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Functional Reach Test- Duncan, 1990; Eagle, 1999; Langley, 2007

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A. Title Functional Reach Test

B.Authors uncan, P.W., Weiner, .K.,Chandler, J., & Studenski, S.(1 )

C. Time required toadminister the test

1 to 2 minutes

. Materials Meter/yard Stick

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A. Purpose of the Test

Descriptive: to etect balance impairment or look

at changes in balance performance over-time ofgeriatric patients

Pre ictive: assess risk of falling

. Target Population

Geriatric / El erly population

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A. Ease ofAdministration

Easy to perform , accessible practical measure

of balance

. Clarity of Directions

mount a yardstick on the wall on shoulder level stand near wall, but not touching it

outstretch arm, with hand in a fist, parallel tofloor

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C. coring Procedures

Compare pre post measurement

scores less than 6-7 inches: limited functionalbalance

scores 10 inches or more: adequate functionalbalance

D. Examiner Qualifications Training

No training required

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A. Norms

. Reliability

Test-retest reliability: r = 0.89

Interrater reliability: r = 0 .98

Age Men Women

20 40 y/o 16.7 + 1.9 14.6 + 2.241 69 y/o 14.9+ 2.2 13.8+ 2.2

70 87 y/o 13.2+ 1.6 13.2+ 1.6

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C. Validity

FRT was strongly associated with measurements:

centre of pressure excursion r = 0.71

linear regression r= 0.51

Moderate correlations

Tandem walk Gait peed: r= 0.67 0.71 Fair correlations

BBS: r= 0.42

POMA: r= 0.47

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Sensitivity

ability to detect falls when they are present = 76%

Specificity ability to identify correctly the absence of falls =

34%

Positive Predictive Value

how well test predicted compared to actualnumber of falls = 33%

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Negative Predictive Value how well negative test correctly predicts absence

of falls = 77% Accuracy

overall rate of agreement between the test andthe actual number of falls = 46%

Prevalence ratio of the number of people who have fallen

divided by the total number of people at risk forfalling = 30%

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Measures one direction of functional

movement (forward reach)

May not identify balance difficulties evidentduring locomotion related activities

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Duncan, P. ., Weiner, D. ., Chandler, J.Studenski S.(1990). Functional reach: a new clinical measure ofbalance.Journal of Gerontology, 145: 192-197.

Eagle, J., Salamara, S., Whitman, D., Evans, L.A., Ho, E.,Olde, J. (1999).Comparison of three instruments in

predicting accidental falls in selected inpatients in ageneral teaching hospital.Journal of Gerontological

Nursing, 25(7), 40-45.Langley, F.A., Mackintosh, S.F. (2007). Functionalbalance assessment of older community dwellingadults: A systemic review of literature.Internet Journalof Allied Health Sciences and Practice, 4(5), 1-11.

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PATIEN

T ASS

ESS

MEN

T

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Name: RMAge: 58 y/o

Gender: MHandedness: (R)

Dx: S/P (R) CVA (2010);(L) Hemiparesis

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c/c: pt. c/o weakness on (L) UE LE; difficulty in

maintaining balance

PMHX: (+) HTN, controlled by meds. since 2000 (+) DM, controlled by meds

Personal/Social Hx (+) alcoholic beverage drinker (-) smoker

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VS: WNL OI:

Ambulatory without assistive device Alert/coherent/cooperative

(+) obvious physical findings: (+) Trophic skin changes: dry, scaly skin

(+) Postural Deviation (+) Gait Deviation

(-) facial asymmetry, typical arm posture, atrophy,deformities

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Palpation:

Normothermic on all exposed body parts

Normotonic on (B) UE LE (-) shoulder sublaxation, tenderness, edema

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Neurologic Eval:

50% sensory deficit as to light touch, pain

pressure on (L) UE LE 100% intact kinesthesia proprioception

Reflex Testing:

Normoreflexia on (B) UE LE

(-) babinski, clonus, associated reactions

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ROM:

WNL, pain free actively passively done on (R)

LOM on (L) UE secondary to pain

MMT:

Major muscles of (L) UE LE grossly graded 3+/5

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Postural Analysis

Pt. in standing position assessed in all views

with postural landmark symmetrical leveledexcept for:

Upper back slightly more rounded

Feet pointing outwards

Gait Analysis Pt. ambulates with wide BOS / toeing-out with

limited arm swing

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ADL

Independent in all aspects ofADL except for:

UE dressing requires minimal to moderate assistance

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Functional Mobility:

Independent as to bed mobility

Minimal assist require during sit to stand transfer

Balance

Good sitting balance and tolerance Fair standing balance

pt is able to maintain balance with handhold support;may require occasional minimal assistance

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Functional Outcome Measure:

Functional Reach Test (FRT) to assess balance impairmentrisk of falling

sig.: impaired functional balance

Trial Starting Position End Position Difference

1 8.5 14.5 6

2 8 14 6

3 8.7 14.8 6.1Ave. 8.4 14.03 6.03 / 15.3 cm.

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Scores:

25.4 cm.): adequate functional balance

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Norms

Age Men (cm.) Women(cm.)

20 40 y/o 42.4 cm. 4.8 cm. 37.1 cm 5.6 cm.

41 69 y/o 37.8 cm. 5.6 cm. 35.1 cm. 5.6 cm.

70 87 y/o 33.5 cm. 4.1 cm. 33.5 cm. 4.1 cm.

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PT Diagnosis

Impaired Motor Function Sensory Integrity

Associated withNon Progressive Disorders of theCNS- Acquired in Adulthood

Impression

Pt. condition is further defined with (L)hemiparesis , hemianesthesia, impaired balance,LOM on (L) UE LE, postural gait deviation.

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Problem List:1. ImpairedBalance

2. Weakness on (L) UE LE3. LOM on (L) UE4. Gait deviation

5. Postural deviation

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Goals1. pt. will be able to demonstrate Good standing

balance as manifested by ability maintainbalance without handhold support withlimited postural sway.

2. Pt. will demonstrate increase mm. strengthfrom 3+ to 5/5.

3. Pt. will be able to demonstrate increase in ROMas manifested by ability to do overhead motionwithout pain difficulty.

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To develop PT protocol / intervention to

improve functional balance.

Justine Ramos, PTRP

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Functional Reach Test: Static vs. Dynamic?

Dynamic measure of balance regardless of

movement strategy (Duncan et.al, 1990) Compensatory movement strategies (e.g. hip

flexion and ankle PF) are more of static whichdoes not increase the moment arm during FR

(Wernick-Robinson et.al, 1999)

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RCT on Therapeutic Exercises (flexibility,strength, balance, endurance UE function) inSubacute Stroke (Duncan et.al, 2003)

RCT onSpecific balance-strategy trainingprogramme for preventing falls among olderpeople (Nitz Choy, 200)

Case study on NDT focusing on postural trainingto improve Functional Reach (Zacharewicz,2002)