MinibesTest, TUG, Flashcards
TUG
5 steps the pt will have to perform
- footwear?
- AD?
- physical assistance?
Instructions to the Patient
The timed “Up and Go” test measures, in seconds, the time taken by an individual to:
- stand up from a standard arm chair
- walk a distance of 3 meters (10 feet), turn
- turn
- walk back to the chair
- sit down.
- regular footwear
- uses their customary walking aid (none, cane, walker)
- No physical assistance is given.
Instructions
They start with their back against the chair, their arms resting on the armrests, and their walking aid at hand.
They are instructed that, on the word “go” they are to get up and walk at a comfortable and safe pace to a line on the floor 3 meters away, turn, return to the chair and sit down again.
The subject walks through the test once before being timed in order to become familiar with the test. Either a stopwatch or a wristwatch with a second hand can be used to time the trial.
Cutoff for Regular Tug and Prediction Rate
13.5 Seconds
90% Prediction Rate
TUG Cognitive
- cutoff
- prediction rate
count backwards from a # between 20 and 100 while performing TUG
15 Seconds, 87% prediction rate
TUG Manual
- cutoff
- prediction rate
carry a full cup of water while performing TUG
- 14.5 seconds
- 90% prediction rate
What is the time taken to complete the TUG correlated with?
The time taken to complete the TUG is correlated with the level of functional mobility –higher risk of falls
the more time that is taken to complete the TUG, the more dependent the person is in ADLs
What does more time to complete the TUG indicate?
the more time that is taken to complete the TUG, the more dependent the person is in ADLs
—higher risk of falls
How is TUG Scored?
- # of secondsCutoff:
TUG: 13.5 seconds, 90% prediction rate
TUG cognitive: 15 seconds, 87% prediction rate
TUG manual: 14.5 seconds, 90% prediction rate - Stable vs Unstable Turning?
- Was a walking aide used? Type of Aide?
Explain
TUG: 13.5 seconds, 90% prediction rate
TUG cognitive: 15 seconds, 87% prediction rate
TUG manual: 14.5 seconds, 90% prediction rate
TUG: 13.5 seconds, 90% prediction rate
90% of patients with 13.5 seconds will fall
TUG cognitive: 15 seconds, 87% prediction rate
87% of patients with 15 seconds on TUG cognitive will fall
TUG manual: 14.5 seconds, 90% prediction rate
90% of patients with 14.5 seconds on TUG manual will fall
How does TUG challenge PD patients?
requires change of position initiations that are an issue in PD, if above cutoff time then it is a good predictor that they will fall
Why use MiniBesTest over Berg?
Berg was only a measure of static standing balance with a ceiling effect
if a patient scored a 56 but still showed risk of falls, they would still have a balance defect
The 2 scales behave similarly, but the Mini-BESTest appears to have a lower ceiling effect, slightly higher reliability levels, and greater accuracy in classifying individual patients who show significant improvement in balance function.
MiniBesTest
# of Items
Scoring
Falls Risk
14 Items (Berg also had 14 items) Scored 0-2 (0,1,2) Falls risk = 19/28
0: lowest level of function
2: highest level of function
Summary of Items on the MiniBesTest
1-3: anticipatory balance
4-6: reactive postural control
7-9: sensory orientation
10-14: dynamic gait index
MiniBesTest 1-3
1-3: anticipatory balance: feed forward, preprogram our balance
- Sit to Stand
- Rise onto toes
- Stand on one leg
MiniBesTest 4-6
4-6: reactive postural control
- compensatory stepping: forward
- compensatory stepping: backwards
- compensatory stepping: lateral
MiniBesTest 7-9
7-9: sensory orientation (vision, proprioception, vestibular)
- STANCE (FEET TOGETHER); EYES OPEN, FIRM SURFACE
- STANCE (FEET TOGETHER); EYES CLOSED, FOAM SURFACE
- INCLINE- EYES CLOSED
MiniBesTest 10-14
10-14: dynamic gait index
- change gait speed
- walk with horizontal head turns
- walk with pivot turns
- step over obstacles
- TUG with dual task of counting backwards by threes
Falls Risk
- 30 second
- Berg
- DGI
- TUG
- MiniBesTest
- 30 second: less than 8 reps of hands free sit to stand is high falls risk for CVA and elderly
- Berg: 42/56 100% falls risk (14 items) [0,1,2,3,4]
- DGI: 19/24 high risk of falls (8 items) [0,1,2,3]
-TUG: 13.5 seconds 90% prediction regular
Cognitive TUG: 15 second, 87%
Manual TUG: 14.5 second 90%
-MiniBesTest: 19/28 falls risk (14 items) [0,1,2]
Items needed for MiniBestTest
foam, chair without armrests or wheels, incline ramp, stopwatch, box 9 inches tall, 3 meters on floor measured out
flathealed shoes or shoes and socks off
MiniBest better than Berg because
MiniBest has limited ceiling effect, it tweaks higher levels of balance.
Higher level test with more discrete gradations: someone can have a good score on the berg of 56 but not great balance, you want to document that they still have impaired balance the minibest will work since it is a
Good choice for minimally disabled (Berg has predictive value where the lower the score the more likely to fall but someone can have a high Berg score and still have a risk of falls)
Can be used to screen and identify specific impairments
Minibest more complex, went through a testing phase to be developed whereas the Berg was randomly created to judge falls risk in nursing home elderly – and is more subjective where catagories overlap and gradations between grades seem more artificial
Berg only looks at balance during stand/sit but not during gait (DGI and MiniBest are more prevocational to solve the problems of the 25 foot walk test which only looks at speed)
ALL WEAKNESS: linoleum world in a clinic is not the uneven terrain, even the obstacles in some tasks are obvious
