Transcript PowerPoint - Interactive Metronome

Fall Risk Reduction Program
Patient Assessment
Module #2 of 6
Shelley Thomas, MPT, MBA
Dara Coburn, M.S., CCC-SLP
AGENDA
Patient assessment
Choosing the most appropriate
assessment protocol
Choosing the top systems of balance
impacting falls
Q & A
Patient Selection
 Patient and family goals and
expectations
 History of falling? Fear of falling?
 Weight bearing status
 Able to weight bear as tolerated? Or partial weight
bearing?
 Cognitive and communicative status
 Attend to task for at least 60 seconds to 2 minutes?
 Able to communicate basic wants and needs?
 Follow simple directions?
 Inpatient vs. outpatient
 Intensity of treatment
Patient Selection
 Discharge Disposition
 Home with help?
 Home alone?
 Ongoing treatment?
 Concomitant diagnosis
 Tolerance to exercise?
 Medications?
 Vision and Hearing Status
 Does the patient have adaptive equipment?
 Is the equipment available for their use?
Patient Selection, cont.
Candidates for this program should have goals that
include ambulation and/or lower extremity weight bearing
transfers
 Standing pivot/squat pivot transfers
 Modified depression transfers
 Ambulation with or without a device
Patients that are dependent with transfers or unable to
walk or have severe to profound cognitive and/or
communication deficits
 May require therapy for other reasons, but focus is less likely
on decreasing falls. Often focus is on caregiver training,
wheelchair mobility, compensatory strategies etc.
Long Term Goals
Functional Limitation
Sample Goal
Fall or loss of balance at home in past month = 6
Patient will only experience two falls or loss of
balance in home per month to decrease risk of
injurywithin 8 weeks.
Falls or loss of balance in community, on uneven
surfaces, in last month = 8
Patient will only experience three falls or loss of
balance in the community per month to decrease
risk of injurywithin 8 weeks.
Unable to safely ascend or descend stairs without
physical assistance due to fear of falling
Patient will ascend and descend 12 steps with a
hand rail independently within 6 weeks.
Increasing risk of falling when reaching for objects
secondary to poor balance reactions
Patient will safely be able to reach for objects
outside of base of support and demonstrate
appropriate balance reactions (ankle, hip, stepping
strategies) to prevent loss of balance within 6
weeks.
Long Term Goals
Functional Limitation
Sample Goal
Unable to transfer on/off toilet or chair without use
of a walker
Patient will transfer independently on/off chair or
toilet within 6 weeks.
Demonstrates increased fall risk while cooking
because difficulty with balance, carrying objects, and
focusing on cooking task
Patient will demonstrate improved dual-tasking
ability by being able to prepare a basic meal without
loss of balance within 4 weeks.
Unable to maintain attention and focus to safely
complete ADL’s
Patient will demonstrate sustained & accurate visual
attention and processing in order to complete a task
with 70% accuracy over 3 minutes.
Unable to self-regulate
Patient will demonstrate sustained attention to task,
self-monitoring, & self-correction during a cognitivemotor task with fewer than 3 errors in a 3 minute
time period.
Unable to follow moderately complex directions
Patient will demonstrate improved receptive
language and auditory comprehension skills by
following a 2 step cognitive/motor task with 50%
accuracy and moderate cues.
Short Term Goals
 Patient will perform both toes for 2
minutes with while holding onto walker
for balance and achieve <200 ms task
average with difficulty level set at 300,
tempo set at 54 bpm, and guide sounds on.
 Patient will attend to task during a synchronized
cognitive/motor activity for 2 minutes with moderate
cues and/or redirection, achieving a temporal
processing score within 150 ms of the reference beat in
order to persist in daily activities and complete them
without constant prompting
Documentation
Documentation should
include:
 IM task to be completed
 Task average to be achieved
 IM settings (i.e. tempo, if guide sounds are
on/off, difficulty level, etc.)
 Assistance to be provided (i.e. verbal cues,
hands on cues, modeling, etc.)
 Relationship to functional outcome
Narrative Note Example
Soap Note Example:
 S – Patient seen for skilled speech therapy. He was alert and
oriented. He participated well in treatment and had no complaints
of pain.
 O – Patient will follow a 2-step direction
 A – Performed a cognitive/motor task direction in the presence of
auditory cues and repetitive task practice with hand over hand
assistance. Required more assistance from clinician as complexity
of auditory cue and feedback was added. Has difficulty in
distraction. Required moderate assistance to persist.
 P – Increase complexity of feedback, reduce amount of clinical
assistance require. Alternate between two different sets of
directions as tolerated.
Slide 10
Determining Patient Baseline
Use both IM assessments
and standardized
evaluation tools to
determine baseline prior
to starting Fall Risk
Reduction Program
IM Assessments
 Short Form Test (SFT)
 Patient performs two 1-minutes task
 One without guide sounds, the other with guide sounds
 Provides baseline task average for ability to pair auditory information
with motor sequencing task
 Long Form Assessment (LFA)
 14 tasks, evaluates coordination and sequencing with different motor
tasks
 Takes approximately 20-25 minutes to administer
 Modify to meet the patient’s current level
 Document any modifications provided
 Should administer one of these assessments when evaluating
patient
Standardized Assessments
 Multitude of standardized
assessments that can be
used to assess fall risk,
ability to perform activities
of daily living, cognitive status
 Important to assess dual-tasking impact on
balance
 It's good a person can walk. But can they walk
and talk? Walk and carry a glass of water? Be
safe when distracted?
Motor Assessments
Motor/Balance
Assessment:
 TUG
 Tinetti Scale
 Functional Reach
 Dynamic Gait Index
 6-Minute Walk Test
Cognitive Assessments
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RIPA
SCATBI
Test of Variables of Attention
Stroop Affect
Trail Making
Delis-Kaplan Executive Functioning Scale (D-KEFS)
Mesulam and Weintraub Cancellation Test (MWCT)
Mini Mental State Examination (MMSE)
Wisconsin Card Sorting Test (WCST)
Woodcock- Johnson, 3rd Edition (WCJ-III)
Confidence Assessments
Activities-Specific Balance Confidence (ABC)
Scale
Modified Falls Efficacy Scale
Including a confidence assessment
helps determine if the patient has
less concerns about falling and
is perceiving improvements in
physical abilities.
Other Useful Tools and Assessments
Functional Assessment Tool
(Developed by Amy Vega)
Stroke Impact Scale
Canadian Occupational
Performance Measure
Timed Up & Go Modification
to Assess Dual Tasking
 Can modify the TUG to incorporate a
cognitive and physical task
 Administer TUG under following
conditions:
 Traditional conditions
 While carrying a glass of water
 While counting backwards from 100 in serial
7's
Normative Values
TUG Condition
High Risk for Falling:
TUG Alone
> 13.5 seconds
TUG Manual (carry full glass of
water)
> 14.5 seconds
TUG Cognitive (count backwards)
> 15 seconds
Shumway-Cook, A., Brauer, S., & Woollacott, M. (2000, September). Predicting the probability for falls
in community-dwelling older adults using the timed up & go test. Physical Therapy , 80(9), 896-903.
Create a Dual Task Condition
with Short Form Test
Compare traditional SFT score with a dual-task
condition (document how you create dual-task
so it can be replicated). Perform SFT while:
 Counting aloud
 Marching in place
 Transfering sit to/from stand
 Walking (use in-motion triggers)
 Naming objects
Summary of Patient
Selection & Assessment
1.
2.
3.
4.
Patient should have goals that include
ambulation and/or transfers (that involve lower
extremity weight bearing)
Use standardized assessment tools to
evaluation motor and cognitive performance
Use IM assessments to get a baseline on ability
to pair auditory information with motor
sequencing.
Assess performance under dual-task conditions
"Homework"
Complete following
worksheet to select
and assess your patient
Patient Selection Worksheet, pg. 1
Interactive Metronome Fall Risk Reduction Program
Patient Selection & Assessment Worksheet, Module 2
Patient name: ________________________
Date Assessed: _________________
Age: ______ Treating Diagnosis: ___________________________________________
Past Medical History: _____________________________________________________
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Patient Goals: ____________________________________________________________
________________________________________________________________________
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Does patient have a goal including ambulation and/or transfers: ___ Yes ___ No
If no, patient not appropriate for this Fall Risk Reduction Program (but may still benefit
from therapy, IM, and other interventions!)
Results from Assessments:
1. Short Form Test:
Task #1: Task Average: _________ Variability: ____________
Task #2: Task Average:__________ Variability: ____________
SRO%: ______
SRO%: ______
2. Long Form Assessment:
Complete and print out the LFA results. Will provide a breakdown of each task.
Overall Task Average: ____________________________
Comments: ______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Patient Selection Worksheet, pg. 2
3. Short Form Test combined with a cognitive or motor task (assess dual tasking):
Condition
Task #1 Scores
Task #2 Scores
Standard condition (can use
results from above)
SFT while also
performing____________
_____________________
_____________________
SFT while also
performing____________
_____________________
_____________________
4. Standardized Evaluation Tool
Assessment Domain
Tool
Score (can also attach copy
to worksheet)
Motor
Cognitive
Self Confidence
Treatment Goals: _________________________________________________________
________________________________________________________________________
________________________________________________________________________
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Questions? Please email [email protected].
Post-test
Complete post-test to receive link for
Module # 3 of 6
Materials Page
This video
PowerPoint
Patient Selection Worksheet
www.interactivemetronome.com/inde
x.php/fall-risk-coaching
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