Functional Mobility Assessment

Functional Mobility Assessments

• Physical therapists use assessments to improve movement and function.
• The presentation was given by Rebecca Pinkus, PT, DPT, NCS.
• Contributions were made by Latasha Thomas, PT, DPT, NCS; Kristen Quinn, PT, DPT, NCS; and Keith Cole, PT, DPT, PhD, MBiomedE, OCS.
• The assessments are from the George Washington University School of Medicine & Health Sciences.

What is a Functional Mobility Scale?

• Patient/Client Management Model involves examination, history review, systems review, tests and measures.
• This also includes evaluation, diagnosis, prognosis, and intervention.
• Tests and Measures assess safety and capacity of movement related to ADL (activities of daily living) tasks.
• This also aids in determining fall risk and need for assistive devices, and measures intervention effectiveness.
• Components to consider include static and dynamic balance, obstacle negotiation, head turning, walking in different directions, walking while talking/attending another task, and capacity for movement.

Berg Balance Scale

• A 14-item objective measure designed for assessing static balance and fall risk in adults.
• Consists of static and dynamic activities.
• Includes functional reach test, static balance, pivot transfer, reaching for items on the floor and stairs, and turns.
• Required materials: stopwatch, chair with arms, tape measure, object, and step stool.
• Assessment time: 15-20 minutes
• Item scores range from 0-4.
• Maximum score is 56.
• A score below 45 indicates increased fall risk (MDC 3.3).

Tinetti Performance-Oriented Mobility Assessment (POMA)

• Measures gait and balance abilities, including fall risk, in older adults.
• The POMA consists of 16 items, with 9 for balance and 7 for gait.
• It uses a 3-point ordinal scale (0-2).
• Scores above 19 indicate a moderate risk of falls, and scores less than 19 indicate a high risk.
• Equipment required: armless chair, stopwatch, 15 ft walkway
• Time to administer: 15 minutes
• Test-Retest, interrater, and intrarater reliability are excellent.

Modified Clinical Test of Sensory Integration in Balance

• Measures postural control under various sensory conditions.
• A sway-referenced conflict dome prevents vision use for movement detection.
• Conditions include standing on firm ground and foam with eyes closed or open.
• 3 trials of 30 seconds are averaged for each condition.
• Equipment: Stopwatch, medium-density foam pad.
• Time to perform: less than 10 minutes
• MDC: 0.34.

Gait Speed

• Measures walking distance over 6 minutes.
• Adapted for 2 minutes (2MWT), estimating aerobic capacity.
• Must be performed at fastest consistent speed possible.
• Assistive devices can be used but should be kept consistent during the test.
• Equipment: Stopwatch, measuring wheel, floor markings for 30 meters.
• Time to test: less than 10 minutes.
• MDC = 0.1m/s.

Walking Speed

• Measures walking speed and its relationship to adverse events (hospitalization, falls).
• Provides different categories for interpretation: extremely frail, extremely fit, and others.
• Measures the risk of death and hospitalization for a year, and cognitive decline.

Timed Up & Go (TUG)

• Assesses mobility, balance, walking ability, and fall risk in older adults.
• On the command "go," the person rises from a chair, walks 3 meters, turns, and sits back down.
• Equipment: Chair without armrests, seating height of 44-47 cm, stopwatch, floor markings at 3 meters.
• Time to test: less than 3 minutes.
• MDC: 3.5 seconds.

Conditions & Populations Studied

• Assessments cover various conditions like stroke, community dwelling older adults, frail elderly, Parkinson's disease, lower extremity amputations, spinal cord injury, arthritis, low back pain, rheumatoid arthritis, acute medical patients, multiple sclerosis, healthy children (ages 3-9), and cerebral palsy. There are different cut-off points for different populations in the TUG test.

Functional Gait Assessment (FGA)

• Adapted from DGI (due to ceiling effects).
• 10 components with scores ranging from 0-3.
• Scores range from 0 (severe impairment) to 3 (normal ambulation).
• Highest score is 30.
• Assessment can be performed with or without assistive devices.
• Equipment: Stopwatch, 12-ft walking area, 9-inch height obstacle.
• Time to perform: 5-10 minutes, with a MDC of 6 points.

6-Minute Walk Test (6MWT)

• Measures walking distance in 6 minutes.
• A sub-maximal estimate of aerobic capacity.
• Should be performed at the fastest consistent speed possible.
• Equipment: Stopwatch, measuring wheel, floor markings.
• Time to test: less than 10 minutes.
• MDC = 58 meters.

2-Minute Step Test

• Measures aerobic endurance.
• Counts the number of times the right knee reaches a 50% femur-length mark on a wall.
• Equipment: Stopwatch and measuring tool to mark the wall.
• Time to test: less than 2 minutes.

Grip Strength

• Measures grip strength using a dynamometer.
• Standardized positioning: seated in a chair, shoulder at neutral, elbow at 90 degrees, forearm neutral, wrist 0-15 degrees ulnar deviation.
• Associated with many functional outcomes, lean mass, strength of lower limbs, premature death, recovery time, and post-surgical functionality.
• A grip strength below 1 SD below the average is indicative of decreased physical function and possible risk of frailty.

30-Second Sit-to-Stand Test

• Measures leg strength and endurance.
• Developed to overcome the floor effect of the 5x sit-to-stand test; used in various populations and helpful to test in assisted living to community dwelling.
• Equipment: Chair, stopwatch.
• Time to test: 30 seconds.

Screen for Dementia

• Screens for progressive cognitive decline often associated with motor impairments, decreased balance, gait speed, and risk of falls in older adults.
• Uses a simple scoring method.
• Does not guarantee a diagnosis but can rule out dementia in some cases.

Which Test?

• Provides examples of patient cases to highlight which test might be most appropriate.

Practice Makes Perfect!

• Encourages continuous practice and refinement of the skills/tests being addressed to achieve perfection.

Test your knowledge on the Functional Mobility Scale and Berg Balance Scale with this quiz. Discover key components, scoring methods, and required materials for assessments. Perfect for students and professionals in physical therapy and rehabilitation.