Study Guide Q's: Assessment and Evaluation Flashcards
Describe temporal changes with gait as we age (2)
- Decreased self-selected gait speed
- Increased stance time and double limb support time
Describe spatial changes with gait as we age
- Decreased step length
- Decreased stride length
- Increased step width (not a universal finding across studies)
Describe kinematic/postural changes with gait as we age
- Decreased excursion of movement at lower extremity joints
- Decreased reliance on ankle kinetics and power
- Less upright posture
What does increased variability of gait as we age mean?
Defined as variability in step or stride time, length, or width
Gait speed of ≥ 1.2 m/s indicates
- Extremely fit
- Can cross street safely
Gait speed of ≥ 1.0 m/s indicates
- Healthy older population with lower risk of hospitalization or adverse health events
- Independent in ADLs
Gait speed of <1.0 (vs. greater than or equal to 1)
- Increased risk for cognitive decline within 5 years
- Increased risk for death and hospitalization within 1 year
Gait speed of < 0.8 m/s indicates
- Increased risk of mortality and mobility/ADL disability at 2 years
- Limited community ambulator
Gait speed of <0.7 m/s
Increased risk of death, hospitalization, institutionalization, and falls
Gait speed of <0.4 m/s
- Functional dependence
- Severe walking disability
Gait speed of <0.2 m/s
- Extremely frail
- Highly dependent
Ways to assess gait speed (instrumented tools)
- GAITrite
- Prokinetics
- Wearables
Ways to assess gait speed (manual tools)
- Stop watch
- Smartphone app
10 MWT significant values (also 2MWT)
- ≥1.2 m/s: cross street
- ≥1.0 m/s healthy aging
- <1.0 m/s inc risk of disability
- <0.8 m/s cut off frailty
- 0.5-0.8 m/s mod frailty
- <0.5 m/s severe frailty
10 MWT
MDC and MCID
- MDC: 0.05 m/s
- MCID: 0.05-0.12 m/s
TUG significant values (MDC and MCID included)
- Significant values: >13.5 seconds indicates fall risk
- MDC: 4 seconds
- MCID: 1 second
DGI significant values (including MCD and MCID)
- Significant values: <19 indicates fall risk
- MDC: ~3 points
- MCID: ~2 points
Functional gait assessment significant values (including MDC and MCID)
- Significant values: <22
- MDC: 4-6 points
- MCID: 4 points
Other gait based outcome measures (2)
- Stair climb test
- Tinetti POMA
Types of interventions that address gait impairments
Flexibility
Strength/power/agility
CV training
balance training
called multimodal approach
Why strength/power/agiliy help with gait training
- LE strength associated with improved gait speed and function
- Don’t forget to incorporate power (rapid bursts are needed for motor control)
- Agility: quick acceleration/deceleration, directional changes, and explosive/reactive strength training
Why CV training helps with gait
- Aerobic exercise enhances functional endurance
gait training
what speed increase could reduce disability and mortality?
- targeted, customized interventions based on multiple patient factors aimed at improving quality and independence of ambulation
- Utilize specificity of training
- Note: an increase of as little as 0.1m/s can reduce disability and mortality
how to progress gait training
when would backward walking increase fall risk?
- Progress task and environment
- Reactive, predictive, and anticipatory control
- Obstacle courses
- Altered terrain
- Obstacle avoidance
- Steps
- Ramps
- Stair training
- Directional training
- Backward and lateral stepping
- Turning 90/180/360 degrees
- Note: backward walking slower than 4.0m/s may increase fall risk
dual task with gait training (motor and cog)
what would increased gait variability with this indicate?
- Reduction in gait speed with simple vs. complex dual task
- Increased gait variability -> decreased postural stability
- Tasks: counting backward, animal naming
purpose of functional performance testing
- Objective, accurate record
- Measures what is pertinent to the patient
- Informs impairments
- Informs goal setting
- Comparison of age based normative data
- Prognostic
types of functional outcome measures
- Self-report: patient self-perception of impairment, function, and QOL
- Patient outcome measures: asks patient about the impact of condition on activities and roles in life
- Observer related: measures observed by the PT
- Physiological measures: measure single biological entity (e.g. cognitive ability, pain, exertion)
Walking tests (2)
- 2MWT
- 6MWT
gait speed outcome measures
- DGI
- FGA
- TUG
- Figure 8 walking test
mobility outcome measurse
- 30 second CRT (chair stand test/30 second STS)
- 5x and 10x STS
- Floor transfer
balance outcome measures
- BESTest, BESTmini, BESTbrief
- Berg Balance Scale
- Activities Specific Balance Confidence Scale
- Functional Reach Test
- 4 Square Step Test
- Tinetti Performance Oriented Mobility Assessment (POMA)
- Single leg stance
physical performance outcome measures
- Physical Performance Test
- Physiological Profile Assessment (PPA)
- Short Physical Performance Battery (SPPB)
- Grip strength
multidisciplinary outcome measures
- Morse Fall Scale
- Hendrich II Fall Risk Model (acute care setting only
intrinsic risk factors for falls
- Gait and balance impairment
- Peripheral neuropathy
- Vestibular dysfunction
- Muscle weakness
- Vision impairment
- Medical illness
- Advanced age
- Impaired ADL’s
- Orthostasis
- Dementia
- Drugs
extrinsic risk factors for falls
- environmental hazards
- poor footwear
- restraints
what parts of the visual system being damaged may contribute to falls?
- Acuity
- Contrast sensitivity
- Depth perception
- Visual field cut
What parts of the vestibular system damaged may contribute to falls/what should be examined
- VOR function
- Gaze stability
- Nystagmus
- Saccades
- Smooth pursuit
- Head impulse test
- Head shake test
- Dynamic visual acuity test
- Skew deviation test
- VOR cancellation test
What needs to be tested for somatosensation that if damaged could contribute to falls?
- Cutaneous sensation
- Proprioception
- Vibration
What other things should be included in examination for a falls risk patient?
- Neuromuscular testing
- Strength
- ROM
- Flexibility
- Aerobic endurance
- 6MWT
- Environmental assessment
- Home safety checklist
- Psychosocial assessment
- Memory deficits
- Dementia
- Depression
- Fear of falling
- ABC scale
- FES-I
interpretation of CTSIB
- fall during conditions 5-6 indicates what?*
- fall during conditions 4,5,6 indicates what?*
- Fall during conditions 5-6 usually indicates vestibular dysfunction
- 4,5,6 indicates surface dependence
describe difference between ankle, hip, stepping, reaching, and suspensory fall strategies
-
Ankle strategy: small disturbance of BOS
- Ankle muscle activation
-
Hip strategy: sudden and forceful disturbance of BOS
- Hip muscle activation
-
Stepping strategy: COG displaced beyond the limits of the BOS
- Forward/backward step
-
Reaching strategy: reaction to large perturbation
- Moving arms to grasp or touch object for support
-
Suspensory strategy: lowers COG to enhance postural stability
- Flexing knees
- Lowering COG
components of a home evaluation assessment
- Considerations
- Thorough home environmental assessment and modification is a key to falls prevention
- Explore potential risk factors
- Identify what changes are necessary
- Identify sources of payment and other potential resources
- Locate quality supplies and qualified installers
- Three part assessment
- Assess commonly used areas inside and outside the home
what should you look at with entryways (home eval)
- Steps
- Railing
- Potential space for a ramp (1 inch rise for 12 inch run)
- Width of doorway
- Fire exits
what should you look at in the living room (home eval)
- favorite chair (type)
- Electrical cords
- Location of phone
- Light switches
- Clear pathways to other rooms
what should be looked at regarding the bedroom (home eval)?
- Bed height and accessibility
- Stability of the bed
- Floor surface and rugs
- Access to clothing
- Lighting
- Distance to bathroom
- Location of phone
what should be looked at regarding the bathroom? (home eval)
- Width of doorway
- Floor surface, rugs
- Style of shower (tub vs. stand up, shower nozzle, H2O temp control)
- Grab bars
- Lighting
What should be looked at in regard to the kitchen (home eval)
- Access to items
- Ability to safely use stove and oven
- Height of countertops
- Refrigerator and its contents
- Lighting
What should you observe for the person during a home eval?
- Home management
- Laundry
- Location of washer/dryer
- Ability to get clothing to laundry room
- Mail: access to mailbox
- Shopping: groceries and other needs
- Housekeeping: safety and manageability
- Cleaning equipment
- Supplies
- Outside housekeeping services
- General maintenance
- House repairs
- Thermostat controls
- Yard maintenance
- Laundry
- Leisure activities
- Ability to safely drive
- Safe community ambulation
- Reading ability: appropriate eyewear
- Use of technology: voice activated remote controls and phone devices
determine the person’s safety/fall risk for home eval
- Door locks
- Alarm systems
- Life alert system
- Ability to hear alarms and smoke detectors
- Ability to safely answer the door
- Access to emergency exit/fire plan
- Lighting (changing bulbs when dim instead of burned out)
- Use of assistive devices in the home
- Use of proper footwear in the home
