Timed Up & Go Test (TUG)
In the upcoming weeks the article series Functional Outcome Tools will be published with valuable information on the purpose, patient population, and extendability of the data received from the test. Please fill in the form below to submit questions you would like to have answered in the article series. By following the link below, a PDF version of the test is available.
Tinetti Performance Oriented Mobility Assessment (POMA)
In the upcoming weeks the article series Functional Outcome Tools will be published with valuable information on the purpose, patient population, and extendibility of the data received from the test. Please fill in the form below to submit questions you would like to have answered in the article series. By following the link below, a PDF version of the test is available.
Submitted by: Jeremy Nelson PT
5.0 Transfers – Part 2
Examining the scoring matrix for this component a wide level of capacity is documented. At the lowest levels the patient “needs two people to assist or supervise to be safe” when moving from one surface to the other. This can have a number of causes and would include inadequate control of the COG to promote any level of stability. Although a higher level of function when the patient “needs one person to assist” there continues to be a lack of COG control. As discussed earlier, these scores do not provide an explanation for why what is occurring, is actually occurring. Any intervention to move towards the next level of function would include an explanation of the body segments contribution to the critical tasks of the movement, in this case inadequate.
To be “able to transfer with verbal cuing and/or supervision” the patient now demonstrates a capacity to control the COG to initiate a weight shift, although continues to require verbal instruction on how to sequence and complete each critical task. The difference between a squat transfer and a standing pivot transfer is the ability to shift the body weight to unweight one of the lower extremities to change position. Transferring requires the center of gravity be maneuvered within the base of support the patient needs to be able to shift their body weight throughout that base of support. The control of the COG to produce the weight shift likely includes critical tasks already performed in the seated and sits to stand motions. Having completed those elements, the patient would be better positioned to orchestrate the complex movements in order to change and establish a new BOS.
Why would a patient be “able to transfer safely definite need of hands”? The upper extremities are extension of the COG control. With the upper extremities supporting weight or providing more information to the brain through touch, the nervous system can better organize the weight shifting and positioning of the COG relative to the changing BOS. Again here the rehab professional is well positioned to describe the use of the upper extremities, whether for support and control of the trunk or simply for touch. Each level of upper extremity supports provides data to support the interventions planned and to document changes as a result of the intervention.
When the patient demonstrates being “able to transfer safely with minor use of hands”, the Berg component is satisfied. However the movement professional may not be as through collaboration with the patient it is learned that the transfers required by the patient to participate in life in a way that matters to the patient are not as simple as moving from one chair to the next. In life, there are varying surface heights, hand positions, motions to be made in addition to the one previously described. As the demands change, the scoring matrix can still be employed as behaviors seen and documented. And having had developed a clear record of what interventions were causative in restoring the capacity of the body to produce the critical task movements to give rise to the functional movement, the movement professional can review their notes and be well positioned to develop progressions on behalf of the patients desired level of function.
Submitted by: Jeremy Nelson PT
5.0 transfers – Part 1
Functional outcome tools like the Berg provide a useful framework for documenting change over time. However answering the question of why that changed happened, and what were the causes of the changes observed requires the unique skills of the movement professional. The functional outcome tools provide a framework for identifying progress over time, as each scoring matrix demonstrates improvement towards a desired level of function. However those data points require further translation making explicit the relationships that give rise to the behavior being observed. Only after this reconstituting of the goal into the component parts can these elements become data points to organize a change effort around.
In the rehabilitation market today, the question “Is the intervention provided the cause of the change observed?” is the so called $50,000 question. Did the change occur as it would have any way, such as the natural progression through the inflammatory phase? Or was the change a result of another intervention, such as the elimination of pain through medication? Functional tools such as the Berg assist in identifying the desired levels of change however more is to be done by the rehabilitation specialist. The role of the rehabilitation specialist is to take that observable and measurable task and then examine and evaluate its constitute relationships. These relationships not only occur between person and the environment but include relationships between body segments and within those segments at the level of individual joints and muscles.
If the medication was the cause of the improvement, then what about the contributing body segments? Is there an acceptable level of organization to produce movement that is nondestructive? This question, motivated by the value of prevention, is a valuable use of the rehabilitation professional’s time. Are the body segments coordinated enough to provide safe movement in other typically environmental demands? Again the rehab professional has the unique tools to comment on the movement of a patient that has had the initial problem of pain reduced to provide improved function.
Consider the fifth component of the Berg, the Transfer. Transfers are basic staple of the work that is done by rehabilitation professionals. It seems so basic and simple, and yet when evaluating and working to improve transferring, the complexity can often be overwhelming. Up and to this point, the berg test has examined the COG in motion or maintained in a position relative to a static BOS. True, the sit to stand and stand to sit does include a change in BOS, however the transfer includes the change of BOS at the level of the extremities as well.
Observing a transfer from one chair to the other both the COG and BOS control is on display, the neuromuscular system ability to control the center of gravity while also organizing a changing base of support . Within a base of support that may include upper extremity support and given that it is a pivot transfer and is not necessarily stand pivot transfer what we may be observing is a use of the upper extremities to compensate for an inability of the core musculature to control the center of gravity. The rehab professional is uniquely qualified to comment on how the transfer is taking place, describing quality of movement. Just because a patient demonstrates movement consistent with a a defined score, it may not be in way that is safe over the long run.