Chris Carpino, MPT - content.ccrn.com

1 Chris Carpino, MPT`Tests designed for various populations`Objective is to utilize appropriate assessment Ask yourself:xIs this test addressing this patient s deficits?xIs this test appropriately/inappropriately tasking the patient?`Nearly 1 million people visit ER as a result of a fall`1/3 of 65+ year old adults fall at least one time/year`This will increase with age`The projected cost for fall injuries is over $30 billion`Anybody over 55 years of age`Somebody who has a fear of falling or previous fall`History of trauma (motor vehicle accident, head injury, sports trauma)`Anybody within this category is appropriate for a Balance Screening`Functional portion of the evaluation`Look for functional movement patterns as they apply to balance`Ask Is this test measuring something the patient would experience on a day to day basis?

2 `Berg Balance Test`Dynamic Gait Index`Rhomberg`Timed up and go (TUG)`Typically tested on patients with a history of CVA`Appropriate for use in an outpatient facility`Can be appropriate for use in an inpatient facility*`Good static balance test`Functional and measurable`A score of <49/56 indicates a risk for fall`Excellent dynamic balance assessment`Functional and measurable`Appropriate for use in an outpatient facility`Can be appropriate for use in an inpatient facility*`Assesses daily movement patterns`Most likely to provoke motion sensitive symptoms`A score of <19/24 indicates a risk for falls`Appropriate for patients with Parkinsonism `Good for patients who experience vertiginous symptoms upon standing and moving`Measure progress with improved times`Assessment of balance and gait for

3 Elderly/adult populations`May not be appropriate for use in most outpatient facilities`May be appropriate in inpatient facilities ie: acute, subacute, long-term facilities`Score <24 indicates risk for falls`No validity reported`Activities-specific Balance Scale`Rhomberg`Fukuda Step Test`Normal, Good, Fair, Poor (+/-)`Computerized Exam(Vest. Technologies, Biodex, Metitur)`Static standing balance test`Provide information regarding postural sway with eyes open and closed`Good objective representation of balance`The 3 systems that control balance: Visual Proprioceptive Vestibular `Remove 1 or 2 of the 3 to strengthen the others.`One s ability to see their environment `Aids in their adaptation to interacting with their environment, as well as make any necessary modifications`People have difficultly maintaining their balance in the dark or with impaired vision.

4 `Position sense`Sense of awareness `Incorporates your somatosensory system. `Provides information regarding the speed and direction of the body s movement. `Sensitive to changes in body position and speed of movement. `People with vestibular dysfunction are at risk for falling`Ankle Strategy Initial correction attempt Contractions are small, working distal proximal`Hip Strategy Movements are large and fast Muscle activation is proximal distal`Static Standing with proprioceptive system altered. Progress with:xclosing eyesxFeet togetherxFeet in tandemxSingle Leg`Wobble Board`Reaching Move client s body outside their base of support Progress with:xUnstable surfacexInclined surfacexUse of weights`Catching Increases reaction time as well as forcing client to extend beyond their base of support Progress with.

5 XWeighted objectsxLarge objectsxUnstable surfaces`Marching in place On cushion/foam On trampoline`Walking with head turns`Side stepping`carioca`Stepping over objects`Stepping around objects`Catching object while walking`Combine Activities Catch a ball on foam Combine all systems`Combine Activities Perform upper extremity exercises while balancing on unstable surface(s) Add a physioball to the mix Add a dynadisc