PCM 2 Unit 4 Functional Test and Measures for Acute Care Practice Flashcards
What is the Purpose of the Acute Care Index of Function (ACIF) test?
- This is used in an acute neurosurgical/neuromedicine unit
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This assesses mental status impairment and activity limitations in bed mobility skills, transfers, and basic gait/wheelchair mobility
-Takes 12 min
-Equipment: Mat, wheelchair, assisted device, stairs
How it the Acute Care Index of Function Scored?
It has 4 subscales:
-Mental Status: verbal commands, commands, learning, safety awareness
-Bed mobility: roll supine to right/left, supine to sit, sit to supine
-Transfers: wheelchair to mat, mat to wheelchair, sit to stand, stand to sit, sitting balance, standing balance
-Mobility: gait with device, gait without device, ascend stairs, descend stairs, prope wheelchair, set-up wheelchair
- The Total score is a percentage or decimal
What is the Purpose of the Activity Measure for Post Acute, Inpatient Basic Mobility Short Form [“6 Clicks”]?
aka. AM-PAC
Assesses difficulty in the execution of a task or action by an individual
- The inpatient basic mobility short, representing the mobility domain of the AM-PAC and consisting of 6 items from the total 131 basic mobility items
-Time: 10 min
-Equipment: Bed, chair with arms (w/c or bedside commode can be substituded), and 3-5 steps with railing
How is the Activity Measure for Post Acute, Inpatient Basic Mobility Short Form [“6 Clicks”]?
Clinician answer the 6 item on the “6 clicks” based on observed patient activity and/or professional judgement
It also used 2 types of questions and repsonse options
1. “How much difficuty does the pt currently have…” and the difficulty is scored on a 4 point scale
2. “How much help from another person does the patient currently need…” also scored on a 4 point scale
- Adding the score on the 6 items to obtain raw score:
(6 = Lowest Functioning, 24 = Highest Functioning)
With the Results of the Activity Measure for Post Acute, Inpatient Basic Mobility Short Form [“6 Clicks”], How can it predict discharge during Acute Hospitalization?
Using the raw score:
- Home = score of 20.1
- Home with home care = score of 17.9
- Skilled Nursing Facility (SNF) = score of 14
- Inpatient rehab facility = score of 13.6
- Long-term Acute care = score of 11.5
What is the Purpose of the Functional Status Score in the ICU?
Assessment of functional status based on the Functional Independence Measure (FIM) and using a limited number of items routinely examined in the ICU setting and important for activity independence and determination of discharge disposition
-Time: Less than 10 min in most patients
-Equipment: Hospital bed andn AD for the sit to stand and ambulation items, as needed
How is the Functional Status Score (FSS) in the ICU scored?
A score is assigned for each 5 tasks: Rolling, Transfer from supine to sit, sitting at the edge of bed, transfer from sit to stand and ambulation.
0 = unable to perform the task (either due to physical limitation or medical status)
1 = total assistance (patient performs < 25% of task or requires more than 1 persons)
2 = maximal assistance (patient performs 25-49% of task)
3 = moderate assistance (patient performs 50-74% of task)
4 = minimal assistance (patient performs 75% or more of task)
5 = supervision or set up
6 = modified independence (requires use of assistive device but no physical assistance)
7 = complete independence
- Then a raw score ranging from 0 to 35 (0 = least functional and 35= maximally functional
With the responsiveness of the Functional Status Score (FSS) in the ICU, what is the average initial ICU score and what is the score at ICU discharge?
- Average Initial score in ICU is 10 (ranged 5-13)
- Average Discharge score in ICU is 14 (ranged 10-23)
What is the purpose of the Physical Function ICU Test (PFIT-s)?
- PFIT components were developed and selected for clinical usefulness, primarily in ICU setting with mechanically ventilated patients, by critical care physical therapists.
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Endurance, muscle strength, and cardiovascular capacity are primarily assessed via the PFIT.
-Time:Routinely less than 5 min
-Equipment: An assistive device for achieving standing may be required, dependent on patient performance
How is the Physical Function ICU Test (PFIT-s) scored?
Its scored on different subscales:
- Assistance for sit to stand, AD doesn’t define as assistance
-0=unable
-1=assist x 2 persons
-2=assist x 1 person
-3=no assistnace
- Cadence (March in place for as long as you can. measuring steps/min)
-0=unable
-1=>0-49 steps/min
-2=50-79 steps/min
-3=80 or greater steps/min
- Shoulder and knee strength (Using MMT grades)
shoulder and knee are both seperate test but use same scale
-0=grade 0, 1 or 2
-1=grade 3
-2=grade 4
-3=grade 5
A total of 12 possible points
What is the purpose of the Performance-Oriented Mobility Assessment (POMA or Tinetti)?
To assess task-oriented abilities specific to gait and balance. The POMA uses a balance subscale of 9 items and a gait subscale of 7 items
- Time: 10-15 min
- Equipment: Harm armless chair, stopwatch,15’ walkway
How is the Performance-Oriented Mobility Assessment (POMA or Tinetti) scored?
Generates a balance and a gait score, which are added for a total POMA score. 16 items arescored on an ordinal scale (0-2).
- Balance Score = 16
- Gait Score = 12
- Total POMA Score = 28
With the Performance-Oriented Mobility Assessment (POMA or Tinetti), what score would a patient need in a SNF that would benefit from PT?
POMA balance subscale score < 14 /16
With the Performance-Oriented Mobility Assessment (POMA or Tinetti), if a patient scored a 25-28, what would this indicate?
Low predicted Fall Risk
With the Performance-Oriented Mobility Assessment (POMA or Tinetti), if a patient scored a 19-24, what would this indicate?
Medium predicted Fall Risk
With the Performance-Oriented Mobility Assessment (POMA or Tinetti), if a patient scored a < 19, what would this indicate?
High predicted Fall Risk
What is the Purpose of the Berg Balance Scale (BBS)?
Designed to measure functional balance, primarily in standing, in older adults in the clinical setting
- Time: 15-20 min
- Equipment: Standard chair, footstool or step, stopwatch, ruler or yardstick
How is the Berg Balance Scale (BBS) scored?
16 items are scored on a 5 point ordinal scale (0-4). Each item has unique scoring criteria requiring the rater to have the directions when scoring.
- Maximum score = 56
Sensitivity: 64% (correctly predicts fallers)
Specificity: 90% (correctly predicts non-fallers)
What score are considered Normal for the Berg Balance Scale (BBS)?
(Age 60-69; 70-79; 80-89)
- Age 60-69: male ≥ 55; female ≥ 54
- Age 70-79: male ≥ 52; female ≥ 52
- Age 80-89: male between 51-54; female between 49-52
With the Berg Balance Scale (BBS), what predicted fall risk does of a score of 41-56 indicate?
Low predicted Fall Risk
With the Berg Balance Scale (BBS), what predicted fall risk does of a score of 21-40 indicate?
Medium predicted Fall Risk
With the Berg Balance Scale (BBS), what predicted fall risk does of a score of 0-20 indicate?
High predicted Fall Risk
With the Berg Balance Scale (BBS), what does of a score of < 36 indicate?
Risk for falls within 6 months
With the Berg Balance Scale (BBS), what does of a score of > 45 indicate?
Predicted for independent safe ambulation
With the Berg Balance Scale (BBS), what predicted walking ability does of a score of 0-20 indicate?
Wheelchair bound
With the Berg Balance Scale (BBS), what predicted walking ability does of a score of 21-40 indicate?
Walking with assistance
With the Berg Balance Scale (BBS), what predicted walking ability does of a score of 41-56 indicate?
Walking independently
What is the Purpose of the Timed Up and Go Test (TUG)?
Developed as a quick, clinical test of functional gait abilities for the elderly
- Time: dependent on patient performance, 1-2 min to set up
- Equipment: Standard chair with arms, 3 meter (~10’) walkway, cone or marker. For TUG manual a cup
of water is needed, and for modified TUG two carpets or mats are needed
Between the Modified TUGs, what is the difference between TUG-Manual and TUG-Cognitive?
- TUG-Manual requires patient perform holding a full cup of water
- TUG-Cognitive requires the patient count backwards from a randomly selected number between 20 and 100
How is the TUG scored?
- The patient is timed (in seconds) performing the test starting with the word “Go” and ending when the patient sits down. The patient should be given one trial run before being timed so they are familiar with the test before being timed. If the patient cannot complete the test a second time, this should be documented
These are typical normal scores:
< 13.5 seconds for TUG
< 14.5 seconds for TUG-manual
< 15 seconds for TUG-cognitive
What is a Normal TUG score for Elderly patients between 60-80 y.o?
< 10 seconds
What is a Normal TUG score for Males and Females at ages 70-79?
- Males: 7-11 seconds
- Females: 8-10 seconds
What is a Normal TUG score for Males and Females at ages 80-89?
- Males: 9-11 seconds
- Females: 9-12 seconds
What is considered a Normal Score for th TUG Manual and TUG Cognitive?
TUG Manual: 11.6 seconds
TUG Cognitive: 9.8 seconds
With TUG, what time is usually indicates a risk for falls in elderly patiens?
> 13.5 seconds = High risk of falls
With TUG, what time is usually indicates a risk for falls in patiens with vestibular disorders?
> 11.1 seconds = increased risk of falls
What is the Purpose of Timed Walking Test (6 min walk test and 2 min walk test)?
These are tests of functional walking abilities, and can reflect issues around endurance during gait. These tests have been used in people with stroke, head injury, Parkinson’s disease, and various cardiovascular and pulmonary disorders
- Time: Depending on test, either 6 min or 2 min
- Equipment: Stopwatch, method to measure distance walked
With the Timed Walking Test (6 min walk test and 2 min walk test), what distance is considered normal for adults 60-69 y.o?
Male: 521-623
Female: 497-579
With the Timed Walking Test (6 min walk test and 2 min walk test), what distance is considered normal for adults 70-79 y.o?
Male: 478-575
Female: 440-507
With the Timed Walking Test (6 min walk test and 2 min walk test), what distance is considered normal for adults 80-89 y.o?
Male: 356-478
Female: 345-440
What is the Purpose of the Function in Sitting Test (FIST)?
- This test was designed to examine the functional deficits seen with sitting balance dysfunction, using everyday tasks. It includes static and dynamic sitting activities ordered from easiest to hardest.
- Items also cover reactive and proactive balance tasks in sitting. Initial validation was in persons with acute stroke, but other neurologic populations in both acute care and inpatient rehabilitation can use the FIST as well
-Time: Less than 10 min
-Equipment: Hospital bed, stool or step, light weighted object, tape measure, stopwatch
How is the Function in Sitting Test (FIST) scored?
14 items are scored on a 5 point ordinal scale (0-4), which is consistent for all items
- Total score of 56
What is the Purpose of the Perme Intensive Care Unit (ICU) Mobility Score?
This test was designed for use specifically with the ICU population. It accounts for limb strength, basic functional mobility tasks, but also includes scoring to account for barriers to movement such as medications, lines, tubes, and cognitive function
- Time: Less than 2 min
- Equipment: Hospital bed, chair, assistive devices for gait as needed
How is the Perme Intensive Care Unit (ICU) Mobility Score scored?
15 items are scored on a dichotomous or ordinal scales.
- Total score ranges from 0 to 32 with higher scores indicative of fewer mobility barriers and less assistance to perform tasks
