Better Measures
Monday September 19, 2011
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Balance problems and falls long have been a serious problem in the elderly population, accounting for most injury deaths in those 65 and over, according to the U.S. Centers for Disease Control. As baby boomers segue into old age, preventing those falls will become an even greater focus for physical therapists. Assessing who’s at risk and to what degree is vital to maintaining a patient’s quality of life. Fortunately for PTs, new technological devices now are available that promise to make this data-gathering process both easier and more accurate.
Assessment tools such as the Berg Balance Scale, the “6-minute-walk test” and the “timed-up-and-go test” have been available for some time, and have proven their efficacy in assessing mobility in the elderly. “The TUG is one of the most frequently used tools for older adults,” said Wendy K. Anemaet, PT, PhD, GCS, assistant professor of physical therapy at Regis University, Denver. “We use it a lot because it’s a good indicator of balance and lower extremity strength, and it also has a gait component.”
Electronic measurement
But therapists at Anemaet’s clinic also use a GaitRite electronic walkway system by CIR Systems Inc., which automates much of the assessment. “There are quite a few studies out there that verify that the GaitRite is an appropriate tool,” she said. “We use it a lot.”
The system features a 2-by-16-foot carpeted path studded with thousands of sensors that measure parameters such as stride length, step length ratio, base of support, velocity, cadence and several other facets of gait. The walkway, which is expandable up to 26 feet, reads a patient’s footprints and captures the relative orientation and position of each footfall. That data is transmitted to a personal computer running the Windows operating system, where it is analyzed by software and the results presented on a monitor, and broken down into tables and graphs. The device can be synchronized with an electromyography instrument or video camera.
The company recently introduced the 4-by-8-foot GaitRite M2 mat, which measures turning and other maneuvers difficult for older patients with various diseases and stages of cognitive decline. “To collect gait [facets] as well, you’ll need the 12-foot or 14-foot versions,” said Michael Rowling, owner of CIR Systems Inc.
Deborah K. Kegelmeyer, DPT, MS, GCS, associate professor of physical therapy at Ohio State University Medical Center College of Medicine, Columbus, also uses the GaitRite. “For someone like myself who’s doing research, it gives me much more specific and detailed information than a regular PT assessment,” she said. “We try to use it as much as we can for our clinical population.”
Test platforms
In addition to the GaitRite, Anemaet uses a Proprio Reactive Balance System in her clinic to test patients’ reactions to balance perturbations. The device was originally invented to serve the athletic and orthopedic rehabilitation market, said Joe Perry, president of manufacturer Perry Dynamics, Inc. “We soon learned that the potential benefits reached far beyond the athletic market,” he said. “Research done at the University of Miami validated the use of Proprio Reactive Balance Systems as a tool to determine who may be at risk of falling.”
The system uses a computer-controlled platform that can move in multiple directions to challenge a patient’s balance and reaction time. The platform’s degree, direction and speed of tilt are programmed by the therapist. Perry explained that, before the test, a sensor is placed at the lumbo-sacral joint position on the patient’s back. “By placing a sensor there, the Proprio system is able to give you actual core movement in six degrees of motion,” he said. “This provides a more accurate assessment of the compensatory strategy of the user, and provides additional information not available from systems that use only forceplates.”
Focus on seniors
Biodex Medical Systems, which has been manufacturing sports medicine rehabilitation products since the 1980s, has shifted focus with the aging of the population. “With the maturation of the baby boomers came a need to redesign our products to address the needs of older and neurologically impaired patients,” said William Galway, clinical education manager at Biodex. Today, the company’s products include an unweighing system used with the Gait Trainer III treadmill for gait assessment, as well as devices to measure balance.
The Balance System SD is a mobile platform with both static and dynamic balance capabilities. The device features five test protocols, six training modes and a touch-sensitive screen. The platform’s degree, direction and speed of tilt are programmable, allowing the therapist to assess a patient’s fall risk, limits of stability and postural stability.
The BioSway shares many of the features of the Balance System SD, but is portable. In addition to its function of balance assessment, it can be used as a balance training device as well, either in the clinic or the field. Biodex has developed interactive games that challenge balance while introducing an element of fun into therapy, intended to boost compliance.
Assessments in stride
Mobility Research offers the GaitSens treadmill, which provides measurement of a variety of gait parameters. These include step length and width, stride length and time, velocity, cadence, amount of double support, duration of stance and swing phase, as well as average pressure and force. The system connects to a personal computer, and a clinician can observe any gait deficiencies in real time as the patient walks.
JTech Medical offers a range of devices to measure movement and strength. “Clinicians and therapists have a strong need for objective data to support the decision-making process for patient diagnosis, treatment and other assessments,” said Amy Plaizier, a JTech spokeswoman. “We provide durable tools to take those measurements and transmit the results directly to a computer for recordkeeping, analysis and reporting.”
Those tools include goniometers and dual inclinometers that measure, document and report a patient’s range of motion. JTech’s Tracker Freedom wireless load cell dynamometers measure muscle strength, grip strength, pinch strength, algometry, lift tests and push/pull strength, producing force graphs during the exercises.
Gauging pressure
Tekscan Inc. has developed the Walkway Pressure Mapping System to assess patient mobility. The Walkway captures foot strikes and calculates values for step and gait time, distance, velocity and cadence. The company also offers the F-Scan, an in-shoe measurement device that quantifies force, contact pressure distribution, timing and gait. It is available in tethered or wireless versions.
All of these companies offer training in their products, ranging from webinars to in-clinic instruction. Many also offer financing plans, and all provide faster and more accurate mobility assessments than older methods. “One major reason to use them is that they help us find more subtle problems earlier,” said Kegelmeyer. “The earlier we get in there and intervene, the better the chances we have of actually preventing falls.”
Mark Cantrell is a freelance writer.
Assessment tools such as the Berg Balance Scale, the “6-minute-walk test” and the “timed-up-and-go test” have been available for some time, and have proven their efficacy in assessing mobility in the elderly. “The TUG is one of the most frequently used tools for older adults,” said Wendy K. Anemaet, PT, PhD, GCS, assistant professor of physical therapy at Regis University, Denver. “We use it a lot because it’s a good indicator of balance and lower extremity strength, and it also has a gait component.”
Electronic measurement
But therapists at Anemaet’s clinic also use a GaitRite electronic walkway system by CIR Systems Inc., which automates much of the assessment. “There are quite a few studies out there that verify that the GaitRite is an appropriate tool,” she said. “We use it a lot.”
The system features a 2-by-16-foot carpeted path studded with thousands of sensors that measure parameters such as stride length, step length ratio, base of support, velocity, cadence and several other facets of gait. The walkway, which is expandable up to 26 feet, reads a patient’s footprints and captures the relative orientation and position of each footfall. That data is transmitted to a personal computer running the Windows operating system, where it is analyzed by software and the results presented on a monitor, and broken down into tables and graphs. The device can be synchronized with an electromyography instrument or video camera.
The company recently introduced the 4-by-8-foot GaitRite M2 mat, which measures turning and other maneuvers difficult for older patients with various diseases and stages of cognitive decline. “To collect gait [facets] as well, you’ll need the 12-foot or 14-foot versions,” said Michael Rowling, owner of CIR Systems Inc.
Deborah K. Kegelmeyer, DPT, MS, GCS, associate professor of physical therapy at Ohio State University Medical Center College of Medicine, Columbus, also uses the GaitRite. “For someone like myself who’s doing research, it gives me much more specific and detailed information than a regular PT assessment,” she said. “We try to use it as much as we can for our clinical population.”
Test platforms
In addition to the GaitRite, Anemaet uses a Proprio Reactive Balance System in her clinic to test patients’ reactions to balance perturbations. The device was originally invented to serve the athletic and orthopedic rehabilitation market, said Joe Perry, president of manufacturer Perry Dynamics, Inc. “We soon learned that the potential benefits reached far beyond the athletic market,” he said. “Research done at the University of Miami validated the use of Proprio Reactive Balance Systems as a tool to determine who may be at risk of falling.”
The system uses a computer-controlled platform that can move in multiple directions to challenge a patient’s balance and reaction time. The platform’s degree, direction and speed of tilt are programmed by the therapist. Perry explained that, before the test, a sensor is placed at the lumbo-sacral joint position on the patient’s back. “By placing a sensor there, the Proprio system is able to give you actual core movement in six degrees of motion,” he said. “This provides a more accurate assessment of the compensatory strategy of the user, and provides additional information not available from systems that use only forceplates.”
Focus on seniors
Biodex Medical Systems, which has been manufacturing sports medicine rehabilitation products since the 1980s, has shifted focus with the aging of the population. “With the maturation of the baby boomers came a need to redesign our products to address the needs of older and neurologically impaired patients,” said William Galway, clinical education manager at Biodex. Today, the company’s products include an unweighing system used with the Gait Trainer III treadmill for gait assessment, as well as devices to measure balance.
The Balance System SD is a mobile platform with both static and dynamic balance capabilities. The device features five test protocols, six training modes and a touch-sensitive screen. The platform’s degree, direction and speed of tilt are programmable, allowing the therapist to assess a patient’s fall risk, limits of stability and postural stability.
The BioSway shares many of the features of the Balance System SD, but is portable. In addition to its function of balance assessment, it can be used as a balance training device as well, either in the clinic or the field. Biodex has developed interactive games that challenge balance while introducing an element of fun into therapy, intended to boost compliance.
Assessments in stride
Mobility Research offers the GaitSens treadmill, which provides measurement of a variety of gait parameters. These include step length and width, stride length and time, velocity, cadence, amount of double support, duration of stance and swing phase, as well as average pressure and force. The system connects to a personal computer, and a clinician can observe any gait deficiencies in real time as the patient walks.
JTech Medical offers a range of devices to measure movement and strength. “Clinicians and therapists have a strong need for objective data to support the decision-making process for patient diagnosis, treatment and other assessments,” said Amy Plaizier, a JTech spokeswoman. “We provide durable tools to take those measurements and transmit the results directly to a computer for recordkeeping, analysis and reporting.”
Those tools include goniometers and dual inclinometers that measure, document and report a patient’s range of motion. JTech’s Tracker Freedom wireless load cell dynamometers measure muscle strength, grip strength, pinch strength, algometry, lift tests and push/pull strength, producing force graphs during the exercises.
Gauging pressure
Tekscan Inc. has developed the Walkway Pressure Mapping System to assess patient mobility. The Walkway captures foot strikes and calculates values for step and gait time, distance, velocity and cadence. The company also offers the F-Scan, an in-shoe measurement device that quantifies force, contact pressure distribution, timing and gait. It is available in tethered or wireless versions.
All of these companies offer training in their products, ranging from webinars to in-clinic instruction. Many also offer financing plans, and all provide faster and more accurate mobility assessments than older methods. “One major reason to use them is that they help us find more subtle problems earlier,” said Kegelmeyer. “The earlier we get in there and intervene, the better the chances we have of actually preventing falls.”
Mark Cantrell is a freelance writer.
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Monday September 19, 2011