Functional Ability Screening Tools for the Clinic

Transcription

1 Functional Ability Screening Tools for the Clinic Shelley Hockensmith,, P.T., NCS Objectives Review screening tools for physical or functional ability including Five Times Sit to Stand, Walking Speed, and Timed Up and Go Practice administering these brief assessments Falls in the Elderly Deaths by Falls in US In ,888 for ages ,850 for ages ,986 for ages ,586 for ages 85 Environmental Factors Medications Sensory decline Orthostatic hypotension Muscle Strength Sources Postural reflex decline Multi-tasking Cognition Flexibility

2 Screening Tools in the Clinic Five Times Sit to Stand Test 10 meter walk Timed Up and Go Fast to administer Reliable and sensitive Applicable across a lot of the geriatric spectrum Immediate results Helpful in determining at risk population for falls and functional decline Promote patient/clinician communication Motivate patients!!!!! Five Times Sit to Stand Test (FTTST) Knee extension strength Can be used for balance however not as strong as other measurement tools in the clinic. Requirements 1. Chair 43cm height 2. Stopwatch FTSST Method 1. Inform the patient of the test, instruct that the timer will start when they initiate the first stand. 2. Start timing when the patient initiates the first stand. He/she must achieve full erect standing each time before sitting. 3. Stop the timer once the patient sits after the 5 th transition.

3 Average FTSST reference values Age = 11.4 seconds Age = 12.6 seconds Age = 14.8 seconds Walking Speed 6 th Vital Sign Fritz, Stacy PT, PhD; Lusardi,, Michelle PT, PhD White Paper: Walking Speed: the Sixth Vital Sign. Journal of Geriatric Physical Therapy: 2009; 32(2): Home and community ambulation status Discharge location Need for rehabilitation Mortality Fear of falling Fall predictor Predict future health status Gait Speed (m/s) 2.00 M (pref) 1.50 F (pref) M (Max) F (Max) 50's 60's 70's Frail M (pref) F (pref) M (Max) F (Max) Lusardi MM et al. Comfortable and fast gait speeds of frail community-living older adults. CSM paper 2002

4 Gait speed indicators Montero-Odasso M studied 102 well functioning adults age 75 and older <0.7m/s was significant predictor of hospitalization, requirement of a caregiver, and new falls. Perry J Post stroke patients Household (<0.4 m/s) Limited community ( m/s) Community (>0.8 m/s) Testing Walking Speed Requirements: 14 meter walking area with masking tape markers at 2 and 12m Stopwatch Method: 1. Measure and mark the course placing tape at 2 meters and 12 meters from your starting point. 2. Instruct the patient that on your cue, he/she is to walk a comfortable pace to a designated target beyond the 12 meter mark. DO NOT refer to the tape. Patients are allowed to use assistive devices if frequently used. 3. START THE STOPWATCH when the participant's first foot crosses the plane of the 2meter line and STOP THE STOPWATCH when the participant's first foot crosses the plane of the 12 meter line. Have the participant continue walking until he/she reaches the target after the 14 meter line. 4. Repeat at comfortable pace. 5. Repeat 2 trials at pace As quickly and safely as you can. Get Up and Go Observe the patient's movements for any deviation from a confident, normal performance. Use the following scale: 1 = Normal 2 = Very slightly abnormal 3 = Mildly abnormal 4 = Moderately abnormal 5 = Severely abnormal

5 Timed Up and Go Requirements: 1. Firm chair with arms 2. 3m distance-marker (tape on the floor) in front of chair 3. Stopwatch *if the patient uses an assistive device for ambulation he/she should use it for the test. Method: 1. Position the patient seated in the chair with back against backrest, arms resting in lap. 2. Instruct as follows On the word go, go, stand up, walk around the marker, come back and sit all the way back in your chair 3. Timing begins on the word go and ends when the back is rested on the chair. 4. Complete a practice trial first. Average two subsequent recorded trials. Modifications for TUG Manual dual task carry a full glass of water Cognitive dual task either count backwards by 3 s s from a randomly selected number or state days of week backwards Shumway-Cook et al - Study participants were community dwelling older adults grouped into no history of falls and history of 2 falls within previous 6 months. TUG seconds classified as fallers with prediction rate of 90%. TUG manual seconds classified as fallers with prediction rate of 90%. TUG cognitive seconds classified as fallers with prediction rate of 87%. Lundin-Olsson and colleagues frail older adults who had a time difference of greater than 4.5 seconds between the TUG manual and the TUG were more prone to falls in the following 6 months.

6 Food for thought Kristensen et al: 79 consecutive elderly people who were hospitalized after hip fractures and were able to perform the TUG when discharged from inpatient rehabilitation to home or skilled nursing setting. 6 month follow up: 32% of the follow-up group experienced 1 or more falls. 24 second cut off was the only significant fall predicting parameter compared to sex, type of fracture, residence, walking aides used, functional level before the fracture, mental status upon admission. Nordin E et al TUG cut-off times may not be reliable fall risk identifier in population of frail older people dependent in ADL and living in residential care facilities. FTSST Walking Speed TUG Strength Recap: Primary use General health indicator Mobility disability Identify fall risk Key values Age = 11.4 seconds Age = 12.6 seconds Age = 14.8 seconds Male Female 60 s 3.11 ft/s s 0.95 m/s 2.85 ft/s 0.87 m/s 70 s 3.08 ft/s 0.94 m/s 2.79 ft/s 0.85 m/s Frail 1.18 ft/s 0.36 m/s 1.38 ft/s 0.42 m/s 10 M walk time Household Ambulator >25 seconds Limited Community Ambulator s 25s Unlimited Community Ambulator 12.6s TUG Focus on Function Add additional tasks conversation, looking at targets, sorting mail/papers while walking Varied surfaces: carpet/hard surface, sidewalks, curbs, gravel yards Environmental factors: lighting, pets, throw rugs, shower set-up Hurrying to answer the phone????? Urinary incontinence during the day or at 3am, in the dark, postural hypotension, AND decreased alertness

7 Kristensen MT, Foss NB, Kehlet H. Timed Up & Go Test as a Predictor of Falls Within 6 Months After Hip Fracture Surgery. Phys Ther Shumway-Cook A, Brauer S, Woollacott,, M. Predicting the Probability for Falls in Community-Dwelling Older Adults Using the Timed Up & Go Test. Phys Ther. 2000; 80: Nordin E, Rosendahl E, Lundin-Olsson E. Timed Up & Go Test: Reliability in Older People Dependent in Activities of Daily Living Focus on Cognitive State. Phys Ther. 2006; 86: Nordin E. Prognostic validity of the Timed Up-and and-go test, a modified Get-Up Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities. Age Ageing 2008; 37 (4): Bohannon RW, Bubela DJ, Magasi SR, Wang Y. Sit-to to-stand test: Performance and determinants across the age-span. Isokinetics Exersc Sci,, 2010; 18(4): Whitney SL et al. Clinical Measurement of sit-to to-stand performance in people with balance disorders: validity of data for f the Five-Times Times-Sit-to-Stand Test. Phys Ther,, 2005; 85(10): Bohannon RW. Reference values for the five-repetition sit-to to- stand test: a descriptive meta-analysis analysis of data from elders. Percept Motor Skills,, 2006; 103(1): Bohannon RW. Comfortable and maximum walking speed of adults aged years: reference values and determinants. Age Aging. 1997; 26: Bibliography Lusardi MM et al. Comfortable and fast gait sppeds of frail community-living older adults. CSM paper Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking handicap in the stroke population. Stroke. 1995;26: Montero-Odasso M, Schapira M, Soriano ER, Varela M, Kaplan R, Camera LA, Mayorga LM. Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. J Gerontol A Biol Sci Med Sci. 2005;60: Questions? Comments? Let s s practice