● The environmental factors that affect these experiences (and whether these factors are facilitators or barriers). Different outcome assessments and exams measure different components included in this model, and it is helpful for the clinician to recognize the areas addressed by the assessments they choose. Additional considerations when choosing a gait or balance assessment could include whether the assessment requires a fee, and the assessment’s degree of challenge. The clinician should choose an assessment that challenges the older adult without
total failure on the test. If an exam is too easy, then the test results may show a ceiling effect, and if the test is too difficult, then the results may indicate a floor effect. Both ceiling and floor effects should be avoided by using an exam that gives credit for some positive attributes, but leaves room for improvement. Clinicians must use their experience and expertise to determine the best gait and balance assessment for each individual. Some of the more common gait and balance tests are listed below and in Table 7, which also shows attributes and fall risk threshold scores for each measurement tool.
Table 7: Gait and Balance Outcome Measures Tests Including Gait Scoring Considerations
Advantages
Disadvantages
ICF Domain
Dynamic Gait Index (DGI; adapted from Shumway-Cook & Woollacott, 1995) Functional Gait Assessment (Wrisley, Marchetti, Kuharsky, & Whitney, 2004)
8 items. Top score: 24. Fall risk: variable, but <19 predicts falls in community elderly. 10 items. Top score: 30. 7 items from DGI. Fall risk: increased if <20; activities similar to the DGI with 3 more challenging tasks of walking with narrow base of support, backward, and with eyes closed. 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.
Minimal time and equipment needed; able to use assistive
Requires 20 ft. of space; may be too challenging for frailer older adults.
Activity.
device; good validity and reliability; includes head turning during gait for vestibular stimulation. 10 - 15 min to perform; dynamic gait activities with head turns assists in identifying fall risk in adults with vestibular disorders; can use assistive device.
May be too challenging for more frail older adults; need 20 ft of space to test.
Activity.
Mini Balance Evaluation Systems Test (MiniBEST; Franchignoni, Horak,
Excellent reliability; 10–15 min to perform.
Discrepancy in scoring; not as familiar to many therapists.
Body function and activity.
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.
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.
Quick and easy to perform; person stands as quickly as possible 5 times from standard chair with arms; excellent reliability.
Compensatory movements common; fatigue may result in floor effect.
Activity.
EliteLearning.com/Physical-Therapy
Page 68
Powered by FlippingBook