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S7- Special Populations > Week 10- Evaluation and Assessment > Flashcards

Week 10- Evaluation and Assessment Flashcards

1
Q

PART 1: GAIT ASSESSMENT

A

PART 1: GAIT ASSESSMENT

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2
Q

Put the 8 phases of gait in one of the following categories.

  • Weight Acceptance
  • Single Limb Support
  • Limb Advancement
A

Weight Acceptance

  • IC
  • LR

Single Limb Support

  • MSt
  • TSt

Limb Advancement

  • PSw
  • ISw
  • MSw
  • TSw
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3
Q

What are some common temporal and spatial gait changes that occur with age?

A

Temporal

  • Decreased self-selected gait speed.
  • Increased stance time and double-limb support time.

Spatial

  • Decreased step and stride length.
  • Increased step width (not a universal finding across studies).
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4
Q

What are some common kinematic/postural changes that occur with age?

A
  • Decreased excursion of movement at lower extremity joints.
  • Decreased reliance on ankle kinetics and power.
  • Less upright posture.
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5
Q

What is the main gait measurement that is associated with risk of institutionalization, death, frailty, falls, and cognition?

A

GAIT SPEED

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6
Q

Gait and Cognition:

  • Decrease in both gait and cognition = high risk of ________.
  • What is MCRS? What are they more likely to develop?
  • Strong need to integrate _______ demands with gait/mobility training.
A
  • DEMENTIA
  • MCRS (Motoric Cognitive Risk Syndrome) is a condition characterized by SLOWED GAIT and COGNITIVE IMPAIRMENT. They are more likely (2-3x) to develop DEMENTIA.
  • cognitive demands
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7
Q

Gait Speed Cut Points:
>___m/s:
-Extremely fit
-Can cross street safely

> ___m/s:

  • Healthy older population with lower risk of hospitalization or adverse health events
  • Independent in ADLs
A
  • > 1.2m/s

- >1.0m/s***

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8
Q

Gait Speed Cut Points:

> ___m/s:

  • Extremely fit
  • Can cross street safely

> ___m/s:

  • Healthy older population with lower risk of hospitalization or adverse health events
  • Independent in ADLs
A
  • <1.0m/s

- <0.8m/s***

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9
Q

Requirements for Functional Ambulation:

  • FIM determinant of highest-level locomotion = ____ft
  • Conservative estimate of distances walked at superstores = _____ft
  • Gait speeds required to safely cross street = ___-___m/s

-What are some important things to consider?

A
  • 150ft
  • 2000ft
  • 0.49-1.32m/s

Important to consider things such as time constraints, ambient conditions, terrain characteristics, external physical load, attentional demands, postural transitions, and traffic level.

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10
Q

Common Environmental Demands for Community Ambulation. (14)

A
  • Starts and stops
  • Acceleration and deceleration
  • Sideways stepping
  • Backward stepping
  • Changing directions and turning around
  • Obstacle clearance/avoidance
  • Picking up/carrying/putting down objects
  • Pushing/pulling doors
  • Managing displacement forces
  • Terrain changes
  • Lighting changes
  • Weather changes
  • Stepping up and down curbs/stairs/ramps of different heights and grades
  • Concurrent execution of other tasks (cognitive and physical)
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11
Q

List of Gait-based Outcome Measures. (7)

A
  • 10MWT
  • 2MWT/6MWT
  • TUG
  • DGI (Dynamic Gait Index)
  • FGA (Functional Gait Assessment)
  • SCT (Stair Climb Test)
  • Tinetti POMA
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12
Q

What is gait training?

A

“Targeted, customized interventions based on multiple patient factors aimed at improving quality and independence of ambulation.”

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13
Q

What are some interventions that could be utilized to address gait impairments based on the impairment? (4)

A
  • Flexibility
  • Strength, power, agility
  • CV training
  • Multimodal training (All of the above)
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14
Q

What are some ways we can progress gait interventions? (6)

A
  • Specificity of training
  • Training speed
  • Progressing task and environment
  • Obstacle courses and stair training
  • Directional training
  • Dual task
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15
Q

1

A

1

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16
Q

PART 2: FALLS ASSESSMENT

A

PART 2: FALLS ASSESSMENT

17
Q

What model is used for optimal patient care?

A

ICF Model

18
Q

Falls and the Elderly:

  • -What is the leading cause of injury and death in those >65 yo?
  • __/__ community-living adults over 65 experiences a fall each year.
  • __/__ falls causes serious injury.
  • Many people who fall, even if they are not injured develop what? What does this lead to?
A
  • falls
  • 1/3
  • 1/5
  • Develop a fear of falling. This creates a downward spiral of inactivity, decreased strength, agility, balance, and loss of independence.
19
Q

Falls and Risk Factors:

  • What are the (4) principle causes of falls?
  • What classifies someone as a recurrent faller?
  • Important to note _______ vs. ________ risk factors that can contribute to falls.
A
  • Trips/slips, drop attack, syncope, dizziness
  • 2 or more falls in 6-12 months
  • Intrinsic vs. Extrinsic
20
Q

Postural Control and Aging:

  • What is postural control?
  • Involves the integration of what 3 systems?
A

-Ability to maintain COG over BOS in static and dynamic situations.

  1. ) Sensory (somatosensory, visual, vestibular)
  2. ) CNS (strategies: ankle, hip, stepping, reaching, suspensory)
  3. ) Neuromuscular (response to balance perturbations affected by muscle strength, endurance, latency, torque, etc.)
21
Q

Managing At-Risk Fallers:

  • Ask about falls within the past ___ months.
  • Assess _______, ______, and _____.
  • Assess need for ____ prescription.
  • Provide ________, ________ exercise program.
A
  • 12 months
  • strength, balance, and gait
  • AD prescription
  • supervised, structed exercise program
22
Q

What are some things we should do for those who have had 2+ falls in the past year? (8)

A
  • Basic fall history
  • Assess for OH
  • Assess visual acuity
  • Assess strength, balance, gait
  • Home assessment for fall hazards
  • Review medications
  • Assess appropriateness of AD
  • Assess cognitive status
23
Q

Postural Control Examination:

  • Examination of what (3) systems is important when assessing postural control/falls?
  • CTSIB: Falls during condition 5 and 6 indicate _______ dysfunction. Falls during 4, 5, and 6 indicate ________
A
  • Vision, Vestibular, Somatosensory

- vestibular dysfunction (4,5), surface dependence (4,5,6)

24
Q

Distinguish which strategy is being explained (ankle, hip, stepping, reaching, suspensory):

  1. ) Reaction to large perturbation (moving arms to grasp for support).
  2. ) Lowers COG to enhance postural stability (flexing knees).
  3. ) Small disturbance of BOS (ankle musculature activation).
  4. ) COG displaced beyond limits of BOS (forward/backward stepping).
  5. ) Sudden and forceful disturbance (hip muscle activation).
A
  1. ) Reaching Strategy
  2. ) Suspensory Strategy
  3. ) Ankle Strategy
  4. ) Stepping Strategy
  5. ) Hip Strategy
25
Q

Thorough home environmental assessment and modification is a key to falls ___________.

A

PREVENTION

26
Q

The home evaluation consists of what (3) parts?

A
  1. ) Assess commonly used areas inside and outside the home.
  2. ) Observe the person moving around the environment.
  3. ) Determine the person’s fall risk and health status.
27
Q

What is a Functional Performance Test?

A
  • Objective, accurate record that measures what is pertinent to the patient and informs us on impairments and goal setting.
  • Compares to age-based normative data to evaluate prognosis.
28
Q

What are some limitations of MMT in older adults? (5)

A
  • Ceiling effect of available strength
  • Make Test/Break Test
  • Subjective grading
  • Patient effort, understanding, willingness affects results
  • Testing position may not reflect functional performance
29
Q

What are the (4) types of Functional Outcome Measures? Describe each.

A

Self-report
-Patient perception of impairment, function, QOL.

Patient outcome measures
-Asks patient about impact of condition on activities and roles in life.

Observer-rated measures
-Measures observed by PT.

Physiological measures
-Measure single biological entity (cognitive ability, pain, exertion).

30
Q

Walking Test Outcome Measures. (6)

A
  • 2 MWT, 6 MWT
  • Gait speed
  • Dynamic Gait Index (DGI)
  • Functional Gait Assessment (FGA)
  • TUG
  • Figure 8 Walking Test
31
Q

Mobility Scales Outcome Measures. (3)

A
  • 30-second CRT
  • 5X and 10X STS
  • Floor transfer
32
Q

Balance Outcome Measures. (7)

A
  • BESTest, BESTmini, BESTbrief
  • Berg Balance Scale
  • Activities Specific Balance Confidence (ABC) Scale
  • Functional Reach Test
  • 4 Square Step Test
  • Tinetti Performance-Oriented Mobility Assessment (POMA)
  • Single leg stance
33
Q

Physical Performance Outcome Measures. (4)

A
  • Physical Performance Test
  • Physiological Profile Assessment (PPA)
  • Short Physical Performance Battery (SPPB)
  • Grip strength
34
Q

Multidisciplinary Fall Risk Tools. (2)

A
  • Morse Fall Scale

- Hendrich II Fall Risk Model (acute care setting only)

35
Q

What are the (6) parts of the ICF Model?

A
  1. ) Health Condition
  2. ) Body Structure/Function
  3. ) Activity Limitations
  4. ) Participation Restrictions
  5. ) Environmental Factors
  6. ) Personal Factors

S7- Special Populations (18 decks)

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