Physical Assessment Tools and Methods

Lecture 2

Coordination | Aerobic Endurance | Falls | Fitness |Physical Activity | Frailty

Lecture Outcomes

• Demonstrate the ability to select, apply, and interpret appropriate assessment tools and methods to evaluate:
• Physical health, including mobility, strength, balance, and coordination

Aerobic Endurance Assessment in the Elderly

1. 6-Minute Walk Test
2. 2-Minute Step in Place Test

2-Minute Step in Place Test

• This test measures aerobic endurance.
• This test is performed as an alternative to the 6-minute walk test for people who use orthopedic devices when walking, as well as in the case of people who have difficulty balancing.
• Can be used as an alternative aerobic endurance test when time constraints and space limitations.
• The number of full steps completed in 2 minutes is counted.

Required equipment

• A tape for marking the wall
• A stopwatch

Procedure

1. A mark is placed on the wall at the midway between the patella and the iliac crest.
2. The subject stands up straight next to the wall.
3. The subject then marches in place for two minutes, lifting the knees to mark placed on the wall.
4. Resting is allowed, and holding onto the wall or a stable chair is allowed.
5. Stop after two minutes.

Recommended Scores for the 2-Minute Step in Place Test based on Age Groups

Men

Women

Scoring → Record the total number of times the testing knee reaches the level in two minutes.

Upper Extremity Coordination Tests

• Finger to Nose Test
• Nose to Clinician’s Finger Test

Finger to Nose Test

• Tests coordination, particularly cerebellar function.
• Procedure →
1. Ask the patient to sit comfortably.
2. Then ask the patient to extend one arm to the side.
3. Instruct them to touch the tip of their index finger to the tip of their nose and then extend it back.
4. Repeat several times, increasing speed gradually.
5. Perform with both arms.
• Always encourage tip-to-tip contact.
• Look for tremors, intention tremor, or missing nose.
• You may ask the patient to close their eyes to assess proprioception.

Nose to Clinician’s Finger Test

• Assesses dynamic coordination and ability to adjust to a moving target.
• Procedure →
1. Ask the patient to touch their index finger to the clinician’s extended index finger.
2. Then, ask them to touch their own nose.
3. Move your finger to different positions after a few repetitions.
4. Repeat several times and on both hands.
• Observe finger-tip accuracy and ability to adjust to the target's location.

Lower Extremity Coordination – Heel to Shin Test

Procedure

1. Ask the patient to lie supine on an examination table.
2. The test can also be done in a sitting position if needed.
3. Instruct the patient to lift one leg and place the heel of that leg on the opposite knee.
4. Ask the patient to slide the heel down along the shin to the ankle, maintaining contact.
5. Repeat the motion several times smoothly and accurately.
6. Gradually ask the individual to perform the movement fast.
7. Repeat the test on the opposite leg to compare both sides.
8. Observe for smoothness of the movement, ability to maintain heel contact with the shin, presence of tremors, jerky or wobbly motion, overshooting or undershooting (dysmetria)
1. You can assess proprioception by asking the patient to close their eyes during the examination.

Falls Probability in the Geriatric Population

• Timed Up and Go (TUG) Test
• Dynamic Gait Index (DGI)

Timed Up and Go Test

• Used to test the probability of falls in the elderly.

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Procedure

• Regular footwear and customary walking aids should be used during the test.
• The individual sits on a standard armchair, placing his/ her back against the chair and resting his/her arms on the chair’s arms.
• Any assistive device used for walking should be nearby.
• The upper extremities should not be on the assistive device at the beginning.
• Instruct the patient that he/ she stands up, walk to a line that is 3 meters away, turn around at the line, walk back to the chair, and sits down.
• Patients should be instructed to use a comfortable and safe walking speed.
• The stopwatch should start when the therapist says go and should be stopped with the patient’s buttocks touch the seat.

Interpretation of Timed Up and Go Test

• ≤ 10 seconds = normal
• ≤ 20 seconds = good mobility, can go out alone, mobile without gait aid
• ≤ 30 seconds = problems, cannot go outside alone, requires gait aid
• A score of ≥ 14 seconds has been shown to indicate a high risk of falls.

Dynamic Gait Index

• Assesses the likelihood of falling in older adults.
• Equipment needed → Box (shoebox), cones (2), stairs, 20’ walkway
• Designed to test eight facets of gait.
• Each item is scored in a four-point ordinal scale, ranging from 0-3.
• “0” indicates the lowest level of function and “3” the highest level of function.
• Interpretation: < 19/24 = predictive of falls risk in community-dwelling elderly.

The Senior Fitness Test/ Fullerton Functional Fitness Test

• A simple and easy-to-use set of tests designed to assess the functional fitness of older adults.
• The list of tests included in Fullerton function Fitness Test
1. 30-Second Chair Stand Test – Lower body strength and endurance
2. Arm Curl (Bicep) Test – Upper body strength
3. Chair Sit and Reach Test – Lower Body Flexibility
4. Back Scratch Test – Upper Body Flexibility
5. 8-Foot Up and Go Test – Agility
6. 6-Minute Walk Test – Aerobic endurance
7. 2-Minute Step in Place Test – Aerobic endurance

Balance Outcome Measure for Elder Rehabilitation (BOOMER)

• A global multi-item static, dynamic, and functional balance measure for the geriatric population.
• This consists of four assessments.
1. Timed Up-and-Go (TUG)
2. Functional Reach Test (FRT)
3. Step test
4. Test of static standing with feet together and eyes closed
• To scale each assessment, 4 cutoff points were selected, creating 5 ordinal categories (scores range 0-4).
• An overall score was created by summing the scores for each item (scores range 0-16).

Falls Risk

• Falls Efficacy Scale (FES)
• Morse Fall Scale

Falls Efficacy Scale (FES)

• Measures a person’s fear of falling during basic daily activities.
• Commonly used in community-dwelling older adults.

Morse Fall Scale

• A rapid and simple method of assessing a patient’s likelihood of falling.
• Primarily used in acute care, rehabilitation, and long-term care facilities.

Tools to Assess Physical Activity in the Elderly

• Barthel Index
• Physical Activity Level Questionnaire (IPAQ)
• Physical Activity Scale for the Elderly

Barthel Index

• Evaluate a subject’s ability to do everyday tasks and their mobility.
• Used to evaluate older adults, people with mobility limitations, and people with neurological problems, such as stroke, Parkinson’s disease, and spinal cord injury.

International Physical Activity Questionnaire (IPAQ)

• A standardized self-report tool designed to measure physical activity levels in populations across different countries and age groups.
• It assesses the frequency, duration, and intensity of physical activity across various domains such as work, transport, household, and leisure.

Physical Activity Scale for the Elderly (PASE)

• An instrument that measures the level of physical activity for individuals aged 65 and older.
• Evaluates leisure, household, and occupational activities over a one-week period to provide a comprehensive activity score.

Tools to Assess Frailty

• Fried Frailty Phenotype (FFP) – Cardiovascular Health Study (CHS) Criteria
• Clinical Frailty Scale (CFS)
• Edmonton Frail Scale (EFS)

Fried Frailty Phenotype (FFP – CHS Criteria)

• Assesses frailty based on five physical criteria: weight loss, exhaustion, weakness, slowness, and low activity.
• Predicts outcomes like hospitalization, disability, and mortality.

Clinical Frailty Scale (CFS)

• A 9-point scale based on clinical judgment to assess overall frailty status.
• Quick and easy to use in various settings, including hospitals and primary care.
• Strong predictor of adverse outcomes such as mortality and institutionalization.

Edmonton Frail Scale (EFS)

• A multidimensional tool assessing domains like cognition, balance, mood, and social support.
• Simple to administer, even by non-specialists, in clinical or community settings.
• Provides a quick yet comprehensive overview of frailty in older adults.

References

1. Guccione, A. A., Wong, R. A., & Avers, D. (Eds.). (2020). Geriatric physical therapy (4th ed.). Elsevier.
2. Rikli, R. E., & Jones, C. J. (2013). Senior fitness test manual (2nd ed.). Human Kinetics.
3. Shirley Ryan AbilityLab. Rehabilitation measures database. Retrieved June 8, 2025, from https://www.sralab.org/rehabilitation-measures
4. Academy of Neurologic Physical Therapy, APTA. Clinical practice resources. Retrieved June 8, 2025, from https://www.neuropt.org

Thank You!