Case Study 1.
Name: Olga Age: 70
Gender: Female
Reason for referral: history of a single fall
SUBJECTIVE
Social. She lives with her spouse in her own home.
Co morbidities: Rates her health as good. She was diagnosed with very mild peripheral neuropathy
in both legs (no history of diabetes).
Exercise History: does not exercise regularly, though walks occasionally with her husband.
Fall History. She reports falling once while walking across the street. The light changed, a car
beeped their horn at her, she tried to hurry to get across quickly and fell. No injuries.
TESTS AND MEASURES.
BERG BALANCE TEST 54/56
1. Sitting to standing 4
2. Stand to Sit
4
3. Transfers 4
4. Standing Unsupported 4
5. Sitting unsupported 4
6. Standing unsupported with eyes closed 4
7. Standing unsupported with feet together 4
8. Reaching forward with outstretched arm 4
9. Pick up object from the floor 4
10. Turning to look behind over left and right shoulders 4
11. Turn 360 degrees 4
12. Count number of times step stool is touched 4
13. Standing unsupported, one foot in front 3
14. Standing on one leg 3
10m Walk Test. Able to walk independently with a walker, speed is 1.6m/s (within normal limits
for her age and gender)
DYNAMIC GAIT INDEX 22/24 (Shumway-Cook, 1995)
1. Gait Level Surface 3
2. Change In Gait Speed 3
3. Gait With Horizontal Head Turns 3
4. Gait With Vertical Head Turns 3
5. Gait and Pivot Turn 3
6. Step Over Obstacle 2
7. Steps Around Obstacle 3
8. Steps 2
Scan Musculoskeletal Exam
Strength - deconditioned, 4/5 on all lower extremity muscles
ROM: Slight decreased range in hamstring and plantarflexors
Pain: Burning sensation in her feet
Sensory Components
a. Peripheral sensibility
somatosensory/vibration: abnormal in both lower extremity
visual acuity: corrected with glasses
Peripheral vision (normal is >70) - OK
b. Sensory Adaptation – CTSIB
Increased sway while standing with eyes closed on foam (both trials)
Case Study 2.
Name: Bill Age: 82 Gender: Male
Primary Diagnosis (ICD-10): 781.2 Gait abnormality
Reason for referral: impaired balance and gait
SUBJECTIVE
Social. He lives in his own home with an adult son.
Co morbidities: Arthritis
Medications: None
Medical history: Heart attack in 1992.
Exercise History: None, though takes care of home, mows lawn etc.
Fall History. No history of falls, but is very careful. Reports feeling unsteady several times
every day.
TESTS AND MEASURES
BERG BALANCE TEST 46/56
1. Sitting to standing 4
2. Stand to Sit 4
3. Transfers
4
4. Standing Unsupported 4
5. Sitting unsupported 4
6. Standing unsupported with eyes closed 3
7. Standing unsupported with feet together 3
8. Reaching forward with outstretched arm 4
9. Pick up object from the floor 4
10. Turning to look behind over left and right shoulders 2
11. Turn 360 degrees 2
12. Count number of times step stool is touched 2
13. Standing unsupported, one foot in front 3
14. Standing on one leg 3
10m Walk Test.
Able to walk independently, 0.8 m/s (60% of normal)
TUG
Single task – 10.1s
Dual Task - 12.8s (errors in counting backwards)
DYNAMIC GAIT INDEX 17/24 (Shumway-Cook , 1995)
1. Gait Level Surface 2
2. Change In Gait Speed 3
3. Gait With Horizontal Head Turns 1
4. Gait With Vertical Head Turns 2
5. Gait and Pivot Turn 2
6. Step Over Obstacle 1
7. Steps Around Obstacle 3
8. Steps 2
CTSIB
Firm eyes open – 30
Firm eyes closed – 30
Foam, eyes open – 30 (supervision for increased sway)
Foam, eyes closed – 10s, 10s
Incline Test (BESTest)
Eyes open –4 stands independently
Eyes closed – 1 – requires assistance
Release Test (BESTest)
Inplace forward – 3 recovers stability using ankle strategy
Inplace Backwards – 3 recovers stability using ankle strategy
Stepping Forward – 0/4 requires assistance to prevent a fall
Stepping Backwards – 0/4 requires assistance to prevent a fall
Scan Musculoskeletal Exam
Strength - deconditioned, 3+ to 4 out of 5 on all lower extremity muscles
ROM: decreased trunk flexibility (stands with fixed structural kyphosis and forward head
posture)
Pain: no complaints of pain
Sensory Components
a. Peripheral sensibility
somatosensory/vibration: normal
visual acuity: corrected with glasses
Peripheral vision (normal is >70) – OK
Case Study 3.
Name: Bonnie Age: 90
Gender: Female
Primary Diagnosis (ICD-10): 781.2 Gait abnormality
Reason for referral: history of falls and instability, impaired balance and gait.
SUBJECTIVE
Social. She lives alone in an apartment in assisted living. She has home care worker 3 days a week
for 5 hours to assist with cooking, cleaning, and shopping.
Co morbidities: Cardiac arythmia, depression, arthritis, spinal stenosis
Medications: Caduet, Lorazapam
Medical/treatment history: Physical therapy for treatment of vertigo several times. Physical
Therapy for imbalance several years ago.
Exercise History: walks every other day for 15 mins.
Fall History. Five falls in previous 6 monhts. Two falls resulted in serious injuries (fractures),
requiring short stay in a skilled nursing facility. Circumstances of previous falls: tripped when
walking, lifting heavy objects, reaching up into a cupboard. She is very fearful of additional falls,
has restricted her activities because of this.
TESTS AND MEASURES
BERG BALANCE TEST 18/56
1. Sitting to standing 1
2. Stand to Sit
3
3. Transfers 1
4. Standing Unsupported 3
5. Sitting unsupported 4
6. Standing unsupported with eyes closed 3
7. Standing unsupported with feet together 1
8. Reaching forward with outstretched arm 1
9. Pick up object from the floor 1
10. Turning to look behind over left and right shoulders 0
11. Turn 360 degrees 0
12. Count number of times step stool is touched 0
13. Standing unsupported, one foot in front 0
14. Standing on one leg 0
Release Test (BESTest)
Inplace forward – 2/4 uses arms to recover
Inplace Backwards – 0/4 requires assistance to prevent a fall
Stepping Forward – 0/4 requires assistance to prevent a fall
Stepping Backwards – 0/4 requires assistance to prevent a fall
CTSIB
Firm eyes open – 30
Firm eyes closed – 30 (supervision for increased sway)
Foam, eyes open – 30 (supervision for increased sway)
Foam, eyes closed – unable without physical assistance
Incline Test (BESTest)
Eyes open – unable
Eyes closed – unable
10m Walk Test.
Able to walk independently with a walker, speed is 0.4m/s (30% of normal).
TUG
Single task – 24.4s
Dual Task – 33.1s (errors in days of week backwards)
DYNAMIC GAIT INDEX 13/24 (Shumway-Cook , 1995)
1. Gait Level Surface 2
2. Change In Gait Speed 1
3. Gait With Horizontal Head Turns 1
4. Gait With Vertical Head Turns 2
5. Gait and Pivot Turn 2
6. Step Over Obstacle 1
7. Steps Around Obstacle 2
8. Steps 2
Scan Musculoskeletal Exam
Strength - deconditioned, 3+ to 4/5 on all lower extremity muscles
ROM: decreased hamstring, plantarflexor and hip flexor range, knee flexion contractures
Pain: knees and low back
Sensory Components
a. Peripheral sensibility
somatosensory/vibration: abnormal
visual acuity: corrected with glasses
Peripheral vision (normal is >70) – OK