Balance Outcome Norms

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1 Functional Assessments Functional Assessments for Geriatric Clients for Geriatric Clients Ann Medley, PT, PhD Ann Medley, PT, PhD Texas Woman Texas Woman’ s University s University School of Physical Therapy School of Physical Therapy Disability Schemes Disability Schemes ! International Classification of Functioning, International Classification of Functioning, Disability, and Health Disability, and Health ! Nagi Nagi 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/disease disorder/disease) Interaction of Concepts Interaction of Concepts ICF ICF Environmental Environmental Factors Factors Personal Personal Factors Factors Body Body function&structure function&structure (Impairment (Impairment) Activities Activities (Limitation) (Limitation) Participation Participation (Restriction) (Restriction) Contextual Factors Contextual Factors Person Person " gender gender " age age " other health other health conditions conditions " coping style coping style " social social background background " education education " profession profession " past experience past experience " character style character style Environment Environment "Products Products "Close milieu Close milieu "Institutions Institutions "Social Norms Social Norms "Culture Culture "Built Built-environment environment "Political factors Political factors "Nature Nature

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

8

Reaching laterally with outstretched arm while unsupported

7

Placing alternate foot on a step stool while sitting unsupported

6

Pick up object from the floor while sitting unsupported

5

Reaching forward with outstretched arm while sitting

4

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