is posted on the website of the APTA Academy of Neurologic Physical Therapy at http://www.neuropt.org. There is a set of core outcome measures recommended by the Academy of Neurologic Physical Therapy to use across all neurologic disorders. This includes the BBS, FGA, Activities-Specific Balance Confidence Scale, 10-Meter Walk Test, 6-Minute Walk Test, and the Five Times Sit to Stand Test. Walking speed in backward walking is timed using the 10- or 3-Meter Walk Tests, as it is in forward walking. The most commonly used measure of functional walking ability and endurance is the 6-Minute Walk Test. This test involves having the individual walk along a path that is 100 feet long, with a cone placed at each end of the path where the person turns. Shorter paths lead to more turns in a 6-minute time frame and result in shorter distances walked; therefore, the standard 100-foot-long distance should be used. The individual may take standing rest breaks during the test but may not sit down. The distance walked in 6 minutes is recorded. The most accurate way to measure the distance walked is to have someone walk beside the individual while pushing a measuring wheel. Falvo and Earhart (2009) found that the distance walked during the 6-Minute Walk Test was less for those with PD (at Hoehn & Yahr stage 2) than for community-dwelling elderly (PD = 392 m; elderly = 631 m). In this study, the 6-Minute Walk distance was explained in part by disease-specific characteristics (UPDRS) and perhaps to a greater extent by impaired balance and predisposition to falling (Falvo & Earhart, 2009), indicating that although impairments directly related to PD affect walking distance, balance and fall risk also play a significant role in walking distance. The TMT (not on the PD EDGE recommended measure list) is a standardized outcome measure that examines gait and has been found to have a good correlation with gait speed (r = 0.53; Kegelmeyer et al., 2007). The test involves going from sit to stand from an armless chair, walking forward and then turning in a 360° circle, and returning to the chair. The therapist rates multiple items on scales ranging from 0 to 2, including step length, step symmetry, and stability. The TMT test also includes standing with eyes closed and a push test. It is easy to administer, requires no special equipment, and takes less than 15 minutes to complete. The test is made up of two scales, balance and gait, and it is intended to be used in full rather than using the subscales individually. Minimal clinical difference has not been established in PD but has been found to be five points in both the elderly (Faber et al., 2006) and those with Huntington’s disease (Quinn et al., 2013). Fall screening Screening for fall risk is critical for ensuring that the safety needs of clients with PD are monitored. One of the best predictors of falls is fall history. Individuals who have fallen are at increased risk of future falls (Bloem et al., 2004). Most typically, 1-week and 6-month fall histories are taken. Any individual who has had a fall is examined for any underlying causes that may be responsive to treatment. For individuals with PD who have not yet had a fall, a fall risk screening is administered. A newer outcome measure is the BESTest, which combines elements of tests such as the Timed Up and Go (TUG) Test and the BBS. Two shorter versions have also been constructed: the Mini-BESTest and the Brief-BESTest. The Mini-BESTest has 14 items, and the Brief-BESTest has 8 items. These shorter versions are both sensitive and specific for predicting falls in individuals with PD (Duncan et al., 2013). Both have maintained the strong clinicometric properties of the BESTest for predicting falls in prospective studies (Duncan et al., 2013). The Mini- BESTest is highly recommended for fall screening in PD and was recommended for use by the PD EDGE taskforce.
examines standard outcome measures across common neurologic disorders and makes recommendations regarding best measures for therapist use in the clinic and research environments. These are known as the EDGE documents . The neurology section has completed EDGE recommendations for stroke, multiple sclerosis, traumatic brain injury, spinal cord injury, PD, and vestibular dysfunction. The PD EDGE document Gait measures One of the easiest and most powerful measures of walking ability is gait speed. Studies have shown that gait speed can be correlated with both function and health outcomes in the elderly and those with PD (Cesari et al., 2005; Elbers et al., 2013). As shown in Table 4, gait speed greater than 0.8 m/s (meters per second) is highly predictive of many health outcomes such as ability of the elderly to ambulate in the community (Elbers et al., 2013) and likelihood of hospitalization or death in the next year (Cesari et al., 2005). Table 4: Gait Speed as Related to Activity and Participation Gait speed Relation to Activity and Participation in the Elderly 1.2 m/s to 1.4 m/s Generally considered normal walking speed. <1.0 m/s Individuals remain high functioning but are at high risk of developing health- related problems. Relative risk of death is 1.64. Relative risk of hospitalization is 1.48. 0.4 m/s to 0.8 m/s Individuals are likely to be limited in community ambulation. <0.4 m/s Individuals are likely to be limited to household ambulation. m/s = meters per second Note . From Western Schools, 2018. In addition, those with walking speeds between 0.4 and 0.8 m/s have limited ability to ambulate in the community. Individuals with PD are a part of this cohort. In individuals with PD, slowing of gait has been shown to correlate to increased disability in ADLs (Cavanaugh et al., 2015) and to increased fall risk (Kataoka et al., 2011). To ensure valid measurement, speed should be measured over the longest distance feasible and include sufficient space for acceleration and deceleration. The standardized method is the 10-Meter Walk Test, in which the therapist marks off a 10-meter distance and times the patient’s gait speed over the central 6 meters. To achieve the most accurate measurement, walking is initiated at least 2 meters before starting the stopwatch and continues for at least 2 meters after timing has stopped (see Figure 5). Figure 5: 10-Meter Walk Test
Note . From Western Schools, 2018.
Because many falls occur in situations requiring a backward step, investigators have begun to establish testing procedures for backward walking (Fritz et al., 2012; Hackney & Earhart, 2009). In community-dwelling elderly, a backward walking velocity of <0.60 m/s was indicative of a high fall risk (Carter et al., 2019; Fritz et al., 2012). In both the elderly and those with PD, differences in gait parameters were greater in backward than forward walking (Fritz et al., 2012; Hackney & Earhart, 2009).
Page 113
EliteLearning.com/Physical-Therapy
Powered by FlippingBook