Ann was referred to me from a home health agency with the diagnosis of a fall causing a hip fracture, which was not operated on. Past medical history included dementia, so patient returned home from the rehab facility with 24/7 care. Upon meeting Ann, she was in a wheelchair and not walking. She was able to perform stand pivot transfers with the help of her caregiver. She had no complaints of pain but was extremely fearful of standing and falling. Exercises were initially performed in the seated position. Upon initial attempts to stand, Ann complained of dizziness and refused to take steps using a rolling walker.
Eventually, as she became accustomed to working with me, we began to perform standing leg exercises with short distance walking with the wheelchair following her. Anxiety remained a big issue limiting her ability to walk and regain her independence. However, she began to walk longer distances and no longer needed a wheelchair to follow. We then began to focus on increasing her stride and her speed while walking, continuing to use the rolling walker. She was able to progress at this time to walking from her bedroom to the treatment area using a walker, relying less on the wheelchair. Eventually, she stopped using the wheelchair. I reviewed her progress with her, explaining to her how she was doing compared to when we started and what the next goals would be. Seeing her progress, she became more excited and motivated to participate.
Next, we progressed from the rolling walker to a straight cane. Standing exercises progressed to more dynamic multi-tasking ones. These included walking around cones as well as walking while bouncing or tossing a ball. She used to enjoy golfing, so we began to incorporate training her golf swing using diagonal patterns. The goal of this was to
continue to challenge her balance as well as her core stability. Eventually, her cane went missing, and she had no issue with that. We began to practice walking with no device in her home and I tried to emphasize the importance of removing the bedside commode from her bed so that she would get out of bed and walk to the bathroom at night.
She initially struggled with getting out of her living room chair due to it swiveling and rocking. However, this was no longer an issue. We now incorporated reaction training as well as direction training using LED lights. She would walk from one light to the next as they lit up and tapped them using her hands. We then had her perform the same activity with the LEDs on the floor. Now she would have to react and walk towards the LED that lit up, balance on one leg to place the other leg on top of the light to turn it off. Then we made all three LEDs light up. Two were the same color and one was different. She had to react
and walk towards the LED that was a different color. This added a cognitive aspect to her balance, walking and reaction training.
At this time, she left the area to go up north to see family for the summer. Three months later, she returned to Florida. Her daughters wanted her to continue training to maintain and further improve her balance and conditioning. She had no limitations or issues when she was up north according to her family and they were extremely appreciative of her progress from being wheelchair bound to being independently walking.
Objective Testing:
Test | Eval | Reeval | Reeval | Reeval | Reeval |
Tinetti | 14/28 | 16/28 | 18/28 | 19/28 | 23/28 |
TUG | 24sec DEVICE | 23SEC NO DEVICE | 18SEC NO DEVICE | 14SEC | 14SEC |
5x STS | 49SEC | 32SEC | 26SEC | 20SEC | 14SEC |
The Tinetti Test, also known as the Tinetti Performance-Oriented Mobility Assessment (POMA), is a clinical assessment tool used to evaluate a person’s balance and gait. Each item is scored on a scale, and the total score can indicate a person’s fall risk:
∙ Low Risk: 24-28 points
∙ Moderate Risk: 19-23 points
∙ High Risk: Less than 19 points
You can see that Ann progressed from very high risk of falls to low/moderate risk.
The TUG (Timed Up and Go) Test is a simple and commonly used clinical test to assess a person’s mobility, balance, and fall risk.
Interpretation of Results:
∙ Normal Mobility: Completing the test in less than 10 seconds is generally considered normal for healthy, mobile adults. ∙ Moderate Risk of Falls: Taking between 10-20 seconds may indicate some mobility limitations and a moderate risk of falls. ∙ High Risk of Falls: Taking more than 20 seconds can indicate significant mobility issues and a high fall risk.
You can see Ann progressed from high risk of falls to moderate risk.
The 5 Times Sit-to-Stand (5xSTS) Test is a functional assessment that evaluates lower body strength, balance, and endurance. Interpretation of Results:
∙ Healthy Adults: Completing the test in less than 12 seconds is generally considered normal for healthy younger adults. ∙ Older Adults or Those with Mobility Impairments: A time greater than 15 seconds may indicate reduced lower extremity strength, balance difficulties, and an increased risk of falls.
You can see Ann progressed from high fall risk to low/moderate risk.
