Outcome Measures & HOAC

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Can you name the outcome measures used in adult neurological rehabilitation and describe the HOAC?

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A Tinetti score lower than this indicates the patient is at high risk for falls
A WWT (40'/first trial) score greater than this indicates the pt is at risk for falls
A Berg score lower than this demonstrates a need for assistive device
A Berg score less than this deems that a patient is at risk for falls
Next step in HOAC II after analyzing the data
Unexpected backward release score: unable to maintain upright balance, takes >2 steps & needs manual assist to restore balance
Part of pt exam that involves identifying the type of movement, the environment, and the temporal sequence
Results should correlate with results of another 'gold standard' test when performed on the same person
Tests involving movement of the entire body as required in sit to stand, walking & turning. AKA balance/mobility tests or gait scales.
Unexpected backward release score: unable to maintain upright balance & restores balance independently with 1 step
Once you have established goals in the HOAC II model, what do you do?
10 items of ADLs for which subjects rate their fear of falling on a scale from 1-10
14 items functional outcome tool designed to assess fall risk that is graded on a 0-4 ordinal scale
Test where subject stands with feet in tandem (non-dominant foot in front) for up to 60 sec with eyes open and then eyes closed
Ability to maintain stability while performing tasks that are potentially destabilizing.
Test's ability to provide an accurate measure of its stated purpose (and to predict)
Test in which examiner places hand between scapula of pt, has pt lean into hand, and quickly flexes elbow until hand no longer contacts pt
What does HOAC stand for?
Maximum Tinetti score for gait
A TUG score between this range indicates the patient has variable mobility
Maximum Tinetti score for balance
Test in which pt walks for 20', turns, and returns; repeats while reciting alphabet; & repeats while reciting every other letter of alphabet
This first step in the HOAC II involves a chart review/referral info, observation, and interviewing the pt
Category for balance adjustments made at the ankle/hip or made by stepping (establish new limits of stability)
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16 items test where subjects rate their confidence (0-100%) when performing specific tasks
In addition to establishing a criteria for testing & predicting resolution of problems, what else should you establish?
Functional outcome tool developed because people with vestibular disorders c/o difficulty walking, but scored high on DGI. Added 2 items to DGI & timing piece to existing items.
Part of HOAC II before the exam that involves generating the problem list
A Tinetti score in this range indicates the patient is at risk for falls
Functional outcome tool with 8 item test (4 item modified), scored on 0-3 scale, & has good sensitivity to falls in the elderly
Test performed on force plate that measures reaction time, movement velocity, distance, and directional control. Gives info about patient's ability & willingness to move COG
Once existing and anticipated problems have been identified (& justified) what is the next step in HOAC II?
Normal Berg score (out of 56) for a person between the ages of 65-95
A TUG score greater than this indicates the patient has impaired mobility
After you have a plan to reassess, what can you begin to plan (in the HOAC II model)?
This test has the patient lean maximally forward, backwards, & to the right/left. Distance is measured at acromion height from the fisted 3rd metacarpal head
Advantageous quality of a tool in which you don't need a lot of time to administer the test
Ability to maintain a safe, independent sitting or standing position. Exams include Romberg, Sharpened Romberg, and SLS
Problems identified by caregivers or observed by the PT, but may not be identified by the patient.
Unexpected backward release score: unable to maintain upright balance, takes 1-2 steps, & restores balance independently
Updated version of the HOAC made in 2003, that addresses newer disablement models & reinforces the pt centered approach
Scores of this or lower on the DGI have been related to increased incidence of falls in the elderly
Functional outcome tool studied mostly in patients following CVA. Reliability/validity are better with more impaired pts.
The ability to recover a stable position following an unexpected perturbation
Advantageous property of a tool in which you do not need specialized equipment or training
Functional outcome tool with 10 items, scored 0-4 & involved tests such as forward reach, turn 360, tandem walk, backward release, SLS, etc.
Functional outcome tool where the pt stands, walks 3m, turns, walks back, and sits (from a standard arm chair with 46 cm seat height).
Limit of lateral stability, in degrees, for a normal adult standing with feet 4 inches apart
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The ability of a tool to detect differences in functional performance
A WWT simple score greater than this indicates the pt is at risk for falls
After the evaluation in the HOAC II the algorithm divides into what 2 branches?
Next step in HOAC II after the examination has been conducted
Next step in HOAC II if you have refined the hypotheses
A WWT complex score greater than this indicates the pt is at risk for falls
A tug score in this range indicates the patient is mostly independent
Part of HOAC II before the exam that involves the process of planning the exam based on hypotheses generated during data collection
Tests that evaluate the functional use of vision, somatosensory, & vestibular input as it pertains to balance.
Functional outcome tool in which the pt walks 100 feet distances at their own pace, taking breaks if needed, during a 6 minute time period.
Functional outcome tool that has 2 sections (gait & balance), scored on 0-2 point ordinal scale, and has maximum score of 28.
Test in which patient stands on 1 leg (without bracing leg or using UE support)
Test's ability to provide similar results when performed on the same person & under the same conditions (both on different occasions & by different raters)
Limit of anterior-posterior stability, in degrees, for a normal adult
A Berg score lower than this indicates a 100% risk for falls
Functional outcome tool developed for post TBI, but found to be valid/reliable for MS as well.
A TUG score lower than this indicates the patient is freely mobile
WWT third trial in which the subject walks the same course while reciting every other letter of the alpahbet
Unexpected backward release score: unable to maintain upright balance, takes >2 steps & restores balance independently
Unexpected backward release score: unable to maintain upright balance, no attempt to step, & requires manual assist to restore balance
What do you do after you have refined the problem list in the HOAC II?
Second trial of WWT in which the subject walks the same course while reciting the alphabet

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