Eval 3 - Cardio, Neuro Flashcards
HRmax equation
206.9 - (0.67 x age)
Cardiopulm red flags
Avoid exercise if resting vitals:
HR >120
SBP >200 or <90
DBP >110
Any wt gain of 1-2lb per day or >5lb in a week (esp CHF).
Why is posture screening important for cardipulm?
Kyphosis = decreased lung expansion.
Rib mobility can also affect breathing.
Modified Bruce Treadmill Test
Start at stage 1 (standard Bruce protocol starts at stage 3).
3min each stage.
Goal is to reach 120bpm - stop test once achieved.
Modified Balke Test
2mph for entire test.
Start 0% incline, increase by 2% every 3min, up to 10%.
Stop at 120bpm.
2 Minute Step Test - procedure & cutoff score
Measure halfway btwn iliac crest & patella, mark wall.
Knee must pass mark each step.
Count how many times 1 leg comes up (if first rep is R leg, count R).
Holding onto chair for balance IS allowed.
<65 = lower functional ability.
Seated Step Test - procedure
Seated, armless chair, aerobic step placed in front.
Metronome 60bpm.
3min each stage.
Goal = 75% HRmax.
Seated Step Test - stages
Stage 1 = 6in
Stage 2 = 12in
Stage 3 = 18in
Stage 4 = 18in + ipsilateral arm raise with each step
6MWT cutoff score & MDC
<656m = risk of mortality.
MDC = 58.2m
COVID Core Set of Measures
In order of difficulty, perform in this order.
1. SLUMS (cognition).
2. PROMIS Global 10 (QOL).
3. Medical Research Council Sum Score (strength).
4. Short Physical Performance Battery (function).
5. 2-Min Step Test (endurance).
Medical Research Council Sum Score procedure
Sum of 6 MMT scores - completed in supine, HOB 45deg.
Shoulder ABD
Elbow Flex
Wrist Ext
Hip Flex
Knee Ext (SAQ)
DF
Short Physical Performance Battery includes…
Gait speed
5x STS
Important screening components for PD
Orthostatic BP - common med side effect.
On/off phenomenon.
Urinary incontinence - usually urge.
Posture assessment (neuro)
Alignment - esp if pusher syndrome.
Vestibular hypofunction - may need help orienting to neutral.
Recommended functional measures for PD
Timed ADL (good test-retest reliability).
UPDRS.
TUG (regular + the 2 dual-task).
What are the only 2 tests that assess reactionary balance?
MiniBEST
Retropulsive Pull Test
Retropulsive Pull Test - pt position, procedure
Pt position: standing, eyes open, feet shoulder width apart. PT stands behind, sufficiently far away to allow enough space for pt to take steps to recover.
Procedure: quick pull on shoulders, hands off, guard at pelvis ready to catch if needed. Can start smaller force then increase. Need to elicit a step before ending test.
Instructions: “Do whatever you need to do to keep your balance, I will not let you fall.”
Retropulsive Pull Test - scoring
0 = recover in 1-2 steps.
1 = recover in 3-5 steps.
2 = recover in >5 steps, unaided.
3 = no recovery, would fall if not caught by PT.
4 = LOB spontaneously or with very light pull.
Retropulsive Pull Test - common result with PD
Retropulsion: a lot of little scoots back instead of a step.
4 Square Step Test
4 canes on floor creating 4 squares. As fast as possible, steps into next square without touching canes.
Start in back L square, CW around to starting square, then CCW. End in starting square.
>15 sec = fall risk.
4 Step Balance Test
Stand for 10sec in each position:
1. Feet together.
2. Semi tandem.
3. Tandem.
4. SLS.
Proceed to next position if they make it 10sec. If unable to hold 10sec, end test.
Unable to complete test = fall risk.
Figure 8 Walking Test
Pt starts in middle, walks in fig-8 around cones at their usual pace.
Assess smoothness (within 2ft of cones), time, and # of steps.
Cutoff = 8.2sec
Neuro Core Set of Measures (6)
- Activities-Specific Balance Confidence Scale (ABC).
- Berg
- FGA
- 10m Walk Test
- 6MWT
- 5xSTS
