Seyed Kazem Malakouti, MD

Tinetti balance and gait evaluation

Scores: ../28Seyed Kazem Malakouti, MD

Faculty of Iran University of Medical Sciences

Seyed Kazem Malakouti, MD

Score: ../16

• Sit the patient on a hard without arms chair1. Sitting balance (0,1)2. Arising (0,2)3. Attempt to rise (0,2)4. Immediate standing in 5 second (0,2)5. Standing balance (0,2)6. Nudging (0,2)7. Eye closed (0,1)8. Turning 360 degrees (0,2)9. Sitting down (0,2)

Seyed Kazem Malakouti, MD

Gait evaluation: score ../12

1. Initiation of gait (0,1)2. Step length and height (lt foot) (0,2)3. Step length and height (rt foot) (0,2)4. Step symmetry (0,1)5. Step continuity (0,1)6. Path about 3 meters (0,2)7. Trunk (0,2)8. Walking stance (0,1)

Seyed Kazem Malakouti, MD

Comprehensive assessment of fallType Exam Red flag

Vital sign Orthostatic BP > 20 mm gh drops in SBP or > 15 increase in pulse from lying to standing x 3 min

TEMPERATURE Hypothermia and fever

Eye Snellen chart Visual acuity imp.

Visual field exam Visual field imp.

Dix-hallpike manuer Nystagmus

Ear Whisper test Unable to hear whisper

Weber rinnie test Conduction vs neurosensory deficit

Otoscopic exam Cerumen impaction, perforation

Neck Carotid auscultation Bruit

Heart auscultation Arrythmia, murmur

Seyed Kazem Malakouti, MD

Comprehensive assessment of fallType Exam Red flag

Musculoskeletal Observation of leg, hand .. Deformity of joint

Range of motion Limitation and deformity

Neurological Sensory Decrease pinprick vibration

Romberg Instability

MMSE Cog. Imp.

GDS Clinical dep.

Tone Rigidity

strength Muscle weakness

Functional gait Get up and go test (rise from the chair, walk 3 meters forward, turn around walk back to the chair and sit down)

Abnormal = takes > 10 sec. to complete the test

Seyed Kazem Malakouti, MD

balance Side by side stance, narrow stance x 10 seconds

Instability

Semi tandem stance (one foot half in front of other with feet touching) x 10 sec

Instability

Full tandem stance (one foot in front of other ) x 10 sec

Instability

Pull test (Gentle pull back at waist from behind while standing)

Postural Instability

mobility Observation of use of cane, walker, personal assistance , if any

InstabilityAnd inability to use assistive device

Presence of restraints if any

Limitation of morbidity

Footwear evaluation Unfit shoes

Seyed Kazem Malakouti, MD

Seyed Kazem Malakouti, MD

Fall due to drug side effectsMedication Side effects to cause fallingAntidep. Cafferine, neuroleptic, stimulants

Agitation

Antiarrthmics ArrhythmiaBDZ, narcotic, anticholinergic

Cog. Imp.

Anticonvulsant Dizziness, orthostatic hypo.Antidep. Neuroleptic

Gait dis. extrapyramidal

Diuretics Urinary incontinenceAnticonvul. BDZ, neurolepic

Postural dis. Balance

Betablocker, nitrate, vasodilator

Syncope

Neuroepic, anticholinegic

Visual dis.