Table 1. Clinical assessments and exercises used during PT intervention in ED (patient ≥ 75 years).
Name of the Assessment | Description | Threshold for initiating exercises within the ED | Example of exercises |
---|---|---|---|
Unipedal Balance Test—UBT [35] Duration: 2 minutes |
The patient is asked to stand barefoot on the limb of his choice, with the other limb raised so that the raised foot was near but not touching the ankle of their stance limb. Each patient is asked to focus on a spot on the wall at eye level in front of him/her, for the duration of the eyes open test. Prior to raising the limb, the patient is instructed to cross his arms over the chest. The investigator uses a stopwatch to measure the amount of time the patient was able to stand on one limb. Time starts: when the patient raised the foot off the floor. Time ends: when the patient either: (1) used his arms (ie, uncrossed arms), (2) used the raised foot (moved it toward or away from the standing limb or touched the floor), (3) moved the weight-bearing foot to maintain his balance (ie, rotated foot on the ground), (4) a maximum of 45 seconds had elapsed, or (5) opened eyes on eyes closed trials. |
< 5 sec | Unipodal stance exercise (each limb) with eyes opened/closed, for a duration of 6 sec |
Romberg test [36] Duration: 2 minutes |
The patient stands on the floor, preferably with shoes off, feet together. The patient is asked to maintain the position with eyes open and then closed. The investigator uses a stopwatch to measure the amount of time the patient (upper limit typically = 30 seconds) is able to maintain the position with eyes open then retested with eyes closed. Prior to raising the limb, the patient is instructed to cross his arms over the chest. The Romberg test is positive when the patient is unable to maintain balance with their eyes closed. Losing balance can be defined as increased body sway, placing one foot in the direction of the fall, or even falling. |
Positive | Transfer from supine to seated position, seated to bipodal stance |
Tinetti Performance Oriented Mobility Assessment Duration: 10 minutes |
For testing the balance abilities: The patient is asked to sit, to stay, to rise up and stay standing from an armless chair. Then, the patient is asked to turn 360° and sit back down. The investigator looks at how the patient rises and sits down, stays upright particularly when eyes are closed or when getting pushed against the sternum. For testing the dynamic balance: the patient is asked to walk a few metres (15 feet) at normal speed, to turn and walk back at a speeder (but safe) velocity, and to sit back on the chair. The investigator looks at the quality of the steps (length and height), the symmetry and continuity of the steps, and to the rigidity of the trunk. Brace, cane, walker or any device used to walk can be used during the test. Balance (/16) and gait (/12) scores are summed to 28. The lower the score, the higher the risk of falling. |
19 | Balance exercise with external perturbation |
Time Up and Go Test—TUG [37] Duration: 5 minutes |
The patient is sitting in a chair. The patient is asked to stand up (command “go”) and walk forward 3 metres (10 feet), to turn around at the foot mark on the floor and to walk back to the chair. The investigator uses a stopwatch to measure the amount of time between the command to start, till the buttocks touch the chair. Brace, cane, walker or any device used to walk can be used during the test. |
> 20 sec | Walking with assistive device related to deficiencies + typical pattern of gait |
Stop Walking When Talking test—SWWT [38] Duration: 5 minutes |
The patient is walking down in the ED service (in a corridor) under the supervision of the investigator. The supervisor observes whether the patient stops or not walking when a conversation in engaged by the investigator. |
Positive | Gait with double task (counting, speaking…) |
Ankle range of motion in dorsiflexion Duration: 5 minutes |
The patient is supine with knee flexed at 90° and foot in neutral position of inversion/eversion. The investigator stabilizes tibia and fibula to prevent hip/knee compensations. Using a goniometer centered at the bottom center of the lateral malleolus, with proximal arm positioned in reference of fibula head and the distal arm in reference to the 5th metatarsal, respectively, the angulation in maximal passive dorsiflexion angle, is measured at the angle corresponding to the onset of pain |
< 5° | Ankle mobilisation/ calf stretches |