Grading: Mark
the lowest category which applies. Total individual scores (24 possible).
Scores of 19 or less have been related to increase incidence of falls in the
elderly.
1.
Gait Level Surface
Instructions:
Walk
at your normal speed from here to the next mark (20').
Grading: Mark
the lowest category that applies.
(3)
Normal: Walks
20', no assistive devices, good speed, no evidence for imbalance, normal gait
pattern.
(2)
Mild impairment: Walks
20', uses assistive devices, slower speed, mild gait deviations.
(1)
Moderate impairment: Walks
20', slow speed, abnormal gait pattern, evidence for imbalance.
(0)
Severe impairment: Cannot walk 20' without
assistance, severe gait deviations, or imbalance.
2.
Change in gait speed
Instructions:
Begin
walking at your normal pace (for 5'), when I tell you "go," walk as
fast as you can (for 5'). When I tell you "slow,"
walk as slowly as you can (for 5').
(3)
Normal: Able
to smoothly change walking speed without
loss of
balance or gait deviation. Shows a significant difference
in
walking speeds between normal, fast, and slow speeds.
(2)
Mild impairment: Able
to change speed but demonstrates
mild gait
deviations, or no gait deviations but unable to achieve
a
significant change in velocity, or uses and assistive device.
(1)
Moderate impairment: Makes
only minor adjustments to
walking
speed, or accomplishes a change in speed with
significant gait
deviations, or changes speed but has significant
gait
deviations, or changes speed but loses balance but is able
to
recover and continue walking.
(0)
Severe impairment: Cannot change speeds,
or loses
balance and
has to reach for wall or be caught.
3.
Gait with horizontal head turns
Instructions:
Begin
walking at your normal pace. When I tell you to "look right," keep
walking straight, but turn your head to the right. Keep looking to the right
until I tell you "look left," then keep walking straight and turn
your head to the left. Keep you head to the left until I tell you, "look
straight," then keep walking straight but return your head to the center.
(3)
Normal: Performs
head turns smoothly with no change in
gait.
(2)
Mild impairment: Performs
head turns smoothly with slight
change in
gait velocity (i.e., minor disruption to smooth gait path
or uses
walking aid).
(1)
Moderate impairment: Performs
head turns with moderate
change in
gait velocity, slows down, staggers but recovers, can
continue to
walk.
(0)
Severe impairment: Performs task with
severe disruptions
of gait
(i.e., staggers outside 15º path, loses balance, stops,
reaches for
wall).
4.
Gait with vertical head turns
Instructions:
Begin
walking at your normal pace. When I tell you to "look up," keep
walking straight, but tip your head and look up. Keep looking up until I tell
you "look down," then keep walking straight and turn your head down.
Keep looking down until I tell you, "look straight," then keep
walking straight but return your head to the center.
(3)
Normal: Performs
head turns with no change in gait.
(2)
Mild impairment: Performs
task with slight change in gait
velocity
(i.e., minor disruption to smooth gait path or uses
walking aid).
(1)
Moderate impairment: Performs
tasks with moderate
change in
gait velocity, slows down, staggers but recovers, can
continue to
walk.
(0)
Severe impairment: Performs task with
severe disruption
or gait
(i.e., staggers outside 15º path, loses balance, stops
reaches for
wall).
5.
Gait and pivot turn
Instructions:
Begin
walking at your normal pace. When I tell you to "stop and turn," turn
as quickly as you can to face the opposite direction and stop.
(3)
Normal: Pivot
and turns safely within 3 seconds and stops
quickly with
no loss of balance.
(2)
Mild impairment: Pivot
turns safely in >3 seconds and
stops with
no loss of balance.
(1)
Moderate impairment: Turns
slowly, requires verbal
cueing,
requires several small steps to catch balance following
turn and
stop.
(0)
Severe impairment: Cannot turn safely,
requires
assistance to
turn and stop.
6.
Step over obstacle
Instructions:
Begin
walking at your normal speed. When you come to the shoe box, step over it, not
around it, and keep walking.
(3)
Normal: Able
to step over box without changing gait speed;
no
evidence for imbalance.
(2)
Mild impairment: Able
to step over box, but must slow
down and
adjust steps to clear box safely.
(1)
Moderate impairment: Able
to step over box but must stop,
then step
over. May require verbal cueing.
(0)
Severe impairment: Cannot perform without
assistance.
7.
Step around obstacles
Instructions:
Begin
walking at your normal speed. When you come to the first cone (about 6' away),
walk around the right side of it. When you come to the second cone (6' past
first cone), walk around it to the left.
(3)
Normal: Able
to walk around cones safely without changing
gait
speed; no evidence of imbalance.
(2)
Mild impairment: Able
to step around both cones, but must
slow down
and adjust steps to clear cones.
(1)
Moderate impairment: Able
to clear cones but must
significantly slow
speed to accomplish task, or requires verbal
cueing.
(0)
Severe impairment: Unable to clear cones,
walks into one
or both
cones, or requires physical assistance.
8.
Stairs
Instructions:
Walk
up these stairs as you would at home (i.e.,using
the rail if necessary). At the top, turn around and walk down.
(3)
Normal: Alternating
feet, no rail.
(2)
Mild impairment: Alternating
feet, must use rail.
(1) Moderate
impairment: Two
feet to stair, must use rail.
(0)
Severe impairment: Cannot perform safely.
(Adapted
from Shumway-Cook A, Wollacott M. Motor Control:
Theory and Practical
Applications.
Baltimore: Williams and
Wilkins,
1995).
II.
mCTSIB (Modified Clinical Test of Sensory Integration on Balance)
Possible score range from 0- 120. Higher is better.
This test allows for preliminary assessment of how well a patient
can integrate various
senses with respect to balance and compensate
when one or more of those
senses are compromised. Sensory system
involvement is modulated as
follows:
Condition 1: Three sensory systems
available for balance (vision, vestibular, somatosensory).
Condition 2: Vestibular and somatosensory available, vision
absent.
Condition 3: Vestibular and vision
available, somatosensory compromised.
Condition 4: Vestibular available,
vision absent, somatosensory compromised.
Equipment/ set-up: Foam pad (dense enough
to avoid bottoming out) and a stopwatch required. Starting position: Patient
stands with feet shoulder width apart and arms crossed over chest.
Protocol: a 30 second trial is
timed using stopwatch. Time is stopped
during a trial and recorded if:
a)
patient deviates from
initial crossed arm position,
b)
patient opens eyes
during an "eyes closed" trial condition or
c)
patient moves feet (takes a step) or requires manual assistance to
prevent loss of balance.
A trial period is successful if the patient is capable of
maintaining the starting position independently for a period of 30
seconds. A maximum of three trials are performed for all
conditions.
Trials are performed until the patient either:
a)
successfully maintains
the starting position for an entire 30- seconds, or
b)
completes three, 30- second trials to the best of their ability.
Scoring: Proceed to next
condition when one, 30-second trial is completed or all 3 trials are performed.
Record mean score if more than one trial performed.
Condition 1:
Eyes open, firm surface
___trial 1_____ trial
2 ____trial 3
Mean score______
Condition 2:
Eyes closed, firm surface
___trial 1_____ trial 2 ____trial 3
Mean score______
Condition 3:
Eyes open, foam surface
___trial 1_____ trial 2 ____trial 3
Mean score______
Condition 4:
Eyes closed, foam surface
___trial 1_____ trial
2 ____trial 3
Mean score______
Total score: _________ / 120
Romberg-
Eyes open
Patient stands with shoes off and feet together
• Arms crossed, hands touching opposite shoulders
• Eyes open with visual target at 3 feet, for 30 seconds.
• Test ends if feet are moved (step) or arms change
position, or eyes open (during closed eyes segment).
Scoring 0-30, higher is better
Romberg-
Eyes closed
Patient stands with shoes off and feet together
• Arms crossed, hands touching opposite shoulders
• Eyes closed for 30
seconds.
• Test ends if feet are moved (step) or arms change
position, or eyes open (during closed eyes segment).
Scoring 0-30, higher is better