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

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