postural assessment and berg balance (2)

8/13/2019 Postural Assessment and Berg Balance (2)

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postural assessment and Berg

Balance Scales

for stroke patient


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What is stroke ?

A stroke is a condition in which the brain cells

suddenly die because of a lack of oxygen

A stroke can be caused by an obstruction in

the blood flow, or the rupture of an artery

that feeds the brain.


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What are the symptoms of stroke?

Trouble walking, loss of balance andcoordination.

Speech problems.

Dizziness.

Numbness, weakness, or paralysis.

Blurred, blackened, or double vision.

Sudden severe headache.

Confusion.
http://www.medicalnewstoday.com/articles/170634.phphttp://www.medicalnewstoday.com/articles/73936.phphttp://www.medicalnewstoday.com/articles/73936.phphttp://www.medicalnewstoday.com/articles/170634.php


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Common problems that faced strokepatient

cognitive problems

communication problems

depression emotional problems fatigue

physical problem

visual problems


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physical problem

Weakness and paralysis

Spasticity

Problems with walking Changes in sensation.

Balance problem.

Postural

problem


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Physicalproblem

posture

Posturalassessment

scale

balance

Berg balancescale


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How to asses the posture and balance

The ability to maintain or to change a position

can be altered in the 3 basic posture:lying

,sitting and standing

Assessment of these critical postures is often

standardized for clinical followup in the term

of


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Ability to roll from supine to side lateral and

vise versa

The ability to maintain an independent sitting

posture without any extension

support(buttocks on a bed and feet on the

floor

The ability to rise up from a chair

The ability to stand unaided


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Equipment needed:

stopwatch or watch with a second hand

ruler indicating 2, 5, and 10 inches

2 standard height chairs-approximately 46 cm (1

with, 1 without armrests; bed can substitute forchair without armrests)

footstool-approximately 21 cm

an object to pick up off the floor (e.g., shoe /

slipper). Directions: The directions for items are provided

on the scoring sheet. (Appendix 2)


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Maintaining a Posture 1. Sitting without support (sitting on the edge of an 50-cm-high

examination table [a Bobath plane, for instance] with the feet

touching the floor)

0=cannot sit 1=can sit with slight support, for example, by 1 hand

2=can sit for more than 10 seconds without support

3=can sit for 5 minutes without support

2. Standing with support (feet position free, no other constraints)

0=cannot stand, even with support

1=can stand with strong support of 2 people

2=can stand with moderate support of 1 person

3=can stand with support of only 1 hand


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3. Standing without support (feet position free, no other constraints)

0=cannot stand without support

1=can stand without support for 10 seconds or leans heavily on

1 leg

2=can stand without support for 1 minute or stands slightly asymmetrically

3=can stand without support for more than 1 minute and at the

same time perform arm movements above the shoulder level

4. Standing on nonparetic leg (no other constraints)

0=cannot stand on nonparetic leg

1=can stand on nonparetic leg for a few seconds 2=can stand on nonparetic leg for more than 5 seconds

3=can stand on nonparetic leg for more than 10 seconds

5. Standing on paretic leg (no other constraints)

Same scoring as item 4


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Changing Posture

Scoring of items 6 to 12 is as follows (items 6 to 11 are to be performed with a 50-cm-high examination table, like a Bobath plane;

items 10 to 12 are to be performed without any support; no other

constraints):

0=cannot perform the activity

1=can perform the activity with much help

2=can perform the activity with little help

3=can perform the activity without help

6. Supine to affected side lateral

7. Supine to nonaffected side lateral

8. Supine to sitting up on the edge of the table

9. Sitting on the edge of the table to supine

10. Sitting to standing up 11. Standing up to sitting down

12. Standing, picking up a pencil from the floor


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Berg Balance Scale

Name: Date of Test: .

1. Sit to Stand

Instructions: Please stand up. Try not to use your hands for support

Grading: Please mark the lowest category that applies

( ) 0: Needs moderate or maximal assistance to stand

( ) 1: Needs minimal assistance to stand or to stabilize

( ) 2: Able to stand using hands after several tries

( ) 3: Able to stand independently using hands

( ) 4: Able to stand with no hands and stabilize independently

2. Standing unsupported

Instructions: Please stand for 2 minutes without holding onto anything


( ) 0: Unable to stand 30 seconds unassisted

( ) 1: Needs several tries to stand 30 seconds unsupported

( ) 2: Able to stand 30 seconds unsupported ( ) 3: Able to stand 2 minutes without supervision

( ) 4: Able to stand safely for 2 minutes

If person is able to stand 2 minutes safely, score full points for sitting unsupported (item 3). Proceed to item 4.


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3. Sitting with back unsupported with feet on floor or on a stool

Instructions: Sit with arms folded for 2 minutes


( ) 0: Unable to sit without support for 10 seconds

( ) 1: Able to sit for 10 seconds

( ) 2: Able to sit for 30 seconds

( ) 3: Able to sit for 2 minutes under supervision

( ) 4: Able to sit safely and securely for 2 minutes

4. Stand to sit

Instructions: Please sit down


( ) 0: Needs assistance to sit

( ) 1: Sits independently but had uncontrolled descent

( ) 2: Uses back of legs against chair to control descent

( ) 3: Controls descent by using hands

( ) 4: Sits safely with minimal use of hands


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5. Transfers

Instructions: Please move from chair to chair and back again (Person moves one way toward aseat with armrests and one way toward a seat without armrests) Arrange chairs for pivot transfer


( ) 0: Needs two people to assist or supervise to be safe

( ) 1: Needs one person to assist

( ) 2: Able to transfer with verbal cueing and/or supervision

( ) 3: Able to transfer safely with definite use of hands ( ) 4: Able to transfer safely with minor use of hands

6. *Standing unsupported with eyes closed

Instructions: Close your eyes and stand still for 10 seconds


( ) 0: Needs help to keep from falling

( ) 1: Unable to keep eyes closed for 3 seconds but remains steady ( ) 2: Able to stand for 3 seconds

( ) 3: Able to stand for 10 seconds without supervision

( ) 4: Able to stand for 10 seconds safely


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7. *Stand unsupported with feet together

Instructions: Place your feet together and stand without holdingon to anything


( ) 0: Needs help to attain position and unable to hold for 15

seconds ( ) 1: Needs help to attain position but able to stand for 15 seconds

with feet together

( ) 2: Able to place feet together independently but unable to holdfor 30 seconds

( ) 3: Able to place feet together independently and stand for 1minute without supervision

( ) 4: Able to place feet together independently and stand for 1minute safely


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The following items are to be performed while

standing unsupported

8. *Reaching forward with outstretched arm

Instructions: Lift you arm to 90 . Stretch out your fingers andreach forward as far as you can (Examiner places a ruler and end offingertips when arm is at 90 . Fingers should not touch the rulerwhile reaching forward. The recorded measure is the distance

toward that the fingers reach while the person is in the mostforward lean position.)

Grading: Please mark the lowest category that applies.

( ) 0: Needs help to keep from falling

( ) 1: Reaches forward but needs supervision

( ) 2: Can reach forward more than 2 inches safely ( ) 3: Can reach forward more than 5 inches safely

( ) 4: Can reach forward confidently more than 10 inches


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11. *Turn 360

Instructions: Turn completely in a full circle. Pause, then turn in a full circle in the otherdirection


( ) 0: Needs assistance while turning

( ) 1: Needs close supervision or verbal cueing

( ) 2: Able to turn 360 safely but slowly

( ) 3: Able to turn 360 safely to one side only in less than 4 seconds ( ) 4: Able to turn 360 in less than 4 seconds to each side

12. *Place alternate foot on bench or stool while standing unsupported

Instructions: Place each foot alternately on the bench (or stool). Continue until each foot hastouched the bench (or stool) four times. (Recommended use of 6-inch-high-bench.)

Grading: Please mark the lowest category that applies.

( ) 0: Needs assistance to keep from falling/unable to try ( ) 1: Able to complete fewer than two steps; needs minimal assistance

( ) 2: Able to complete four steps without assistance but with supervision

( ) 3: Able to stand independently and complete eight steps in more than 20 seconds

( ) 4: Able to stand independently and safely and complete eight steps in less than 20 seconds


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13. *Stand unsupported with one foot in front

Instructions: Place one foot directly in front of the other. If you feel that you cant place your footdirectly in front, try to step far enough ahead that the heel of your forward foot is ahead of the toesof the other foot (Demonstrate this test item)


( ) 0: Loses balance while stepping or standing

( ) 1: Needs help to step but can hold for 15 seconds

( ) 2: Able to take small step independently and hold for 30 seconds ( ) 3: Able to place one foot ahead of the other independently and hold for 30 seconds

( ) 4: Able to place feet in tandem position independently and hold for 30 seconds

14. *Standing on one leg

Instructions: Please stand on one leg as long as you can without holding onto anything


( ) 0: Unable to try or needs assistance to prevent fall

( ) 1: Tries to lift leg, unable to hold 3 seconds but remains standing independently

( ) 2: Able to lift leg independently and hold up to 3 seconds

( ) 3: Able to lift leg independently and holds for 5 to 10 seconds

( ) 4: Able to lift leg independently and hold more than 10 seconds


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Total Score /56

Note: Perform only items 6 thorough 14 (*) in

the modified version of the scale. Maximum

score for modified version is 36 points.


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Reliability Internal consistency

- 3 studies have reported excellent internal consistency of the PASS.- 1 study reported excellent internal consistency of PASS trunk control items (PASS-TC).

- 1 study reported adequate to excellent internal consistency of the SFPASS.

Intra-rater

- 1 study reported adequate to excellent same-day intra-rater reliability of the SwePASS inpatients with acute stroke.

Inter-rater

- 2 studies reported adequate to excellent inter-rater reliability of individual PASS items and

excellent inter-rater reliability of the PASS total score.

- 1 study reported excellent inter-rater reliability of the PASS-TC.

- 1 study reported excellent inter-rater reliability of the SwePASS. Test-retest3 studies reported

adequate to excellent intra-rater reliability of individual PASS items and excellent test-retest

reliability of PASS total scores. Further, 1 study reported small limits of agreement using Bland-

Altman plots, indicating high stability with low natural variation. 1 study reported excellent test-

retest reliability of individual items and total score of the SFPASS.


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http://strokengine.ca/assess/module_pass_qu

ick-en.html

http://www.rehabmeasures.org/Lists/RehabM

easures/DispForm.aspx?ID=888
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postural assessment and berg balance (2)

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