Functional Reach Test
Gisselle Molina Diaz
Keiser University
Functional reach test on elderly women at risk of falls
The brain is a computer that programs and connects all the human systems to work together. Each of these systems has its own function, but more than one system may contribute to one specific function. For example, the somatosensory, visual, and vestibular systems are the three sensory systems that contribute to maintain balance under different activities of daily living and environmental conditions. Elements found in the musculoskeletal system provide good stability and equilibrium. Assessing balance is part of the scope of practice of the physical therapist and physical therapist assistants in order
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to predict the impairment they have to focus on. There are multiple balance tests that can determine the patients’ abilities to maintain balance during daily functional activities. One such test is the functional reach test, which predicts risks of falls in the elderly population. Functional Reach Test (FRT) The functional reach test is a balance test that predicts risk of fall in the elderly population.
To perform this test, a yardstick is placed on the wall at the acromion process’s height. The patient must stand parallel to the wall with his/her feet open to shoulder height. The arm closest to the wall is positioned at 90 degrees of shoulder flexion with the elbow and hand extended. The tester records the starting position at the third metacarpal head on the yardstick. Next, the patient—without moving his/her feet—moves his/her trunk forward and reaches as far as he/she can. At this point, the tester locates the position of the third metacarpal and obtains the first measurement, usually in inches. After that, the patient returns to the starting position, waits three seconds, and repeats the test. The functional reach test is performed three times; however, the average measurement of the last two times is considered the final measurement (Sonu & Manoj, 2014).
The recently study to 100 females of age above 65 years old at risk of falls demonstrates the differences between the regular functional reach test (FRT) versus a target oriented-functional reach test (TOFRT). The article “Non-Target and Target-Oriented Functional Reach among elderly females at risk of falls” compares the results of the standard functional reach test to a target- oriented functional reach test by performing the regular FRT first and then by providing a target.
Selection
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Process The testers selected 100 females above the age of 65 among outpatient clinics, hospitals, and homes. These subjects had to achieve at least 90 degrees of shoulder flexion as well as elbow extension limitation no greater than 20 degrees. The individuals were not allowed to use any assistive devices during testing. Likewise, patients with musculoskeletal, cardiovascular, neurological or vestibular impairments which could cause loss of balance and falls while testing were immediately disqualified for the study. Also the quality of test performance was taken into consideration. If the subject touched the wall with any part of her body or took step in any direction due to lose of balance then the patient is not considered good subject for this particular study. Another requirement was do not reach greater than 7” in the FRT. Test Performance The testers had two stations, one in which they tested the functional reach test and the other in which they performed the target-oriented functional reach test. First, the height of the acromion process of each participant was measured and recorded in standing position. Next, a yardstick was placed on the wall at the height to the right acromion process of the subject, and the subjects performed the FRT test exactly as previously described. After that, a tripod with a 10.5 can of soup on, was placed at the second station at the level of the FRT subject’s final measurement (Sonu & Manoj, 2014). Then the patient had to lean forward as in the regular test and reach for the soup can. To altered the test, the tripod was advance one inch of increment and the average of 7 trials of the maximal distance that the subject could reach beyond the functional reach score to get the can of soup, was recorded as the target-oriented functional reach. Results The results of this study indicate that a group of elderly female at risk of falls was able to reach further when they had a target- a can of soup- than in the regular FRT.
Average scores for the study were 5.3720 inches of FRT and 8.5090 inches of TOFR. A relevant result was that 14 subjects ‘scores were 9.5-9.9 inches or greater on the Target-Oriented Functional Reach, indicating a minimal risk for falling according to Sonu & Manoj, (as cited in Shumway, Gruber, Baldwin & Liao, 1997)
Obviously, statistical analysis showed differences between the two methods which means that FTOFR is not exchangeable for the FRT and therapist are advised to use the original functional reach test. On the other hand both tests measure balance in patients at risk for fall but one of the limitations of this study was the level of fatigue of the subjects trying to reach further limits.
The authors stated that future studies should validated in others groups of subjects such as men. Without doubt “…altering the functional reach test by providing a target would produce mild correlated score and use functional reach test as its original format.” (Sonu & Manoj, 2014, p.167).
References
Sonu, P. & Manoj, M. (2014). Non-Target and Target-Oriented Functional Reach among elderly females at risk of falls. Indian Journal of Physiotherapy & Occupational Therapy. Vol,8,
No,2.
When performing manual muscle testing for shoulder flexion and abduction, PTA’s typically place their hand at the wrist verses the mid-extremity because placing their hands at the wrist increases the length of the lever thus testing the muscles ability to resist externally applied force overtime and across the bone-joint lever arm system. Shorter lever arms will provide higher testing scores when compared to using longer lever arms, thus changing the point of force application affects the length of the lever arm and therefore the muscle torque.
The key objective of the project is to produce a report on fall among the geriatric population, which will help to improve an awareness and knowledge of the importance of lessens falls in elderly and encourage action to lower falls and related
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Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis. Archives of gerontology & geriatrics, 56(3), 407-415. doi:10.1016/j.archger.2012.12.006
It is important that key factors in determining who is and who is not a risk to fall are sought out by the health care team. In this paper we will focus on how to determine who is a fall risk.
Fatigue, decreased mobility and impaired balance from the rheumatoid and osteoarthritis pain also increases the risk of falls (Stanmore et al., 2013). Age related changes such as sarcopenia causes muscle tone and strength to decrease, especially in the lower limbs and as a result, balance and gait become impaired (Culross, 2008). These factors significantly influence the risk of falls and also affect the ability to carry out daily activities therefore, with a physiotherapists assistance, the nurse could introduce a personalised exercise regime to enhance muscle tone and strength (Culross, 2008). According to Neuberger et al (1997), exercise lessens fatigue and improves muscle tone and balance in older people. Recommending an exercise programme for Mrs Jones that incorporates strength training exercises and aerobics, could potentially improve muscle tone and strength and as a result improve mobility, balance and lessen the risk of falls (Bird, Pittaway, Cuisick, Rattray & Ahuja, 2013). The nurse could also suggest safety precautions such as advising Mrs Jones to use a mobility aid (Gooberman-Hill & Ebrahim,
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Kinesiology is a complimentary therapy used to identify and correct internal issues to relieve stress, allergies, and pain. Being described as a complimentary therapy, kinesiology is not meant to be a cure-all for the patient, but a secondary method of increasing positive results of the original therapy; this method however can be used as a primary or secondary form of therapy depending on the results for the patient and satisfaction with said results. During treatment the doctor tests 14 different areas of muscles balance, these major muscles and how they react are believed to uncover problems that need correction which cannot be found with any other testing (Rude Health).
A fall is a lethal event that results from an amalgamation of both intrinsic and extrinsic factors which predispose an elderly person to the incident (Naqvi et al 2009). The frequency of hospital admission due to falls for older people in Australia, Canada, UK and Northern Ireland range from 1.6 to 3.0 per 10 000 population (WHO 2012). The prevalence of senior citizen’s falls in acute care settings varies widely and the danger of falling rises with escalating age or frailty. Falls of hospitalized older adults are one of the major patient safety issues in terms of morbidity, mortality, and decreased socialization (Swartzell et al. 2013). Because the multi-etiological factors contribute to the incidence and severity of falls in older society, each cause should be addressed or alleviated to prevent patient’s injuries during their hospital stay (Titler et al. 2011). Therefore, nursing interventions play a pivotal role in preventing patient injury related to hospital falls (Johnson et al. 2011). Unfortunately, the danger of falling rises with age and enormously affect one third of older people with ravages varying from minimal injury to incapacities, which may lead to premature death (Johnson et al. 2011). In addition, to the detrimental impacts on patient falls consequently affect the patient’s family members, care providers, and the health organization emotionally as well as financially (Ang et al. 2011). Even though falls in hospital affect young as well as older patients, the aged groups are more likely to get injured than the youth (Boltz et al. 2013). Devastating problems, which resulted from the falls, can c...
When taking steps to analyze and apply intervention strategies for falls, we must examine the factors that cause these occurrences. There are numerous reasons that falls occur, such as intrinsic and or extrinsic risk factors. Intrinsic risk factors for falls may be due to changes that are part of the normal aging process and acute or chronic conditions. According to Zheng, Pan and Hua et al. (2013), about 35-45 percent of individuals who are usually older than 65 years and other 50 percent of the elderly individuals report cases of fall every year. Extrinsic factors are those related to physical environment such as lack of grab bars, poor condition of floor surfaces, inadequate or improper use of assistive devices (Currie). Patient falls is not an easy thing to eliminate. With many clinical challenges, there’s no easy answer to the challenges posed by patient falls; howe...
In our everyday lives, we almost take for granted this idea of balance or equilibrium that is maintained within our bodies. In general, no real thought processes are required. It is only when something is disturbed within our balance system that one is able to take notice of changes in the equilibrium. There may be several different factors that cause a disturbance to our bodies. One major area pertains to dizziness. Dizziness is found to be "the chief complaint in 8 million physician visits a year" (1). Vertigo is one type of dizziness, causing illusions of movement, that is being researched more and more today because of its widespread symptoms.
Vasconcelos, O., Rodrigues, P., Barreiros, J. & Jacobsohn, L. (2009). Laterality, developmental coordination disorders and posture. In L. P. Rodrigues, L. Saraiva, J. Barreiros & O. Vasconcelos (Eds.) Estudos em desenvolvimento motor da criança II (pp.19-26). Escola Superior de Educação, Instituto Politécnico de Viana do Castelo.
Athletes must accomplish amazing feats of balance and coordination of the body. As scientist, Mikhail Tsaytin discovered in the 1970s, acrobats can successfully make a two person human tower in the dark, but after adding a third acrobat, not even the most talented can maintain the balance required to keep the tower intact while in the dark (1). What does darkness have to do with it? The point is that balance relies on at least three signals coming from the body, and one of those is sight. Once you eliminate one of these signals, the body cannot accomplish the required task. In addition to sight, signals coming from muscles and joints, called proprioceptors are sensitive to changes in position. The third contributor to the human tower and the topic of discussion of this paper is the vestibular system. A three-person human tower in the dark must not have enough information coming from the vestibular and proprioceptive systems to function without vision, whereas the two-person tower did have enough information.