New York Physical Therapy Ebook Continuing Education

Table 12: Scoring the Subsections of the Short Physical Performance Battery Score Balance Gait Speed

Five Chair Stands Cannot perform task.

0 1

• Stand feet side-by-side 0 to 9 seconds.

Cannot perform task.

• Stand feet side-by-side 10 seconds. • Stand feet semitandem 0 to 9 seconds. • Stand feet semitandem 10 seconds. • Stand full tandem 0 to 2 seconds.

<0.43 meter/second.

>16.7 seconds to completed.

2

0.44 to 0.60 meter/second.

13.7 to 16.6 seconds to completed.

3 4

• Stand full tandem 3 to 9 seconds.

.0.61 to 0.77 meter/second 11.2 to 13.6 seconds to completed.

• Stand full tandem 10 seconds.

>0.78 meters/second.

<11.1 seconds to completed.

Note . Adapted from Guralnik (1995).

How to measure changes after flexibility exercises Flexibility changes can be measured metrically or functionally. Standard occupational therapy prompts during a functional screen to observe functional movement include putting both hands behind one’s head, putting both hands behind one’s back, and touching one’s toes etc. Goniometric measurements can more specifically show changes by an improvement in range of

motion that can have a numeric value and can be compared to norms determined for older adults, but there are not generally accepted values for adults over age 69. Table 13 shows some values suggested from the American College of Sports Medicine for 65- to 69-year-old men and women.

Table 13: Normal Range of Motion for Men and Women ages 65–69 Joint Movement Men

Women

Hip extension

13° to 15°

16° to 18°

Hip flexion

126° to 129°

129° to 132°

Knee flexion

132° to 134°

137° to 139°

Ankle dorsiflexion

0° to 1°

1° to 2°

Shoulder flexion

162° to 166°

167° to 170°

Elbow extension

–2° to 0°

3° to 5°

Elbow flexion

142° to 145°

147° to 149°

Note : Adapted from Liguori & American College of Sports Medicine (2020). How to measure changes after balance exercises Historically, balance has not been included in clinical testing, but the Berg is a widely accepted static and dynamic balance assessment tool. The Berg The Berg Balance scale is a 14-item performance measure that assesses static and dynamic balance in adults. While it takes a bit longer to administer than other balance assessments, it does not require any special equipment and the standard error of measurement is low (Shirley Ryan Ability Lab, 2022). It is available in the public domain for free. Supplemental assessments are highly recommended for clients with neurological conditions. The test items are static and dynamic balance activities of varying difficulty, such as standing on one Special concerns The benefits of both aerobic and resistance exercise for older adults are clear. Exercise is generally considered to be a relatively safe activity, but good clinical judgment is still necessary when evaluating and prescribing both aerobic and resistance exercise for older adults. Despite its benefits for a majority of older adults, exercise is contraindicated for a minority of individuals due to health concerns (WHO, 2020). When not able to engage in the typical activity recommendations, adults with chronic conditions should aim to engage in physical activity according to their abilities, starting with small amounts of physical activity and gradually increasing the frequency, intensity, and duration over time (WHO, 2020). When not contraindicated, older adults with and without chronic conditions

foot or with one foot in front of the other. Scoring items depends on whether the test subject needed to touch something for support or how long they could keep one foot off of the ground. Item-level scores are determined by the ability to perform each assessed activity. Items are scored and then summed to a maximum score of 56. The test takes 15 to 20 minutes to administer, and no training is required. Minimal clinically important difference is seen at a score change of between 3.3 and 6.9, depending on initial score, and between 8 and 10.5 for older adults who are living in nursing homes or institutionalized. Scores of less than 45 indicate a greater risk of falling, and less than 40 indicates an almost 100% fall risk (Shirley Ryan Ability Lab, 2022). can increase moderate-intensity aerobic physical activity to more than 300 minutes or do more than 150 minutes of vigorous- intensity aerobic physical activity or an equivalent amount of moderate- and vigorous- intensity aerobic exercise throughout the week (WHO, 2020). Many older adults, however, experience certain comorbid conditions, such as diabetes, arthritis, and/or dementia, that may warrant special considerations before and after exercise prescription. While exercise is not contraindicated in these conditions, practitioners working with older adults should be aware of the various concerns that may arise.

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Book Code: PTNY1024

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