Fall Risk Reduction Program Patient Assessment Module #2 of 6
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Fall Risk Reduction Program Patient Assessment Module #2 of 6 Shelley Thomas, MPT, MBA Dara Coburn, M.S., CCC- SLP
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Fall Risk Reduction Program Patient Assessment Module #2 of 6. Shelley Thomas, MPT, MBA Dara Coburn, M.S., CCC-SLP. AGENDA. Patient assessment Choosing the most appropriate assessment protocol Choosing the top systems of balance impacting falls Q & A. Patient Selection. - PowerPoint PPT Presentation
Transcript of Fall Risk Reduction Program Patient Assessment Module #2 of 6
Fall Risk Reduction Program
Patient AssessmentModule #2 of 6
Shelley Thomas, MPT, MBA
Dara Coburn, M.S., CCC-SLP
AGENDA
Patient assessmentChoosing the most appropriate
assessment protocolChoosing the top systems of
balance impacting fallsQ & A
Patient Selection Patient and family goals and
expectations History of falling? Fear of falling?
Weight bearing status Able to weight bear as tolerated? Or partial weight
bearing? Cognitive and communicative status
Attend to task for at least 60 seconds to 2 minutes? Able to communicate basic wants and needs? Follow simple directions?
Inpatient vs. outpatient Intensity of treatment
Patient Selection Discharge Disposition
Home with help? Home alone? Ongoing treatment?
Concomitant diagnosis Tolerance to exercise? Medications?
Vision and Hearing Status Does the patient have adaptive equipment? Is the equipment available for their use?
Patient Selection, cont. Candidates for this program should have goals that include ambulation and/or lower extremity weight bearing transfers
Standing pivot/squat pivot transfers Modified depression transfers Ambulation with or without a device
Patients that are dependent with transfers or unable to walk or have severe to profound cognitive and/or communication deficits
May require therapy for other reasons, but focus is less likely on decreasing falls. Often focus is on caregiver training, wheelchair mobility, compensatory strategies etc.
Long Term GoalsFunctional Limitation Sample Goal
Fall or loss of balance at home in past month = 6
Patient will only experience two falls or loss of balance in home per month to decrease risk of injurywithin 8 weeks.
Falls or loss of balance in community, on uneven surfaces, in last month = 8
Patient will only experience three falls or loss of balance in the community per month to decrease risk of injurywithin 8 weeks.
Unable to safely ascend or descend stairs without physical assistance due to fear of falling
Patient will ascend and descend 12 steps with a hand rail independently within 6 weeks.
Increasing risk of falling when reaching for objects secondary to poor balance reactions
Patient will safely be able to reach for objects outside of base of support and demonstrate appropriate balance reactions (ankle, hip, stepping strategies) to prevent loss of balance within 6 weeks.
Long Term GoalsFunctional Limitation Sample Goal
Unable to transfer on/off toilet or chair without use of a walker
Patient will transfer independently on/off chair or toilet within 6 weeks.
Demonstrates increased fall risk while cooking because difficulty with balance, carrying objects, and focusing on cooking task
Patient will demonstrate improved dual-tasking ability by being able to prepare a basic meal without loss of balance within 4 weeks.
Unable to maintain attention and focus to safely complete ADL’s
Patient will demonstrate sustained & accurate visual attention and processing in order to complete a task with 70% accuracy over 3 minutes.
Unable to self-regulate
Patient will demonstrate sustained attention to task, self-monitoring, & self-correction during a cognitive-motor task with fewer than 3 errors in a 3 minute time period.
Unable to follow moderately complex directions
Patient will demonstrate improved receptive language and auditory comprehension skills by following a 2 step cognitive/motor task with 50% accuracy and moderate cues.
Short Term Goals Patient will perform both toes for 2
minutes with while holding onto walker for balance and achieve <200 ms task average with difficulty level set at 300, tempo set at 54 bpm, and guide sounds on.
Patient will attend to task during a synchronized cognitive/motor activity for 2 minutes with moderate cues and/or redirection, achieving a temporal processing score within 150 ms of the reference beat in order to persist in daily activities and complete them without constant prompting
DocumentationDocumentation should include: IM task to be completed Task average to be achieved IM settings (i.e. tempo, if guide sounds
are on/off, difficulty level, etc.) Assistance to be provided (i.e. verbal
cues, hands on cues, modeling, etc.) Relationship to functional outcome
Narrative Note ExampleSoap Note Example: S – Patient seen for skilled speech therapy. He was alert and
oriented. He participated well in treatment and had no complaints of pain.
O – Patient will follow a 2-step direction A – Performed a cognitive/motor task direction in the presence of
auditory cues and repetitive task practice with hand over hand assistance. Required more assistance from clinician as complexity of auditory cue and feedback was added. Has difficulty in distraction. Required moderate assistance to persist.
P – Increase complexity of feedback, reduce amount of clinical assistance require. Alternate between two different sets of directions as tolerated.
Slide 10
Determining Patient Baseline
Use both IM assessments
and standardized evaluation tools to
determine baseline prior to starting Fall Risk Reduction Program
IM Assessments Short Form Test (SFT)
Patient performs two 1-minutes task One without guide sounds, the other with guide sounds Provides baseline task average for ability to pair auditory
information with motor sequencing task Long Form Assessment (LFA)
14 tasks, evaluates coordination and sequencing with different motor tasks
Takes approximately 20-25 minutes to administer Modify to meet the patient’s current level Document any modifications provided Should administer one of these assessments when
evaluating patient
Standardized Assessments Multitude of standardized
assessments that can be used to assess fall risk, ability to perform activitiesof daily living, cognitive status
Important to assess dual-tasking impact on balance It's good a person can walk. But can they walk
and talk? Walk and carry a glass of water? Be safe when distracted?
Motor Assessments
Motor/Balance Assessment:TUGTinetti ScaleFunctional ReachDynamic Gait Index6-Minute Walk Test
Cognitive Assessments RIPA SCATBI Test of Variables of Attention Stroop Affect Trail Making Delis-Kaplan Executive Functioning Scale (D-KEFS) Mesulam and Weintraub Cancellation Test (MWCT) Mini Mental State Examination (MMSE) Wisconsin Card Sorting Test (WCST) Woodcock- Johnson, 3rd Edition (WCJ-III)
Confidence AssessmentsActivities-Specific Balance Confidence (ABC)
ScaleModified Falls Efficacy Scale
Including a confidence assessment helps determine if the patient has
less concerns about falling and is perceiving improvements in
physical abilities.
Other Useful Tools and Assessments
Functional Assessment Tool(Developed by Amy Vega)
Stroke Impact ScaleCanadian Occupational
Performance Measure
Timed Up & Go Modification to Assess Dual Tasking
Can modify the TUG to incorporate a cognitive and physical task
Administer TUG under following conditions: Traditional conditions While carrying a glass of water While counting backwards from 100
in serial 7's
Normative Values
TUG Condition High Risk for Falling:
TUG Alone > 13.5 seconds
TUG Manual (carry full glass of water) > 14.5 seconds
TUG Cognitive (count backwards) > 15 seconds
Shumway-Cook, A., Brauer, S., & Woollacott, M. (2000, September). Predicting the probability for falls in community-dwelling older adults using the timed up & go
test. Physical Therapy , 80(9), 896-903.
Create a Dual Task Condition with Short Form Test
Compare traditional SFT score with a dual-task condition (document how you create dual-task so it can be replicated). Perform SFT while: Counting aloud Marching in place Transfering sit to/from stand Walking (use in-motion triggers) Naming objects
Summary of Patient Selection & Assessment
1. Patient should have goals that include ambulation and/or transfers (that involve lower extremity weight bearing)
2. Use standardized assessment tools to evaluation motor and cognitive performance
3. Use IM assessments to get a baseline on ability to pair auditory information with motor sequencing.
4. Assess performance under dual-task conditions
"Homework"
Complete following worksheet to select and assess your patient
Post-test
Complete post-test to receive link for Module # 3 of 6
Materials Page
This videoPowerPointPatient Selection Worksheet
www.interactivemetronome.com/index.php/fall-risk-coaching
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