Balance Tests (as used in OTAGO 1 programme)

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Henry Marshall
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1 Balance Tests (as used in OTAGO 1 programme) The OTAGO 1 programme utilises 2 standardised functional tests to aid decisions regarding exercise prescription and to monitor progress. These tests are simple to apply in the home since they require no specialist equipment. a) Chair Stand Test Aim Be able to safely and effectively undertake the test Background This test gives an indication of the Service User s leg power, as well as their ability to perform a basic functional task 2. Their performance gives some indication as to what level to prescribe the knee bend (1) and sit to stand (11) exercises of the OTAGO programme. The test requires the Service User to sit stand five times as quickly as they can without using upper limbs to aid push off. If the Service User cannot rise without using their upper limbs they cannot complete the test and this must be recorded. Procedure 1. Check the Service User has no contraindications which may prevent them performing the task safely. If so discontinue and seek advice from registered practitioner The following may contraindicate the test: Painful lower limb joints (due to arthritis) Back pain Osteoporosis affecting the spine See when to stop 2. Explain the reason for the test, e.g. I would like do a test with you to see how strong your leg muscles are. This may indicate to us what we can do to help improve this. Explain what the test involves. Ensure you gain consent.

2 3. Position of Service User sitting in a firm, straight backed chair with no armrests. Place the chair with a wall behind to prevent it tipping during the test. 4. Position of Rehabilitation Assistant at the side of the service user so they can assist if needed, and can observe the Service User. 5. Explain how to perform the test you will start the test sitting (on straight backed chair) and will then stand up and sit down 5 times as quickly as you can manage safely with your arms folded across your chest. I will time how long it takes. If you can t manage to stand up without using your arms I will stop the test. 6. Ready Ask the service user to start and record the time taken using a stop watch, from the start of first stand to the final sit down. If the service user cannot stand up without use of arms then they cannot do the test (this is recorded as an unsuccessful attempt). Allow a maximum of 2 minutes to complete the task. 7. Completion check the service user feels alright. Give them feedback on their test and seek feedback from them. 8. Document whether the test was successfully completed within 2 minutes, and the actual time taken. If not successfully completed document the number of chair rises completed and the time taken. 9. Feedback results to the Registered Practitioner who delegated the task.

3 b) Four Test Balance Scale Aim To be able to safely and effectively undertake the four test balance scale. Background This test comprises four STATIC balance tests of increasing difficulty 3. They are performed without assistive devices and ideally in bare feet. The positions are: 1. Feet together stand 2. Semi-tandem stand 3. Tandem stand 4. One leg stand The Service User can be assisted to assume each foot position and chooses which foot to move, then must try and hold this for 10 seconds, before progressing to the next position. If the Service User cannot assume a position or cannot hold it for 10sec then do not continue (failed test). Stop timing if the Service User moves their feet from the set position, needs support from the assessor or touches an external object for support. The test is scored by documenting the highest level task successful. This test aids decisions regarding prescription of the balance exercises. Procedure 1. Check the service user has no contraindications which may prevent them performing the task safely. If so, discontinue and seek advice from registered practitioner 2. Explain the reason for the test I would like to do a series of tests to check your balance. This may indicate what we can do to help. The tests involve you standing up and changing the position of your feet. Each new position is more difficult then the previous one, and the aim is to try and hold the position for 10 seconds- except the final position which you need to hold for 30 seconds. Ensure you gain consent. 3. Position of Service User barefoot if able, positioned with supporting surface nearby e.g. work surface. A chair should be nearby for rests if needed.

4 4. Position of Rehabilitation Assistant at the side of the service user, to assist if balance lost. 5. Explain how to perform the test you are going to stand and get your balance (you can hold the support). Then I will ask you to move your feet together, then step one foot forward, then one foot in front of the other and finally stand on one foot. I can help you assume each position then I will time you in each position. If you can t hold the position for the required time I will stop the test. 6. Ready..Once in the start position ask the service user to let go of the support and maintain their balance. Explain that you are timing them and it is important to hold the position as long as they can, but reassure that if they do feel unsafe or lose their balance they can put their hand or foot out for support Start timing as soon as they take position unsupported.if Service User cannot assume the position discontinue task. Feedback to Registered Practitioner who delegated task. Work through each of the 4 foot positions a. Stand with feet together. b. Stand with feet together, one foot half way in front of the other. service user can choose which foot to be in front. c. Stand with one foot in front of the other, heel to toe. Service user can choose which foot to be in front. d. Stand on one leg, service user can choose which foot to stand on. Timing starts as soon as one foot is raised from the ground. The service user must hold each position (1 to 3) for 10 seconds before progressing. Single leg stance (position 4) to be held for 30 seconds. Stop timing if the service user moves their feet from the test position, the assessor provides support to prevent a fall or the service user touches for support with hands or feet. 7. Completion Record the highest level task achieved. Feedback to the service user and seek feedback from them. 8. Document the result in the service user s notes. 9. Feedback the result of the test to the Registered Practitioner who delegated the task. References 1. Campbell AJ et al. J Am Geriatr Soc 1999;47: Guralnik JM et al. J Gerontol Med Sci1994;49:M Rossiter-Fornoff JE et al. A cross-sectional validation study of the FICSIT common data base static balance measures. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Gerontol Med Sci 1995;50A:M

5 SUPERVISED TASKS/EXERCISES CARRIED OUT BY REHABILITATION ASSISTANT COMPETENCIES NAME: TAUGHT MODELLED COMPETENT OTAGO a) CHAIR STAND TEST DATE DATE DATE 1 Check for contraindications 2 Explain reason for the test and any equipment used. Gain consent 3 Position of Service User 4 Position of Rehabilitation Assistant 5 Explain how to perform the test 6 Supervision of the test Including instruction, correction, timing, appropriate stop to test 7 Feedback to Service User and seek feedback from service user 8 Document 9 Feedback to Registered Practitioner regarding how the service user managed the test and their results. Sign and date when achieved Signature of Learner Signature of Assessor Date of review

6 SUPERVISED TASKS/EXERCISES CARRIED OUT BY REHABILITATION ASSISTANT COMPETENCIES NAME: TAUGHT MODELLED COMPETENT OTAGO b) FOUR STEP BALANCE TEST DATE DATE DATE 1 Check plan and check for contraindications to the test 2 Explain reason for the test & any equipment used. Gain consent 3 Position of Service User 4 Position of Rehabilitation Assistant 5 Explain how to perform the test 6 Supervision of the test instruction, timing, appropriate stop, completion 7 Feedback to Service User and seek feedback from them 8 Document the results of the test in service user s notes 9 Feedback to Registered Practitioner regarding the test result and how the service user performed. Sign and date when achieved Signature of Learner Signature of Assessor Date of review

To safely and effectively teach and supervise a Service User undertaking prescribed functional exercise

BED MOBILITY Aim To safely and effectively teach and supervise a Service User undertaking prescribed functional exercise To enable Service User to practice moving in bed and sitting up in bed Turning in