Functional Reach Test

- Duncan, 1990; Eagle, 1999; Langley, 2007

A. Title B. Authors

Functional Reach Test uncan, P.W., Weiner, .K., Chandler, J., & Studenski, S. ) (1 1 to 2 minutes Meter/yard Stick

C. Time required to administer the test . Materials

A.


Purpose of the Test

Descriptive: to etect balance impairment or look at changes in balance performance over-time of geriatric patients  Pre ictive: assess risk of falling

.


Target Population
Geriatric / El erly population

A.

Ease of Administration


Easy to perform , accessible of balance

practical measure

Clarity of Directions
  

mount a yardstick on the wall on shoulder level stand near wall, but not touching it outstretch arm, with hand in a fist, parallel to floor

   

Note starting position number on ruler where the person s MCP joint is reach as far forward as possible, without taking a step At their maximum forward reach, take note of end position The person gets 2 practice trials, and then have them reach forward 3 times, and average the 3 distances.

C. coring Procedures  Compare pre post measurement  scores less than 6-7 inches: limited functional balance  scores 10 inches or more: adequate functional balance D. Examiner Qualifications Training  No training required

A.

Norms
Age 20 40 y/o 41 69 y/o 70 87 y/o Men 16.7 + 1.9 14.9 + 2.2 13.2 + 1.6 Women 14.6 + 2.2 13.8 + 2.2 13.2 + 1.6

.
 

Reliability
Test-retest reliability: Interrater reliability: r = 0.89 r = 0 .98

C.

Validity  FRT was strongly associated with measurements: centre of pressure excursion r = 0.71 linear regression r= 0.51
 

Moderate correlations Tandem walk Gait peed: Fair correlations BBS: POMA:

r= 0.67 0.71 r= 0.42 r= 0.47

Sensitivity
 ability to detect falls when they are present = 76%

Specificity
 ability to identify correctly the absence of falls =

34%

Positive Predictive Value

 how well test predicted compared to actual

number of falls = 33%

Negative Predictive Value

 how well negative test correctly predicts absence

of falls = 77%

Accuracy
 overall rate of agreement between the test and

the actual number of falls = 46%

Prevalence
 ratio of the number of people who have fallen

divided by the total number of people at risk for falling = 30%

Measures one direction of functional movement (forward reach) May not identify balance difficulties evident during locomotion related activities

Duncan, P. ., Weiner, D. ., Chandler, J. Studenski S. (1990). Functional reach: a new clinical measure of balance. Journal of Gerontology, 145: 192-197. Eagle, J., Salamara, S., Whitman, D., Evans, L.A., Ho, E., Olde, J. (1999). Comparison of three instruments in predicting accidental falls in selected inpatients in a general teaching hospital. Journal of Gerontological Nursing, 25(7), 40-45. Langley, F.A., Mackintosh, S.F. (2007). Functional balance assessment of older community dwelling adults: A systemic review of literature. Internet Journal of Allied Health Sciences and Practice, 4(5), 1-11.

PATIENT ASSESSMENT

Name: Age: Gender: Handedness: Dx:

RM 58 y/o M (R) S/P (R) CVA (2010); (L) Hemiparesis

c/c:
 pt. c/o weakness on (L) UE

maintaining balance

LE; difficulty in

PMHX:
 (+) HTN, controlled by meds. since 2000  (+) DM, controlled by meds

Personal/Social Hx
 (+) alcoholic beverage drinker  (-) smoker

VS: WNL OI:

 Ambulatory without assistive device  Alert/coherent/cooperative  (+) obvious physical findings: (+) Trophic skin changes: dry, scaly skin (+) Postural Deviation (+) Gait Deviation (-) facial asymmetry, typical arm posture, atrophy, deformities

Palpation:
 Normothermic on all exposed body parts  Normotonic on (B) UE LE  (-) shoulder sublaxation, tenderness, edema

Neurologic Eval:
 50% sensory deficit as to light touch, pain

pressure on (L) UE LE  100% intact kinesthesia

proprioception

Reflex Testing:
 Normoreflexia on (B) UE

LE  (-) babinski, clonus, associated reactions

ROM:
 WNL, pain free actively

passively done on (R)  LOM on (L) UE secondary to pain

MMT:
 Major muscles of (L) UE

LE grossly graded 3+/5

Postural Analysis
 Pt. in standing position

assessed in all views with postural landmark symmetrical leveled except for:
Upper back slightly more rounded Feet pointing outwards

Gait Analysis
 Pt. ambulates with wide BOS / toeing-out

with

limited arm swing

ADL
 Independent in all aspects of ADL except for: UE dressing requires minimal to moderate assistance

Functional Mobility:
 Independent as to bed mobility  Minimal assist require during sit to stand transfer

Balance
 Good sitting balance and tolerance  Fair standing balance pt is able to maintain balance with handhold support; may require occasional minimal assistance

Functional Outcome Measure:  Functional Reach Test (FRT) to assess balance impairment risk of falling
Trial 1 2 3 Ave. Starting Position 8.5 8 8.7 8.4 End Position 14.5 14 14.8 14.03 Difference 6 6 6.1 6.03 / 15.3 cm.

sig.: impaired functional balance

Scores: <6-7 (<15.24 - 17.78 cm.): limited functional balance; indicates a frail person with limited ability to perform ADLs increased risk of fall.

>10 (>25.4 cm.): adequate functional balance

Norms
Men (cm.) 42.4 cm. 4.8 cm. 37.8 cm. 5.6 cm. 33.5 cm. 4.1 cm. Women(cm.) 37.1 cm 5.6 cm. 35.1 cm. 5.6 cm. 33.5 cm. 4.1 cm.

Age 20 40 y/o 41 69 y/o 70 87 y/o

PT Diagnosis
 Impaired Motor Function

Sensory Integrity Associated with Non Progressive Disorders of the CNS- Acquired in Adulthood

Impression
 Pt. condition is further defined with (L)

hemiparesis , hemianesthesia, impaired balance, LOM on (L) UE LE, postural gait deviation.

 Problem List: 1. Impaired Balance 2. Weakness on (L) UE 3. 4. 5.

LE

LOM on (L) UE Gait deviation Postural deviation

Goals pt. will be able to demonstrate Good standing balance as manifested by ability maintain balance without handhold support with limited postural sway. 2. Pt. will demonstrate increase mm. strength from 3+ to 5/5. 3. Pt. will be able to demonstrate increase in ROM as manifested by ability to do overhead motion without pain difficulty.
1.

To develop PT protocol / intervention to improve functional balance.

Justine Ramos, PTRP

Functional Reach Test: Static vs. Dynamic?

 Dynamic measure of balance regardless of

movement strategy (Duncan et.al, 1990)  Compensatory movement strategies (e.g. hip flexion and ankle PF) are more of static which does not increase the moment arm during FR (Wernick-Robinson et.al, 1999)

RCT on Therapeutic Exercises (flexibility, strength, balance, endurance UE function) in Subacute Stroke (Duncan et.al, 2003) RCT on Specific balance-strategy training programme for preventing falls among older people (Nitz Choy, 200) Case study on NDT focusing on postural training to improve Functional Reach (Zacharewicz, 2002)