Examination and Treatment of Postural and Locomotor Control

Size: px
Start display at page:

Download "Examination and Treatment of Postural and Locomotor Control"

Transcription

1 Examination and Treatment of Postural and Locomotor Control Not to be copied without permission. 1

2 15-minute Bedside Balance Systems Tests Contents FIVE TIMES SIT TO STAND TEST... 3 SINGLE LEG STANCE... 4 ROMBERG AND TANDEM ROMBERG... 4 IN PLACE RESPONSES... 5 COMPENSATORY STEPPING... 6 FUNCTIONAL REACH TEST... 7 MODIFIED CLINICAL TEST OF SENSORY INTERACTION IN BALANCE... 8 FOUR SQUARE STEP TEST TIMED UP AND GO TEST DYNAMIC GAIT INDEX ITEM DYNAMIC GAIT INDEX FUNCTIONAL GAIT ASSESSMENT METER WALK TEST Not to be copied without permission. 2

3 FIVE TIMES SIT TO STAND TEST Cauka & McCarty (1985) Purpose: Measures functional LE strength and provides information about postural control during transitions to/from standing. Original Population: Older adults Special Populations: Vestibular disorders, stroke, arthritis, and renal failure WHO ICF Components: Activity Limitation Time to Complete: < 5 minutes Equipment Needed: Stopwatch and chair (43.5cm) Patient Instructions: Start with your back against the backrest, arms folded, and both feet flat on the floor. Stand [all the way] up and sit back down 5 times as quickly and as safely as possible when I say, Go! Your arms should remain folded at all times. Your back should not touch the backrest of the chair between repetitions. Therapist Considerations: Whitney et al. (2005) 1) Chair height = 43 cm height and 47.5 cm depth 2) The chair should not be secured against a support (wall) 3) Allow one full practice test before recording the official trial 4) For patients who may fatigue, demonstrate the task and ask for two repetitions of practice before recording 5) Inability to complete any repetition as directed indicates a failed test 6) Start timing on Go! and stop when buttocks touches the chair after the fifth attempt 7) Avoid talking to patients during testing as this may affect speed 8) Switch to the 30-second Chair Stand Test for patients who need to use upper extremity assistance to stand Not to be copied without permission. 3

4 SINGLE LEG STANCE Whitney (1999) Therapist Considerations: 1. Difficult test for older adults to perform 2. Requires significant lower extremity strength 3. Criteria for stopping test need to be established and followed consistently by all clinic staff 4. Right and left timed scores are usually very consistent in normal individuals 5. Though often timed for 30 seconds, this is an artificial ceiling for young adults 6. Foot, head, and eye position is important, both initially and during the test 7. Ideally the test is performed with shoes off about 3 from any wall Patient Instructions: (Eyes Open) Stand on one leg, place your arms across your chest with your hands touching your shoulders and do not let your legs touch each other. Look straight ahead at the object in front of you. Criteria for Stopping the Test Legs touch each other, Stance foot moves on the floor, Raised foot touches down, Arms moved from the start position Patient Instructions: (Eyes Closed) Stand on one leg, place your arms across your chest with your hands touching your shoulders and do not let your legs touch each other. Close your eyes once you have gotten in position. Criteria for Stopping the Test Legs touch each other, Stance foot moves on the floor, Raised foot touches down, Arms moved from the start position, Eyes open during the test ROMBERG AND TANDEM ROMBERG Whitney (1999) Patient Instructions: (Eyes Open) Stand with both ankle bones and big toes touching each other (one foot directly in front of the other-sharpened Romberg) with your arms crossed and your hands touching the opposite shoulder. Look straight ahead. Try to hold this position for 30 seconds. Criteria for Stopping the Test Feet are moved on the floor or arms are moved from the crossed position Patient Instructions: (Eyes Closed) Stand with both ankle bones and big toes touching each other (one foot directly in front of the other-sharpened Romberg) with your arms crossed and your hands touching the opposite shoulder. Close your eyes once you have achieved this position. Hold for 30 seconds. Criteria for Stopping the Test Feet are moved on the floor, arms are moved from the crossed position, eyes open during test Not to be copied without permission. 4

5 IN PLACE RESPONSES Horak, from the BESTest 10. IN PLACE RESPONSE - FORWARD Patient: Stand in your normal posture with your feet shoulder width apart, arms at your sides and resist my push. Try to keep your balance without taking a step, but step if you have to. Examiner Instructions: Stand in front of the patient, place one hand on each shoulder and lightly push the patient backward until their anterior ankle muscles contract, then suddenly release. You may score only the second trial (best response) if the patient is unprepared or you pushed too hard. (1) Recovers stability with ankles, no added arms or hips motion (2) Recovers stability with arm or hip motion (0) Takes a step to recover stability (0) Would fall if not caught OR requires assist OR will not attempt 11. IN PLACE RESPONSE - BACKWARD Patient: Stand with your feet shoulder width apart, arms at your sides and resist my push. Try to keep your balance without taking a step. Examiner Instructions: Stand behind the patient, place one hand on each shoulder and isometrically hold against the patient s backward lean until their posterior ankle muscles contract, then suddenly release. You may score only second trial (best response) if patient is unprepared or you push too hard. (3) Recovers stability with ankles, no added arms or hips (1) Recovers stability with arms or hip motion (1) Takes a step to recover stability (0) Would fall if not caught OR requires assist OR will not attempt Not to be copied without permission. 5

6 COMPENSATORY STEPPING Horak, from the BESTest 12. COMPENSATORY STEPPING CORRECTION- FORWARD Patient: Lean forward to your limits. Stand with your feet shoulder width apart, arms at your sides and resist my push. Try to keep your balance. Do not fall. Examiner Instructions: Stand in front of the patient with one hand on each shoulder and allow them to lean forward to their limits of stability and then resist, pushing backwards until there is tibialis anterior recruitment (enough to cause a step), then suddenly release. (2) Recovers independently with a single, large step (2) Small step or more than one step used but stable and recovers independently (1) Takes sideways steps to recover equilibrium, needs assistance to prevent a fall (0) No steps so would fall if not caught 13. COMPENSATORY STEPPING CORRECTION - BACKWARD Patient: Stand with your feet shoulder width apart, arms at your sides, lean backward to your limits, and resist my push. Try to keep your balance. Do not allow yourself to fall. Examiner Instructions: Stand behind the patient with one hand on each shoulder and allow them to lean backward to their limits of stability and then resist, pushing forwards until there is triceps surae recruitment (enough to cause a step), then suddenly release. (3) Recovers independently with a single, large step (2) More than one step used but stable and recovers independently (1) Takes sideways steps to recover equilibrium, needs assistance (even light touch) to prevent a fall (0) No steps so would fall if not caught 14. COMPENSATORY STEPPING CORRECTION - LATERAL Patient: Stand with your feet close together, arms at your sides, and resist my push. Try to keep your balance. Do not allow yourself to fall. Examiner Instructions: Stand behind the patient, place one hand on the side of each pelvis and allow them to lean into your hand beyond their limits of stability and then suddenly release your hold. Right Left (3) Recovers independently with 1 step of normal length and width (3) (2) Several small steps used, but recovers independently (2) (1) Steps but needs to be assisted to prevent a fall (1) (0) Falls (0) Not to be copied without permission. 6

7 FUNCTIONAL REACH TEST Duncan, et al. (1990) Purpose: Measures unsupported dynamic standing balance impairment in adults Original Population: Community dwelling elderly Special Populations: Vestibular, elderly, PD, Stroke, SCI WHO ICF Components: Activity Limitation Time to Complete: < 5 minutes Equipment Needed: Yardstick Therapist Considerations: 1. Yardstick is mounted on the wall at patient s shoulder height. 2. Starting line is marked so patient s flexed UE enters the first half of the yardstick. 3. May be performed with or without shoes. 4. Patients are allowed to use various reaching techniques, but cannot step. 5. Position patient with the UE closest to the wall in 90 shoulder flexion, hand is fisted. 6. Patient s feet should be shoulder distance apart. 7. Recordings are made where the MCP joint of the third digit is aligned with the ruler. 8. Patient s shoulder should not be protracted. 9. Patient should be standing erect at the start of the test. 10. Patients must be guarded at all times. 11. Patients with certain musculoskeletal problems may have difficulty performing the task. 12. Decrease anxiety by allowing the patient to lightly touch your hand (guide the reach). 13. Perceived limits of stability impact the test Patient Instructions Reach as far as you can without losing your balance. Keep your feet on the floor. You are not allowed to touch the wall or the ruler. You are not allowed to take a step. You are allowed two practice trials before I record how far you can reach. Photograph: Whitney, SL & Herdman, SJ. Ch 15: Physical Therapy Assessment of Vestibular Hypofunction. In: Vestibular Rehabilitation. Ed: Herdman, SJ. FA Davis (2000) Not to be copied without permission. 7

8 MODIFIED CLINICAL TEST OF SENSORY INTERACTION IN BALANCE Adopted from Shumway-Cook & Horak (1986 and 1987) by Cohen & Blatchly (1993) Purpose: Measures the functional use of somatosensory, visual, and vestibular feedback for quasi-static, standing postural control in normal and sensory conflict conditions. Original Population: Adults Special Populations: Vestibular, pediatrics, elderly, stroke, Alzheimer s disease WHO ICF Components: Impairment Time to Complete: < 5 minutes Equipment Needed: Stopwatch and low-memory foam that prevents orientation via the surface Therapist Considerations: 1. The test may be performed with or without shoes without impact in reliability, but should be assessed and documented in a consistent manner across each administration for a given patient 2. Testing the patient with feet together (medial maleoli touching) and arms folded across shoulders increases the correlation with computerized platform posturography 3. Patient should look straight ahead (visual fixation is allowed, but not necessarily encouraged) 4. Test duration is 30 seconds or until patient loses balance. Additional criteria to stop testing: 1. Patient s arms or feet move from starting position 2. Patient opens eyes during condition 2 or 4. Research has shown that neither the position of the feet nor the footwear influence the scores (Whitney and Wrisley 2004, Wrisley and Whitney 2004). Weber and Cass, 1993, used the Sensory Organization Test (SOT) as the gold standard for the mctsib with patients with complaints of dizziness or imbalance. The mctsib condition 4, standing on foam with the eyes closed had a sensitivity of 95%, and a specificity of 90% compared to SOT condition 5. Not to be copied without permission. 8

9 Patient Instructions: For each condition: Stand with your feet touching and arms folded across your shoulders. Try to keep your balance for at least 30 seconds. Whitney, SL & Herdman, SJ. Ch 15: Physical Therapy Assessment of Vestibular Hypofunction. In: Vestibular Rehabilitation. Ed: Herdman, SJ. FA Davis (2000) Condition 1: Normal vision non-compliant surface Condition 2: Absent vision non-compliant surface Condition 3: Normal vision compliant surface (6 Sunmate T-foam) Condition 4: Absent vision compliant surface (6 Sunmate T-foam) Not to be copied without permission. 9

10 FOUR SQUARE STEP TEST Dite & Temple (2002) Purpose: Measures postural stability in multi-directional stepping Original Population: Community-living older adults Special Populations: Vestibular, PD, stroke, transtibial amputations, geriatric WHO ICF Components: Activity Limitation Time to Complete: < 5 minutes Equipment Needed: Stopwatch and four t-handle style canes Patient Instructions: Try to complete the sequence as quickly and as safely as possible without touching the canes. Both feet must make contact with the floor in each square. If possible, face forward during the entire sequence. Therapist Considerations: 1. Four canes are arranged on the floor in the shape of a plus sign. 2. T-handle style cane should be used to limit the chance of the patient rolling over a cane. 3. Each cane should be 90 cm in length. 4. Demonstrate the test first 5. Allow one practice trial and then record the fastest time for the next two trials. 6. Begin timing when the right foot contacts the floor in square Repeat a trial if the patient: falls, loses balance, makes contact with a cane. 8. Patients are encouraged to face forward during the entire test, but timed accordingly if they turn % of participants had unsuccessful trials at least once during testing, Participants found the test more difficult to perform than the Step Test. However, FSST was preferred by participants because they felt it was relevant to daily life and examined challenging skills (Blennerhassett and Jayalath, 2008). The Four Square Step Test may be helpful in identifying individuals (older adults > 65 y/o) with vestibular disorders who have difficulty changing directions (Whitney 2007). Not to be copied without permission. 10

11 Not to be copied without permission. 11

12 TIMED UP AND GO TEST Podsiadlo et al, (1991) Purpose: Measures the dynamic postural control during transitions to/from standing, walking with/without a device, and during turning while walking. Original Population: Neurologically intact adults, independent in balance & mobility skills Special Populations: Numerous! WHO ICF Components: Activity Limitation Time to Complete: < 5 minutes Equipment Needed: Stopwatch, 3m walkway, standard height chair Patient Instructions: When I say go, I want you to stand up and walk just past the line, turn and then walk back to this chair and sit down again. Walk at your normal pace. Additional Modifications: Patient walks at fast pace to show how quickly they can ambulate Patient turns head left, right, up, or down to show if performance changes with head turns TUG Dual-task: interference by having patient perform a secondary task while walking Not to be copied without permission. 12

13 Therapist Considerations: The patient sits in the chair with his/her back against the chair back On the command go, the patient rises from the chair, walks 3 meters at a comfortable and safe pace, turns, walks back to the chair and sits down Timing begins at the instruction go and stops when the patient is seated Scores range from 1 to 5 based on the observer's perception of the patient s risk of falling (Mathias et al, 1986). We typically score based on timing as the 1 to 5 scale introduces greater chance of measurement error. Podsiadlo & Richardson, 1991, quantified the test by recommending timing (sec) the time between the command to start, till the buttocks touch the chair The patient should have one practice trial that is not included in the score (Podsiadlo & Richardson, 1991) Patient must use the same assistive device each time he/she is tested to be able to compare scores In the vestibular population it is suggested to test with both right and left turning (Whitney and Herdman, chapter 19 in Herdman, 2007:pg. 293) The TUG may demonstrate less reliability among patients suffering from cognitive impairment Chairs with armrests and a seating height of cm should be used (Siggeirsdottir et al, 2002) Results suggest using age-related normative data for adults between the ages of 60 and 90 years. (Steffen et al, 2002) Intrarater reliability may be affected by subject performance when completing multiple assessments indicating patients quickly become familiar with this test resulting in the first test affecting the second test (vanhedel et al, 2005). TUG was designed to be tested with people walking at a comfortable speed, yet at times is tested with the walking at a quick yet safe speed. Clinically it is important that the chair is free standing, and not placed against a wall Not to be copied without permission. 13

14 DYNAMIC GAIT INDEX Shumway-Cook (1995) Purpose: Measures the dynamic postural control required for proactive and reactive gait. Original Population: Older adults Special Populations: Vestibular, TBI, stroke, MS, PD, geriatrics WHO ICF Components: Activity Limitation Time to Complete: < 15 minutes Equipment Needed: 20 x16 walkway, shoe box, 2 cones, and standard stairs Therapist Considerations: 1. Test should be performed in a quiet hallway 2. Patient should ambulate between two strips of tape, 15 apart 3. Test with or without shoes 4. Test with or without orthotics 5. Test with or without assistive devices 6. Reading glasses should not be worn during the test 7. Busy environments may increase motion intolerance 8. Record any symptoms the patient experiences during the test Scoring: Indicate the lowest category that applies. Not to be copied without permission. 14

15 1. Gait on level surface Instructions: Walk at your normal speed from here to the next mark (20 ) 3 Normal: Walks 20 without assist. device, good speed, no evidence for imbalance, normal gait pattern 2 Mild Impairment: Walks 20, uses assistive device, 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 assistive device, severe gait deviations or imbalance 2. Gait with changes in speed Instructions: Begin walking at your normal speed. (5 ) When I say go, walk as fast as you can. (5 ) When I say slow walk as slowly as you can. (5 ) 3 Normal: Able to smoothly change walking speed without loss of balance or gait deviations. Shows a significant difference in walking speeds between normal, fast, and slow speed. 2 Mild Impairment: Is able to change speeds, but demonstrates mild gait deviations or shows no gait deviations, but is unable to significantly change velocity, or uses an assistive device. 1 Moderate Impairment: Makes only minor adjustments in walking speed or accomplishes a change in speed with significant gait deviations or changes speed and 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 needs to be caught. 3. Gait with horizontal head turning Instructions: Begin walking at your normal pace. When I tell you 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 full head turns smoothly with no change in gait pattern. 2 Mild Impairment: Performs full head turns smoothly with slight change in gait velocity or pattern, or uses assistive device. 1 Moderate Impairment: Performs head turns with moderate change in gait velocity or pattern, slows down, staggers, but recovers and continues to walk. 0 Severe Impairment: Performs task with severe disruption in gait, staggers outside 15 path; loses balance, stops, reaches for wall, or must be caught. 4. Gait with vertical head turning Instructions: Begin walking at your normal pace. When I tell you to look up, keep walking straight, but turn your head up. Keep looking up until I tell you, look down, then keep walking straight and turn your head down. Keep you head down until I tell you, look straight, then keep walking straight, but return your head to the center. 3 Normal: Performs full head turns smoothly with no change in gait pattern. 2 Mild Impairment: Performs full head turns smoothly with slight change in gait velocity or pattern, or uses assistive device. 1 Moderate Impairment: Performs head turns with moderate change in gait velocity or pattern, slows down, staggers, but recovers and continues to walk. 0 Severe Impairment: Performs task with severe disruption in gait, staggers outside 15 path; loses balance, stops, reaches for wall, or must be caught. Not to be copied without permission. 15

16 5. Gait and pivot turn Instructions: Begin walking at your normal pace. When I tell you, turn and stop, turn as quickly as you can to face the opposite direction and stop. 3 Normal: Pivot turns slowly within 3 seconds and stops quickly with no loss of balance. 2 Mild Impairment: Pivot turns safely in greater than 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 obstacles Instructions: Begin walking at your normal speed. When you come to the obstacle, step over it, not around it, and keep walking. 3 Normal: Is able to step over obstacles without changing speed or evidence of imbalance. 2 Mild Impairment: Able to step over obstacle, but must slow down and adjust steps to clear safely. 1 Moderate Impairment: Able to step over obstacle, but must stop, then step over. May require verbal cues 0 Severe Impairment: Cannot perform without assistance. 7. Step around obstacles Instructions: Begin walking at your normal speed. When you come to the first obstacle (about 6 feet away), walk around the right side of it. When you come to the second obstacle (6 past the first obstacle), walk around it to the left. Obstacles are 4-6 in height and width. 3 Normal: Able to walk around obstacles without changes in speed or gait pattern (continuous steps), no evidence of imbalance. 2 Mild Impairment: Able to step around both obstacles safely, but must slow down slightly, adjust steps to clear obstacles. 1 Moderate Impairment: Able to step around both obstacles, but must slow down significantly or requires verbal cueing. 0 Severe Impairment: Unable to clear obstacles, walks into one or both obstacles, or requires physical assistance. 8. Steps 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: Ascends and descends using alternating stair pattern. Does not use a rail. 2 Mild Impairment: Ascends and descends using alternating stair pattern. Must use a rail. 1 Moderate Impairment: Step to gait pattern on either ascending or descending or both. Must use rail. 0 Severe Impairment: Cannot do safely. Not to be copied without permission. 16

17 4-ITEM DYNAMIC GAIT INDEX Marchetti & Whitney (2006) 1. Gait on level surface Instructions: Walk at your normal speed from here to the next mark (20 ) 3 Normal: Walks 20 without assist. device, good speed, no evidence for imbalance, normal gait pattern 2 Mild Impairment: Walks 20, uses assistive device, 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 assistive device, severe gait deviations or imbalance 2. Gait with changes in speed Instructions: Begin walking at your normal speed. (5 ) When I say go, walk as fast as you can. (5 ) When I say slow walk as slowly as you can. (5 ) 3 Normal: Able to smoothly change walking speed without loss of balance or gait deviations. Shows a significant difference in walking speeds between normal, fast, and slow speed. 2 Mild Impairment: Is able to change speeds, but demonstrates mild gait deviations or shows no gait deviations, but is unable to significantly change velocity, or uses an assistive device. 1 Moderate Impairment: Makes only minor adjustments in walking speed or accomplishes a change in speed with significant gait deviations or changes speed and 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 needs to be caught. 3. Gait with horizontal head turning Instructions: Begin walking at your normal pace. When I tell you 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 full head turns smoothly with no change in gait pattern. 2 Mild Impairment: Performs full head turns smoothly with slight change in gait velocity or pattern, or uses assistive device. 1 Moderate Impairment: Performs head turns with moderate change in gait velocity or pattern, slows down, staggers, but recovers and continues to walk. 0 Severe Impairment: Performs task with severe disruption in gait, staggers outside 15 path; loses balance, stops, reaches for wall, or must be caught. 4. Gait with vertical head turning Instructions: Begin walking at your normal pace. When I tell you to look up, keep walking straight, but turn your head up. Keep looking up until I tell you, look down, then keep walking straight and turn your head down. Keep you head down until I tell you, look straight, then keep walking straight, but return your head to the center. Not to be copied without permission. 17

18 FUNCTIONAL GAIT ASSESSMENT Wristley et al. (2004) Purpose: Measures the dynamic postural control required for proactive and reactive gait, particularly with higher level performance Original Population: Vestibular Special Populations: Older adults, PD, SCI, stroke WHO ICF Components: Activity Limitation Time to Complete: < 15 minutes Equipment Needed: 20 x12 walkway, 1-2 shoe box(es), and stairs Position of therapist did not make difference in interrater reliability (Wrisley et al, 2004) Addressed the ceiling effect of the DGI in persons with vestibular dysfunction. (Wrisley et al, 2004) Not to be copied without permission. 18

19 FUNCTIONAL GAIT ASSESSMENT Score Task Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria) 1. Score: Time: 2. Score: 3. Score: 1. Gait Level Surface: Walk from here to the wall at your normal speed (time for 20 ) 2. Change In Gait Speed Begin walking at your normal pace [5 ft]. When I tell you go, walk as fast as you can [5 ft]. When I tell you slow, walk as slowly as you can [5 ft]. 3. Gait With Horizontal Head Turns Walk from here to the next mark 20 ft away. When I tell you look right, turn your head right and keep walking straight, when I tell you look left, turn your head left and keep walking straight. Have subject turn head every 3 steps. (3) Normal: Walks 20 ft in less than 5.5 seconds, no assistive devices, good speed, no evidence for imbalance, normal gait pattern, deviates no more than 6 in outside of the 12-in walkway. (2) Mild impairment: Walks 20 ft in less than 7 seconds but greater than 5.5 seconds, uses assistive device, slower speed, mild gait deviations, or deviates 6 10 in outside of the 12-in walkway width. (1) Moderate impairment: Walks 20 ft, slow speed, abnormal gait pattern, evidence for imbalance, or deviates in outside of the 12-in walkway. Requires more than 7 seconds to ambulate 20 ft. (0) Severe impairment: Cannot walk 20 ft without assistance, severe gait deviations or imbalance, deviates greater than 15 in outside of the 12-in walkway width or reaches and touches the wall. (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. Deviates no more than 6 in outside of the 12-in walkway width. (2) Mild impairment: Is able to change speed but demonstrates mild gait deviations, deviates 6 10 in outside of the 12-in walkway width, or no gait deviations but unable to achieve a significant change in velocity, or uses an assistive device. (1) Moderate impairment: Makes only minor adjustments to walking speed, or accomplishes a change in speed with significant gait deviations, deviates in outside the 12-in walkway width, or changes speed but loses balance but is able to recover and continue walking. (0) Severe impairment: Cannot change speeds, deviates greater than 15 in outside 12-in walkway width, or loses balance and has to reach for wall or be caught. (3) Normal: Performs head turns smoothly with no change in gait. Deviates no more than 6 in outside 12-in walkway width. (2) Mild impairment: Performs head turns smoothly with slight change in gait velocity (eg, minor disruption to smooth gait path), deviates 6 10 in outside 12-in walkway width, or uses an assistive device. (1) Moderate impairment: Performs head turns with moderate change in gait velocity, slows down, deviates in outside 12-in walkway width but recovers, can continue to walk. (0) Severe impairment: Performs task with severe disruption of gait i.e., staggers 15 in outside 12-in walkway width, loses balance, stops, or reaches for wall. Not to be copied without permission. 19

20 4. Score: 5. Score: 6. Score: 4. Gait With Vertical Head Turns Walk from here to the next mark 20 ft away. When I tell you look up, tip your head up and keep walking straight, when I tell you look down, tip your head down and keep walking straight. Have subject turn head every 3 steps. 5. Gait And Pivot Turn Begin with walking at your normal pace. When I tell you, turn and stop, turn as quickly as you can to face the opposite direction and stop. 6. Step Over Obstacle Begin walking at your normal speed. When you come to the shoe box, step over it, not around it, and keep walking. (3) Normal: Performs head turns with no change in gait. Deviates no more than 6 in outside 12-in walkway width. (2) Mild impairment: Performs task with slight change in gait velocity (eg, minor disruption to smooth gait path), deviates 6 10 in outside 12-in walkway width or uses assistive device. (1) Moderate impairment: Performs task with moderate change in gait velocity, slows down, deviates in outside 12-in walkway width but recovers, can continue to walk. (0) Severe impairment: Performs task with severe disruption of gait (eg, staggers 15 in outside 12-in walkway width, loses balance, stops, reaches for wall). (3) Normal: Pivot 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, or pivot turns safely within 3 seconds and stops with mild imbalance, requires small steps to catch balance. (1) Moderate impairment: Turns slowly, requires verbal cueing, or requires several small steps to catch balance following turn and stop. (0) Severe impairment: Cannot turn safely, requires assistance to turn and stop. (3) Normal: Is able to step over 2 stacked shoe boxes taped together (9 in total height) without changing gait speed; no evidence of imbalance. (2) Mild impairment: Is able to step over one shoe box (4.5 in total height) without changing gait speed; no evidence of imbalance. (1) Moderate impairment: Is able to step over one shoe box (4.5 in total height) but must slow down and adjust steps to clear box safely. May require verbal cueing. (0) Severe impairment: Cannot perform without assistance Not to be copied without permission. 20

21 7. Score: # steps: 8. Score: Time: 9. Score: 8. Gait With Narrow Base Of Support Walk on the floor with arms folded across the chest, feet aligned heel to toe in tandem. The number of steps taken in a straight line are counted for a maximum of 10 steps. 9. Gait With Eyes Closed Walk at your normal speed from here to the next mark [20 ft] with your eyes closed. 10. Ambulating Backwards Walk backwards until I tell you to stop. (3) Normal: Is able to ambulate for 10 steps heel to toe with no staggering. (2) Mild impairment: Ambulates 7 9 steps. (1) Moderate impairment: Ambulates 4 6 steps. (0) Severe impairment: Ambulates less than 4 steps heel to toe or cannot perform without assistance. (3) Normal: Walks 20 ft, no assistive devices, good speed, no evidence of imbalance, normal gait pattern, deviates no more than 6 in outside 12-in walkway width. Ambulates 20 ft in less than 7 seconds. (2) Mild impairment: Walks 20 ft, uses assistive device, slower speed, mild gait deviations, deviates 6 10 in outside 12-in walkway width. Ambulates 20 ft in less than 9 seconds but greater than 7 seconds. (1) Moderate impairment: Walks 20 ft, slow speed, abnormal gait pattern, evidence for imbalance, deviates in outside 12-in walkway width. Requires more than 9 seconds to ambulate 20 ft. (0) Severe impairment: Cannot walk 20 ft without assistance, severe gait deviations or imbalance, deviates greater than 15 in outside 12-in walkway width or will not attempt task. (3) Normal: Walks 20 ft, no assistive devices, good speed, no evidence for imbalance, normal gait pattern, deviates no more than 6 in outside 12-in walkway width. (2) Mild impairment Walks 20 ft, uses assistive device, slower speed, mild gait deviations, deviates 6 10 in outside 12-in walkway width. (1) Moderate impairment Walks 20 ft, slow speed, abnormal gait pattern, evidence for imbalance, deviates in outside 12-in walkway width. (0) Severe impairment Cannot walk 20 ft without assistance, severe gait deviations or imbalance, deviates greater than 15 in outside 12-in walkway width or will not attempt task. 10. Score: 11. Steps Walk up these stairs as you would at home (ie, 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 a stair; must use rail. (0) Severe impairment: Cannot do safely. FGA modified from Wrisley DM et al. Reliability, Internal Consistency, and Validity of Data Obtained with the Functional Gait Assessment. Physical Therapy 2004;84: Reprinted with permission: Personal communication: Wrisley, DM (2007) Not to be copied without permission. 21

22 FUNCTIONAL GAIT ASSESSMENT VS. DYNAMIC GAIT INDEX Subject Code: Date: Rater: Combined Dynamic Gait Index/Functional Gait Assessment Score Task Grading Criteria: Mark the highest category that applies (i.e. the highest category in which the subject meets all criteria) 1. FGA: DGI: Time: 2. FGA: DGI: 3. FGA: DGI: 4. FGA: DGI: 5. FGA: DGI: 1. Gait Level Surface: Walk from here to the wall at your normal speed (time for 20 ) 2. Change In Gait Speed Begin walking at your normal pace [5 ft]. When I tell you go, walk as fast as you can [5 ft]. When I tell you slow, walk as slowly as you can [5 ft]. 3. Gait With Horizontal Head Turns Walk from here to the next mark 20 ft away. When I tell you look right, turn your head right and keep walking straight, when I tell you look left, turn your head left and keep walking straight. Have subject turn head every 3 steps. 4. Gait With Vertical Head Turns Walk from here to the next mark 20 ft away. When I tell you look up, tip your head up and keep walking straight, when I tell you look down, tip your head down and keep walking straight. Have subject turn head every 3 steps. 5. Gait And Pivot Turn Begin with walking at your normal pace. When I tell you, turn and stop, turn as quickly as you can to face the opposite direction and stop. FGA (3) Normal: Walks 20 ft in less than 5.5 seconds, no assistive devices, good speed, no evidence for imbalance, normal gait pattern, deviates no more than 6 in outside of the 12-in walkway. (2) Mild impairment: Walks 20 ft in less than 7 seconds but greater than 5.5 seconds, uses assistive device, slower speed, mild gait deviations, or deviates 6 10 in outside of the 12-in walkway width. (1) Moderate impairment: Walks 20 ft, slow speed, abnormal gait pattern, evidence for imbalance, or deviates in outside of the 12-in walkway. Requires more than 7 seconds to ambulate 20 ft. (0) Severe impairment: Cannot walk 20 ft without assistance, severe gait deviations or imbalance, deviates greater than 15 in outside of the 12-in walkway width or reaches and touches the wall. (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. Deviates no more than 6 in outside of the 12-in walkway width. (2) Mild impairment: Is able to change speed but demonstrates mild gait deviations, deviates 6 10 in outside of the 12-in walkway width, or no gait deviations but unable to achieve a significant change in velocity, or uses an assistive device. (1) Moderate impairment: Makes only minor adjustments to walking speed, or accomplishes a change in speed with significant gait deviations, deviates in outside the 12-in walkway width, or changes speed but loses balance but is able to recover and continue walking. (0) Severe impairment: Cannot change speeds, deviates greater than 15 in outside 12-in walkway width, or loses balance and has to reach for wall or be caught. (3) Normal: Performs head turns smoothly with no change in gait. Deviates no more than 6 in outside 12-in walkway width. (2) Mild impairment: Performs head turns smoothly with slight change in gait velocity (eg, minor disruption to smooth gait path), deviates 6 10 in outside 12-in walkway width, or uses an assistive device. (1) Moderate impairment: Performs head turns with moderate change in gait velocity, slows down, deviates in outside 12-in walkway width but recovers, can continue to walk. (0) Severe impairment: Performs task with severe disruption of gait i.e., staggers 15 in outside 12-in walkway width, loses balance, stops, or reaches for wall. (3) Normal: Performs head turns with no change in gait. Deviates no more than 6 in outside 12-in walkway width. (2) Mild impairment: Performs task with slight change in gait velocity (eg, minor disruption to smooth gait path), deviates 6 10 in outside 12-in walkway width or uses assistive device. (1) Moderate impairment: Performs task with moderate change in gait velocity, slows down, deviates in outside 12-in walkway width but recovers, can continue to walk. (0) Severe impairment: Performs task with severe disruption of gait (eg, staggers 15 in outside 12-in walkway width, loses balance, stops, reaches for wall). (3) Normal: Pivot 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, or pivot turns safely within 3 seconds and stops with mild imbalance, requires small steps to catch balance. (1) Moderate impairment: Turns slowly, requires verbal cueing, or requires several small steps to catch balance following turn and stop. (0) Severe impairment: Cannot turn safely, requires assistance to turn and stop. DGI (3) Normal: Walks 20 ft; no assistive devices, good speed, no evidence for imbalance, normal gait pattern. (2) Mild impairment: Walks 20 ft; uses assistive device, slower speed, mild gait deviations. (1) Moderate impairment: Walks 20 ft; slow speed, abnormal gait pattern, evidence for imbalance. (0) Severe impairment: Cannot walk 20 ft without assistance, severe gait deviations or imbalance (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: Is able to change speed but demonstrates mild gait deviations, or no gait deviations but unable to achieve a significant change in velocity, or uses an 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 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) Normal: Performs head turns smoothly with no change in gait. (2) Mild impairment: Performs head turns smoothly with slight change in gait velocity (eg, minor disruption to smooth gait path), or uses an assistive device. (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 disruption of gait i.e., staggers outside 15 in path, loses balance, stops, or reaches for wall. (3) Normal: Performs head turns smoothly with no change in gait. (2) Mild impairment: Performs head turns smoothly with slight change in gait velocity (eg, minor disruption to smooth gait path), or uses an assistive device. (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 disruption of gait i.e., staggers outside 15 in path, loses balance, stops, or reaches for wall. (3) Normal: Pivot 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, or requires several small steps to catch balance following turn and stop. (0) Severe impairment: Cannot turn safely, requires assistance to turn and stop. Not to be copied without permission. 22

23 6. FGA: DGI: 7. DGI: 8. FGA: # steps: 9. FGA: Time: 6. Step Over Obstacle Begin walking at your normal speed. When you come to the shoe box, step over it, not around it, and keep walking. 7. Step Around Obstacles Begin walking at your normal speed. When you come to the first cone walk around the right side, when you come to the second cone walk around it to the left. 8. Gait With Narrow Base Of Support Walk on the floor with arms folded across the chest, feet aligned heel to toe in tandem. The number of steps taken in a straight line are counted for a maximum of 10 steps. 9. Gait With Eyes Closed Walk at your normal speed from here to the next mark [20 ft] with your eyes closed. (3) Normal: Is able to step over 2 stacked shoe boxes taped together (9 in total height) without changing gait speed; no evidence of imbalance. (2) Mild impairment: Is able to step over one shoe box (4.5 in total height) without changing gait speed; no evidence of imbalance. (1) Moderate impairment: Is able to step over one shoe box (4.5 in total height) but must slow down and adjust steps to clear box safely. May require verbal cueing. (0) Severe impairment: Cannot perform without assistance (3) Normal: Is able to ambulate for 10 steps heel to toe with no staggering. (2) Mild impairment: Ambulates 7 9 steps. (1) Moderate impairment: Ambulates 4 6 steps. (0) Severe impairment: Ambulates less than 4 steps heel to toe or cannot perform without assistance. (3) Normal: Walks 20 ft, no assistive devices, good speed, no evidence of imbalance, normal gait pattern, deviates no more than 6 in outside 12-in walkway width. Ambulates 20 ft in less than 7 seconds. (2) Mild impairment: Walks 20 ft, uses assistive device, slower speed, mild gait deviations, deviates 6 10 in outside 12-in walkway width. Ambulates 20 ft in less than 9 seconds but greater than 7 seconds. (1) Moderate impairment: Walks 20 ft, slow speed, abnormal gait pattern, evidence for imbalance, deviates in outside 12-in walkway width. Requires more than 9 seconds to ambulate 20 ft. (0) Severe impairment: Cannot walk 20 ft without assistance, severe gait deviations or imbalance, deviates greater than 15 in outside 12-in walkway width or will not attempt task. (3) Normal: Is able to step over box without changing gait speed; no evidence of imbalance. (2) Mild impairment: Is able to step over box but must slow down and adjust steps to clear box safely. (1) Moderate impairment: Is able to step over box but must stop, then step over. May require verbal cueing. (0) Severe impairment: Cannot perform without assistance (3) Normal: Is able to walk around cones safely without changing gait speed; no evidence of imbalance. (2) Mild impairment: Is able to step around both cones, but must slow down and adjust steps to clear cones. (1) Moderate impairment: Is able to clear cones but must significantly slow speed to accomplish task or requires verbal cueing. (0) Severe impairment: Cannot perform without assistance. 10. FGA: 10. Ambulating Backwards Walk backwards until I tell you to stop. (3) Normal: Walks 20 ft, no assistive devices, good speed, no evidence for imbalance, normal gait pattern, deviates no more than 6 in outside 12-in walkway width. (2) Mild impairment Walks 20 ft, uses assistive device, slower speed, mild gait deviations, deviates 6 10 in outside 12-in walkway width. (1) Moderate impairment Walks 20 ft, slow speed, abnormal gait pattern, evidence for imbalance, deviates in outside 12-in walkway width. (0) Severe impairment Cannot walk 20 ft without assistance, severe gait deviations or imbalance, deviates greater than 15 in outside 12-in walkway width or will not attempt task. 11. DGI: FGA: 11. Steps Walk up these stairs as you would at home (ie, 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 a stair; must use rail. (0) Severe impairment: Cannot do safely. (3) Normal: Alternating feet, no rail. (2) Mild impairment: Alternating feet, must use rail. (1) Moderate impairment: Two feet to a stair; must use rail. (0) Severe impairment: Cannot do safely. DGI Total Score (Items 1-7 & 11): Scores of 19/24 indicates increased risk of falling FGA Total Score (Items 1-6, 8-11): DGI modified from Shumway-Cook A, Woollacott MH. Motor control: theory and practical applications. Baltimore: Williams & Wilkins; p FGA modified from Wrisley DM et al. Reliability, Internal Consistency, and Validity of Data Obtained with the Functional Gait Assessment. Physical Therapy 2004;84: Reprinted with permission: Personal communication: Wrisley, DM (2007) Not to be copied without permission. 23

24 10-METER WALK TEST Source: rehabmeasures.org Purpose: Assesses walking speed in m/sec over a short distance Original Population: Adults Special Populations: Numerous WHO ICF Components: Activity Limitation Time to Complete: < 5 minutes Equipment Needed: 10 meter (32.8 feet) walkway, stopwatch, start and stop lines Scoring: Normative data General Information: individual walks without assistance 10 meters (32.8 feet) and the time is measured for the intermediate 6 meters (19.7 feet) to allow for acceleration and deceleration Therapist Instructions: Start timing when the toes of the leading foot crosses the 2-meter mark Stop timing when the toes of the leading foot crosses the 8-meter mark Assistive devices can be used but should be kept consistent and documented from test to test If physical assistance is required to walk, this should not be performed Can be performed at preferred walking speed or fastest speed possible Documentation should include the speed tested (preferred vs. fast) Collect three trials and calculate the average of the three trials Set-up: (derived from the reference articles): Measure and mark a 10-meter walkway Add a mark at 2-meters Add a mark at 8-meters Patient Instructions: (derived from the reference articles): Normal comfortable speed: I will say ready, set, go. When I say go, walk at your normal comfortable speed until I say stop Maximum speed trials: I will say ready, set, go. When I say go, walk as fast as you safely can until I say stop References: \ Bohannon, R. W. Comfortable and maximum walking speed of adults aged years: reference values and determinants." Age Ageing. 1997;26(1): Bohannon RW, Andrews AW, Thomas MW. Walking speed: reference values and Not to be copied without permission. 24

25 correlates for older adults. J Orthop Sports Phys Ther. 1996;24(2): Wolf SL, Catlin PA, Gage K, Gurucharri K, Robertson R, Stephen K. Establishing the reliability and validity of measurements of walking time using the Emory Functional Ambulation Profile. Phys Ther. 1999;79(12): Not to be copied without permission. 25

26 Decreased Base of Support Decreased Base of Support: These exercises are used to treat abnormal reactive balance and sensory organization when used in conjunction with manipulation of sensory inputs. Stimulus: Position Speed: Stable (unless including head movement, then start slow) Duration: 4 reps x 30 seconds each, total of 2 minutes Frequency: 1-2 times a day Symptoms: Avoid pain and more than 2/10 dizziness Progression: Start with the most difficult position in which patient is unstable, but able to independently self-correct and still feels safe, then progress as tolerated Not to be copied without permission. 26

27 Postural Strategies: Hip Postural Strategies - Hip: These exercises are used to develop the appropriate use of the hip strategy. Postural strategies are often intact for patients with vestibular dysfunction, but are poorly controlled. Stimulus: Combination of foot position and surface (compliant or narrow) Speed: Fast, controlled movements of the hips Duration: 4 reps x 30 seconds each, total of 2 minutes Frequency: 1-2 times a day Symptoms: Avoid pain and more than 2/10 dizziness Progression: Alter BOS, surface, activity, or visual input Not to be copied without permission. 27

28 Sensory Organization Sensory Organization: These exercises are used to treat impaired functional use of sensory input for postural control. The sample is an example of treatment of impaired use of vestibular input for balance. This is an example of a vestibular adaptation exercise since the patient is trained to change the use of remaining vestibular input. Stimulus: Position in combination with surface and visual manipulation Speed: Stable (unless including head movement, then start slow) Duration: 4 reps x 30 seconds each, total of 2 minutes Frequency: 1-2 times a day Symptoms: Avoid pain and more than 2/10 dizziness Progression: Start with the most difficult position in which patient is unstable, but able to independently self-correct and still feels safe, then progress as tolerated Not to be copied without permission. 28

or

or INTRODUCTION The consequences of postural dyscontrol are pervasive and have a significant impact on activities of daily living, community mobility and social, work and leisure pursuits. The Community Balance

More information

The Activities-specific Balance Confidence (ABC) Scale*

The Activities-specific Balance Confidence (ABC) Scale* Name: C c2s1- Date: The Activities-specific Balance Confidence (ABC) Scale* Instructions to Participants: For each of the following, please indicate your level of confidence in doing the activity without

More information

The Activities-specific Balance Confidence (ABC) Scale*

The Activities-specific Balance Confidence (ABC) Scale* The Activities-specific Balance Confidence (ABC) Scale* Administration: The ABC can be self-administered or administered via personal or telephone interview. Larger typeset should be used for self-administration,

More information

Assessments. BLAST Study (Backward Locomotion After STroke) Forms. Funded by VA RR&D

Assessments. BLAST Study (Backward Locomotion After STroke) Forms. Funded by VA RR&D Assessments Forms BLAST Study (Backward Locomotion After STroke) Funded by VA RR&D Blinded Assessments 1. C1.Ten Meter Walk Test (initial) 2. C2.Three meter Backward Walk Test (initial) 3. C3.Modified

More information

Balance Item Score (0-4)

Balance Item Score (0-4) BERG BALANCE SCALE Patient Name: Rater Name: Date: Balance Item Score (0-4) 1. Sitting unsupported 2. Change of position: sitting to standing 3. Change of position standing to sitting 4. Transfers 5. Standing

More information

Subjective Examination/ Patient Interview:

Subjective Examination/ Patient Interview: Patient Name/Age/Gender: William, a 76 y.o. male Reason for referral: evaluate and treat Medical Diagnosis/ Health Condition: Parkinson s disease Subjective Examination/ Patient Interview: Current History:

More information

0 = unable 5 = needs help cutting, spreading butter, etc., or requires modified diet 10 = independent

0 = unable 5 = needs help cutting, spreading butter, etc., or requires modified diet 10 = independent Standardized Testing 11.14.13 Barthel ADL Index Berg Balance Scale Dynamic Gait Index Functional Reach Timed Up and Go Test (TUG) Tinetti Assessment Speech Assessments Barthel ADL Index Guidelines 1. The

More information

or

or INTRODUCTION The consequences of postural dyscontrol are pervasive and have a significant impact on activities of daily living, community mobility and social, work and leisure pursuits. The Community Balance

More information

Name: MJ Tinetti Performance Oriented Mobility Assessment (POMA)*

Name: MJ Tinetti Performance Oriented Mobility Assessment (POMA)* Name: MJ Tinetti Performance Oriented Mobility Assessment (POMA)* Description: The Tinetti assessment tool is an easily administered task-oriented test that measures an older adult s gait and balance abilities.

More information

ALWAYS SOMETIMES NO. P1. Does looking up increase your problem? E2. Because of your problem, do you feel frustrated?

ALWAYS SOMETIMES NO. P1. Does looking up increase your problem? E2. Because of your problem, do you feel frustrated? Dizziness Handicap Inventory The purpose of this scale is to identify difficulties that you may be experiencing because of your dizziness. Please mark always, sometimes or no to each question. Answer each

More information

Assessments SIMPLY GAIT. Posture and Gait. Observing Posture and Gait. Postural Assessment. Postural Assessment 6/28/2016

Assessments SIMPLY GAIT. Posture and Gait. Observing Posture and Gait. Postural Assessment. Postural Assessment 6/28/2016 Assessments 2 SIMPLY GAIT Understanding movement Evaluations of factors that help therapist form professional judgments Include health, palpatory, range of motion, postural, and gait assessments Assessments

More information

An Exercise Guide. Please speak with your fitness staff if you have questions about your safe completion of these exercises.

An Exercise Guide. Please speak with your fitness staff if you have questions about your safe completion of these exercises. Please speak with your fitness staff if you have questions about your safe completion of these exercises. Looking for more information? Check out [community fitness center] [Manager Name, Contact Number]

More information

Mobility Lab provides sensitive, valid and reliable outcome measures.

Mobility Lab provides sensitive, valid and reliable outcome measures. Mobility Lab provides sensitive, valid and reliable outcome measures. ith hundreds of universities and hospitals using this system worldwide, Mobility Lab is the most trusted wearable gait and balance

More information

Gait Instructions. Total Hip Joint Replacement. David F. Scott, MD

Gait Instructions. Total Hip Joint Replacement. David F. Scott, MD 785 E. Holland Spokane, WA 99218 (877) 464-1829 (509) 466-6393 Fax (509) 466-3072 Total Hip Joint Replacement Walking Recommendations Use your walker or cane as needed for assistance during the first 6-weeks

More information

GOLF SPECIFIC DYNAMIC WARM UP

GOLF SPECIFIC DYNAMIC WARM UP GOLF SPECIFIC DYNAMIC WARM UP Golf-related injury is common. The three most common areas injured include: 1. The back 2. The wrists, and 3. The elbows. A golf-specific dynamic warm-up is recommended by

More information

ACL Base Strength Program Day 1

ACL Base Strength Program Day 1 ACL Base Strength Program Day 1 Welcome to the Cratos ACL prevention program. This program was written by Physical Therapist and Athletic Trainer, Tasha Mulligan, to serve as a pre-season base strength

More information

Walking Tall: Mobility Drills for Seniors

Walking Tall: Mobility Drills for Seniors Walking Tall: Mobility Drills for Seniors What is Functional Mobility Training? Selecting exercises that improve the foundation for movement Working in multiple planes Teaching reaction time, decision

More information

OrthoBethesda Therapy Services Total Hip Replacement Home Exercise Program

OrthoBethesda Therapy Services Total Hip Replacement Home Exercise Program OrthoBethesda Therapy Services Total Hip Replacement Home Exercise Program General Instructions: Initially perform 10 repetitions of each exercise, 3 times per day. Increase to 20 repetitions, 3 times

More information

NHS Training for Physiotherapy Support Workers. Workbook 16 Gait re-education

NHS Training for Physiotherapy Support Workers. Workbook 16 Gait re-education NHS Training for Physiotherapy Support Workers Workbook 16 Gait re-education Contents Workbook 16 Gait re-education 1 16.1 Aim 3 16.2 Learning outcomes 3 16.3 Preparation for walking assessment and walking

More information

Warm Ups. Standing Stretches

Warm Ups. Standing Stretches Warm Ups Mild warm-ups are a necessity for everyone. The need for warm-ups increases with age as the body becomes less elastic over time. It is recommended that you execute the warm-up routine in this

More information

Chair exercises Sally Ann Belward, Falls Clinical Lead Physiotherapist

Chair exercises Sally Ann Belward, Falls Clinical Lead Physiotherapist Chair exercises Sally Ann Belward, Falls Clinical Lead Physiotherapist Exercise safety Exercise should be comfortable and fun Ensure participants are sat on a sturdy chair, have comfortable clothing and

More information

Sighted Guide Techniques I. Basic Sighted Guide Position and Alignment

Sighted Guide Techniques I. Basic Sighted Guide Position and Alignment Sighted Guide Techniques I. Basic Sighted Guide Position and Alignment 1. The sighted guide gives verbal cue ("take my arm/wrist") and/or nonverbal cue (touching the back of the person who is blind's hand

More information

Movement Skills: Object Manipulation

Movement Skills: Object Manipulation 4-6 3-6 Movement Skills: Object Manipulation Objective: To assess the students object control and manipulation skills using tasks that involves both the upper and lower body and a ball. Rationale: Students

More information

Rock, Paper, Scissors Locomotion!

Rock, Paper, Scissors Locomotion! Rock, Paper, Scissors Locomotion! Movement Skills: Locomotor Objective: To assess the students ability to move, stop, and change direction in a controlled manner. Definitions: Locomotion: moving the body

More information

Stability Trainer. New! Balance Products. Rocker and Wobble Boards. New!

Stability Trainer. New! Balance Products. Rocker and Wobble Boards. New! New! Stability Trainer Balance Products Rocker and Wobble Boards New! www.thera-band.com Rocker and Wobble Boards The Hygenic Corporation 1245 Home Avenue, Akron, Ohio 44310 USA 330.633.8460 1.800.321.2135

More information

Rules of Hurdling. Distance Between Hurdles

Rules of Hurdling. Distance Between Hurdles The Hurdle Events Introduction Brief discussion of rules, safety practices, and talent demands for the hurdles. Examine technical and training considerations for the hurdle events. 100 Meter Hurdles for

More information

premise that interdependent body systems (e.g. musculoskeletal, motor, sensory, and cognitive

premise that interdependent body systems (e.g. musculoskeletal, motor, sensory, and cognitive APPENDIX 2 Motor Control Intervention Protocol The dynamic systems approach underlying motor control intervention is based on the premise that interdependent body systems (e.g. musculoskeletal, motor,

More information

Ab Plank with Straight Leg Raise

Ab Plank with Straight Leg Raise Ab Plank with Straight Leg Raise Position yourself face up with your knees bent at 90 degrees, feet flat on the floor. Your hands should be directly under your shoulders facing forward. While in this position

More information

Movement: Using the chest muscles and a slight bend in the elbow, bring your arms together in front of your chest.

Movement: Using the chest muscles and a slight bend in the elbow, bring your arms together in front of your chest. Chest Fly Anchor: Chest height Start: Stand with a split stance arms open out to the side, palms facing forward. Movement: Using the chest muscles and a slight bend in the elbow, bring your arms together

More information

and crutches after surgery before, during and after your surgery

and crutches after surgery before, during and after your surgery A Walking New Knee Aids for for You HIP YOUR AND GUIDE KNEE TO REPLACEMENT KNEE REPLACEMENT PATIENTS How to What fit and to safely do and use what your to expect walker, cane and crutches after surgery

More information

Dynamic Warm up. the age of the athlete current physical condition and prior exercise experience

Dynamic Warm up. the age of the athlete current physical condition and prior exercise experience Dynamic Warm up 10-20 minutes May be dependent on: the age of the athlete current physical condition and prior exercise experience Prepares the body for the demands of a work out or practice Increases

More information

LEVEL 1 SKILL DEVELOPMENT MANUAL

LEVEL 1 SKILL DEVELOPMENT MANUAL LEVEL 1 SKILL DEVELOPMENT MANUAL Lesson Manual C A Publication Of The USA Hockey Coaching Education Program The USA Hockey Coaching Education Program is Presented By LESSON C-1 SPECIFIC OBJECTIVES 1. Refine

More information

Surfers who ride waves in a standing position with or without orthotics and prosthesis. Surfers must be in catching waves and recovering after wave.

Surfers who ride waves in a standing position with or without orthotics and prosthesis. Surfers must be in catching waves and recovering after wave. 08 Hawaii Adaptive Surfing Classification Sport Class Stand without paddle Functions Sub-C Description lass Surfers who ride waves in a standing position with or without orthotics and prosthesis. Surfers

More information

BODY BALANCE. Focusing on improved lower body strength, core strength, and overall balance. Warm Up:

BODY BALANCE. Focusing on improved lower body strength, core strength, and overall balance. Warm Up: BODY BALANCE Focusing on improved lower body strength, core strength, and overall balance Warm Up: Seated Forward big arm circles/backward big arm circles (10 seconds) Forward small arm circles/ backward

More information

Shoulder Exercises for Combined Labrum Repair Rehabilitation Protocol

Shoulder Exercises for Combined Labrum Repair Rehabilitation Protocol Shoulder Exercises for Combined Labrum Repair Rehabilitation Protocol The exercises illustrated and described in this document should be performed only after instruction by your physical therapist or Dr.

More information

CARDS. Core Strength Positioning

CARDS. Core Strength Positioning Core Strength Positioning CARDS Core Strength involves the activation of the muscles of the torso and neck that keep the trunk and head stable, aligned, and erect when the limbs are moving. A strong and

More information

Structure (Down plane)

Structure (Down plane) By Lauren Russell Structure (Down plane) The body (toes, knees, hips, wrists and shoulders) is aligned parallel to the intended target line. The torso is tilted over the ball from the hips whilst maintaining

More information

Beginner Skier Progression -Class Levels One and Two Never-ever skiers to skiers making advanced wedge turns

Beginner Skier Progression -Class Levels One and Two Never-ever skiers to skiers making advanced wedge turns Beginner Skier Progression -Class Levels One and Two Never-ever skiers to skiers making advanced wedge turns This is an in depth progression which would be more suitable for students who are not particularly

More information

Fullerton Advanced Balance (FAB) Scale Scoring Form

Fullerton Advanced Balance (FAB) Scale Scoring Form Fullerton Advanced Balance (FAB) Scale Scoring Form Name: Test Date of Test: Stop watch; 36 ruler; pen or pencil; 6 bench; metronome; 2 airex pads and one or more 12 inch lengths of non-slip material.

More information

STEP 1. STANCE. The stance must be a consistent, repeatable and comfortable.

STEP 1. STANCE. The stance must be a consistent, repeatable and comfortable. STEP 1. STANCE The body can be divided into 2 parts the upper body from the hips up and the lower body from the hips down. The upper part of the body must maintain consistent position from shot to shot

More information

Saddle Seat Equitation

Saddle Seat Equitation I. List of Faults 1. Minor Faults Saddle Seat Equitation JUDGING GUIDELINES 1 to 2 steps on the wrong diagonal or lead. Break in gait of 2 to 3 steps. 1 to 2 feet ahead or behind point on the pattern.

More information

Get Fit and Prevent a Fall!! Fun Exercises for Seniors!

Get Fit and Prevent a Fall!! Fun Exercises for Seniors! Get Fit and Prevent a Fall!! Fun Exercises for Seniors! The Idaho Department of Health and Welfare Injury Prevention Program, in conjunction with District Health Departments, offers you the Fit and Fall

More information

Normative data of postural sway by using sway meter among young healthy adults

Normative data of postural sway by using sway meter among young healthy adults Normative data of postural sway by using sway meter Original Research Article ISSN: 2394-0026 (P) Normative data of postural sway by using sway meter among young healthy adults Tejal C Nalawade 1*, Shyam

More information

C-Brace Orthotronic Mobility System

C-Brace Orthotronic Mobility System C-Brace Orthotronic Mobility System You ll always remember your first step Information for practitioners C-Brace Orthotics reinvented Until now, you and your patients with conditions like incomplete spinal

More information

AEROBIC GYMNASTICS Code of Points APPENDIX II Guide to Judging Execution and Difficulty

AEROBIC GYMNASTICS Code of Points APPENDIX II Guide to Judging Execution and Difficulty FÉDÉRATION INTERNATIONALE DE GYMNASTIQUE FONDÉE EN 1881 AEROBIC GYMNASTICS Code of Points 2009 2012 DRAFT OCTOBER 2008 APPENDIX II Guide to Judging Execution and Difficulty Page 1 of 80 INTRODUCTION This

More information

The Hurdle Events. Jeff Martin IATCCC Clinic. Indianapolis, Indiana. 5 Myth s about Hurdling

The Hurdle Events. Jeff Martin IATCCC Clinic. Indianapolis, Indiana. 5 Myth s about Hurdling The Hurdle Events Jeff Martin Indianapolis, Indiana 5 Myth s about Hurdling - Speed is not a necessity to hurdle fast - Good form not pure speed makes a good hurdler - An athlete that can t jump, throw,

More information

Coaching the Triple Jump Boo Schexnayder

Coaching the Triple Jump Boo Schexnayder I. Understanding the Event A. The Run and Its Purpose B. Hip Undulation and the Phases C. Making the Connection II. III. IV. The Approach Run A. Phases B. Technical Features 1. Posture 2. Progressive Body

More information

Chapter 1 - Injury overview Chapter 2 - Fit for Running Assessment Chapter 3 - Soft Tissue Mobilization... 21

Chapter 1 - Injury overview Chapter 2 - Fit for Running Assessment Chapter 3 - Soft Tissue Mobilization... 21 Table of Contents Introduction Chapter 1 - Injury overview... 6 Chapter 2 - Fit for Running Assessment... 13 Chapter 3 - Soft Tissue Mobilization... 21 Chapter 4 - Dynamic Warm-up... 28 Chapter 5 - Strengthening...

More information

ROWING CANADA AVIRON ROWING TECHNIQUE MOVEMENT PATTERNS IN SWEEP AND SCULLING TECHNIQUE IN CANADA FEBRUARY 28, 2017

ROWING CANADA AVIRON ROWING TECHNIQUE MOVEMENT PATTERNS IN SWEEP AND SCULLING TECHNIQUE IN CANADA FEBRUARY 28, 2017 ROWING CANADA AVIRON ROWING TECHNIQUE MOVEMENT PATTERNS IN SWEEP AND SCULLING TECHNIQUE IN CANADA FEBRUARY 28, 2017 INTRODUCTION TECHNIQUE CAN BE DEFINED AS A SPECIFIC SEQUENCE OF MOVEMENTS OR PARTS OF

More information

DEVELOPMENT AND VALIDATION OF A GAIT CLASSIFICATION SYSTEM FOR OLDER ADULTS BY MOVEMENT CONTROL AND BIOMECHANICAL FACTORS. Wen-Ni Wennie Huang

DEVELOPMENT AND VALIDATION OF A GAIT CLASSIFICATION SYSTEM FOR OLDER ADULTS BY MOVEMENT CONTROL AND BIOMECHANICAL FACTORS. Wen-Ni Wennie Huang DEVELOPMENT AND VALIDATION OF A GAIT CLASSIFICATION SYSTEM FOR OLDER ADULTS BY MOVEMENT CONTROL AND BIOMECHANICAL FACTORS by Wen-Ni Wennie Huang B. S. in Physical Therapy, Queen s University, Canada, 1997

More information

S t r e t c h i n g E x e r c i s e s

S t r e t c h i n g E x e r c i s e s Stretches for side of neck: 1. Sit or stand with arms hanging loosely at sides 2. Turn head to one side, then the other 3. Hold for 5 seconds, each side 4. Repeat 1 to 3 times Stretches For the side of

More information

DUPLICATION PROHIBITED by copyright holder. 6 THE ROLE OF THE OUTSIDE LEG Engagement and Canter Transitions 98

DUPLICATION PROHIBITED by copyright holder. 6 THE ROLE OF THE OUTSIDE LEG Engagement and Canter Transitions 98 CONTENTS Foreword by CARL HESTER MBE 10 WHY I WROTE THIS BOOK 13 ACKNOWLEDGEMENTS 18 INTRODUCTION 21 1 BALANCE Questions and Answers 26 2 THE AIDS FOR IMPULSION Forward and Straight 44 3 REIN AIDS Ask

More information

PARTNER With all partner stretches: communicate with partner and use caution!!

PARTNER With all partner stretches: communicate with partner and use caution!! - warm up prior to stretching - isolate the muscle group to be stretched - move slowly and smoothly into stretch - use proper mechanics and correct alignment - breathe normal - slowly come out of stretch

More information

Gait Analyser. Description of Walking Performance

Gait Analyser. Description of Walking Performance Gait Analyser Description of Walking Performance This brochure will help you to understand clearly the parameters described in the report of the Gait Analyser, provide you with tips to implement the walking

More information

Sledge Hockey NatioNal team FitNeSS testing guidelines

Sledge Hockey NatioNal team FitNeSS testing guidelines Sledge Hockey National Team Fitness Testing Guidelines ABOUT THIS RESOURCE This manual is designed to serve as a guideline for sledge hockey players and coaches who are striving to take their game to the

More information

The BESS can be performed in nearly any environment and takes approximately 10 minutes to conduct.

The BESS can be performed in nearly any environment and takes approximately 10 minutes to conduct. Balance Error Scoring System (BESS) Developed by researchers and clinicians at the University of North Carolina s Sports Medicine Research Laboratory, Chapel Hill, NC 27599 8700 The Balance Error Scoring

More information

WORKBOOK/MUSTANG. Featuring: The R82 Next Step Development Plan. mustang. R82 Education

WORKBOOK/MUSTANG. Featuring: The R82 Next Step Development Plan. mustang. R82 Education WORKBOOK/MUSTANG Featuring: The R82 Next Step Development Plan mustang R82 Education CLINICAL WORK BOOK/MUSTANG PAGE 2 PAGE 3 What is Mustang? Mustang is a highly adaptable walking aid for children and

More information

Neurorehabil Neural Repair Oct 23. [Epub ahead of print]

Neurorehabil Neural Repair Oct 23. [Epub ahead of print] APPENDICE Neurorehabil Neural Repair. 2009 Oct 23. [Epub ahead of print] Segmental Muscle Vibration Improves Walking in Chronic Stroke Patients With Foot Drop: A Randomized Controlled Trial. Paoloni M,

More information

40 Allied Drive Dedham, MA (office)

40 Allied Drive Dedham, MA (office) Standing forward flexion Stand facing a mirror with the hands rotated so that the thumbs face forward. Raise the arm upward keeping the elbow straight. Try to raise the arm by hinging at the shoulder as

More information

COACHING WINDMILL PITCHERS GETTING STARTED

COACHING WINDMILL PITCHERS GETTING STARTED COACHING WINDMILL PITCHERS GETTING STARTED INTRODUCTION Coaching pitchers in NOT difficult. All you need is some interest and a little information to understand what you're doing. The interest has to come

More information

A bit of background. Session Schedule 3:00-3:10: Introduction & session overview. Overarching research theme: CPTA

A bit of background. Session Schedule 3:00-3:10: Introduction & session overview. Overarching research theme: CPTA A Cognitive-Biomechanical Perspective for the Management of Common Chronic Musculoskeletal Conditions Skulpan Asavasopon, PT, PhD Loma Linda University Christopher M. Powers, PT, PhD, FAPTA University

More information

Mobilising. Mobilising

Mobilising. Mobilising Shoulder Rehabilitation Exercises (See attached information supplement) P1 of 7 1) Arms relaxed, circle your shoulders by shrugging the shoulders up, then drawing them back, down and forward. 2) You can

More information

Ankle biomechanics demonstrates excessive and prolonged time to peak rearfoot eversion (see Foot Complex graph). We would not necessarily expect

Ankle biomechanics demonstrates excessive and prolonged time to peak rearfoot eversion (see Foot Complex graph). We would not necessarily expect Case Study #1 The first case study is a runner presenting with bilateral shin splints with pain and tenderness along the medial aspect of the tibia. The symptoms have increased significantly over the last

More information

Let s Walk Together Safe Guiding Techniques for Individuals with Intellectual Disability and Vision Loss

Let s Walk Together Safe Guiding Techniques for Individuals with Intellectual Disability and Vision Loss Let s Walk Together Safe Guiding Techniques for Individuals with Intellectual Disability and Vision Loss Narrator: Human Guide, also known as Sighted Guide, is a technique whereby a person with vision

More information

Normal Gait and Dynamic Function purpose of the foot in ambulation. Normal Gait and Dynamic Function purpose of the foot in ambulation

Normal Gait and Dynamic Function purpose of the foot in ambulation. Normal Gait and Dynamic Function purpose of the foot in ambulation Normal Gait and Dynamic Function purpose of the foot in ambulation Edward P. Mulligan, PT, DPT, OCS, SCS, ATC Assistant Professor; Residency Chair UT Southwestern School of Health Professions Department

More information

Breaking Down the Approach

Breaking Down the Approach Breaking Down the Approach Written by Andre Christopher Gonzalez Sunday, July 31, 2005 One of the biggest weaknesses of the two-legged approach is the inability of the athlete to transfer horizontal momentum

More information

CEC Article : River and channel usage (2 A-PAI CEC s) By C. H. Krafft

CEC Article : River and channel usage (2 A-PAI CEC s) By C. H. Krafft CEC Article : River and channel usage (2 A-PAI CEC s) By C. H. Krafft Many leisure pools now have rivers or channels that can be used for effective programming for seniors or triathletes/advanced participants.

More information

Meeting the Challenges of Diverse Seniors Many with Dementia, Stroke, Parkinson s disease BIODEX

Meeting the Challenges of Diverse Seniors Many with Dementia, Stroke, Parkinson s disease BIODEX CASESTUDY Meeting the Challenges of Diverse Seniors Many with Dementia, Stroke, Parkinson s disease Odom Health & Wellness BIODEX Biodex Medical Systems, Inc. 20 Ramsey Road, Shirley, New York, 11967-4704,

More information

Mindfulness Lesson Plan

Mindfulness Lesson Plan Mindfulness Lesson Plan What is Mindfulness? MEDICAL DISCLAIMER Not all exercises are suitable for everyone and it is recommended that you consult your doctor before beginning this or any exercise program.

More information

Speed Training. Speed Training

Speed Training. Speed Training Lesson 4.2 By Carone Fitness Walking for fitness is often referred to as power walking, or speed walking. Usually, there is less focus on technique than there is in race walking, as there is no risk of

More information

Basic Movement Patterns Locomotor Skills 1.3

Basic Movement Patterns Locomotor Skills 1.3 Basic Movement Patterns Locomotor Skills 1.3 Jumping Forward & Sideways & Landing Extending Arms upward upon takeoff Arms Reach Full Extension about head height at lift off Extending the Hips, Knees, and

More information

Physical Therapy for Children with Down Syndrome. Patricia C. Winders, PT

Physical Therapy for Children with Down Syndrome. Patricia C. Winders, PT Physical Therapy for Children with Down Syndrome Patricia C. Winders, PT What we will cover: 1. Goal of physical therapy 2. Physical factors that impact the development of gross motor skills 3. Compensations

More information

Techniques To Treat Your Pain At Home (512)

Techniques To Treat Your Pain At Home (512) Techniques To Treat Your Pain At Home (512) 288-5322 7010 W. TX-71 Suite 360 Austin TX, 78735 Arm Only Bird Dog Start in the quadruped position (all fours) with arms and thighs perpendicular to the floor.

More information

Make sure that my muscles are really warmed up so the balance activities are easier to perform.

Make sure that my muscles are really warmed up so the balance activities are easier to perform. ? What 1 2 3 do I need to know BEFORE PERFORMING the balance activities? Make sure that my muscles are really warmed up so the balance activities are easier to perform. Perform the balance activities in

More information

ARENA EXERCISES AND PATTERNS BEST

ARENA EXERCISES AND PATTERNS BEST 50 ARENA EXERCISES AND PATTERNS BEST Essential Schooling for English and Western Riders Ann Katrin Querbach Contents DUPLICATION PROHIBITED Introduction 2 1. Finding Your Center The Correct Seat 4 1.1

More information

As a physiotherapist I see many runners in my practice,

As a physiotherapist I see many runners in my practice, When rubber meets road Mark Richardson reveals the story that our running shoes can tell us, and how it can help you avoid running injury at a glance This article: Shows you how to analyse the sole of

More information

MODERN GLOSSARY OF TERMS AND TECHNICAL INFORMATION PREPARATORY

MODERN GLOSSARY OF TERMS AND TECHNICAL INFORMATION PREPARATORY MODERN GLOSSARY OF TERMS AND TECHNICAL INFORMATION PREPARATORY Alternate straight kicks Lying down on the floor, side of body towards front, head in line with body. Hands flat on floor and not touching

More information

Rugby Fitness Testing Protocols. Order of Testing:

Rugby Fitness Testing Protocols. Order of Testing: 6 P a g e Rugby Fitness Testing Protocols Order of Testing: Testing can be completed in any order, with the exception of the ENDURANCE Test (1200m) which HAS TO BE completed at the end of the session.

More information

Swimming practical examination support materials

Swimming practical examination support materials Swimming Curriculum Council, 2011 This document apart from any third party copyright material contained in it may be freely copied, or communicated on an intranet, for non-commercial purposes by educational

More information

A Publication Of The USA Hockey Coaching Education Program The USA Hockey Coaching Education Program is Presented By

A Publication Of The USA Hockey Coaching Education Program The USA Hockey Coaching Education Program is Presented By LEVEL 1 SKILL DEVELOPMENT MANUAL Lesson Manual B A Publication Of The USA Hockey Coaching Education Program The USA Hockey Coaching Education Program is Presented By LESSON B-1 SPECIFIC OBJECTIVES 1.

More information

Coaching Principles. STEPS IN TEACHING A DRILL 1. Introduce 2. Demonstrate 3. Explain 4. Organize 5. Execute 6. Correct 7. Practice GENERAL PRINCIPLES

Coaching Principles. STEPS IN TEACHING A DRILL 1. Introduce 2. Demonstrate 3. Explain 4. Organize 5. Execute 6. Correct 7. Practice GENERAL PRINCIPLES Alpine Skiing Drill Book Updated August 2008 STEPS IN TEACHING A DRILL 1. Introduce 2. Demonstrate 3. Explain 4. Organize 5. Execute 6. Correct 7. Practice GENERAL PRINCIPLES Coaching Principles Drills

More information

Discus Technique: Basic Technique A Technical Analysis Grip Fork Gr Purpose: To provide control over Discus is held with Discus is held

Discus Technique: Basic Technique A Technical Analysis Grip Fork Gr Purpose: To provide control over Discus is held with Discus is held Discus Technique: A Technical Analysis Sandy Fowler University of Michigan Assistant Track & Field Coach Grip Purpose: To provide control over the implement throughout the spin. To provide for a proper

More information

The BIG BOOK of Golf Drills

The BIG BOOK of Golf Drills The BIG BOOK of Golf Drills 1 How to Use This Guide Congratulations on purchasing the Big Book of Golf Drills! This book is designed to use as a reference guide. We do not recommend printing this out as

More information

Hammer Technical Model

Hammer Technical Model Hammer Technical Model Progression related to Multi-Events Development (aged 8/9-12 years) can be referenced to Athletics 365 More technical information can be found HERE IAAF CECS Level II Event Specific

More information

CRUTCHES, WALKERS & CANES

CRUTCHES, WALKERS & CANES CRUTCHES, WALKERS & CANES Walking Aids to Get You On Your Feet Again When You Need a Walking Aid Do you have an injury or condition that makes it harder for you to get around? A walking aid (crutches,

More information

Sprint/Speed Training

Sprint/Speed Training Sprint/Speed Training By Paul Tramontanas In footy, speed is required over distances from 10m-70m depending on the state of play. This being the case, the full range of distances need to be trained to

More information

Clinical view on ambulation in patients with Spinal Cord Injury

Clinical view on ambulation in patients with Spinal Cord Injury Clinical view on ambulation in patients with Spinal Cord Injury Sasa Moslavac Spinal Unit, Special Medical Rehabilitation Hospital, Varazdinske Toplice,, Croatia 1 Spinal Cord Injury (SCI) to walk again

More information

WALKING AIDS AND GAIT TRAINING

WALKING AIDS AND GAIT TRAINING WALKING AIDS AND GAIT TRAINING By:Dr. Chaman Lal B.S.PT, DPT, Dip. in sports Injuries, MPPS(PAK), PG in Clinical Electroneurophysiology (AKUH), Registered.EEGT (USA), Member of ABRET, AANEM & ASET (USA).

More information

3 people 3 unique lifestyles 3 advanced foot solutions

3 people 3 unique lifestyles 3 advanced foot solutions 3 people 3 unique lifestyles 3 advanced foot solutions Reclaim your life Information for practitioners Shelby Hans Intelligent feet are made for more than just walking Today s advanced microprocessor controlled

More information

Motor Milestones by 3 Months Gross Motor Skills

Motor Milestones by 3 Months Gross Motor Skills Motor Milestones by 3 Months -Laying on back: -Kick legs together and alternately -Reach for/ bat at toys held over head in midline with each arm together and alternately -Laying on tummy: -Turn head from

More information

To keep the body in good health is a duty otherwise we shall not be able to keep our mind strong and clear. - Guatama Buddha

To keep the body in good health is a duty otherwise we shall not be able to keep our mind strong and clear. - Guatama Buddha To keep the body in good health is a duty otherwise we shall not be able to keep our mind strong and clear. - Guatama Buddha Desk Stretches Why Stretch? Stretching allows the muscle to release tension.

More information

Routine For: Total Knee Arthroplasty (All)

Routine For: Total Knee Arthroplasty (All) TOTAL KNEE - 1 Ankle Pump TOTAL HIP - 1 Quad Set Bend ankles up and down, alternating feet. Slowly tighten muscles on thigh of straight leg while counting out loud to. with other leg. TOTAL HIP - 2 Gluteal

More information

THERAPUTTY ACTIVITIES

THERAPUTTY ACTIVITIES THERAPUTTY ACTIVITIES Theraputty activities will help to develop your hand strength and ability to control fine finger movements. Activities to be complete: (therapists to tick which activity you want

More information

A7HLE71CO PHYSICAL THERAPY

A7HLE71CO PHYSICAL THERAPY I A7HLE71CO Runner's Video Gait Analysis Matthew Wolin, 12/4/2018 Footwear: Altra Torin 3.0 Treadmill speed: 7.0 mph VGA Analyst: Chris Jensen, PT, MPT, OCS, CKPT POSTERIOR VIEW FINDINGS: (mid-stance)..

More information

At Home. SCI Arm Workout

At Home. SCI Arm Workout At Home SCI Arm Workout Just because your therapy may be over doesn t mean that your workouts should be. Use this packet to get an effective workout at home 1 of 2 ways: -theraband or -free weights Also

More information

Performance-Oriented Environmental Mobility Screen (POEMS)

Performance-Oriented Environmental Mobility Screen (POEMS) AMBULATION BEDROOM Gait is continuous, without hesitation. Gait is noncontinuous, with hesitation (1) (2). Gait is straight, without deviation from the Gait deviates from a straight path (1) (2) (5). path.

More information

12 Week Training Guide

12 Week Training Guide 12 Week Training Guide Start slow and easy if you need to take short breaks during your activity that is OK. The goal is to get moving and log the distances that total up to complete a triathlon. Make

More information

Hip Surgery: Rehab Exercises

Hip Surgery: Rehab Exercises Hip Surgery: Rehab Exercises Your Care Instructions Here are some examples of rehabilitation exercises for hip surgery. Start each exercise slowly. Ease off the exercise if you start to have pain. Your

More information

Transfer Assessment Instrument Training. Laura Rice, PhD, MPT, APT Chung-Ying Tsai, MS

Transfer Assessment Instrument Training. Laura Rice, PhD, MPT, APT Chung-Ying Tsai, MS Transfer Assessment Instrument Training Laura Rice, PhD, MPT, APT Chung-Ying Tsai, MS Instrument Introduction Objectively measure transfer quality No other outcome measure evaluates quality Evaluates all

More information

Gait. Kinesiology RHS 341 Lecture 12 Dr. Einas Al-Eisa

Gait. Kinesiology RHS 341 Lecture 12 Dr. Einas Al-Eisa Gait Kinesiology RHS 341 Lecture 12 Dr. Einas Al-Eisa Definitions Locomotion = the act of moving from one place to the other Gait = the manner of walking Definitions Walking = a smooth, highly coordinated,

More information