Week 10- Evaluation and Assessment Flashcards
PART 1: GAIT ASSESSMENT
PART 1: GAIT ASSESSMENT
Put the 8 phases of gait in one of the following categories.
- Weight Acceptance
- Single Limb Support
- Limb Advancement
Weight Acceptance
- IC
- LR
Single Limb Support
- MSt
- TSt
Limb Advancement
- PSw
- ISw
- MSw
- TSw
What are some common temporal and spatial gait changes that occur with age?
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).
What are some common kinematic/postural changes that occur with age?
- Decreased excursion of movement at lower extremity joints.
- Decreased reliance on ankle kinetics and power.
- Less upright posture.
What is the main gait measurement that is associated with risk of institutionalization, death, frailty, falls, and cognition?
GAIT SPEED
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.
- 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
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
- > 1.2m/s
- >1.0m/s***
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
- <1.0m/s
- <0.8m/s***
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?
- 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.
Common Environmental Demands for Community Ambulation. (14)
- 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)
List of Gait-based Outcome Measures. (7)
- 10MWT
- 2MWT/6MWT
- TUG
- DGI (Dynamic Gait Index)
- FGA (Functional Gait Assessment)
- SCT (Stair Climb Test)
- Tinetti POMA
What is gait training?
“Targeted, customized interventions based on multiple patient factors aimed at improving quality and independence of ambulation.”
What are some interventions that could be utilized to address gait impairments based on the impairment? (4)
- Flexibility
- Strength, power, agility
- CV training
- Multimodal training (All of the above)
What are some ways we can progress gait interventions? (6)
- Specificity of training
- Training speed
- Progressing task and environment
- Obstacle courses and stair training
- Directional training
- Dual task
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PART 2: FALLS ASSESSMENT
PART 2: FALLS ASSESSMENT
What model is used for optimal patient care?
ICF Model
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?
- 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.
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.
- Trips/slips, drop attack, syncope, dizziness
- 2 or more falls in 6-12 months
- Intrinsic vs. Extrinsic
Postural Control and Aging:
- What is postural control?
- Involves the integration of what 3 systems?
-Ability to maintain COG over BOS in static and dynamic situations.
- ) Sensory (somatosensory, visual, vestibular)
- ) CNS (strategies: ankle, hip, stepping, reaching, suspensory)
- ) Neuromuscular (response to balance perturbations affected by muscle strength, endurance, latency, torque, etc.)
Managing At-Risk Fallers:
- Ask about falls within the past ___ months.
- Assess _______, ______, and _____.
- Assess need for ____ prescription.
- Provide ________, ________ exercise program.
- 12 months
- strength, balance, and gait
- AD prescription
- supervised, structed exercise program
What are some things we should do for those who have had 2+ falls in the past year? (8)
- 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
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 ________
- Vision, Vestibular, Somatosensory
- vestibular dysfunction (4,5), surface dependence (4,5,6)
Distinguish which strategy is being explained (ankle, hip, stepping, reaching, suspensory):
- ) Reaction to large perturbation (moving arms to grasp for support).
- ) Lowers COG to enhance postural stability (flexing knees).
- ) Small disturbance of BOS (ankle musculature activation).
- ) COG displaced beyond limits of BOS (forward/backward stepping).
- ) Sudden and forceful disturbance (hip muscle activation).
- ) Reaching Strategy
- ) Suspensory Strategy
- ) Ankle Strategy
- ) Stepping Strategy
- ) Hip Strategy
Thorough home environmental assessment and modification is a key to falls ___________.
PREVENTION
The home evaluation consists of what (3) parts?
- ) Assess commonly used areas inside and outside the home.
- ) Observe the person moving around the environment.
- ) Determine the person’s fall risk and health status.
What is a Functional Performance Test?
- 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.
What are some limitations of MMT in older adults? (5)
- Ceiling effect of available strength
- Make Test/Break Test
- Subjective grading
- Patient effort, understanding, willingness affects results
- Testing position may not reflect functional performance
What are the (4) types of Functional Outcome Measures? Describe each.
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).
Walking Test Outcome Measures. (6)
- 2 MWT, 6 MWT
- Gait speed
- Dynamic Gait Index (DGI)
- Functional Gait Assessment (FGA)
- TUG
- Figure 8 Walking Test
Mobility Scales Outcome Measures. (3)
- 30-second CRT
- 5X and 10X STS
- Floor transfer
Balance Outcome Measures. (7)
- 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
Physical Performance Outcome Measures. (4)
- Physical Performance Test
- Physiological Profile Assessment (PPA)
- Short Physical Performance Battery (SPPB)
- Grip strength
Multidisciplinary Fall Risk Tools. (2)
- Morse Fall Scale
- Hendrich II Fall Risk Model (acute care setting only)
What are the (6) parts of the ICF Model?
- ) Health Condition
- ) Body Structure/Function
- ) Activity Limitations
- ) Participation Restrictions
- ) Environmental Factors
- ) Personal Factors
