letter
2. Card turning
3. Stacking checkers
4. Stimulated feeding
5. Moving light objects
6. Moving heavy objects
7. Picking up small common objects
iii. Scoring: sum of times for each subsetmax time allotted per subtest=120sec.
1. Lower score = greater function/ better performance
2. Assesses speed, not quality of performance
3. Normative values for age/gender/hand dominance
iv. Time: up to 45 minutes
v. Populations: stroke, TBI, orthopedic, SCI
h. Fugl-Meyer Assessment of Physical Performance
i. Purpose: evaluates and measures recovery in post-stroke hemiplegic patients
1. Used in both clinical and research settings
2. One of the most widely used quantitative measures of motor
impairment
3. Evaluates both UE and LE
4. Can help determine where pt. is in recovery (Brustrom level)
ii. Scoring:
1. 3-point ordinal scale
- 0= cannot perform, 1= performs partially, 2 = performs fully
- Max score = 226
- Hierarchal administration
- Higher score = better performance
iii. Components:
1. Motor function (UE max score 66, LE max score =34)
2. Sensory function (max score =24)
3. Balance (max score = 14)
4. Joint ROM (max score = 44)
5. Joint pain (max score = 44)
iv. Subscales can be administered without using the whole test
v. Time: 30 +++ minutes
vi. Populations: stroke

NOTES:
Client Buy-in affects performance
Predictive validity?Is performance on this assessment reliable and valid to what the
function is that the pt. is needing to return to?
Tests that are shorter in complexity are less likely to provide you with a lot of knowledge into
the totality of performance/function.
Clinical Considerations:
o Diagnosis, Age, Clinical Setting, Function, Time, Cost, Frequency

6. Fall Risk Assessment:

a. Activity-specific Balance Confidence Scale


i. Purpose: measure of confidence in performing various ambulatory activities
without falling or experiencing a sense of unsteadiness
ii. 16 item self-report measure
iii. Scoring: rating scale from 0-1000 = no confidence, 100 = complete
confidence
1. Overall score adding item scores and dividing by total # items
iv. Time: 10-20 minutes
v. Populations: elderly, MS, PD, stroke, vestibular
b. Modified Falls Efficacy Scale
i. Purpose: self report questionnaire/ functional assessment of self-confidence
with ADLs/ mobility as a reflection of balance/stability/ postural control
ii. 14 activity questionnaire
1. Get dressed
2. Prepare a meal
3. Take a bath/shower
4. Get in/out of chair
5. Get in/out of bed
6. Answer the door or telephone
7. Walk around the inside of your home
8. Reach into cabinets/closets
9. Simple shopping
10. Using public transportation
11. Crossing roads
12. Light gardening
13. Using front or rear steps at home
iii. Time: less than 5 minutes
iv. Scoring: each item scored on a 10 point visual analogue scale
1. 0= not confident/not sure at all, 5= fairly confident/fairly sure, 10 =
completely confident/completely sure
2. Scores can fall in between 0.5. 10
3. Higher scores reflect more confidence and less fear of falling
c. Modified Gait Efficacy Scale
i. Purpose: addresses older adults perception of their level of confidence in
walking during certain circumstances
ii. 10 item questionnaire
1. Walking safely on level surface
2. Walking safely on grass
3. Walking safely over an obstacle in your path
4. Safely stepping down from a curb
5. Safely stepping up on a curb
6. Safely walking up stairs holding on a railing
7. Safely walking down stairs holding on a railing
8. Safely walking up stairs if you are not holding a railing
9. Safely walking down stairs if you are not holding a railing
10. Safely walking a long distancesuch as mile
iii. Scoring: each item scored on a 10 point likert scale with 1 denoting no
confidence and 10 representing complete confident
1. Lowest score 10--- highest score 100
iv. Time: less than 5 minutes

d. Survey of Activities and Fear of Falling in the Elderly (SAFFE) instruments.


i. Purpose: Assessing both the fear of falling and activities limited/ADLs
restricted due to fear of falling
ii. 11 items representing ADLs, mobility, and social activities
iii. Scored as the number of activities they do out of 11
1. Activity Level: Number of activities they do out of 11--
No/nonresponse are given a 0 and a yes is given a 1
2. Fear of falling: low scores mean low fear, 0= not at all, 3= very
worried
3. Activity Restriction: number of activities that are reported as doing
less than used to (range from 0-11)
4. Count not at all worried responses to determine the # of activities
that are not done due to reasons other than falling
5. Count the number of yes responses to determine the number of
activites that are not done because of other reason in addition to fear
of falling
iv. Higher Scores indicate a greater risk for falling
v. Time: less than 10 minutes

7. Other Functional Measures:

a. Functional Independence Measure (FIM)


i. Purpose: provides a uniform system of measurement based on ICF model
measures the level of assistance required for individual to carry out ADLs
ii. Contains 18 items (13 motor tasks, 5 cognitive tests)
1. Eating, grooming, bathing, UE/LE dressing, toileting, bladder/bowel
2. Bed-chair transfer, toilet transfer, shower transfer, locomotion, stairs
3. Cognitive comprehension, expression, social interaction, problem
solving, memory
iii. Scoring: 7 point ordinal scale
1. total assist pt. performs less than 25%
2. max assist- pt. perfroms 25-49%
3. Moderate assistpt. can perform 50-75%
4. Minimal Contact Assistpt. can perform > 75% of task
5. Supervision (set up)
6. Modified Independentrequires device but no assist
7. Complete Independence
iv. Time: 30-45 minutes
v. Populations: TBI, geriatrics, MS, orthopedic, PD, SCI, stroke

b. Barthel Index
i. Purpose: Assess ability of pt. with neuro/msk disorders to take care of
themselves
ii. 10 ADL/mobility activities
1. Feeding, bathing, grooming, dressing, bowel, bladder, toileting, chair
transfer, ambulation, stair climbing
iii. Scoring: 0-5 scale, 0- dependent, 10= independent total out of 100
iv. Time: 2-5 minutes (self-report), 20 minutes (observation)
v. Populations: stroke, neurological disorders, TBI, geriatrics

c. OPTIMAL tool
i. Purpose: measures difficulty and self confidence in performing 22
movements that pt. needs to accomplish in order to do various functional
activities
1. Rated on both difficulty and confidence
2. From the items listed choose 3 activities most likely to do without
difficulty
3. From list of 3 activities choose primary activity to do without
difficulty
ii. Scoring: 1-5 scale
1. Subtract the discharge (final) from admission sum of scores (baseline)
the higher the change score the more improvement
iii. Time: 20-30 minutes

1. Discuss the benefits and risks associated with using physical performance measures to predict fall
risk in a given patient

Gait Analysis

1. Compare and contrast the gait analysis sections of the Performance Oriented Mobility
Assessment and the Gait Assessment Rating Scale
2. Be able to identify common causes of various gait deviations (OS Tables 7.5-7.7, pp. 264-8)

Sit them upright so they have optimal ability to

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