Clinical Reasoning Assignment

Outcome Measures & Tests/Measures

Berg Balance Scale (BBS)

What it measures: 14 functional balance tasks (0-56 scale)

Standard Cutoff / Norm: < 45/56 indicates high fall risk

Primary Problem: Fall risk / Static & Dynamic Balance
“I would use the BBS because it measures 14 functional balance tasks (on a 0-56 scale), which could help determines the patient’s static & dynamic balance and if they are at fall risk (<45/56 indicates high fall risk)

Timed Up and Go (TUG)

What it measures: Time to stand, walk 3m, turn, and sit

Standard Cutoff / Norm: > 12-13.5 seconds indicates fall risk

Primary Problem: Basic Mobility & Fall Risk

2-Minute Walk Test (2MWT)

What it measures: Total distance walked in 2 minutes

Standard Cutoff / Norm: Distance compared to age/gender norms (ideal for low-tolerance acute cases like CHF)

Primary Problem: Aerobic Endurance / Low Tolerance

10-Meter Walk Test (10MWT)

What it measures: Walking speed (m/s) over 10 meters

Standard Cutoff / Norm:

• < 0.4 m/s = household ambulator

• 0.4 - 0.8 m/s = limited community

• > 0.8 m/s = community ambulator

Primary Problem: Gait Speed / Community Mobility

"I would use the 10-Meter Walk Test because it measures comfortable gait speed (in meters per second) and helps determine whether the patient is a household ambulator (less than 0.4 m/s), limited community ambulator (0.4 to 0.8 m/s), or full community ambulator (greater than 0.8 m/s)."

Dynamic Gait Index (DGI)

What it measures: 8 gait adaptation tasks (0-24 scale)

Standard Cutoff / Norm: ≤ 19/24 indicates increased fall risk

Primary Problem: Dynamic Gait & Head Turns

"I would use the Dynamic Gait Index (DGI) because it measures gait adaptability across 8 functional tasks on a 0 to 24 scale, which helps determine dynamic balance and fall risk using the established cutoff score of less than or equal to 19 out of 24."

Activity Measure for Post-Acute Care (AM-PAC) “Six Clicks”

What it measures: patient's capacity and level of physical assistance required to execute 6 core mobility tasks in acute/post-acute care settings

Standard Cutoff / Norm:

• Higher Scores: Higher likelihood of direct discharge home.

• Lower Scores: Higher likelihood of discharge to an institutional/facility setting requiring greater support

Primary Problem: Discharge planning / General Mobility & Function
“I would use the AM-PAC 6 Clicks because it measures how much assistance he needs with basic mobility including bed mobility and transfers, which is where he currently functions, and it helps determine whether he can return to living alone.”

Francis Example for AM-PAC “Six Clicks”

I would use the AM-PAC 6 Clicks because it measures how much assistance he needs with basic mobility including bed mobility and transfers, which is where he currently functions, and it helps determine whether he can return to living alone.

Performance Oriented Mobility Assessment (Tinetti POMA)

What it measures: Screening balance and fall risk in older adults with general medical debility.

7-Question Order

Chart —> Screen —> Outcome —> Test —> Treat —> Home —> Team

Chart

Find 5 relevant pieces of info

“___ is relevant because it affects ___”

Example: “The patient is WBAT after surgery. This is relevant because it determines how much weight they can put through the involved leg during transfers and gait.”

Screen

Pick a system to screen

Answer formula: “I would screen the _____ system because the patient has _____, which could affect _____.”

Outcome

Choose an outcome measure

Answer formula: “I would use the _____ because it measures _____ and helps determine _____.”

Test

Choose a specific test or measure

Answer formula: “I would assess [test/measure] because [impairment] could affect the patient’s ability to _____.”

Possible tests/measures for these impairments

• Weakness

• Limited motion

• Neuropathy / sensory loss

• Edema

• Shortness of breath

• Poor balance

• Coordination problem

• Pain

• Skin concern

• Weakness —> MMT

• Limited motion —> ROM

• Neuropathy / sensory loss —> Sensation Testing

• Edema —> Pitting edema assessment

• Shortness of breath —> Dyspnea scale / SpO₂ response as appropriate

• Poor balance —> static or dynamic balance testing

• Coordination problem —> finger-to-nose or heel-to-shin

• Pain —> pain rating / symptom assessment

• Skin concern —> skin or wound inspection

Treat

Pick one intervention and explain why

Answer formula: “I would perform _____ because the patient demonstrates _____. I could progress it by _____ or regress it by _____.”

Pick an intervention for these functional limitations

• cannot walk well

• difficulty standing

• weakness

• poor balance

• difficulty transferring

• low endurance

• cannot walk well —> gait / ambulation training

• difficulty standing —> sit-to-stand practice

• weakness —> strengthening

• poor balance —> balance activites

• difficulty transferring —> transfer training

• low endurance —> graded mobility with rest breaks

Progress vs Regress

Progress it: longer distance, less assistance, less AD, more resistance/reps, more cognitive challenge, more eccentric control.

Regress it: shorter distance, more assistance/AD, decreased ROM/resistance/reps, longer rest breaks.

Home

What do you need to know for discharge?

Answer formula: "Knowing that [Home Setup / Social Support Detail] is important for discharge because it [How it impacts safety / fall risk / caregiver burden] and allows us to [Treatment plan focus / Discharge equipment or assistance needed]."

Team

Choose 2 interdisciplinary team members

Answer formula: “I would involve _____ because _____.”

What problem do these team members focus on and why?

• Physician

• Nurse

• Pharmacist

• Social Worker

• OT

• SLP

• Dietitian

• Case Manager

Reference the study guide