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50 Cards in this Set
- Front
- Back
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Fear of Falling Scales: |
•Activites-Specific Balance Confidence Scale(ABC) •Modified Falls Efficacy Scale |
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Activites-Specific Balance Confidence Scale (ABC) |
-Self administered or administered via personal or telephone interview -The patient is asked to indicate his or her level of confidence in doing the activity without losing balance or becoming unsteady |
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Modified Falls Efficacy Scale |
-Completed by clinician or patient -Very quick--5 minutes--Great for screening -Scored on a 10-point visual analog 0 = not confident/not sure at all 5 = fairly confident/fairly sure 10 = completely confident/completely sure |
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Balance Assessments: |
-Berg Balance Scale -Functional Reach Test -TUG -Tinetti Assessment Tool |
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Berg Balance Scale |
-A scale that measures balance and mobility during 14 functional activities -Useful in a frailer population -5-point scale -Scoring: a 5 point ordinal scale, ranging from 0-4, where 0 indicates the lowest level of function and 4 indicates the highest level of function -Graded according to to ability to do independently without assistance (4), requires supervision to minimal assistance (3), requires moderate assistance (2), requires maximal assistance (1), unable to do (0) on the 5-point scale; total possible score = 56 |
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Functional Reach Test |
-With a ruler taped to a wall or free-standing tripod, the elder stands/sits at the end of the ruler and reaches as far as he or she can before having to take a step or catch themselves -The distance obtained on the ruler that is reaches is recorded and called functional reach -Limits of stability during reach in standing and sitting -Cone of stability shrinks with age -Forward, sideways, diagonal and backward stability measured |
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The Get -Up and Go (TUG) Test |
-Measures balance, gait, and overall mobility -The elder is asked to stand up from a chair, stand still, then walk toward a wall and before reaching the wall, turn without touching it and return to the chair. -Observations are made of steadiness, difficulty in getting into or out of the chair, gait, ability to turn and strategies for accommodating for balance loss -Older adults who take longer than 14 seconds to complete the TUG have a high risk for falls |
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Tinetti Assessment Tool |
-Combines assessment of balance and gait -A 3-point ordinal scale ranging from 0-2: 0 = the highest level of impairment and 2 = the level of the individual's independence -Provides a cumulative score for balance that is rated against a possible 16 total points: 16 indicative of no balance problems; deficits in tested areas are noted as a fraction (10/16) -Gait score has a high score of 12 and is reported as a fraction as well -A total score for balance and gait uses a fraction of N/28 --Total balance score = 12 --Total gait score = 16 --Total test score = 28 -Interpretation: 25 to 28 = low fall risk, 19-24 = medium fall risk, <19 = high fall risk |
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Functional Independence Measure |
-An assessment used to describe the degree of disability experienced by an older adult -Evaluates change in functional status over time -7 point scale to evaluate 18 items in areas of self-care, sphincter control, mobility, locomotion, communication, and social cognition -7 or 6 = complete to relative independence -5 and below indicate that assistance is required |
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Cardiopulmonary Tests: |
•Blood pressure •Heart rate •Pulse palpation •Respiratory rate •Pulse oximetry •Dyspnea Scales •Rating of Perceived Exertion (RPE) |
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Dyspnea Scale: |
-A scale that has the individual subjectively rate the sensation of difficulty breathing during exercise |
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Rate of Perceived Exertion (RPE) Scale: |
-A rating scale used by the exercising individual that reflects his or her perception of exercise intensity from very, very light to very, very hard |
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Fugl-Meyer Assessment: |
•Strokeassessment based on Brunnstrom’ssequence of recovery •6 components: Jointmotion, pain, sensation, balance, UE & LE motor function |
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Parkinson’s Disability Rating Scale |
-Comprehensive physical and functional assessment -Mentalstatus, motor function, functional tasks |
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Mini-Mental Status Exam (MMSE): |
•Assesses orientation, ability to follow verbal and written directions,attention, recall, language, reading, writing •High correlation with Alzheimer’s disease |
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Timed Walk Test |
-Measures cardiovascular endurance in the clinical setting by noting the distance walked in a fixed period of time such as 1, 3, 6, or 12 minutes |
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At what intensity should an older adult perform endurance training? |
•60-90% of MHR or 12-16 on 19 pt. RPE scale |
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How many minutes per day should an older person exercise in order to reduce risk of pathology? |
20-60 minutes per session OR 150 minutes per week of moderate intensity exercise. |
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What are the presentations of Parkinson's Disease? |
•Rigidity and trembling of head •Rigidity of extremities •Forward tilt of trunk •Reduced arm swing •Shuffling gait with short steps •Narrow base of support |
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True or False: •Step width can determine safety |
False!! Step LENGTH can determine safety and Step width can indicate patient comfort in balance |
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True Or False: •Walking distance is a great predictor of endurance |
TRUE |
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True or False: •Walking speed is a great predictor of fall risk |
TRUE (use of a metronome good for pacing) |
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Name one thing that is paramount in regaining functional independence: |
Gait training |
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What can indicate less stability and increased energy consumption duringambulation? |
Lack of pelvic rotation |
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Pre-gait exercises for the elderly: |
-Strengthening of extensor muscle groups -Hip abduction -Sit <> stand -SLS -Toe raises -Sideways and backward ambulation -Pelvic tilts and bridges -Weight shifting/proprioceptive training |
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Static and dynamic balance activities: |
-Controlled reaching in sitting and standing -Leaning in all directions in sitting and standing -Sitting posture control with perturbations -Weight shifting in all directions -Standing on foam pads -Varying surfaces during ambulation -Directional changes |
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Why should you perform balance activities in both sitting and standing? |
To promote increased stability |
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Balance Grades: Normal: |
-Static: Patient able to maintainsteady balance without handhold support -Dynamic: Patient accepts maximal challengeand can shift weight easily within full range in all directions |
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Good: |
-Static: Patient able to maintainbalance without handhold support, limited postural sway -Dynamic:Patient accepts moderatechallenge; able to maintain balance while pickingobject off floor |
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Fair: |
-Static: Patient able to maintainbalance with handhold support; may require occasional minimal assistance -Dynamic: Patient accepts minimal challenge;able to maintain balance while turning head/trunk |
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Poor: |
-Static: Patient requires handholdsupport and moderate to maximalassistance to maintain position -Dynamic: Patient unable to acceptchallenge or move without loss of balance |
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Therapeutic Exercise: |
Review table 10-4 |
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Interventions for Patients withCardiovascular Pathologies: CAD: |
–Workat a level that doesn’t cause angina –Lowintensity decreases elevation of HR and BP (decreasesoxygen demand of the heart) –Lengthensthe fill time to improve oxygen availability –Lengthenoverall time/duration of workout •Flexibilityexercises •Breathingand relaxation exercises |
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Conditioning exercises for patients with CAD: |
–Beginat low intensity and progress as tolerated–Ifexercise is too intense, you will see: •Angina•SOB•Peripheralcyanosis |
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Musclestrengthening exercises for patients with CAD: |
–Maynot see typical exercise-related rise in BP –Strokevolume will decrease with exercise in these patients –Focuson functional tasks/ADLs |
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Interventions for Patients withRespiratory Compromise: |
•ChestPT (as prescribed/discussed with PT)•Breathingand relaxation •Energyconservation to lower oxygen demands |
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Interventions for Patients withAlzheimer’s |
•Enduranceand conditioning exercises •Balanceand coordination exercises •Modificationof environment •Motivationto exercise! |
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General Guidelines forWorkingwithPatientswithCompromisedMental Status |
•Encouragecaregiver or family member to be present at treatment sessions •Encouragedaily exercise •Repeat,repeat, repeat •Speakslowly, clearly and basically •Givehandouts to family or patient if they are able to use them |
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What is the Brunnstrom approach for stroke rehab? |
–Synergisticmovements that develop early in stroke recovery –Encourageddevelopment of flexor or extensor synergies hoping that with training, thesecould transition into voluntary movement/muscle activation |
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Describe an UE flexor synergy. |
•Flexion of elbow •elevationand/or retraction of shoulder girdle•ERof shoulder abd of shoulder •Fullsupination •Maysee flexion of wrist and fingers but not always |
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Describe an UE extensor synergy. |
•IR of the shoulder •Add of the arm in front of the body •Elbowextension •Fullpronation •Maysee wrist extension with fist closure •Protraction of shoulder girdle *Do notsee finger extension with either UE synergy |
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Describe a LE flexor synergy. |
•Flexion of the hip •Abdand ER of the hip •Flexionof knee to 90 •DFand invof ankle •DFof toes |
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Describe a LE extensor synergy. |
•Add and IR of hip •Ext of knee •PFand invof ankle •PFof toes – inconsistent •Ext of hip *Do notsee ankle eversion with either LE synergy |
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What are Brunnstrom's Stages of Recovery? |
•Stage1 – flaccidity •Stage2 – recovery begins, basic synergies appear •Stage3 – voluntary control of synergies in partial ROM •Stage4 – some movement out of synergy•Stage5 – more movement out of synergy•Stage6 – individual joint movements possible•Stage7 – normal motor function |
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Neurodevelopmental Training (NDT): |
•Bobath •manuallyfacilitate normal movement patterns–Inhibitorypostures and inhibitory movements to facilitate voluntary movement •Youcan see other manual approaches involved–MFR,neural tension, mobilization |
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More about NDT: |
•Hands-on,guided movement to restore motor function: –Posturalalignment –Inhibitingreflexes –Keypoints of control –to block or facilitate movement –Functionalpatterns of movement based on developmental sequence •Basedon Brunnstromsstages of recovery•Graduallymove to hands-off as patient has more self-control, flexibility, motor controland strength |
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Proprioceptive Neuromuscular Facilitation(PNF): |
•Utilizationof sensory and neuromuscular channels to facilitate movement and control •Manualcontacts to facilitate motor responses•Canalso provide quick stretch, resistance, traction, or approximation |
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Rehab for Parkinson's Disease: |
•Remember: basal ganglia and substantianigraare the processor for movement •Gaittraining–Encouragestep length •Balancetraining–Weightshifting •Functionalexercise to encourage strengthening and mobility–Extensorgroups •Encouragedaily exercise –endurance,strengthening, flexibility |
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Should you document conversations with your supervising PT? |
Yes. |
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If patient is unable to give a subjective report should you ask their caregiver or a close family member? |
Yes. |
