Functional Balance and Coordination Scales.pptx

All activities of daily living need to balance control in static and dynamic movements. In recent years, a numerous increase can be seen in the functional balance assessment tools. Functional balance tests emphasize on static and dynamic balance, balance in weight transfer, the equilibrium response to the imbalances, and functional mobility. These standardized and available tests assess performance and require minimal or no equipment and short time to run. Functional balance is prerequisite for the most static and dynamic activities in daily life and needs sufficient interaction between sensory and motor systems. According to the critical role of balance in everyday life, and wide application of functional balance tests in the diagnosis and assessment of patients, a review of the functional balance tests was performed Methods.

1. Functional Balance And Coordination Scale s Presenred By Dr. Manisha Yadav ( PT) MPT (Neuro )

2. Balance Perform assessment of balance during functional activities, with or without the use of assistive, adaptive, orthotic, & prosthetic devices Assess static & dynamic balance

3. Static and Dynamic Balance Scale Static balance tests Dynamic balance tests Romberg Test Functional Reach Test Tandem (Sharpened) Romberg Test Multidirectional Reach Test One-Legged Stance Test Berg Balance Scale Timed Get Up and Go Test CTSIB

4. Static Balance Scale

5. Romberg Test Patient stands with feet together & eyes opened for 20 sec . Patient stands with feet together & eyes closed for 20 s ec. Positive (indicating balance problems) if patient sways excessively, takes astep or falls .

6. T andem (Sharpened) Romberg Test Patient stands with one foot in front of the other in a heel-to-toe position with eyes open for 30 sec . Patient then stands with one foot infront of the other in a heel-to-toe position with eyes closed for 60 sec . Positive (indicating balance problems) if patient sways excessively, takes astep or falls

7. One-Legged Stance Test With arms over chest, patient lifts one leg & holds it with hip in neutral & knee flexed to 90°for 30 sec (lifted leg may not press into stance leg) . Patient then repeats test with other leg . Examiner stops timing if patient’s legs touch each other or foot touches the floor .

8. Dynamic B alance T ests

9. Functional Reach Patient reaches forward as far as possible from a comfortable standing position . Using a yardstick placed on the wall at shoulder level, examiner measures(in inches) the excursion of arm reachfrom start to finish .

10. Multidirectional Reach Test From a comfortable standing position, patient reaches forwardas far as possible without moving feet or taking a step, leans as far back as possible & reaches sideways (to either side) asfar as possibl e. Using a yardstick fixed on a tripod or attached to the wall at shoulder level, examiner measures the starting & ending positions of the index finger of the patient’s outstretched hand .

11. Berg Balance Scale This scale Measure Balance in Older Adults G ENERAL INSTRUCTION S Please document each task and/or give instructions as written. When scoring, please record the lowest response category that applies for each item . Equipment: Yardstick One standard chair with arm rests One standard chair without arm rests Footstool/step Stopwatch or wristwatch 15 foot walkway

12. Scoring: A five-point scale, a range of 0-4. 0 = lowest level of function 4 = highest level of function. Highest possible score = 56 Score of < 45 indicates a greater risk of falling 41-56 = low fall risk 21-40 = medium fall risk 0 –20 = high fall risk

13. Category Itemes Score Sitting balanc e Sitting unsupporte d 0-4 Standing balance Standing unsupported 0-4 Standing with eyes closed 0-4

14. Standing with Feet together 0-4 Standing on one foot 0-4 Turning to look behind 0-4

15. Retrieving object from floor 0-4 Tandem standing 0-4 Reaching forward while standing 0-4

16. Dynamic Balance Sitting to Standing 0-4 Standing to Sitting 0-4 T ransfer 0-4 Turning 360 degree 0-4

17. Stool stepping 0-4 Total 0-56

18. Timed Get Up and Go Test { TUG } • Patient sits comfortably in a firm chair with back resting against backrest • Patient stands, walks 10 ft toward a target at normal walking speed, turns around without touching the target, walks back to the chair, turns around & sits down • Examiner times performance with a stop watch beginning with the verbal instruction “go” & ending when the patient returns to starting position .

19. Patient gets one practice & two test trials Examiner records test trial average (in sec) Most healthy adults can complete the test in 10 sec 10 to 20 seconds is acceptable for the frail elderly or patients wit h disabilities

20. Clinical Test for Sensory Interaction in Balance (CTSIB) (for children 4 years and up, and adults) Instruct the patient to stand with arms folded across the chest & with feet shoulder width apart. The patient should be able to maintain balance in each condition for 30 seconds & is allowed three trials. Two or more falls are considered to be indicative of deficits of sensory information required for standing balance. A condition is failed if the person steps, unfolds arms, or opens eyes (in eyes closed conditions).

21. Observation of sway in each condition is graded as: Grades Category 1 Minimal Sway 2 Mild Sway 3 Moderate Sway 4 Fall

22. Scale for the assessment and rating of ataxia (SARA) SARA is an 8-item performance based scale, yielding a total score of o (no ataxia) to 40 (most severe ataxia) . EQUIPMENT REQUIRED • Stopwatch • 10 meter walkway • Examination table

23. SCORES The score ranges from o (no ataxia) to 40 (severe ataxia). The individual item scores are as follows: • Gait (o to 8) • Stance (o to 6) • Sitting (o to 4) • Speech disturbance(o to 6) • Finger chase (o to 4) • Nose-finger test (o to 4) • Fast alternating hand movements (o to 4) • Heel-shin slide (o to 4) • Limb kinetic functions (items 5 to 8) are rated independently for both body sides, and its arithmetic mean is included in total score.

24. S. no. Items Score 1 Gait 0 Normal, 1 Slight difficulties 2 Clearly abnormal 3 Considerable staggering, difficulties in half-turn 4 Marked staggering, intermittent support of the wall required 5 Need assisted Device 6 Need Minior Assistance 7 Need Major Assistance 8 Unable 2 Stance 0 Normal, 1 Able to stand with feet together without sway 2 Able to stand with feet togetherwith sway 3 Able to stand but not with feet together 4 Able to stand for with intermittent support 5 Able to stand with constant support of one arm 6 Unable to stand 3 Sitting 0 Normal, 1 Slight difficulties, 2 Constant sway, but able to sit without support 3 Able to sit for with intermittent support 4 Unable to sit for

25. 4 Speech disturbance 0 Normal 1 Suggestion of speech disturbance 2 Impaired speech, but easy to understand 3 Occasional words difficult to understand 4 Many words difficult to understand 5 Only single words understandable 6 anarthria 5 Finger chase 0 No dysmetria 1 Dysmetria, under/ overshooting target <5 cm 2 Dysmetria, under/ overshooting target < 15 cm 3 Dysmetria, under/ overshooting target > 15 cm 4 Unable to performs 6 Nose-finger test 0 No tremor 1 Tremor with an amplitude < 2 cm 2 Tremor with an amplitude < 5 cm 3 Tremor with an amplitude > 5 cm 4 Unable to perform 5 pointing movements

26. 7 Fast alternating hand movements 0 Normal, no irregularities (performs <10s) 1 Slightly irregular (performs <10s) 2 Clearly irregular, single movements difficultto distinguish or relevant interruptions, butperforms <10s8 3 Very irregular, single movements difficultto distinguish or relevant interruptions,performs >10s 4 Unable to complete 10 cycles 8 Heel-shin slide 0 Normal 1 Slightly abnormal, contact to shin maintained 2Clearly abnormal, goes off shin up to 3 timesduring 3 cycles3Severely abnormal, goes off shin 4 or more timesduring 3 cycles4 Unable to perform the task

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