PT7522- Outcome Measures and Sensory Testing

6 minute walk test

Measures walking endurance and aerobic capacity.

Cardiovascular patient, higher level function, community ambulators /c complaints of fatigue and feeling tired, patient who voices concern about endurance

What is patient population for 6 minute walk test?

50 m

MDC/MCID for 6 minute walk test?

10 meter walk test

Measures gait speed.

Patient trying to get back to community ambulation, neuro patient, ortho patient /c arthritis or WB restrictions that restrict gait speed

Can be used /c anyone to see what kind of functional ambulator they are → Helps make decisions about the type of education you provide and discharge destination

Patient population for 10 meter walk test?

0.16 m/s

MDC/MCID 10 meter walk test in stroke population?

Reg: 0.15 m/s

Fast: 0.25 m/s

MDC/MCID for 10 meter walk test in TBI population?

<0.4 m/s; 0.4-0.8 m/s; 0.8-1.2 m/s; >1.2 m/s

Cut-off values/normal data for 10 meter walk test in stroke population (can technically also be applied to TBI):

- Non-functional: _____________________

- Household amb: _____________________

- Limited community amb: _____________________

- Safe to cross street: _____________________

Berg Balance Scale (BBS)

Measures static/dynamic standing balance.

Neuro patient, lower level function, patient who voices concern about fall risk, patient who recently experienced a fall, patient who voices concern about balance, patient who voices concern about transfer skills

Patient population for Berg Balance Scale (BBS)?

4 points

MDC/MCID for Berg Balance Scale (BBS)?

<45

What score on Berg Balance Scale (BBS) is fall risk?

0-20; 21-40; 41-56

Berg Balance Scale (BBS) Scoring:

- Wheelchair bound: _______________________

- Walk /c assistance: _______________________

- Independent amb: _______________________

Functional Gait Assessment (FGA)

Measures fall risk/postural stability while ambulating.

Higher level function, patient who wants to get back to community ambulation, patient who wants to get back to functional household ambulation (i.e., stairs, turning backwards)

Patient population for Functional Gait Assessment (FGA)?

5 points

MDC/MCID for Functional Gait Assessment (FGA)?

≤22

What score on Functional Gait Assessment (FGA) is fall risk?

Activities Balance Confidence Scale (ABC)

Measures balance via self-report.

Patients /c balance impairment, patient who voices concern about fall risk, patients who recently experienced a fall

Patient population for Activities Balance Confidence Scale (ABC)?

11-13%

MDC/MCID for Activities Balance Confidence Scale (ABC)?

<81%

What score on Activities Balance Confidence Scale (ABC) is fall risk?

5x STS

Measures functional LE strength.

Ortho patients (especially post-op), patients /c complaints of LE weakness and fatigue, patient who voices concernes about transfer skills

Patient population for 5x STS?

>12 s

What score on 5x STS is fall risk (for younger individuals)?

Postural Assessment Scale for Stroke (PASS), Trunk Impairment Scale, Modified Ashworth Scale (MAS)

Which outcome measures are stroke-specific?

Postural Assessment Scale for Stroke (PASS)

Measures postural stability and ability to change posture (bed mobility, transfers, reaching).

Patients after stroke (best 3-6 months after CVA), higher level function (since test requires patient to change positions several times)

Patient population for Postural Assessment Scale for Stroke (PASS)?

>12.5 points

What cut off score on Postural Assessment Scale for Stroke (PASS) is predictive of ambulation at discharge?

Trunk Impairment Scale

Measures static/dynamic sitting balance and coordination.

Patient must be hemiparetic, lower level function, non-ambulatory patients, patients /c seated postural instability

Patient population for Trunk Impairment Scale?

0

If the patient scores a 0 on first item on Trunk Impairment Scale, then what is the score on the whole test?

Modified Ashworth Scale (MAS)

Measures changes in muscle tone.

Any patient /c spasticity (must perform test at high speed)

Patient population of Modified Ashworth Scale (MAS)?

Agitated Behavioral Scale, High Level Mobility Tool (HiMAT), Community Balance and Mobility Scale

Which outcome measures are TBI-specific?

Agitated Behavioral Scale

Measures behavioral aspects of agitation (i.e., disinhibition, ability to pay attention).

Early stage TBIs, any patient exhibiting agitation, any patient exhibiting personality changes

Patient population for Agitated Behavioral Scale?

≤21, 22-28, 29-35, >35

Agitated Behavioral Scale Scoring:

- WNL: _____________________

- Mild: _____________________

- Moderate: _____________________

- Severe: _____________________

High Level Mobility Tool (HiMAT)

High level motor performance (i.e., walking, walking backwards, running, skipping, hopping, bounding, stairs).

Must be able to ambulate for 20 meters without AD, higher level function /c TBI (i.e., athlete who suffered brain injury)

Patient population for High Level Mobility Tool (HiMAT)?

4 points

MDC/MCID for High Level Mobility Tool (HiMAT)?

Community Balance and Mobility Scale

High level motor performance (i.e., SLS, tandem walking, tandem pivot, lateral foot scooting, hopping, crouch and walking, running /c controlled stop, stairs, etc.).

Used to predict ambulation at discharge.

Higher level function, can use cane, patient who wants to get back to community ambulation but is unsteady

Patient population for Community Balance and Mobility Scale?

9 points

MDC/MCID for Community Balance and Mobility Scale?

Sensory detection

- Can you feel this?

- Determines minimal amount of sensory input the patient can feel

- Assesses the integrity of the receptors, peripheral nerve, and spinal pathways

Sensory discrimination

- Can you tell where this is?

- Better for populations /c brain injuries → Prevents bad movement patterns and future injuries

- How sensitive is that system? → You can gauge if a patient is getting better if you touch them and they can feel it /c monofilament and/or lighter pressure than previous trials

Passive sensory discrimination

Patient has eyes closed and is asked about sensory input.

Active sensory discrimination

Patient is actively seeking sensory stimulus and uses movement to find it.

Peripheral tests

Evaluates detection /c light touch, light touch threshold (monofilament), vibration, and temperature.

Light touch

- Use a cotton swab, tissue, or finger

- Can test B or U/L

Light touch threshold

- Done /c 5.07 monofilament → for feet

- Important to note where calluses are

- Want filament to bend slightly!

- Put on spots of foot and see if patient is able to detect pressure

- Want ~5 trials at each side, but 2-3 trials is adequate if pressed for time

- Used commonly for diabetic neuropathy → Patient reports changes in sensations (i.e., numbness & tingling) that are progressing. This is not indicative of TBI or stroke!

Vibration

- Tuning fork

- Put on bony prominences /c vibration and ask if they feel it

Temperature

- Typically, we are short on time in clinic so you ask patient if they have any difficulty feeling hot vs. cold

- Can use ice cup and hot pack if you want to test

Central tests

Evaluates discrimination.

Light touch

- Ask patient if they feel it

- Then ask where they feel it → Ask patient to point to area

Sharp vs. dull

- Take paper clip and unravel it → Use pointy end as sharp and round end as dull

- Ask the patient “Is this sharp or dull?”

- Test unaffected limb first! → Make sure they can tell the difference

- Pressure should be enough to blanche skin

- Start /c thigh and work down

- Ensure patient’s eyes are closed!

- Tell patient to check for skin breakdown, wounds, and cuts

- To document, use percentage (i.e., 90%) or EMR will give options for intact, impaired, absent

Two-point discrimination

- Most useful for determining hand function → It tests the ability of 2 pieces of info to be processed at the same time

- Perform on thumb, index finger, and pinky

- Show patient what two-points feels like vs. one-point

- Use a caliper → Start at 10 mm on unaffected side and have patient close eyes

- Patient should be able to tell two-points vs. one-point contact and anywhere from 3-5 mm difference

- Slowly bring caliper ends closer together/in

- Must get 80% accuracy or 5 correct responses in a row

Proprioception Test 1: Direction?

- Perform /c shoe off or can do without sock → Try to have patient don and doff own shoe and sock

- Perform on ankle or big toe

- Grab on sides of foot! Not on dorsum or plantar surface

- Check ROM as you perform

- Have patient close eyes and tell them you are going to move their foot up and down

- Move foot in different directions and ask patient to answer “Up or down?” → Repeat multiple times

- Documentation: Intact, impaired, or absent (or percentage)

- Could also have patient report while actively moving foot through ROM

Proprioception Test 2: Match It

- Perform /c shoe off or can do without sock → Try to have patient don and doff own shoe and sock

- - Perform on ankle or big toe

- Grab on sides of foot! Not on dorsum or plantar surface

- Check ROM as you perform

- Have patient close eyes and tell them you are going to move their foot in different directions

- Instruct patient to match the same position /c unaffected foot (i.e., put L ankle in dorsiflexion, instruct patient to match /c R foot)

Proprioception Test 3: Find Your Thumb

- Patient closes eyes

- PT moves patient’s arm in space and directs patient to grab (find) thumb /c other arm /c eyes still closed

Proprioception Test 4: Bilateral Simultaneous Stimulation Extinction Test (Double Simultaneous Stimulation)

- Can either do to LE or UE

- Make sure patient knows L from R!

- Used for attentional neglect/inattention

- Before the test, make sure the patient has the ability to perceive light touch

- Perform light touch at same time on both extremities then one at a time – keep mixing it up!

- (+) if patient is able to feel you touch each side separately, but then only feels you touch the unaffected limb when you are touching B (at same time)

Graphesthesia

- Take patient's hand and write letters or shapes → See if they can denote it

- Make sure patient knows shapes and alphabet

Object discrimination/property matching

- Have objects that are similar but have differences like texture, shape, size, weight, or temp in 2 bags → Make sure it is not too different!

- Easiest: Varying one or two properties at a time (i.e., 2 markers)

- Hardest: Changing multiple properties (i.e., find me not just a coin, but a quarter)

- We want patient to match object properties: Size, shape, texture, weight, surface compliance, temp

- We can distinguish about 1 oz differences in weight

- For someone having difficulty /c sensory → Start easier!

- Patient must have hand function /c grasping and releasing

Object identification (stereognosis)

- Place two objects in box and instruct patient to go find the object

- If they have aphasia, use pics to let them know what you’d like them to grab.

- When testing, acknowledge and observe all mechanics! → Not just neuro and if test is done correct

- Watch shoulder movements, synergy patterns, flaccid, etc. → Can do facilitation of shoulder if needed

- Can be used /c any brain injury patient

Dexterity

- Nine Hole Peg Test: We time them on how many seconds it takes to remove and replace for affected and unaffected. OT use it more often, but we use it as well.

- Better way to test for dexterity: Make it specific! (i.e., Trouble buttoning shirt → Have them button shirt and time it)

- Can be used /c patient who report having trouble picking up objects (like coins), buttoning shirt, putting in earrings