Timed Walking and Hand Grip Assessments
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- Julia Fox
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1 Timed Walking and Hand Grip Assessments MACSID: Visit #: Examiner Code: Date: / / M M D D Y Y Time Began: : AM... PM... Section A: Measured Walk A. Was measured walk test attempted? CIRCLE YOUR ANSWERS No... Yes... Go to A Physical Impairment... Cognitive Impairment... Other Reason... Specify: A. Does the participant use an assistive device for walking?.. Go to A a. What type of device? Standard cane... Quad cane... Walker... Wheelchair... White cane... Crutches ( or )... Other... Specify: A. Does the participant use a lower extremity orthosis (plastic or metal leg brace at or above the ankle)? S:\visits\v44\forms\Timed Walking and Hand Grip Assessments.wpd September 6, 005
2 Page of 6 A4. Is the participant missing any limbs? Go to A6 Which limb(s)? No Yes a. b. c. d. Left arm... Right arm... Left leg... Right leg... A5. Does the participant use a prosthesis (artificial limb)? Go to A6 Which limb(s)? No Yes a. b. c. d. Left arm... Right arm... Left leg... Right leg... A6. Does participant have paralysis of an extremity or side of the body? Go to PROMPT Which side of the body? No Yes a. b. Left... Right... MEASURED WALK ATTEMPT #: PROMPT: Read to Participant: In this test, I would like you to walk at your usual pace from this line to the line at the end of the hall. Do you think you could do that? Good. Can you see the tape? Good. Let me demonstrate what I want you to do. (DEMONSTRATE.) To do this test, place your feet with your toes behind, but touching, the line where we start. I will time you. When I say Ready, go! walk at your usual pace to the line at the end of the hall. I will walk with you. WHEN THE PARTICIPANT IS PROPERLY AT THE LINE, SAY Ready, go! AND BEGIN TIMING. S:\visits\v44\forms\Timed Walking and Hand Grip Assessments.wpd September 6, 005
3 Page of 6 A7. Did the participant complete the measured walk? No... Attempted, but unable physically... Go to A7.b Go to A0 Go to A0 Specify: Go to A0 b. Did the participant use an assistive device on walk? A8. What length course did the participant walk? meters... 4 meters... A9. Time in seconds to walk course:. seconds MEASURED WALK ATTEMPT #: PROMPT: READ TO PARTICIPANT: Now, I d like you to try this test a second time. When I say Ready, go! walk at your usual pace to the line at the end of the hall. I will walk with you. WHEN THE PARTICIPANT IS PROPERLY AT THE LINE, SAY Ready, go! AND BEGIN TIMING. A0. Did the participant complete the measured walk? No... Attempted, but unable physically... Go to A0.b Specify: S:\visits\v44\forms\Timed Walking and Hand Grip Assessments.wpd September 6, 005
4 Page 4 of 6 b. Did the participant use an assistive device on walk? A. What length course did the participant walk? meters... 4 meters... A. Time in seconds to walk course:. seconds Section B: Grip Strength B. Did participant attempt to perform grip strength assessment? Physical impairment... Go to B Specify: B. Can the participant lift his arms to the table independently? a. Left arm? b. Right arm? PROMPT: READ TO PARTICIPANT: In this exercise, I am going to use this instrument to measure the strength in your hands. S:\visits\v44\forms\Timed Walking and Hand Grip Assessments.wpd September 6, 005
5 Page 5 of 6 B. Have you had a recent worsening of pain in your wrists? Go to B4 a. Do you think you could safely squeeze this as hard as you can? Go to B5 B4. Have you had any surgery on your hands or arms during the last weeks? Go to B5 PROMPT: READ TO PARTICIPANT: I d like you to take your dominant arm, place your forearm on the table, and grab the two pieces of metal together like this. (EXAMINER SHOULD DEMONSTRATE AT THIS POINT.) When I say squeeze, squeeze as hard as you can. The two pieces of metal will not move but I will be able to read the force of your grip on the dial. I will ask you to do this three times. If you feel any pain or discomfort, tell me and we will stop. (DEMONSTRATE TO PARTICIPANT.) Now you should place your arm on the table at right angles to your body. Grip the two pieces of metal with your dominant hand. Your wrist should be straight. Ready? Go! (BE SURE TO COACH: Squeeze, squeeze, squeeze! ALSO BE SURE TO TELL THE PARTICIPANT WHEN TO Stop! ) DO DOMINANT HAND ONLY. B5. Was grip strength test done? Attempted, but unable physically... Go to B5.b Specify: b. Which hand was tested (dominant hand)? Left... Right... S:\visits\v44\forms\Timed Walking and Hand Grip Assessments.wpd September 6, 005
6 Page 6 of 6 B6. First try: KG B7. Second try: KG B8. Third try: KG B9. Time ended: : AM PM S:\visits\v44\forms\Timed Walking and Hand Grip Assessments.wpd September 6, 005
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