Transcript Tinetti balance and gait evaluation

Tinetti balance and gait
evaluation
Scores: ../28
Seyed Kazem Malakouti, MD
Faculty of Iran University of Medical Sciences
Seyed Kazem Malakouti, MD
Score: ../16
• Sit the patient on a hard without arms chair
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Sitting balance (0,1)
Arising (0,2)
Attempt to rise (0,2)
Immediate standing in 5 second (0,2)
Standing balance (0,2)
Nudging (0,2)
Eye closed (0,1)
Turning 360 degrees (0,2)
Sitting down (0,2)
Seyed Kazem Malakouti, MD
Gait evaluation: score ../12
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Initiation of gait (0,1)
Step length and height (lt foot) (0,2)
Step length and height (rt foot) (0,2)
Step symmetry (0,1)
Step continuity (0,1)
Path about 3 meters (0,2)
Trunk (0,2)
Walking stance (0,1)
Seyed Kazem Malakouti, MD
Comprehensive assessment of fall
Type
Exam
Red flag
Vital sign
Orthostatic BP
> 20 mm gh drops in SBP or
> 15 increase in pulse from
lying to standing x 3 min
TEMPERATURE
Hypothermia and fever
Snellen chart
Visual acuity imp.
Visual field exam
Visual field imp.
Dix-hallpike manuer
Nystagmus
Whisper test
Unable to hear whisper
Weber rinnie test
Conduction vs
neurosensory deficit
Otoscopic exam
Cerumen impaction,
perforation
Neck
Carotid auscultation
Bruit
Heart
auscultation
Arrythmia, murmur
Eye
Ear
Seyed Kazem Malakouti, MD
Comprehensive assessment of fall
Type
Exam
Red flag
Musculoskeletal
Observation of leg, hand ..
Deformity of joint
Range of motion
Limitation and deformity
Sensory
Decrease pinprick vibration
Romberg
Instability
MMSE
Cog. Imp.
GDS
Clinical dep.
Tone
Rigidity
strength
Muscle weakness
Get up and go test (rise
from the chair, walk 3
meters forward, turn
around walk back to the
chair and sit down)
Abnormal = takes > 10 sec.
to complete the test
Neurological
Functional gait
Seyed Kazem Malakouti, MD
balance
Side by side stance, narrow Instability
stance x 10 seconds
Semi tandem stance (one
Instability
foot half in front of other
with feet touching) x 10 sec
mobility
Full tandem stance (one
foot in front of other ) x 10
sec
Instability
Pull test (Gentle pull back
at waist from behind while
standing)
Postural Instability
Observation of use of cane, Instability
walker, personal assistance And inability to use
, if any
assistive device
Presence of restraints if
any
Limitation of morbidity
Footwear evaluation
Unfit shoes
Seyed Kazem Malakouti, MD
Seyed Kazem Malakouti, MD
Fall due to drug side effects
Medication
Side effects to cause falling
Antidep.
Cafferine,
neuroleptic,
stimulants
Agitation
Antiarrthmics
Arrhythmia
BDZ, narcotic,
anticholinergic
Cog. Imp.
Anticonvulsant
Dizziness, orthostatic hypo.
Antidep.
Neuroleptic
Gait dis. extrapyramidal
Diuretics
Urinary incontinence
Anticonvul. BDZ,
neurolepic
Postural dis. Balance
Betablocker,
nitrate,
vasodilator
Syncope
Seyed Kazem Malakouti, MD