Eval 3 - Cardio, Neuro

Question 1

HRmax equation

Answer 1

206.9 - (0.67 x age)

Question 2

Cardiopulm red flags

Answer 2

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).

Question 3

Why is posture screening important for cardipulm?

Answer 3

Kyphosis = decreased lung expansion.
Rib mobility can also affect breathing.

Question 4

Modified Bruce Treadmill Test

Answer 4

Start at stage 1 (standard Bruce protocol starts at stage 3).
3min each stage.
Goal is to reach 120bpm - stop test once achieved.

Question 5

Modified Balke Test

Answer 5

2mph for entire test.
Start 0% incline, increase by 2% every 3min, up to 10%.
Stop at 120bpm.

Question 6

2 Minute Step Test - procedure & cutoff score

Answer 6

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.

Question 7

Seated Step Test - procedure

Answer 7

Seated, armless chair, aerobic step placed in front.
Metronome 60bpm.
3min each stage.
Goal = 75% HRmax.

Question 8

Seated Step Test - stages

Answer 8

Stage 1 = 6in
Stage 2 = 12in
Stage 3 = 18in
Stage 4 = 18in + ipsilateral arm raise with each step

Question 9

6MWT cutoff score & MDC

Answer 9

<656m = risk of mortality.
MDC = 58.2m

Question 10

COVID Core Set of Measures

Answer 10

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).

Question 11

Medical Research Council Sum Score procedure

Answer 11

Sum of 6 MMT scores - completed in supine, HOB 45deg.
Shoulder ABD
Elbow Flex
Wrist Ext
Hip Flex
Knee Ext (SAQ)
DF

Question 12

Short Physical Performance Battery includes…

Answer 12

Gait speed
5x STS

Question 13

Important screening components for PD

Answer 13

Orthostatic BP - common med side effect.
On/off phenomenon.
Urinary incontinence - usually urge.

Question 14

Posture assessment (neuro)

Answer 14

Alignment - esp if pusher syndrome.
Vestibular hypofunction - may need help orienting to neutral.

Question 15

Recommended functional measures for PD

Answer 15

Timed ADL (good test-retest reliability).
UPDRS.
TUG (regular + the 2 dual-task).

Question 16

What are the only 2 tests that assess reactionary balance?

Answer 16

MiniBEST
Retropulsive Pull Test

Question 17

Retropulsive Pull Test - pt position, procedure

Answer 17

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.”

Question 18

Retropulsive Pull Test - scoring

Answer 18

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.

Question 19

Retropulsive Pull Test - common result with PD

Answer 19

Retropulsion: a lot of little scoots back instead of a step.

Question 20

4 Square Step Test

Answer 20

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.

Question 21

4 Step Balance Test

Answer 21

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.

Question 22

Figure 8 Walking Test

Answer 22

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

Question 23

Neuro Core Set of Measures (6)

Answer 23

1. Activities-Specific Balance Confidence Scale (ABC).
2. Berg
3. FGA
4. 10m Walk Test
5. 6MWT
6. 5xSTS