Senior Health Lab- Final

Quad cane checklist

o Hold cane in front with
involved
side hand and twist toward non-involved side
o Use hand on non-involved side to push up while holding cane with other hand
o Placed cane on non-involved side
o Hold onto Dr while cane adjusted to match
crease of wrist an

Single Point cane checklist

o Hold cane in front with involved side hand and twist toward non-involved side
o Use hand on non-involved side to push up while holding cane with other hand
o Placed cane on non-involved side
o Hold onto Dr while cane adjusted to match crease of wrist
o

Pick up walker checklist

o Hold onto walker with involved side hand and twist toward non-involved side
o Use hand on non-involved side to push off table while other hand remains on walker
o Walker adjustment checked to match crease of wrist of patient when standing
o
Move walker

Rolling walker checklist

o Hold onto walker with involved side hand and twist toward non-involved side
o Use hand on non-involved side to push off table while other hand remains on walker
o Walker adjustment checked to match crease of wrist of patient when standing
o
Roll walker

Instruct your patient how to walk up a curb using a
cane

o Cane moves slightly ahead of involved leg
o Up with good leg first
o Down with bad leg first
Going up-Hold cane on good side, lift good leg onto curb, shift weight over good leg to push self up curb, cane and bad leg follow
Going down- Shift weight to g

Instruct your patient how to walk up the
stairs with a handrail
using a cane

o Hold onto handrail and place cane in other hand regardless of which side is involved
o Cane moves slightly ahead of involved leg
o Up with good leg first
o Down with bad leg first
Going up on good leg side- Hold cane on bad side, hold handrail, lift goo

Perform the BERG Balance Scale: SITTING TO STANDING

INSTRUCTIONS: Please stand up. Try not to use your hand for support.
( ) 4 able to stand without using hands and stabilize independently
( ) 3 able to stand independently using hands
( ) 2 able to stand using hands after several tries
( ) 1 needs minimal

Perform the BERG Balance Scale: STANDING UNSUPPORTED

Make sure their back is towards a wall
INSTRUCTIONS: Please stand for
two minutes
without holding on.
( ) 4 able to stand safely for 2 minutes
( ) 3 able to stand 2 minutes with supervision
( ) 2 able to stand 30 seconds unsupported
( ) 1 needs several tr

Perform the BERG Balance Scale: SITTING WITH BACK UNSUPPORTED BUT FEET SUPPORTED ON FLOOR OR ON A STOOL

INSTRUCTIONS: Please sit with
arms folded for 2 minutes
( ) 4 able to sit safely and securely for 2 minutes
( ) 3 able to sit 2 minutes under supervision
( ) 2 able to able to sit 30 seconds
( ) 1 able to sit 10 seconds
( ) 0 unable to sit without support

Perform the BERG Balance Scale: STANDING TO SITTING

INSTRUCTIONS: Please sit down.
( ) 4 sits safely with minimal use of hands
( ) 3 controls descent by using hands
( ) 2 uses back of legs against chair to control descent
( ) 1 sits independently but has uncontrolled descent
( ) 0 needs assist to sit

Perform the BERG Balance Scale: TRANSFERS

INSTRUCTIONS: Arrange chair(s) for pivot transfer. Ask subject to transfer one way toward a seat with armrests and one way toward a seat without armrests. You may use two chairs (one with and one without armrests) or a bed and a chair.
( ) 4 able to trans

Perform the BERG Balance Scale: STANDING UNSUPPORTED WITH EYES CLOSED

Make sure their back is towards a wall
INSTRUCTIONS: Please close your eyes and stand still for
10 seconds
( ) 4 able to stand 10 seconds safely
( ) 3 able to stand 10 seconds with supervision
( ) 2 able to stand 3 seconds
( ) 1 unable to keep eyes closed

Perform the BERG Balance Scale: STANDING UNSUPPORTED WITH FEET TOGETHER

Make sure their back is towards a wall
INSTRUCTIONS: Place your feet together and stand without holding on.
( ) 4 able to place feet together independently and stand
1 minute
safely
( ) 3 able to place feet together independently and stand 1 minute with s

Perform the BERG Balance Scale: REACHING FORWARD WITH OUTSTRETCHED ARM WHILE STANDING

INSTRUCTIONS: Lift arm to 90 degrees. Stretch out your fingers and reach forward as far as you can. (Examiner places a ruler at the end of fingertips when arm is at 90 degrees. Fingers should not touch the ruler while reaching forward. The recorded measur

Perform the BERG Balance Scale: PICK UP OBJECT FROM THE FLOOR FROM A STANDING POSITION

INSTRUCTIONS: Pick up the shoe/slipper, which is in front of your feet.
( ) 4 able to pick up slipper safely and easily
( ) 3 able to pick up slipper but needs supervision
( ) 2 unable to pick up but reaches 2-5 cm(1-2 inches) from slipper and keeps balan

Perform the BERG Balance Scale: TURNING TO LOOK BEHIND OVER LEFT AND RIGHT SHOULDERS WHILE STANDING

INSTRUCTIONS: Turn to look directly behind you over toward the left shoulder. Repeat to the right. (Examiner may pick an object to look at directly behind the subject to encourage a better twist turn.)
( ) 4 looks behind from both sides and weight shifts

Perform the BERG Balance Scale: TURN 360 DEGREES

INSTRUCTIONS: Turn completely around in a full circle. Pause. Then turn a full circle in the other direction.
( ) 4 able to turn 360 degrees safely in
4 seconds or less
( ) 3 able to turn 360 degrees safely one side only 4 seconds or less
( ) 2 able to tu

Perform the BERG Balance Scale: PLACE ALTERNATE FOOT ON STEP OR STOOL WHILE STANDING UNSUPPORTED

INSTRUCTIONS: Place each foot alternately on the step/stool. Continue until each foot has touched the step/stool
four times
.
( ) 4 able to stand independently and safely and complete
8 steps in 20 seconds
( ) 3 able to stand independently and complete 8

Perform the BERG Balance Scale: STANDING UNSUPPORTED ONE FOOT IN FRONT

Make sure their back is towards a wall
INSTRUCTIONS: (DEMONSTRATE TO SUBJECT) Place one foot directly in front of the other. If you feel that you cannot place your foot directly in front, try to step far enough ahead that the heel of your forward foot is

Perform the BERG Balance Scale: STANDING ON ONE LEG

Make sure their back is towards a wall
INSTRUCTIONS: Stand on one leg as long as you can without holding on.
( ) 4 able to lift leg independently and hold > 10 seconds
( ) 3 able to lift leg independently and hold 5-10 seconds
( ) 2 able to lift leg indep

How would you categorize a patient's fall risk if they scored between 41-56 on the Berg Balance Scale?

Low fall risk

How would you categorize a patient's fall risk if they scored between 21-40 on the Berg Balance Scale?

Medium fall risk

How would you categorize a patient's fall risk if they scored between 0-20 on the Berg Balance Scale?

High fall risk

Perform a FAB scale for:
Stand with feet together and eyes closed

With your arms over your chest, I want you to stand with your feet together and close your eyes. After 30 sec has passed, "Open your eyes & bring your feet over"
( ) 0 Unable to obtain the correct standing position independently
( ) 1 Able to obtain the c

Perform a FAB scale for:
Reach forward to retrieve an object (pencil) held at shoulder height with outstretched arm

The pencil should be held
10" away
from the tip of their fingers
( ) 0 Unable to reach the pencil without taking more than two steps
( ) 1 Able to reach the pencil but needs to take two steps
( ) 2 Able to reach the pencil but needs to take one step
( ) 3

Perform a FAB scale for:
Turn 360 degrees in right and left directions

When demonstrating, make sure to show them in
4 steps or less
( ) 0 Needs manual assistance while turning
( ) 1 Needs close supervision or verbal cueing while turning
( ) 2 Able to turn 360 degrees but takes more than four steps in both directions
( ) 3 A

Perform a FAB scale for:
Step up onto and over a 6-inch bench

They need to be able to swing their opposite leg up and over the box
( ) 0 Unable to step up onto the bench without loss of balance or manual assistance
( ) 1 Able to step up onto the bench with leading leg, but trailing leg contacts the bench or leg swin

Perform a FAB scale for:
Tandem walk

Their heels should be directly in contact with their other toes & they should not step away from the line
( ) 0 Unable to complete 10 steps independently
( ) 1 Able to complete the 10 steps with more than five interruptions
( ) 2 Able to complete the 10 s

Perform a FAB scale for:
Stand on one leg

Their arms should be
folded across their chest
( ) 0 Unable to try or needs assistance to prevent falling
( ) 1 Able to lift leg independently but unable to maintain position for more than 5 seconds
( ) 2 Able to lift leg independently and maintain positi

Perform a FAB scale for:
Stand on foam with eyes closed

Their feet should be
hip width apart, arms across their chest
and make sure to assist them while getting on and off the foam
( ) 0 Unable to step onto foam or maintain standing position independently with eyes open
( ) 1 Able to step onto foam independent

Perform a FAB scale for:
Two-footed jump

Measure the length of their feet first (you wouldn't normally do this on pts with DJD or OA)
( ) 0 Unwilling or unable to attempt or attempts to initiate two-footed jump, but one or both feet do not leave the floor
( ) 1 Able to initiate two-footed jump,

Perform a FAB scale for:
Walk with head turns

Clap a beat for them to turn their head too
( ) 0 Unable to walk 10 steps independently while maintaining 30o head turns at an established pace
( ) 1 Able to walk 10 steps independently but unable to complete required number of 30o head turns at an establ

Perform a FAB scale for:
Reactive postural control

Don't tell them what you are doing. Now I want you to "Push back into my hand until I tell you to stop" then remove your hand. Make sure you are capable of catching the patient.
( ) 0 Unable to maintain upright balance; no observable attempt to step; requ

Perform the Modified CTSIB for Condition
One

Standing with your
feet shoulder width apart
, I want you to
stand on the ground with your eyes open
and time it. Do 3x 30 second trials
All sensory systems (i.e., vision, somatosensory, and vestibular) are available for maintaining balance

Perform the Modified CTSIB for Condition
Two

Standing with your feet shoulder width apart, I want you to
stand on the ground with your eyes closed
and time it. Do 3x 30 second trials
Vision has been removed and the older adult must rely on the somatosensory and vestibular systems to balance

Perform the Modified CTSIB for Condition
Three

Standing with your feet shoulder width apart, I want you to stand on this
foam surface with your eyes open
and time it. Do 3x 30 second trials
The somatosensory system has been compromised and the older adults must use vision and the vestibular system to

Perform the Modified CTSIB for Condition
Four

Standing with your feet shoulder width apart, I want you to stand on this
foam surface with your eyes closed
and time it. Do 3x 30 second trials
Vision has been removed and the somatosensory system has been compromised. The older adults must now rely prim

Perform the MDR (multidirectional reach) for the
Forward
Direction

The ruler should be shoulder height & measure with the palm closest to wall should be facing outward. Finger tips should be at edge of the ruler.
I want you to reach as far forward as you safely can before you feel like you are going to fall or your feet

Perform the MDR (multidirectional reach) for the
Backward
Direction

The ruler should be shoulder height & measure with the palm closest to wall should be facing outward. Finger tips should be at edge of the ruler.
I want you to reach as far backward as you safely can before you feel like you are going to fall or your feet

Perform the MDR (multidirectional reach) for the
Right lateral
Direction

The ruler should be shoulder height & measure with the palms facing outward. Finger tips should be at edge of the ruler.
I want you to reach as far over to the right as you safely can before you feel like you are going to fall or your feet lift off the gr

Perform the MDR (multidirectional reach) for the
Left lateral
Direction

The ruler should be shoulder height & measure with the palms facing outward. Finger tips should be at edge of the ruler.
I want you to reach as far over to the left as you safely can before you feel like you are going to fall or your feet lift off the gro

Perform the Seated COG-Anticipatory and Reactive Postural Control

- Ball is held for pt while getting on & off
- Chair is place within arms reach
- Student guards pt with both arms
o Patient told to sit tall/good posture
o Hands on lap or hips to start
o Patient told to breath normal
o Patient told to sit with feet hip

Perform Seated COG-Arm Movements

- Ball is held for pt while getting on & off
- Chair is place within arms reach
- Student guards pt with both arms
o Patient told to sit tall/good posture
o Hands on lap or hips to start
o Patient told to breath normal
o Patient told to sit with feet hip

Perform Seated COG-heel lifts/toe lifts

- Ball is held for pt while getting on & off
- Chair is place within arms reach
- Student guards pt with both arms
o Patient told to sit tall/good posture
o Hands on lap or hips to start
o Patient told to breath normal
o Patient told to sit with feet hip

Perform Seated COG-dynamic weight shifts

- Ball is held for pt while getting on & off
- Chair is place within arms reach
- Student guards pt with both arms
o Patient told to sit tall/good posture
o Hands on lap or hips to start
o Patient told to breath normal
o Patient told to sit with feet hip

Perform Seated COG-knee lifts (marching)

- Ball is held for pt while getting on & off
- Chair is place within arms reach
- Student guards pt with both arms
o Patient told to sit tall/good posture
o Hands on lap or hips to start
o Patient told to breath normal
o Patient told to sit with feet hip

Perform Seated COG-SLR

- Ball is held for pt while getting on & off
- Chair is place within arms reach
- Student guards pt with both arms
o Patient told to sit tall/good posture
o Hands on lap or hips to start
o Patient told to breath normal
o Patient told to sit with feet hip

Perform Standing COG - altered basses of support Rhomberg, semitandem, tandem and single leg

o Patient told to stand near wall or place step by wall for safety
o Student guards patient with both arms
o Patient told to stand tall/good posture
o Patient told to breath normal
o Patient told to stare at a point in front of them (except for step)
o St

Perform Standing COG - Multidirectional Weight shifts with 4 corner stepping

o Patient told to stand near wall or place step by wall for safety
o Student guards patient with both arms
o Patient told to stand tall/good posture
o Patient told to breath normal
o Patient told to stare at a point in front of them (except for step)
o St

Perform Weight shifts and transfers against gravity utilizing a box -
forward direction

o Patient told to stand near wall or place step by wall for safety
o Student guards patient with both arms
o Patient told to stand tall/good posture
o Patient told to breath normal
o Patient told to stare at a point in front of them (except for step)
o St

Perform Weight shifts and transfers against gravity utilizing a box - lateral direction

o Patient told to stand near wall or place step by wall for safety
o Student guards patient with both arms
o Patient told to stand tall/good posture
o Patient told to breath normal
o Patient told to stare at a point in front of them (except for step)
o St

Perform Standing COG-ankle strategy

o Patient told to stand near wall or place step by wall for safety
o Student guards patient with both arms
o Patient told to stand tall/good posture
o Patient told to breath normal
o Patient told to stare at a point in front of them (except for step)
o St

Perform Standing COG-step strategy

o Patient told to stand near wall or place step by wall for safety
o Student guards patient with both arms
o Patient told to stand tall/good posture
o Patient told to breath normal
o Patient told to stare at a point in front of them (except for step)
o St

Instruct the patient how to do Self Mobilization to increase
external rotation

Pt sits w/ bad arm resting on table, shoulder in
scaption
, elbow bent 90 degrees,
palm down
� Pt bends forward at waist

Instruct the patient how to do Self Mobilization to increase
forward flexion
of the shoulder

Pt faces table with arm resting on table edge, and elbow slightly flexed. Can put towel under arm to help arm slide.
� Have the patient slide the forearm forward along the table while bending from the waist

Instruct the patient how to do Wand exercises (AAROM) for Forward Flexion

� Pt supine holding cane/wand/ T-bar
� Pt uses good arm to move cane
� Perform FF-w/ hands
palm down lift
t* arms overhead

Instruct the patient how to do Wand exercises (AAROM) for Abduction

� Pt supine holding cane/wand/ T-bar
� Pt uses good arm to move cane
� Perform Abduction-w/ bad arm in
ER, thumb up, elbow straight
t*, push cane toward bad side w/ arms in path of scaption

Instruct the patient how to do Wand exercises (AAROM) for External Rotation

� Pt supine holding cane/wand/ T-bar
� Pt uses good arm to move cane
� Perform ER-w/ arm by side, bad arm
flexed 90 degrees at elbow, thumb up
p*, push cane toward bad arm

Have your patient perform a joint mobilization to increase elbow extension to emphasize the
brachialis muscle

� Pt supine, shoulder on table, w/ elbow hanging off table and elbow straight (can place towel under distal humerous as fulcrum)
� Pt supports anterior shoulder w/ opposite hand

Palm up
p*- brachialis
� Progress to adding small arm cuff weight

Have your patient perform a joint mobilization to increase elbow extension to emphasize the
biceps muscle

� Pt supine, shoulder on table, w/ elbow hanging off table and elbow straight (can place towel under distal humerous as fulcrum)
� Pt supports anterior shoulder w/ opposite hand

Palm down
n*- biceps
� Progress to adding small arm cuff weight

Have your patient perform a joint mobilization to increase elbow extension to emphasize the
brachioradialis muscle

� Pt supine, shoulder on table, w/ elbow hanging off table and elbow straight (can place towel under distal humerous as fulcrum)
� Pt supports anterior shoulder w/ opposite hand

Thumb up
p*-brachioradialis
� Progress to adding small arm cuff weight

Have your patient perform a joint mobilization to increase knee extension ROM utilizing
prone hangs

� Patient prone w/ feet off edge of table
� Place a rolled up towel under lower thigh
� Add ankle weight to progress

Have your patient perform a joint mobilization to increase knee extension ROM utilizing
supine heel prop

� Patient supine, one leg straight &
one leg bent
� Place a rolled towel under ankle to raise calf off table
� Add weight to lower thigh to progress

Have your patient perform a joint mobilization to increase knee flexion ROM utilizing
heel slides

� Patient supine or seated
� start AAROM (dr assisted) dr hand under knee and one hand on heel
o then have patient do AROM,
� performed best with sock on or using a towel under heel

Have your patient perform a quad set

� Patient supine w/ leg extended & other leg is bent
� Patient tightens/contracts thigh muscle to lift patella up and hold for
6-10 seconds
s* (try to eliminate joint movement)
� Patient can add tactile cueing to assist activation if needed

Have your patient perform a Hamstring sets/Heel digs

� Pt supine w/ knee in about 20-45 degrees of flexion (w/ towel rolled up under knee to support knee if performing at lower angle)
� Patient gently pushes heel into table
� Hold for
6-10 seconds
You can increase the angle to progress but you want to keep

Have your patient perform SLR

� Patient supine w/ leg extended
� Patient tightens/contracts thigh muscle to lift patella up and hold for 6-10 seconds (try to eliminate joint movement)
� Patient can add tactile cueing to assist activation if needed
� Pt performs quad set as above , oth