BalanceandMobilityScreeningTri-CountyRehabilitationCanfield’sLittleClinicwithBIGResults

BruceWestonPT,DPT,OCSPurpose

InaccordancewithAmericanGeriatricSocietyrecommendations:Provideanongoingscreeningtooltomonitorfallriskandlevelofmobilityforolderadultsinourcommunity.Determinethoseolderadultsinneedofamoreextensivemultifactorialfallriskassessment.RecognizethoseolderadultsinneedofspecificinterventionstodecreasetheirfallriskandimprovetheirADLmobilityandsafety.CriteriaforscreeningIndividuals65andolder,referredtoTri-CountyRehabilitationforanyconditionwillbeofferedacomplimentaryscreenoftheirbalanceandmobility.AsummarywillbeforwardedtotheirPCP,withtheirpermission.Otherindividuals65andoldermaybescreenedata$20.00chargewithresultsforwardedtotheirPCP.ComponentsofthescreenShortPhysicalPerformanceBattery(SPPB)GaitSpeedActivity-SpecificBalanceConfidence(ABC)Scale1.)ShortPhysicalPerformance Battery(SPPB)Ashortscreenofbalance,gaitspeed,andlowerextremitystrength.Thetotalpossiblescoreis12.Scores<10arepredictiveoffallriskinolderadults.2.)GaitSpeedComputedovera4meterto15foot(4.57meter)course.Showntobeapredictoroflifeexpectancyandnursinghomeadmission.Slowertimesaresensitiveandspecificforpredictingfallsinalderadults,withacutoffof0.57m/secforrecurrentfallsGaitSpeedandLifeExpectancy

StudenskiS,etal.GaitSpeedandSurvivalinOlderAdults.JAMA.2011,January5;305(1):50-583.)Activity-SpecificBalance Confidence(ABC)ScaleConsistsofquestionsregardinganolderperson’sconfidenceinperformingsixteendifferentADLactivities.Eachactivityisscoredonascalefrom0%to100%confidence.Anaveragescoreiscomputedwithscores<67%predictiveoffallriskinolderadults.TheActivities-specificBalanceConfidence(ABC)ScaleForeachofthefollowingactivities,pleaseindicateyourlevelofself-confidencebychoosingacorrespondingnumberfromthefollowingratingscale:0%102030405060708090100%noconfidence

completelyconfident

Howconfidentareyouthatyouwillnotloseyourbalanceorbecomeunsteadywhenyou……walkaroundthehouse?____%

…walkupordownstairs?____%

…bendoverandpickupaslipperfromthefrontofaclosetfloor____%

…reachforasmallcanoffashelfateyelevel?____%

…standonyourtiptoesandreachforsomethingaboveyourhead?____%

…standonachairandreachforsomething?____%

…sweepthefloor?____%

…walkoutsidethehousetoacarparkedinthedriveway?____%

…getintooroutofacar?____%

…walkacrossaparkinglottothemall?____%

…walkupordownaramp?____%

…walkinacrowdedmallwherepeoplerapidlywalkpastyou?____%…arebumpedintobypeopleasyouwalkthroughthemall?____%

…stepontooroffanescalatorwhileyouareholdingontoarailing?____%

…stepontooroffanescalatorwhileholdingontoparcelssuchthatyoucannotholdontotherailing?____%

…walkoutsideonicysidewalks?____%

DocumentationAsummaryisfaxedtoeachindividual’sPCPwithcopiesmaintainedatTri-CountyRehabilitation.ReassessmentisperformedatsubsequentreferralsforphysicaltherapyoratintervalsdeterminedbythePCP.Reassessmentisalsoperformedattherequestoftheindividual.CaseReport79y/ofemalewhotrippedandfellwalkingintohergarage,09/21/12.Deniedpriorfallsorproblemsonintakeform.PMH:RTKA(10/11/10),atrialfibwithpacemaker(May,2012).ReferredwithdiagnosisofOAofthekneesandleftkneepain.PTevaluationrevealedtendonitisoftheleftpesanserine,patellartendon,andITbandinsertion.CaseReportAspartofherevaluationabalanceandmobilityscreenwasalsoperformed.SPPBBalance:Feettogether=10sec=1pointSemi-tandem=10sec=1pointFull-tandem=1.9sec=0pointGait(4m)=4.72sec=4pointsChairStand=5xin20.8sec=1pointTotalscore=7/12(lowleveloffunction,scores<10/12arepredictiveoffallrisk)Gaitspeed=4m/4.72sec=0.83m/sec(moderateleveloffunction,gaitspeedof0.56m/secandlessarepredictiveofrecurrentfalls)ABC=64%confidence(moderatelevelofconfidence,scores<67%arepredictiveoffallrisk)

HomePacketApacketisprovidedtoeachindividualscreenedcontaining:Ageneralhomeprogramofbalanceandmobilityexercises.Educationalandhomesafetyinformation.Balancesystembasics:Howdoesthebalancesystemwork?Balancesystembasics:Balancestrategies.HomeSafetyTipsforOlderAdults:fromAGSfoundationforhealthinagingwebsite.WinterSafetyTipsforOlderAdults:fromAGSwebsiteDealingwith“persistent”PaininLaterLife:fromAGSwebsiteFallRiskReductionandPrevention:APTApowerpointBalanceSystemBasicsBalancecomesfromdifferentsystemsworkingtogethertocreatestability.Goodbalancedependsoncorrectsensoryinformation,properuseofthatinformationbythebrain,andtherightresponsefromthemuscles.Thesensoryinformationthatisneededcomesfromthreesystems:VisualsystemSematosensorysystemVestibularsystemBalanceSystemBasics(con.)Thestateofyourbalancesystemisdeterminedbyhowwellyourcentralnervoussystemdealswiththevariousinputsfromyourvisual,sematosensory,andvestibularsystemsinordertokeepyourcenterofgravityoveryourbaseofsupport.BalanceSystemBasics(con.)Youemployvoluntaryandinvoluntarystrategiestomaintainyourbalanceandkeepfromfalling.BalanceSystemBasics(con.)Voluntarystrategiesareconsciousandunderyourcontrol.Walkingslowerwithshorterandwiderstepsinthedark.Shufflingyourfeetwithyourkneesslightlybentandarmsoutstretchedwhilewalkingonicysurfaces.Takingsomeone'sarmwhilewalkingonanunevensurfaceinhighheels.Inchingalonganarrowbeamonyourbottom.BalanceSystemBasics(con.)Involuntarystrategiesarerapidandreflexiveresponsestoanexternalstimulusorperturbation.Therearefourinvoluntarystrategiesthatyourbodyusesinordertomaintainyourbalance.AnklestrategiesHipstrategiesSuspensorystrategiesSteppingstrategiesHomeBalanceandMobilityProgramDesignedtomaintain/improvefactorsneededtosuccessfullyemploytheseinvoluntarybalancestrategies.AdequateROMthruthetrunkandlowerextremitiesAdequatestrengththruthetrunkandlowerextremitiesAdequateresponsetovarioussensorysysteminputsMustbesimpletodoandeasytounderstand.HomeBalanceandMobilityProgramTheindividualisinstructedtoinitiateexercisesinasafemannerusingakitchencounterorasecurechairtohelpwithbalance.AsROM,strength,andabilitytorespondtovarioussensoryinputsimproves,eachexercisecanbemadegraduallymorechallengingby:RelyinglessonthechairorcounterforsupportNarrowingbaseofsupportIncreasingstepwidthorlengthShiftingmoreweightontothesteppinglegEmployingheadmovementsClosingeyesPerformingexerciseonathickrugCountingbackwar