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Special Pops (Review Q's/Re-outlined PPT) > Study Guide Q's: Assessment and Evaluation > Flashcards

Study Guide Q's: Assessment and Evaluation Flashcards

1
Q

Describe temporal changes with gait as we age (2)

A
  • Decreased self-selected gait speed
  • Increased stance time and double limb support time
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2
Q

Describe spatial changes with gait as we age

A
  • Decreased step length
  • Decreased stride length
  • Increased step width (not a universal finding across studies)
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3
Q

Describe kinematic/postural changes with gait as we age

A
  • Decreased excursion of movement at lower extremity joints
  • Decreased reliance on ankle kinetics and power
  • Less upright posture
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4
Q

What does increased variability of gait as we age mean?

A

Defined as variability in step or stride time, length, or width

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5
Q

Gait speed of ≥ 1.2 m/s indicates

A
  • Extremely fit
  • Can cross street safely
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6
Q

Gait speed of ≥ 1.0 m/s indicates

A
  • Healthy older population with lower risk of hospitalization or adverse health events
  • Independent in ADLs
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7
Q

Gait speed of <1.0 (vs. greater than or equal to 1)

A
  • Increased risk for cognitive decline within 5 years
  • Increased risk for death and hospitalization within 1 year
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8
Q

Gait speed of < 0.8 m/s indicates

A
  • Increased risk of mortality and mobility/ADL disability at 2 years
  • Limited community ambulator
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9
Q

Gait speed of <0.7 m/s

A

Increased risk of death, hospitalization, institutionalization, and falls

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10
Q

Gait speed of <0.4 m/s

A
  • Functional dependence
  • Severe walking disability
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11
Q

Gait speed of <0.2 m/s

A
  • Extremely frail
  • Highly dependent
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12
Q

Ways to assess gait speed (instrumented tools)

A
  • GAITrite
  • Prokinetics
  • Wearables
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13
Q

Ways to assess gait speed (manual tools)

A
  • Stop watch
  • Smartphone app
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14
Q

10 MWT significant values (also 2MWT)

A
  • ≥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
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15
Q

10 MWT

MDC and MCID

A
  • MDC: 0.05 m/s
  • MCID: 0.05-0.12 m/s
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16
Q

TUG significant values (MDC and MCID included)

A
  • Significant values: >13.5 seconds indicates fall risk
  • MDC: 4 seconds
  • MCID: 1 second
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17
Q

DGI significant values (including MCD and MCID)

A
  • Significant values: <19 indicates fall risk
  • MDC: ~3 points
  • MCID: ~2 points
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18
Q

Functional gait assessment significant values (including MDC and MCID)

A
  • Significant values: <22
  • MDC: 4-6 points
  • MCID: 4 points
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19
Q

Other gait based outcome measures (2)

A
  • Stair climb test
  • Tinetti POMA
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20
Q

Types of interventions that address gait impairments

A

Flexibility

Strength/power/agility

CV training

balance training

called multimodal approach

21
Q

Why strength/power/agiliy help with gait training

A
  • 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
22
Q

Why CV training helps with gait

A
  • Aerobic exercise enhances functional endurance
23
Q

gait training

what speed increase could reduce disability and mortality?

A
  • 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
24
Q

how to progress gait training

when would backward walking increase fall risk?

A
  • 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
25
Q

dual task with gait training (motor and cog)

what would increased gait variability with this indicate?

A
  • Reduction in gait speed with simple vs. complex dual task
  • Increased gait variability -> decreased postural stability
  • Tasks: counting backward, animal naming
26
Q

purpose of functional performance testing

A
  • Objective, accurate record
  • Measures what is pertinent to the patient
  • Informs impairments
  • Informs goal setting
  • Comparison of age based normative data
  • Prognostic
27
Q

types of functional outcome measures

A
  • 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)
28
Q

Walking tests (2)

A
  • 2MWT
  • 6MWT
29
Q

gait speed outcome measures

A
  • DGI
  • FGA
  • TUG
  • Figure 8 walking test
30
Q

mobility outcome measurse

A
  • 30 second CRT (chair stand test/30 second STS)
  • 5x and 10x STS
  • Floor transfer
31
Q

balance outcome measures

A
  • 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
32
Q

physical performance outcome measures

A
  • Physical Performance Test
  • Physiological Profile Assessment (PPA)
  • Short Physical Performance Battery (SPPB)
  • Grip strength
33
Q

multidisciplinary outcome measures

A
  • Morse Fall Scale
  • Hendrich II Fall Risk Model (acute care setting only
34
Q

intrinsic risk factors for falls

A
  1. Gait and balance impairment
  2. Peripheral neuropathy
  3. Vestibular dysfunction
  4. Muscle weakness
  5. Vision impairment
  6. Medical illness
  7. Advanced age
  8. Impaired ADL’s
  9. Orthostasis
  10. Dementia
  11. Drugs
35
Q

extrinsic risk factors for falls

A
  1. environmental hazards
  2. poor footwear
  3. restraints
36
Q

what parts of the visual system being damaged may contribute to falls?

A
  • Acuity
  • Contrast sensitivity
  • Depth perception
  • Visual field cut
37
Q

What parts of the vestibular system damaged may contribute to falls/what should be examined

A
  • VOR function
  • Gaze stability
    • Nystagmus
    • Saccades
    • Smooth pursuit
    • Head impulse test
    • Head shake test
    • Dynamic visual acuity test
    • Skew deviation test
    • VOR cancellation test
38
Q

What needs to be tested for somatosensation that if damaged could contribute to falls?

A
  • Cutaneous sensation
  • Proprioception
  • Vibration
39
Q

What other things should be included in examination for a falls risk patient?

A
  • 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
40
Q

interpretation of CTSIB

  • fall during conditions 5-6 indicates what?*
  • fall during conditions 4,5,6 indicates what?*
A
  • Fall during conditions 5-6 usually indicates vestibular dysfunction
  • 4,5,6 indicates surface dependence
41
Q

describe difference between ankle, hip, stepping, reaching, and suspensory fall strategies

A
  • 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
42
Q

components of a home evaluation assessment

A
  • 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
    1. Assess commonly used areas inside and outside the home
43
Q

what should you look at with entryways (home eval)

A
  • Steps
  • Railing
  • Potential space for a ramp (1 inch rise for 12 inch run)
  • Width of doorway
  • Fire exits
44
Q

what should you look at in the living room (home eval)

A
  • favorite chair (type)
  • Electrical cords
  • Location of phone
  • Light switches
  • Clear pathways to other rooms
45
Q

what should be looked at regarding the bedroom (home eval)?

A
  • Bed height and accessibility
  • Stability of the bed
  • Floor surface and rugs
  • Access to clothing
  • Lighting
  • Distance to bathroom
  • Location of phone
46
Q

what should be looked at regarding the bathroom? (home eval)

A
  • Width of doorway
  • Floor surface, rugs
  • Style of shower (tub vs. stand up, shower nozzle, H2O temp control)
  • Grab bars
  • Lighting
47
Q

What should be looked at in regard to the kitchen (home eval)

A
  • Access to items
  • Ability to safely use stove and oven
  • Height of countertops
  • Refrigerator and its contents
  • Lighting
48
Q

What should you observe for the person during a home eval?

A
  • 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
  • Leisure activities
    • Ability to safely drive
    • Safe community ambulation
    • Reading ability: appropriate eyewear
    • Use of technology: voice activated remote controls and phone devices
49
Q

determine the person’s safety/fall risk for home eval

A
  • 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

Special Pops (Review Q's/Re-outlined PPT) (24 decks)

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