Practical Material Flashcards
FABS test
≥25 points = high fall risk
high sensitivity and specificity
MiniBEST
16/28 indicates high fall risk
high specificity and sensitivity
Berg Balance Test
Cutoff score ≤ 50 points
ceiling effect, patients can score a high score but still be at a fall risk
low sensitivity, high specificity
TUG
cuttoff score ≥ 12 sec
low sensitivity, high specificity
Combining TUG, gait speed, and miniBEST
if all 3 tests are + = 89% chance or ID person at risk of falling
if all 3 tests are - = 3% chance of obtaining a false negative result
Gait Speed
no clear cut off score identified
SPIN/SNOUT not reported
Most promise in identifying fall risk
previous history of falling
modified functional reach test
gait speed
balance tests that assess multiple balance resources
Using Knees to get off the floor
- turn onto back
- roll onto side
- push onto hands
- push up onto hands and knees
- kneel, using stable furniture to steady
- place strongest leg forward
- stand up
- Turn slowly
- Sit down, rest, notify someone of fall
Using arms to get up from fall
- turn onto back
- roll onto side
- push onto hands
- prop self up with both arms behind
- use cusion as a low seat
- lift bottom back onto cushion
- push as far back as possible
- lift bottom back onto chair
- sit down, rest and tell someone of fall
Ocular ROM
- Ask pt if they have noticed difficulty with eye movement of gaze
- ask the patient if they experienced blurry or double vision with any movements performed
- instruct patient that you’ll be testing strength and coordination of eye muscles
- Demonstrate the H movement
- Pause briefly at the end of each movement
- Assess conjugate eye movements, observe to ensure the eyes move together
Neuroanatomy of ocular ROM
CN 3, 4, 6 (motor)
CN 3 = m. rectus, s. rectus, i. rectus, i. oblique
CN 4 = s. oblique
CN 6 = l. rectus
Documentation of Ocular ROM
describe any asymmetry in resting eye position and any observed inability to move the eye and in which direction
Smooth Pursuit
- Inform the patient you will be assessing the coordination of their eye movements
- PT holds target with point perpendicular to pts eyes
- ask the pt to maintain focus on the target with their head still as target slowly moves
- Target should be about 20 in from pts’ face
- Move your pen tip slowly in + pattern across a distance of approx 18 in to the left, right, above, below midline over 2 seconds
- observe for skips, jumps, etc
Neuroanatomy of smooth pursuit
Cerebellum – flocculonodular lobe, vermis
Documentation of smooth pursuit
describe the eye movements as normal or saccadic
describe the direction of saccadic intrusions
Saccades
- Ensure pts have intact oculomotor innervation
- Inform that you will be testing coordination of their eye movements
- Demonstrate saccades by placing a pen adjacent to your ear and instructing the pt you will be asking them to shift gaze between the pen and your nose several times
- Hold pen adjacent to your ear with the tip in the same plane as your nose
- ask the pt to shift gaze from your nose to your pen when you say nose/pen
- continue testing moving from ear to top of had to opposite ear, to below chin in midline
Neuroanatomy of saccades
cerebral cortex = frontal eye fields, purposeful eye movements
basal ganglia = impaired initiation or suppression
cerebellar vermis = dysmetria (overshoot/undershoot)
Documentation of saccades
describe the movement as normal, hypermetric, or hypometric including direction of saccade
normal gaze shift requires only 1-2 saccades
Gaze Holding Nystagmus
- ask the pt to hold their gaze on targets
- target should be approximately 20” from face
- observe for nystagmus at rest
- move target through + sign
- Set the target 30°from midline in all quadrants
6 Have pt maintain their gaze for 10s on each target
Neuroanatomy for Gaze holding nystagmus
vestibular system
cerebellum
Documentation of gaze holding nystagmus
document as intact or impaired
document the direction of impaired fization, in which eye it is noted, and associated S/S
it is normal for pts to have nystagmus present at end range gaze so its important that the target isn’t at end range