prac Flashcards
Balance:
• Determine from c/o and fxal ability – steady state – anticipatory / ongoing control – reactive control – sensory system manipulation – cognitive demand – combination test batteries
Timed Up and Go Test
assesses “transferring” and “mobilising”
which we can assess a patient’s sit-to-stand transfer ability and independent mobilisation. h measures speed during functionally important tasks which potentially threaten balance.
TUG
Seat height between between 44-47cm, line 3m away on floor, normal footwear or mobility aid, back against chair, : “On the word “go”, I want you to walk at a comfortable and safe pace to the line on the floor, turn, walk back to the chair and sit down again.” Perform practice run.
- Can also be performed as a speed test “as quickly and as safely as possible”
- TUG Cognitive: Patient walks as quickly and as safely as possible, whilst counting backwards in threes from a randomly selected number between 20 and 100. Test can do numerical task first. Can also name household objects beginning with letter “S”
- TUG MOTOR: Patient walks as quickly and as safely as possible whilst carrying a full cup of water
Step Test
assess dynamic single-leg balance, assess the patient’s ability to maintain balance whilst negotiating steps) – self perturbation
“On the word go I want you to lift your foot up onto this block and then place it back onto the floor as many times as you can in 15 seconds. Do not move the opposite (supporting) foot during the test.” One complete step involves placing the foot fully up onto the step, then returning it to the floor
- Sart with feet 10cm apart, block 5cm infront of patient and height is 7.5cm for stroke, 11cm for normal, need stopwatch
- No hands on support unless patient loses balance, . If this occurs, counting stops at the number of completed steps, and the score of completed steps is recorded.
- REPEAT WITH OPPOSITE LEG
Functional Reach Test
: assesses ability to transfer weight/change position/control movement of the centre of mass, when carrying out daily activities
Feet 10cm apart, no shoes, The non-affected arm is raised to 90 degrees shoulder flexion and the therapist reads off the level of the knuckles (third metacarpal head) on the tape measure (not touching wall). instructed to lean forwards as far as possible, and the therapist notes the level of the knuckles at the point of furthest reach. Standardised instructions: “Keeping your arm out in front of you, I want you to reach as far forward as you can without losing your balance or moving your feet.”
DON’T TOUCH WALL, ALLOED TWO PRACTISES
LATERAL REACH
: assesses ability to transfer weight/change position/control movement of the centre of mass, when carrying out daily activities
: same as above but back facing wall and feet 30˚ outwards, “Please reach as far as you can to the left / right without overbalancing, taking a step or touching the wall.” FEET MUST REMAIN ON THE GROUND AND MAXIMUM DISTANCE HELD OUT FOR 3 SECONDS BEFORE RETURNING TO START
MARDSEN PULL:
assess ability to withstand an external perturbation, assesses reactionary balance
Deliever a brief tug on shoulder in posterior direction (stand behind), anterior(in front) and lateral (behind and to the side) at the hips on both left and right sides.
Pateint’s eyes remain open, “try to resist the pull’
The patient’s response is rated according to the following:
0 = staying upright without taking a step
1 = staying upright, with one step required for stability
2 = two or more steps required for stability, but able to steady self
3 = several steps, but unable to steady self, requiring therapist to steady patient
4 = falling within attempting to step
Standardised instruction: “I am going to give you a brief tug from behind. I want you to resist the backward movement [alter the direction, as applicable]”
CLINICAL TEST OF SENSORY INTEGRATION OF BALANCE (CTSIB) -
– determines what system person is most reliant on for sensory information
– determines ability to resolve sensory conflict
Need Stopwatch, high density foam, visual conflict dome
- Feet together or apart (10cm), no shoes, “steady as they can during the test procedures”, demonstrate, 30 seconds
If the patient overbalances or requires steadying before the 30 seconds is complete, they are allowed up to two further trials. The highest duration balanced, or 30 seconds is recorded for each test (whichever is the highest). The therapist notes the amount of sway – minimum, moderate, maximum
CONDITIONS:
The six test conditions are:
- Eyes open, firm support surface: All senses operating.
- Eyes closed, firm support surface: Removes vision to determine an over-reliance on this system.
- Visual conflict dome on firm support surface: Gives false information – as the patient sways, the dome moves with them. If patients can’t integrate this information, they lose balance/fall.
- Eyes open, foam surface: Reduces the available proprioceptive input.
- Eyes closed, foam surface: This is a test of the integrity of the vestibular system.
- Visual conflict dome, foam surface: This condition has two systems giving false/altered information and tests the ability of the vestibular system to integrate information.
Quiet Stance:
Barefoot, hands by side,
commences each 30 second test period using a stop watch and the “starting now”, and stops each test after 30 seconds. If the patient overbalances or requires steadying before the 30 seconds is complete, they are allowed up to two further trials. The highest duration balanced, or 30 seconds is recorded for each test (whichever is the highest) The therapist notes the amount of sway – minimum, moderate, maximum
• If patient has UL impairment, not which foot is infront
Quiet Stance:
2
The progression of test conditions is: start firm floor then progress to foam surface
Feet apart (comfortable width) – eyes open
Feet apart (comfortable width) – eyes closed
Feet together – eyes open
Feet together – eyes closed
Stride stance – eyes open
Stride stance – eyes closed
Tandem stance – eyes open
Tandem stance – eyes closed
One leg stance – eyes open
One leg stance – eyes closed
Other consideration:
“low-care residential aged care facility” which could infer that the patient is relatively independent with minimal input from the nursing/care home staff, again suggesting that you might want to assess her mobility
Intervention
: focus on patient’s independent ability and want to maintain as much as possible.
challenges the patient’s dynamic balance (i.e. gait) and simulates the indoor/outdoor environment she may encounter when mobilising. Obstacle courses which incorporate different surfaces, turning, negotiation of steps etc. would therefore be ideal
Safety aspects
– supervision and support.
Alone: close to a kitchen worktop which they can hold on to (or along a corridor close to the wall), if feeling unsteady. All exercises to be performed barefoot or in shoes (not socks only).
Exercise prescription and dose:
There are relatively few guidelines which specify an exact balance exercise dose for older adults. Therefore, based on the patient’s physical impairments/exercise capacity, I would recommend a starting point of between 5- 10 repetitions of the exercise, 1-2 times a day. Alternatively, you can give a prescription based on “time”, particularly if you are wanting to target fatigue resistance. You would need to assess the patient’s physical performance during their initial assessment to determine an individual prescription – paying close attention to the onset of fatigue, any deterioration in the quality of performance, onset of symptoms etc.
