Lecture 3 Measures Of Balance

Question 1

What is sitting balance?

Answer 1

Measures sitting balance for frail older adults - primarily non ambulatory

Question 2

What does a high score indicate for the sitting balance test

Answer 2

Higher scores indicate higher level of function

Question 3

What’s the score for a healthy, community dwelling older adults with good functional capabilities? (SITTING BALANCE)

Answer 3

43/44

Question 4

What is the score to be considered older adults with pathologies requiring home health assistance or reside in a skilled nursing facility? (SITTING BALANCE)

Answer 4

34/44

Question 5

What is the anatomical landmark for the starting position of the Functional Reach Test?

Answer 5

3rd metacarpal head

Question 6

(T/F) Largest limitation of functional reach is that it measures multiple direction.

Answer 6

False. Measures one direction

Question 7

How to instruct the patient for Romberg?

Answer 7

Feet together
Eyes open
Arms folded across chest
They must maintain the position unaided for 30sec
Patient then asked to repeat eyes closed

Question 8

How to instruct the patient for Sharpened Romberg?

Answer 8

Patient instructed to stand with: feet semi tandem EO x 10 secs, then EC x 10secs, feet tandem (heel-toe position) EO x 10 secs, then EC x 10 seconds, arms folded across chest for all the test

Question 9

SLS cut off score

Answer 9

Less than 5 seconds indicates 2x risk of falling

Question 10

SLS performance norms scores

Answer 10

Eyes closed: 60-69 years old = 10.2 secs
70-79 years old = 4.3 seconds

Question 11

What indicates an increased RISK OF FALLING for an older adult for the 4 stage balance test

Answer 11

If they cannot hold the tandem stance for at least 10 seconds is at increased risk of falling

Question 12

What is Tinetti Falls efficacy scale

Answer 12

Assesses patients fear of falling

Question 13

What does a higher score indicate for the Tinetti Falls Efficacy Scale

Answer 13

Higher scores indicate greater fear of falling

Question 14

In the tinetti falls efficacy scale, what score indicates that a person had a fear of falling

Answer 14

Greater than 70

Question 15

What is the cut off score for four step square test for older adults/geriatric

Answer 15

Less than 15 secs =risk for falls

Question 16

What is the Fullerton advanced balance scale

Answer 16

Test both static and dynamic balance under varying sensory conditions

Question 17

What is the cut off score for the Fullerton advanced balance scale

Answer 17

Score of 25/40 or lower is at high risk of fall

Question 18

What are the 6 underlying systems for the balance evaluation systems test & mini bestest

Answer 18

1. Biomechanical
2. Stability limit
3. Postural responses
4. Anticipatory postural adjustment
5. Sensory orientation
6. Dynamic balance during gait & cognitive effects

Question 19

Cut off score for balance evaluation systems test (BESTest) and mini bestest

Answer 19

Score of less than 69% identifies risk for falls

Question 20

What is floor effect

Answer 20

No change is seen in scores even with lower performance

Question 21

What is ceiling effect

Answer 21

No change is seen in scores even wit better performance

Question 22

Floor and ceiling effects scores

Answer 22

Excellent: no floor effects
Adequate: floor effects < 20%
Poor: floor effects > 20%

Question 23

What are the 3 complex part sensorimotor control systems that help with balance

Answer 23

Sensory input
Integration of sensory input
Motor output

Question 24

What is ankle strategy

Answer 24

Shifting of the COM forward and back by moving the body as s fixed pendulum over the ankle joints

Question 25

What is hip strategy

Answer 25

Shifts COM by flexing or extending at the hips Hip ABD/ADD are activated to control lateral sway

Question 26

What is step strategy

Answer 26

Realigns the BOS under the COM by using rapid steps or hops in the direction of the displacing force Typically recruited in response to fast, large postural perturbations

Question 27

What STATIC balance grade would a “patient to maintain steady balance without support” received?

Answer 27

4 - Normal

Question 28

What STATIC balance grade would a “patient able to maintain balance without support, limited postural sway” received ?

Answer 28

3 - good

Question 29

What STATIC balance grade would a “patient able to maintain balance without support handhold support, may require occasional minimal assistance” received?

Answer 29

2 - Fair

Question 30

What STATIC balance grade would a “patient require handholding support and MOD to MAX A to maintain position” receive

Answer 30

1 - poor

Question 31

What STATIC balance grade would a “patient unable to maintain balance” received

Answer 31

0 - Absent

Question 32

What DYNAMIC balance grade would a “ patient accept maximal challenge and can shift weight easily within full range in all directions” receive?

Answer 32

4 - normal

Question 33

What DYNAMIC balance grade would a “patient accepts moderate challenge; able to maintain balance while picking up objects off floor” receive

Answer 33

3 - good

Question 34

What DYNAMIC balance grade would a “patient accepts minimal challenge; able to maintain balance while turning head/trunk” receive

Answer 34

2 - fair

Question 35

What DYNAMIC balance grade would a “patient unable to accept challenge or move without LOB” receive

Answer 35

1 - poor

Question 36

What DYNAMIC balance grade would get if “patient unable to maintain balance”

Answer 36

0 - absent

Question 37

What is the purpose of the functional reach test

Answer 37

Assess a patient’s stability by measuring the maximum distance an individual can reach forward while standing in a fixed position

Question 38

What is the population tested for functional reach test

Answer 38

Community dwelling elderly PD Peripheral vascular disorders Spinal cord injury Stroke Vestibular disorders

Question 39

How do you set up the patient for the functional reach test

Answer 39

Patient is instructed to stand close to NOT TOUCHING a wall and position the arm closest to the wall at 90 degrees shoulder flexion with a closed fist

Question 40

How many trial are performed for the functional reach test

Answer 40

3 trials are performed and the average of the last 2 are noted

Question 41

What is the cut off score for a “community dwelling elderly” for the functional reach test

Answer 41

Less than 17.78 cm indicates unable to leave neighborhood w/o help, limited in mobility skills and most restricted ADLS

Question 42

What is the cut off score for “frail elderly patients” for the functional reach test

Answer 42

Less than 18.5cm indicates fall risk

Question 43

What is the cut off score for Parkinson’s disease for the functional reach test

Answer 43

Less than 31.75cm indicates fall risk

Question 44

What is the cut off score for stroke patients for the functional reach test

Answer 44

Less than 15 cm indicates fall risk

Question 45

What is the purpose of the Romberg

Answer 45

Neurological test to detect poor balance

Question 46

Other than balance, what else does the Romberg detect?

Answer 46

Detects if a patient has the inability to maintain steady standing posture with eyes closed

Question 47

What is the population tested for Romberg

Answer 47

Vestibular and non-vestibular clients

Question 48

What does a negative test for the Romberg indicate?

Answer 48

No change or minimal worsening with eyes closed compared to eyes open

Question 49

What is a positive test for the Romberg indicate

Answer 49

Patient is able to stand with eyes open, but demonstrates a significant increase in sway and/or instability with eyes closed Indicates a loss of proprioception and/or peripheral neuropathy

Question 50

What is the purpose of SLS

Answer 50

Commonly used as a measure of static balance

Question 51

What is the purpose of the 4-stage balance test

Answer 51

To assess standing balance AD not allowed!!!

Question 52

What is the purpose of the four step square test (FSST)

Answer 52

Test dynamic balance that clinically assesses the person’s ability to step over objects forward, sideways and backwards

Question 53

What is the purpose of the BESTest and mini BESTest

Answer 53

Differentiates balance into 6 underlying systems that may constrain balance It’s sensitive, quantitative balance assessment that will identify subtle deficits and changes with therapy