Table 7: Gait and Balance Outcome Measures Tests Including Gait Scoring Considerations
Advantages
Disadvantages
ICF Domain Body function and activity.
Mini Balance Evaluation Systems Test (MiniBEST; Franchignoni, Horak,
14 items. Top score 28 or 32 if right & left lower extremities are scored separately. Fall risk: increased with scores <20. 16 items. Top score: 28 is a combination of gait score & balance score. Fall risk: generally increased with scores <20.
Excellent reliability; 10–15 min to perform.
Discrepancy in scoring; not as familiar to many therapists.
Godi, Nardone, & Giordano, 2010)
Tinetti Performance Oriented Mobility Assessment (POMA or TNT; Tinetti, 1986) Gait Speed (Lusardi, Pellecchia, & Schulman, 2003)
Excellent reliability; includes gait and balance activities; easier for frailer older adults, gait does not include head-turning activities. Quick and easy to perform; can use assistive device; norms available for 8 ft, 20 ft, and 10 m.
May lack sensitivity to change as Likert scale has < 3 items to choose from to document change. Typically need 20 ft to perform and may encounter fatigue due to the need for 3 trials, depends on distance tested.
Activity.
Average of 3 trials. Fall risk: increased if >1.1 m/s.
Activity.
Tests For Balance Without Gait Component Berg Balance Scale (Berg, Wood-Dauphinee, Williams, & Maki, 1992)
Scoring Considerations
Advantages
Disadvantages
ICF Domain
14 items. Top score: 56. Fall risk: generally increased risk with scores <45. Max distance a person can reach forward while standing in fixed position. 3 trials with average of last 2 noted. Best of 2 timed dynamic stepping over 2 crossed canes on floor. Fall risk: increased if >15 s.
Mostly static balance activities, so easier for adults with poorer physical function; excellent reliability, validity for several populations. Can be modified for sitting balance; quick and easy to perform; free; norms available for several populations; can have 2 practice trials; excellent reliability. Less than 5 min to perform; must be able to follow stepping sequence as fast as possible; excellent reliability. Quick and easy to perform; good reliability. Quick and easy to perform; person stands as quickly as possible 5 times from standard chair with arms; excellent reliability. Quick and easy to perform; most normative data based on preferred stance leg.
Limited dynamic balance activities; may take >10 min to perform; ceiling effect for more active older adults. Easy for person to compensate during exam (lean on wall, extend fingers, lean protract shoulder without cues to perform correctly). Less common than other tests; should face forward during testing, but can turn sideways. Some inconsistency with preferred vs. dominant leg in backward stance position.
Activity.
Functional Reach (standing; Duncan, Weiner, Chandler, & Studenski, 1990)
Activity.
Four Square Balance Test (FSST; Dite & Temple, 2002) Tandem Stance (Briggs, Grossman, Birch, Drews, & Shaddeau, 1989)
Activity.
Timed task in static posture Fall risk: increased if <10 s.
Body function.
5 Times Sit to Stand (Guralnik et al., 2000)
Single timed activity. Fall risk: increased if >15 s.
Compensatory movements common; fatigue may result in floor effect.
Activity.
Single-Leg Stance (Vellas, Wayne, Romero, Baumgartner, & Garry, 1997) 30-Second Chair Stand (Jones, Rikli, & Beam, 1999)
Timed task in static posture. Fall risk: normative data available for age and sex.
Some inconsistency with preferred vs. dominant leg as stance leg; need to observe for compensatory movements. May be too challenging for frail older adult.
Body function.
Single timed activity. Fall risk: normative data available for age and sex.
Quick and easy to perform; should not use upper extremities to perform.
Body function and activity.
ICF = International Classification of Functioning. Normative values for various patient populations can be found at https://www.sralab.org/rehabilitation-measures, along with citations for statistical measures for a variety of patient populations. Original author cited in first column.
Note : From Western Schools, 2019. Strength and range of motion
ROM is important to assess as limitations at any lower extremity joint can impact posture, balance, and gait quality. In particular, adequate ankle ROM is necessary for effective use of the ankle balance strategy, as well as adequate knee and hip ROM for effective hip and stepping balance strategies. Testing sensation on the soles of the feet using monofilaments is crucial for determining sensory deficits that could cause an older adult to rely heavily on vision or vestibular system function, both of which tend to decline in efficiency with age (Migliarese, 2017).
Basic areas of therapeutic evaluation should not be ignored, including extremity strength, ROM, and sensation, with emphasis on the lower extremities. Screening for strength loss that is related to fall risk can be accomplished easily through manual muscle testing, hand-held dynamometry, and functional lower extremity screens such as the 30-Second Chair Stand test or the 5 Times Sit to Stand test. Both tests can be used for a functional assessment of lower extremity strength in adults where standard lower extremity manual muscle testing and positioning may be contraindicated or difficult to accomplish. Lower extremity
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