Neuro Scales 2

Question 1

Berg Balance Scale

Answer 1

Measures balance. 14 item list with each item consisting of a 5-point ordinal scale ranging from 0 (low) - 4 (high).

***<45 below is high fall risk.

***56 is functional for balance

***It does not include an assessment of gait

You need: a ruler, 2 standard chairs (one with arm rests, other without), a footstool or step, 15ft walkway, stopwatch/wristwatch

Question 2

Tinetti Test

Answer 2

Also called the performance-oriented mobility assessment (POMA). Assesses gait an fall risk assessment. Also used to assess perception of balance and stability during ADLs.

Test requires armless chair, a stopwatch, and a 15ft even formed walkway.

It has 2 sections: one assesses balance abilities in a chair and also in standing; the other assesses dynamic balance during gait on a 15 feet even walkway

Procedure: The patient is to sit in an armless chair and will be asked to rise up and stay standing. The patient will then turn 360° and then sit back down. Testing this, the evaluator will look at several key points including how does the patient rise from and sits down on his/her chair, whether or not the patient stays upright while sitting and standing, what happens when the patients’ eyes are closed or when the patient gets a small push against the sternum

Next, the patient will have to walk a few meters at a normal speed, followed by turning and walking back at a “fast but safe” speed. The patient will then sit back down. As well as in the first part of the test, there are some points the evaluator has to look at. These are the length and height of the steps, the symmetry and continuity of the steps and straightness of the trunk.

*During the test, the patient can use their assistive device.

Grading: Has a gait score (12) and a balance score (16). Has a 3 point ordinal scale (0,1,2). Total is 28

18 or less is High risk

19-23 is Moderate Risk

24 or greater is Low Risk

Question 3

BBS vs Tinetti

Answer 3

Both on tell you IF you are a fall risk. Neither tell you WHY you would be falling.

Tinetti tells you fall risk with gait

Question 4

Heel to Shin Test

Answer 4

Coordination…specific to cerebellum. Cerebellum is ispsilateal signs.

Question 5

Activity-Specific Balance Confidence Scale (ABC)

Answer 5

Self-report tool for balance-confidence. It is out of percentages of each of the 16 questions. You answer them even if you don’t do the activities on a daily basis.

Question 6

Fullerton Advanced Balance Scale

Answer 6

The Fullerton Test is mainly intended to identify highly-active older adults who are at an increased risk to experience fall-related injuries due to sensory impairments. The test uses both dynamic and static balance under different situations to identify balance deficits in older adults.

The test includes:

10 performance based activities in both static and dynamic phases

Score of 0-40/40 points possible (higher scores are better)

Items scored on a 5 point ordinal scale (0-4)

*25 or lower is at risk for falls

Question 7

Dynamic Gaze Assessment

Answer 7

Tests eyesight/visual acuity while moving the head

Question 8

Modified Falls Effeciency Scale

Answer 8

self reported measure of fear of falling; 14 item

• incorporates higher functional activities than FES
• includes outdoor activities
• discriminates between older adults with and without hx of falling

Question 9

Clinical Test of Sensory Integration and Balance (CTSIB)/Sensort Organization Test (SOT)

Answer 9

Somatosensory System, Visual System, and Auditory System is all a part of balance. This test is used to see what the patient USES to stay upright. (When you take away vision, you are then testing somatosensory and auditory. When you are on the FOAM, you are testing visual and auditory)

•Measures how much your body moves when you are trying to stand still during 6 conditions

*So challenge a patient with the system they USE THE MOST! (e.g. someone who doesn’t have good hearing or eyesight should be challenged by the Somato system)

Question 10

CSTIB Level 1

Answer 10

• Condition 1: Called the “Baseline”
• Eyes open
• Stable Surface
• Clinical Interpretation
• Roger Falls or Increased Sway

which MEANS…All Systems Impaired

• No Fall and No Sway
• WE DON’T KNOW!! SO…
• A SYSTEM MAY BE COMPENSATED FOR SOO.. CONTINUE TESTING ROGER

Question 11

What is Sensory Selection?

Answer 11

When a patient is getting conflicting sensory information, and they have to determine what they need to listen to. So images 3-6

Question 12

CTSIB Level 2

Answer 12

• Condition 2: Testing Your Somatosensory
• Eyes Closed
• Stable Surface
• Clinical Interpretation
• Roger falls or Increased Sway
• Somatosensory Impaired
• No Fall and No Sway
• Somatosensory is Intact

Question 13

CTSIB 3

Answer 13

• Condition 3: Testing your Somatosensory
• Stable Surface
• Dome (Eyes are inaccurate)
• Clinical Interpretation
• Roger Falls or Increased Sway
• Somatosensory Impaired
• Visually Dependent
• No Fall and No Sway
• Somatosensory is Intact

Question 14

CTSIB 4

Answer 14

• Conditions
• Condition 4: Testing Vision
• Eyes open
• Unstable Surface (somatosensory blindfolded)
• Clinical Interpretation
• Roger Falls or Increased Sway
• Vision Impaired
• No Fall and No Sway
• Vision Intact

Question 15

Functional Reach Test (FRT)

Answer 15

Functional Reach Test (FRT) is a clinical outcome measure and assessment tool for ascertaining dynamic balance in one simple task. Correlates with a risk of falling.

Position arm at 90* of shoulder flexion with a closed fist. Feet are shoulder width, reach, then measure at knuckle of 3rd finger. 3 trials, last two are averaged and used.

Values: 10” or greater, Low risk

6”-10” is a fall risk 2x greater than normal

6” or less is 4x greater risk

Unwilling to reach due to fear is 8x greater risk of falling

Question 16

Multidirectional Reach Test

Answer 16

Determines limits of stability in 4 directions while the BOS is stationary.

Arm is put up next to yardstick, then measured. Then measured when forward, side/side, then backwards.

Question 17

Dizziness Handicap Inventory (DHI)

Answer 17

Good for Post-Concussion Syndrome. 25 item questionnaire measuring self-perceived disability due to unsteadiness and dizziness. Items are scored from 0-100, with higher scores indicating a greater perceived level of disability. Clinically significant change = 18 or more.

16-34 Points (mild handicap) 36-52 Points (moderate handicap) 54+ Points (severe handicap)

Question 18

Timed Up and Go Test (TUG)

Answer 18

To determine fall risk and measure the progress of balance, sit to stand and walking.

Need: One chair with armrest, Stopwatch, Tape (to mark 3 meters)

Patients wear their regular footwear and can use a walking aid, if needed.

The patient starts in a seated position

The patient stands up upon therapist’s command: walks 3 meters, turns around, walks back to the chair and sits down.

The time stops when the patient is seated.

Be sure to document the assistive device used.

***12 sec or greater is an adult at risk for falling!

Question 19

Dynamic Gait Index (DGI)

Answer 19

The DGI tests the ability of the participant to maintain walking balance while responding to different task demands, through various dynamic conditions. It is a useful test in individuals with vestibular and balance problems and those at risk of falls.

It includes eight items, walking on level surfaces, changing speeds, head turns in horizontal and vertical directions, walking and turning 180 degrees to stop, stepping over and around obstacles, and stair ascent and descent.

*BEST possible score is 24. 0 being severe-3 indicating normal performance. Score of 19 or below is an increased risk for falls.

Question 20

Fugl-Meyer

Answer 20

The Fugl-Meyer Assessment is an assessment of motor function, sensation, and balance that was designed specifically for patients who have had a stroke. It
does not include measurement of activities such as transfers, ambulation, and stairs.