Balance Outcome Norms
Transcript of Balance Outcome Norms
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Functional Assessments Functional Assessments for Geriatric Clientsfor Geriatric Clients
Ann Medley, PT, PhDAnn Medley, PT, PhDTexas WomanTexas Woman’’s Universitys UniversitySchool of Physical TherapySchool of Physical Therapy
Disability SchemesDisability Schemes
!! International Classification of Functioning, International Classification of Functioning, Disability, and HealthDisability, and Health
!! NagiNagi Scheme (adopted by APTA and Scheme (adopted by APTA and included in the Guide to PT Practice)included in the Guide to PT Practice)
Health Condition Health Condition ((disorder/diseasedisorder/disease))
Interaction of Concepts Interaction of Concepts ICFICF
Environmental Environmental FactorsFactors
Personal Personal FactorsFactors
Body Body function&structurefunction&structure
(Impairment(Impairment))
ActivitiesActivities(Limitation)(Limitation)
ParticipationParticipation(Restriction)(Restriction)
Contextual FactorsContextual Factors
PersonPerson"" gendergender"" ageage"" other health other health
conditionsconditions"" coping stylecoping style"" social social
backgroundbackground"" educationeducation"" professionprofession"" past experiencepast experience"" character stylecharacter style
EnvironmentEnvironment""ProductsProducts""Close milieuClose milieu""InstitutionsInstitutions""Social NormsSocial Norms""CultureCulture""BuiltBuilt--environmentenvironment""Political factorsPolitical factors""NatureNature
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NagiNagi
Disability
Active Pathology
Impairment
Functional Limitations
Components of Components of Functional AssessmentFunctional Assessment
!! Basic Activities of Daily Living (ADL, BADL)Basic Activities of Daily Living (ADL, BADL)!! Instrumental Activities of Daily Living Instrumental Activities of Daily Living
(IADL)(IADL)!! WorkWork!! Recreation ??? measuresRecreation ??? measures!! MobilityMobility
!! BalanceBalance!! AmbulationAmbulation
Assessments of ADLAssessments of ADL
!! Functional Independence Measure (FIM)Functional Independence Measure (FIM)!! 18 items, 7 point scale18 items, 7 point scale!! Includes cognitive and communication Includes cognitive and communication
componentscomponents
!! BarthelBarthel IndexIndex!! 10 items, 100 points total10 items, 100 points total
Instrumental ADLInstrumental ADL
!! Lawton IADL Lawton IADL Lawton and Brody, 1969; Lawton, 1988Lawton and Brody, 1969; Lawton, 1988
!! 9 items, 3 points for a total score of 279 items, 3 points for a total score of 27!! Financial management, shopping, transportation use, Financial management, shopping, transportation use,
telephoning, medication use, housekeeping, cooking, telephoning, medication use, housekeeping, cooking, laundrylaundry
19.8619.86
InIn--HomeHome
18.1518.1525.1525.1524.5124.51
Waiting for Waiting for LTCLTC
Public Public HousingHousing
CommunityCommunity
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WorkWork!! Walk up 10 stepsWalk up 10 steps!! Walk quarter of a mileWalk quarter of a mile!! Sit for 2 hoursSit for 2 hours!! Stand for 2 hoursStand for 2 hours!! Stoop, crouch, kneelStoop, crouch, kneel!! Reach up overheadReach up overhead!! Reach out to shake handsReach out to shake hands!! Grasp with fingersGrasp with fingers!! Lift or carry 10 poundsLift or carry 10 pounds!! Lift or carry 25 poundsLift or carry 25 pounds
!! 95% of people 95% of people classified as having classified as having no disability had no disability had minimal physical minimal physical limitationslimitations
!! 67.9% of people 67.9% of people considered disabled considered disabled had severe physical had severe physical limitationslimitations
!! NagiNagi, 1976, 1976
Measures of Functional MobilityMeasures of Functional Mobility
!! Psychological measuresPsychological measures!! Sitting measuresSitting measures!! Standing measuresStanding measures
!! StaticStatic!! DynamicDynamic
!! Measures of functional mobilityMeasures of functional mobility
Assessing Psychological Aspects of Balance
! Activity-Specific Balance Confidence Scale (ABC)ABC)
!! Falls Efficacy Scale (FES)Falls Efficacy Scale (FES)
ActivityActivity--Specific Balance Specific Balance Confidence (ABC) Scale Confidence (ABC) Scale Powell & Myers, 1995Powell & Myers, 1995
!! 1616--item selfitem self--report questionnaire asking patients report questionnaire asking patients to rate their confidence level while completing to rate their confidence level while completing various functional activitiesvarious functional activities
!! Scoring: 11Scoring: 11--point scale ranging from 0% = no point scale ranging from 0% = no confidence to 100% = complete confidence confidence to 100% = complete confidence
!! Interpretation: Interpretation: !! less than 50 = low level of physical functioning (home less than 50 = low level of physical functioning (home
care)care)!! 5151--80 = moderate level of functioning (retirement 80 = moderate level of functioning (retirement
homes/chronic conditions)homes/chronic conditions)!! 8181--100 = highly functioning active older adults100 = highly functioning active older adults
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Falls Efficacy Scale (FES)Falls Efficacy Scale (FES)ME Tinetti, D Richman, L Powell 1990
!! FES (10 point scale with high score FES (10 point scale with high score associated with low confidence)associated with low confidence)!! Rate confidence for completing 10 activities Rate confidence for completing 10 activities
without fallingwithout falling!! Reduced FES associated with decline in ADL, Reduced FES associated with decline in ADL,
IADL, and social functionIADL, and social function!! Discriminates between those who avoid Discriminates between those who avoid
activity due to fear of falling and those who activity due to fear of falling and those who do notdo not
FES (continued)FES (continued)!! rFESrFES (revised; 11 point scale with low score (revised; 11 point scale with low score
associated with low confidence)associated with low confidence)!! Same as FES but scoring reversedSame as FES but scoring reversed!! Good testGood test--retest retest reliabiltyreliabilty ICC= .88ICC= .88
!! mFESmFES (modified) low score associated with low (modified) low score associated with low confidenceconfidence!! Original 10 items plus 4 moreOriginal 10 items plus 4 more!! Good testGood test--retest reliability ICC=.95retest reliability ICC=.95!! Compared healthy elders with patients at a falls and Compared healthy elders with patients at a falls and
balance clinic balance clinic Hill et al., 1996Hill et al., 1996
!! Mean scores on each item for healthy elders: 9.76 (136.6)Mean scores on each item for healthy elders: 9.76 (136.6)!! Mean scores for patients: 7.69 (107.7)Mean scores for patients: 7.69 (107.7)
Sitting TestsSitting Tests
!! Sitting forward reachSitting forward reach!! Sitting lateral reachSitting lateral reach!! SBSSBS
SITTING SITTING FUNCTIONAL FUNCTIONAL
REACHREACH
20.3 cm20.3 cm26.7 cm26.7 cm29.5 cm29.5 cmLateral Lateral ReachReach
32.9 cm32.9 cm42.3 cm42.3 cm44.9 cm44.9 cmForward Forward ReachReach
OldOld6565--9393
MiddleMiddle4040--5959
YoungYoung2121--3939
Thompson & Medley, 2007
A
DC
B
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SBSSBSMedley & Thompson, 2006, 2007Medley & Thompson, 2006, 2007
!! 12 item tool with 4 point 12 item tool with 4 point scalescale
!! Strong relationship Strong relationship (r=.76, p=.001) between (r=.76, p=.001) between total score of selftotal score of self--assessed steadiness & assessed steadiness & total SBS scoretotal SBS score
•• Clinicians agreed that Clinicians agreed that reaching forward with an reaching forward with an outstretched arm was outstretched arm was most important while side most important while side bending on foam was bending on foam was least important in least important in assessing sitting balanceassessing sitting balance
Lateral bend to elbow in sitting on foam12
Pick up an object from the floor while sitting unsupported on foam
11Sit to stand transfers10
Lateral bend to elbow in sitting9
Turning to look behind over left and right shoulders while sitting
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Reaching laterally with outstretched arm while unsupported
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Placing alternate foot on a step stool while sitting unsupported
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Pick up object from the floor while sitting unsupported
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Reaching forward with outstretched arm while sitting
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Sitting unsupported with arms as levers3Sitting unsupported with eyes closed2
Sitting unsupported with eyes open1DescriptionItem STATIC BALANCE TESTSSTATIC BALANCE TESTS
!! RombergRomberg!! Sharpened RombergSharpened Romberg!! One Leg StanceOne Leg Stance
ROMBERG TESTROMBERG TEST
!! Stand with feet parallel and Stand with feet parallel and together together (Some say with arms folded across chest)(Some say with arms folded across chest)
!! Close eyes for 20Close eyes for 20--30 30 secondsseconds
!! Judge the amount of sway Judge the amount of sway or time position heldor time position held
!! Abnormal testAbnormal test!! Eyes openEyes open!! Loss of balanceLoss of balance!! Stepping during testStepping during test
SHARPENED ROMBERGSHARPENED ROMBERG
!! Stand in heelStand in heel--toto--toe positiontoe position!! Arms folded across chest with eyes closed Arms folded across chest with eyes closed
for 60 secondsfor 60 seconds!! Time 4 trials for a maximum score of 240 Time 4 trials for a maximum score of 240
seconds; or just time one trial up to 60 sseconds; or just time one trial up to 60 s!! Abnormal testAbnormal test
!! Excessive swayExcessive sway!! Loss of balanceLoss of balance!! Stepping during testStepping during test
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SHARPENED ROMBERG SHARPENED ROMBERG PERFORMANCE NORMS PERFORMANCE NORMS Briggs et al., 1989Briggs et al., 1989
45458080--8686
39397575--7979
48487070--7474
56566565--6969
56566060--6464Score (seconds)Score (seconds)AgeAge
ONE LEG STANCE TESTONE LEG STANCE TEST
!! Stand with arms crossed, then pick up one Stand with arms crossed, then pick up one leg and hold with hip in neutral and knee leg and hold with hip in neutral and knee flexed to 90 degreesflexed to 90 degrees
!! Five 30Five 30--second trials; max score 150 sec. second trials; max score 150 sec. or hold for 60 seconds one trialor hold for 60 seconds one trial
!! Test both sides noting any differencesTest both sides noting any differences!! Criteria to stop: legs touch each other, Criteria to stop: legs touch each other,
foot touches down, arms move from start foot touches down, arms move from start positionposition
ONE LEG STANCE TEST ONE LEG STANCE TEST Briggs et al., 1989Briggs et al., 1989
20202020All groupsAll groups
101011118080--8686
121211117575--7979
202018187070--7474
242424246565--6969
343438386060--6464
NonNon--dominantdominantDominant Dominant AgeAge
ACTIVE STANDING TESTSACTIVE STANDING TESTS
!! Functional Reach (forward and lateral)Functional Reach (forward and lateral)!! Multi Directional Reach TestMulti Directional Reach Test!! Berg Balance ScaleBerg Balance Scale!! Step TestStep Test
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FUNCTIONAL REACHFUNCTIONAL REACH
!! Designed for elderly populationDesigned for elderly population!! Consists of patient reaching as far forward Consists of patient reaching as far forward
as possible while maintaining a fixed BOS as possible while maintaining a fixed BOS in standingin standing
!! Score is normScore is norm--based on extent of forward based on extent of forward reach along a yardstickreach along a yardstick
!! Score of 6Score of 6--7 inches indicates a frail person 7 inches indicates a frail person with limited ability to perform with limited ability to perform ADLsADLs & & increased risk of falls increased risk of falls Duncan et al. (1990)Duncan et al. (1990)
FR Test: Reach ForwardFR Test: Reach Forward
FUNCTIONAL REACH NORMSFUNCTIONAL REACH NORMS
13.213.2””++ 1.61.6””13.213.2””++ 1.61.6””7070--87yrs87yrs
13.813.8””++ 2.22.2””14.914.9””++ 2.22.2””4141--69 yrs69 yrs
14.614.6”” ++2.22.2””
16.716.7”” ++ 1.91.9””2020--40 yrs40 yrs
WomenWomenMenMenAgeAge
FUNCTIONAL REACH STUDIESFUNCTIONAL REACH STUDIES
!! Reliability Reliability Duncan et al., 1990Duncan et al., 1990
!! TestTest--retest reliability r = .89retest reliability r = .89!! InterraterInterrater agreement on reach measurement = agreement on reach measurement =
.98.98!! ValidityValidity
!! Discriminates levels of physical frailtyDiscriminates levels of physical frailty!! FR< 7 in were unable to stand on one leg for 1 sec*FR< 7 in were unable to stand on one leg for 1 sec*!! FR < 7 could not perform tandem walking*FR < 7 could not perform tandem walking*!! FR < 7 had slower walking speed*FR < 7 had slower walking speed*!! FR < 6FR < 6--7 in more likely to fall**7 in more likely to fall**
•Weiner, et al., 1992 *
•Duncan, et al., 1992 **
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Lateral ReachLateral Reach
!! Measures lateral postural stabilityMeasures lateral postural stability!! Maximum distance an individual can reach Maximum distance an individual can reach
laterally in a standing positionlaterally in a standing position!! Start position: 90 degrees abduction with Start position: 90 degrees abduction with
elbow extended elbow extended !! Feet in contact with floor, no knee flexion, no Feet in contact with floor, no knee flexion, no
trunk flexion or rotationtrunk flexion or rotation!! Good testGood test--retest reliability: ICC .94retest reliability: ICC .94
FR Test: Lateral ReachFR Test: Lateral Reach
Lateral Reach Performance DataLateral Reach Performance Data
14.3 cm 14.3 cm ++ 5.6 5.6 (5.4 (5.4 ++ 1.8)1.8)
14.9 cm 14.9 cm ++ 5.9 5.9 (5.9 (5.9 ++ 1.8)1.8)
DeWaardDeWaard et al., et al., 20022002
21.04 cm 21.04 cm ++ 2.52.5(8.3 (8.3 ++ 1)1)
20.06 cm 20.06 cm ++ 4.9 4.9 (7.9 (7.9 ++ 1.9)1.9)
BrauerBrauer et al., et al., 1999 1999
LeftLeftRightRightAuthorAuthor
Normative Values for Normative Values for Lateral Reach Lateral Reach (Isles et al, 2004)(Isles et al, 2004)
15.7 15.7 ++ 0.490.497070--79 (91)79 (91)
17.11 17.11 ++ 0.480.486060--69 (90)69 (90)
18.37 18.37 ++ 0.480.485050--59 (93)59 (93)
18.96 18.96 ++ 0.470.474040--49 (95)49 (95)
23.09 23.09 ++ 0.660.663030--39 (47)39 (47)
22.95 22.95 ++ 0.70.72020--29 (40)29 (40)
Lateral Reach (cm)Lateral Reach (cm)Age Group (n)Age Group (n)
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MultiMulti--Directional Reach TestDirectional Reach Test
!! Reach forward, to Reach forward, to the right, the left the right, the left and lean backward. and lean backward.
!! MeansMeans!! Forward Forward 8.9 in8.9 in!! Backward Backward 4.6 in4.6 in!! Right Right 6.8 in6.8 in!! LeftLeft 6.6 in6.6 in
Newton, 1997
Validity of MultiValidity of Multi--Directional Directional Reach TestReach Test
6.866.865.675.675.725.726.606.606.566.566.946.945.335.337.337.33Left Left
7.087.086.126.125.25.5.25.6.536.537.07.07.547.545.625.627.577.57RightRight
4.804.804.064.063.333.333.863.865.095.095.165.163.253.255.395.39BackwardBackward
9.079.078.388.386.436.438.818.819.079.079.299.297.107.109.729.72Forward Forward (in)(in)
NonNon--FallerFaller
FallerFallerPoor Poor HealthHealth
Fair Fair HealthHealth
Good Good HealthHealth
Excellent Excellent HealthHealth
AD*AD*NO NO ADAD
Newton, 2001* Assistive Device
BERG BALANCE SCALE BERG BALANCE SCALE Berg, et al., 1992Berg, et al., 1992
!! Designed to test sitting & standing balance of Designed to test sitting & standing balance of elderly patientselderly patients
!! Consists of 14 items including sitting balance, sit Consists of 14 items including sitting balance, sit !!stand, transfersstand, transfers
!! Scoring on a five point ordinal scale Scoring on a five point ordinal scale (0=unable,4=independent) (0=unable,4=independent)
!! Score of < 45 = risk for multiple fallsScore of < 45 = risk for multiple falls!! Score of Score of << 36: 100% risk of falling 36: 100% risk of falling ShumwayShumway--Cook et al. Cook et al.
(1997)(1997)
Step Test Step Test Hill et al., 1996Hill et al., 1996
!! Stepping one foot on, then off, a block as quickly as Stepping one foot on, then off, a block as quickly as possible in a set time period (15 seconds)possible in a set time period (15 seconds)
!! Incorporates dynamic single limb stanceIncorporates dynamic single limb stance
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Step TestStep Test
4.4 4.4 ++ 6.2 6.2 affectedaffected
6.2 6.2 ++ 6.3 6.3 unaffectedunaffected
Sherrington Sherrington and Lord, and Lord, 2005 (5 cm 2005 (5 cm block) post block) post hip hip fxfx
13.7313.7315.5915.5917.1317.1318.7718.7720.1720.1720.7220.72Isles et Isles et al., 2004al., 2004(8.5 cm (8.5 cm block)block)
14.00 14.00 14.2814.28
15.5915.5915.8515.85
16.91 16.91 16.98 16.98
18.8818.8818.6918.69
NitzNitz et et al., 2003al., 2003
17.67 17.67 ++3.223.22
17.35 17.35 ++3.033.03
17.67 17.67 ++3.223.22
17.35 17.35 ++3.033.03
Hill et al., Hill et al., 19961996
7070--79796060--69695050--59594040--49493030--39392020--2929
DYNAMIC BALANCE TESTSDYNAMIC BALANCE TESTS
!! Dynamic Gait IndexDynamic Gait Index!! Functional Gait AssessmentFunctional Gait Assessment!! TinettiTinetti Performance Oriented Assessment Performance Oriented Assessment
of Balance and Gaitof Balance and Gait
DYNAMIC GAIT INDEXDYNAMIC GAIT INDEX
!! Evaluates and documents the ability to Evaluates and documents the ability to modify gait in response to changing task modify gait in response to changing task demandsdemands
!! Excellent Excellent intraraterintrarater, , interraterinterrater and testand test--retest reliability retest reliability (Wolf et al., 2001; (Wolf et al., 2001; ShumwayShumway--Cook, Gruber, et al. Cook, Gruber, et al. 1997)1997)
!! Predicts falls among the elderlyPredicts falls among the elderly!! Score associated with fall riskScore associated with fall risk
!! <19, 2.58 times more likely to fall <19, 2.58 times more likely to fall Whitney et al. Whitney et al. (2000(2000))
Functional Gait AssessmentFunctional Gait AssessmentWrisleyWrisley, et al., 2004, et al., 2004
!! 10 item tool based on DGI10 item tool based on DGI!! Developed for use with younger patients Developed for use with younger patients
with vestibular problemswith vestibular problems!! ReliabilityReliability
!! Intra rater: ICC = .83Intra rater: ICC = .83!! Inter rater: ICC = .84Inter rater: ICC = .84
!! Moderate correlations with other balance Moderate correlations with other balance measuresmeasures
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PERFORMANCE ORIENTED PERFORMANCE ORIENTED ASSESSMENT OF BALANCE & ASSESSMENT OF BALANCE &
GAIT SCALE GAIT SCALE TinettiTinetti & & GinterGinter, 1988, 1988
!! Designed for elderly patientsDesigned for elderly patients!! Consists of 9 balance items & 7 gait itemsConsists of 9 balance items & 7 gait items!! Scoring on ordinal scale of 0Scoring on ordinal scale of 0--2 2
!! 0 = most impairment0 = most impairment!! 2 = independent2 = independent
!! Maximum combined score = 28 Maximum combined score = 28 (Balance=16, Gait=12) (Balance=16, Gait=12)
!! Interpretation:Interpretation:!! score below 19 = high risk for fallsscore below 19 = high risk for falls!! score between 19score between 19--24 = moderate risk for falls24 = moderate risk for falls
Tests of Functional MobilityTests of Functional Mobility
!! Five times sit to standFive times sit to stand!! TUGTUG
!! TUGCTUGC!! TUGMTUGM
!! LL--testtest
Five Times Sit to Stand Test Five Times Sit to Stand Test Whitney, et al., 2005Whitney, et al., 2005
!! Sit in chair with arms across chestSit in chair with arms across chest!! Stand and sit down 5 times as quickly as Stand and sit down 5 times as quickly as
possiblepossible!! Time on word Time on word ““gogo”” and end when and end when
buttocks touch chair on 5buttocks touch chair on 5thth trial.trial.!! Chair 43 cm height, 47.5 cm depthChair 43 cm height, 47.5 cm depth 8080--89897070--79796060--6969
12.712.7
13.413.4
Older Older control control 6363--84 84 yearsyears
12.612.611.411.4Bohannon, Bohannon, 20062006Meta analysisMeta analysis
16.416.415.315.38.28.2Whitney, et al. Whitney, et al. 20052005
Older with Older with balancebalance6161--90 years90 years
Young with Young with balancebalance1414--59 59 yearsyears
Young Young controlcontrol2323--57 57 yearsyears
Five Times Sit to StandFive Times Sit to Stand
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Four Square Step TestFour Square Step Test
!! ReliabilityReliability!! Test retest ICC = .98Test retest ICC = .98!! Inter rater ICC = .99Inter rater ICC = .99
!! Cut off score of 15 seconds Cut off score of 15 seconds DiteDite, 2002, 2002
!! >15 seconds: multiple faller>15 seconds: multiple faller!! <15 seconds non multiple faller<15 seconds non multiple faller
Four Square Step TestFour Square Step Test
NonNon--multiple Fallsmultiple FallsMultiple FallsMultiple Falls
16.2 16.2 ++ 5.35.332.6 32.6 ++ 10.110.1DiteDite, et al. , et al. 2007; pts with 2007; pts with amputationamputation
14.8 14.8 ++ 4.34.312.4 12.4 ++ 4.24.2Whitney, et al., Whitney, et al., 2007; vestibular2007; vestibular
>>65 years 65 years >64 years>64 years
8.78.712.0112.0123.5923.59DiteDite, et al., , et al., 20022002
ControlControlNonNon--multiple Fallsmultiple FallsMultiple FallMultiple Fall
Timed Up & Go (TUG) TestTimed Up & Go (TUG) Test!! Adaptation of Get Up & Go Test Adaptation of Get Up & Go Test !! Designed for elderly populationDesigned for elderly population!! Scoring based on time it takes to go from Scoring based on time it takes to go from
sit sit ## stand stand ## walk 3 meters & back to walk 3 meters & back to ##sitsit!! Score of 20 or less = independent with Score of 20 or less = independent with
transfers & gaittransfers & gait!! Score of 20Score of 20--30 = 30 = ““a gray zonea gray zone””!! Score of 30 or more = assistance with Score of 30 or more = assistance with
balance & functional activities balance & functional activities PodsiadloPodsiadlo & Richardson, & Richardson, 19911991
TUG TestTUG Test--continuedcontinued
!! Studies by Thompson & Medley (1995)Studies by Thompson & Medley (1995)!! 175 subjects (65175 subjects (65--79yr) without device scored 79yr) without device scored
10.34 seconds10.34 seconds!! 50 subjects (mean age 24) without device 50 subjects (mean age 24) without device
scored 7.5 secondsscored 7.5 seconds!! 175 volunteers with a cane scored 13.67 175 volunteers with a cane scored 13.67
secondsseconds
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TUG Test & Effect of TUG Test & Effect of Assistive DevicesAssistive Devices
!! 187 subjects 187 subjects randomly assigned to randomly assigned to one of three groups: one of three groups: cane, RW, SWcane, RW, SW
!! Age accounted for Age accounted for 15% of variance15% of variance
!! Device accounted for Device accounted for 75% of variance 75% of variance (Medley (Medley & Thompson, 1997)& Thompson, 1997)
42.27s42.27s12.32s12.32sSWSW
18.37s18.37s11.36s11.36sRWRW
13.14s13.14s10.04s10.04sCaneCane
With With devicedevice
Without Without devicedevice
DeviceDevice
TUG Test & TUG Test & Parkinson DiseaseParkinson Disease
!! Thompson & Medley (1998) reported:Thompson & Medley (1998) reported:
!! TUG Test did not discriminate between TUG Test did not discriminate between
subjects with unilateral involvement vs. subjects with unilateral involvement vs.
bilateral involvementbilateral involvement
!! TUG Test did differentiate between subjects TUG Test did differentiate between subjects
with functional limitations vs. subjects without with functional limitations vs. subjects without
limitationslimitations
TUG VariationsTUG Variations!! InstructionsInstructions
!! Normal safe paceNormal safe pace!! Fast safe paceFast safe pace
!! CognitiveCognitive!! Perform cognitive task (math)Perform cognitive task (math)!! Difference score of Difference score of 5.565.56 s or greater likely to fall s or greater likely to fall
ShumwayShumway--Cook et al., 2000Cook et al., 2000
!! ManualManual!! Carry a cup of water while walkingCarry a cup of water while walking!! Difference score of Difference score of >>4.54.5 ((LundinLundin--Olsson et al., 1998) Olsson et al., 1998) or >or >4.984.98
((ShumwayShumway--Cook et al., 2000)Cook et al., 2000) likely to falllikely to fall
LL--TestTestDeatheDeathe & Miller, 2005& Miller, 2005
!! Modified version of the TUG; total distance Modified version of the TUG; total distance 20 m20 m
!! 2 transfers and 2 turns2 transfers and 2 turns!! Comfortable and safe paceComfortable and safe pace!! Reliability with frail older adults Reliability with frail older adults Nguyen, et al., 2007Nguyen, et al., 2007
!! InterraterInterrater: ICC = 1.00: ICC = 1.00!! IntraraterIntrarater: ICC = .97: ICC = .97
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LL--TestTest
18.4918.49
3030--3939
Trans Trans femoral femoral 41.741.7secsec
19.3819.38
2020--2929
62 62 ++4747 secsec
Trans Trans tibialtibial29.5 29.5 secsec
Medley & Medley & Thompson, Thompson, 2008 2008 unpublished unpublished data 160 data 160 participantsparticipants
Nguyen, et al. Nguyen, et al. 2007; frail 2007; frail elderselders
DeatheDeathe & & Miller, 2005; Miller, 2005; patients with patients with amputationsamputations
29.0229.0223.3423.3420.0320.0320.3220.3219.3319.33
>80>807070--79796060--69695050--59594040--4949
LABLAB
!! Go through lab packet and perform Go through lab packet and perform measures that you are not familiar withmeasures that you are not familiar with