Neuromuscular 2 Unit 2 Flashcards
What are different Outcome Measure used to assess Balance?
- Romberg
- Sharpened Romberg
- BERG Balance Scale
- Tinetti Performance-Oriented Mobility Assessment
- Functionl Reach
Balance Measure
With the Romberg OM, what does it assess and what ICF category does it test? What is the Critera to stop the test?
- Static standing balance assessment
- ICF: Body Structure and Function
- Criteria to stop test: Stop the test if the patient moves their feet, changes their arm position or opens their eyes. The test should be timed and can also be rated on the amount of sway observed
Lacks reliability and validity
Balance Measure
With the Sharpened Romberg OM, what does it assess and what ICF category does it test? What is the critera to stop?
- Static standing balance - Tandem Stance
- ICF: Body Structure and Function
-
Criteria to stop test: Stop the test if the patient moves their feet, changes their arm position or
opens their eyes.
Lacks reliability and validity
Balance Measure
With the BERG Balance Scale, what does it assess? How many task are there? What score indicates fall risk? What ICF category does it test?
- Static/Dynamic standing balance/Functional mobility
- There are 14 task each with a rated score from 1-4 for a total of 56 points
(The lower the score = Decreased balance) - < 45 = functional (lower has been associated with fall risk)
- ICF: Activity
Excellent Test-Retest and inter/intra rater reliability
Balance Measure
With the Tinetti Performance Assessment OM, what does it assess? How many items are there? What score indicates fall risk? What ICF category does it test?
- Static/Dynamic balance/Gait Screen
- 2 categories: Balance (9 items) and Gait (7 Items)
- < 19 = Fall risk
- ICF: Activity
Excellent reliability for most neuro diagnosis
Balance Measure
With the Functional Reach OM, what does it assess? With what conditions is it recommended for? What ICF categoty does it Test?
- Quick standing balance screen
- Maximum distance reached while in static position
- Modified for sitting
- Highly recommended for use in Stroke and PD; Recommended for MS
- < 6in is indicative of significant fall risk
- ICF: Activity
Excellent reliability
Balance Measure
What is the PASS OM?
Assesses postural control in stroke survivors
What does the PASS OM focus on?
- Assessment of the ability to maintain a given posture and to maintain equilibrium when changing postures
- Applicable to stroke survivors, even in the acute phase of recovery, who demonstrate poor postural control
- Assessment should contain components of increasing difficulty
What is the ICF category for PASS? If (+) what is it an indicator of?
Activity
Indicator of fall risk
What are some different Outcome Measure that assess Balance and Gait Measures?
- Timed Up and GO Test (TUG)
- Timed Walking Test (6 minute Walk and 10 Meter walk)
- Dynamic Gait Index (DGI)/Functional Gait Assessment (FGA)
With the Timed Up and GO Test (TUG), what does it assess? With what conditions is it recommened? What score indicated Fall risk? What ICF category does it Test?
- Quick screen of dynamic balance and mobility in elderly
- Highly recommended for elderly, PD and MS
- Community dwelling adults: >13.5 seconds = fall risk
- Frail elderly: >32.6 seconds = fall risk
- ICF: Activity
With the 6 Minute Walk Test, what does it assess? With what conditions is it recommended? What ICF category does it test?
- Measures functional endurance/ Activity tolerance
- Highly recommended for most neurological diagnosis
- ICF: Activity
Excellent Reliability
With the 10 Meter Walk Test, what ICF category does it test?
- ICF: Activity
- AD may be used
- Assist may be given
Assesses Gait Speed
What are the Cut Off score for the 10 Meter Walk Test?
- Full Community ambulation gait speed (able to safely cross street) >1.2 m/s (2.7 mph)
- Community ambulation gait speed is >0.8m/s (>2mph)
- Household to limited community ambulation gait speed is 0.4 – 0.8m/s (1-2mph)
- Household only gait speed is < 0.4m/s (< 1mph)
With the DGI and FGA, what does it assess? What ICF category does it test?
- Assesses higher level functional mobility
- ICF: Activity
What is the Cut off score for DGI?
- The DGI has a total score of 24
- < 19 is considered a fall risk
What is the Fugl Meyer OM?
An OM with objective measure of neurological recovery at the impairment level following stroke.
How is Fugl Meyer scored?
Items are scored on a 3-point ordinal scale
- 0 = cannot perform
- 1 = performs partially
- 2 = performs fully
Maximum Score = 226 points
The Five domains assessed include:
- Motor function (UE maximum score = 66; LE maximum score = 34)
- Sensory function (maximum score = 24)
- Balance (maximum score = 14)
- Joint range of motion (maximum score = 44)
- Joint pain (maximum score = 44)
What is the Functional Independence Measure (FIM)?
Why is it important?
A common outcome measure used in the Acute rehab setting
- Assesses caregiver burden with “levels” associated with specific tasks (18 different)
- Commonly used at evaluation, re-evaluation (at least weekly) and discharge
- At discharge, will determine overall functional improvement
Importance:
- Effect in POC
- Effect on reimbursement
- Effect on length of stay
What are the Items rates with the Functional Independence Measure?
- Self care
- Sphincter control
- Transfers
- Locomotion
- Communication
- Social Cognition
When scoring FIM, what does a 7 mean?
Complete independence (No assistance, no DME, no extra time needed)
DME = Durable Medical Equipment
When scoring FIM, what does a 6 mean?
Modified Independence (Use of AD, requires extra time)
When scoring FIM, what does a 5 mean?
Supervision (Verbal cues or supervision for safety is required)
When scoring FIM, what does a 4 mean?
Minimal Assistance (25% assistance required. Patient able to perform at least 75%)
Contact Guard Assist (CGA) and Stand By Assist (SBA) fall iin this category as well
When scoring FIM, what does a 3 mean?
Moderate Assistance (50% assistance required. Patient able to perform at least 50%)
When scoring FIM, what does a 2 mean?
Maximum Assistance (50-75% assistance required. Patient able to perform at least 25%)
When scoring FIM, what does a 1 mean?
Total Assistance (>75% is required, or use of >1 person)
When scoring FIM, what does a 0 mean?
Task does not occur
What is the Overarching Role of the PTA?
Assists the PT in the provision of physical Therapy
What are the Specific Roles and Responsibilites of a PTA?
- Reports to the PT in all practice settings
–In-person OR via telecommunication - Attend regularly scheduled and documented conferences with the PT
- Request the PT to perform re-examination, POC modifications, and oversight with changes in medical status prior to initiating novel treatment
- Attend supervisory visits by the PT at least once per month
In an Acute Hospital Setting what is the typical LOS? What is the STG and LTG timeframe?
Typical LOS: 3-10 days
STG Time: < 1 week
LTG Time: Expected LOS (3-10 days)
In the Acute Hospital Setting, what are the considerations?
Discharge Disposition:
- Post Acute Rehab vs Home
In an Post Acute Rehab Setting what is the typical LOS? What is the STG and LTG timeframe?
Typical LOS: 2-6 weeks
STG Time: 1 week
LTG Time: Expected LOS (2-6 weeks)
In the Post Acute Rehab Setting, what are the considerations?
Recovery Vs. Compensation
In an Outpatient Setting what is the typical LOS? What is the STG and LTG timeframe?
Typical LOS: 2-3 Months
STG Time: 1 Month
LTG Time: Expected LOS (2-3 Months)
In the Outpatient Setting, what are the considerations?
LOS dependent on dx and insurance;
once d/c from OP, therapy is complete
In an Home Health Setting what is the typical LOS? What is the STG and LTG timeframe?
Typical LOS: 1-2 Months
STG Time: 2 Weeks
LTG Time: 1-2 months
In the Home Health Setting, what are the considerations?
D/c disposition:
OP vs. Completed Therapy
