STEADI STATE
The acronym STEADI
Stop Elderly Accidents, Deaths, and Injuries
Ms Wory is 76 years old and says I can't seem to sit down without using my arms. Is she a faller?
Yes! She is a faller because a fall is event that leads to an unplanned, unexpected contact with a supporting surface.
Evidence-based practice considers 3 elements
Clinical expertise, patient values and research evidence
Test that assesses gait in STEADI toolkit.
TUGT
Ankle strategy, hip strategy and stepping strategy
The first question of 3 to screen adults for falls
Have you had any falls in the past year? If so, how many?
Mr Ooops says "I tripped on the rug but the wall caught me." Did Mr Ooops just fall? Next step?
Yes!
Screen for falls - ask him the 3 questions.
3 outcome measures that require the pt to cross arms in front of the chest
30 Chair Stand Test
5 Sit to Stand Test
Modified CTSIB
Feet positions in 4 Stage Balance Test
Stage 1: Romberg
Stage 2: Semi-tandem
Stage 3: TandemStage
4: Single limb stance
4 domains of Reactive Control that can be manipulated to challenge balance
Vision, surface, base, motion
The second question of 3 to screen adults for falls
Do you ever feel unsteady when standing or moving around?
Mrs Tripp has not fallen in the past year, is not worried about falling and has a steady gait. Is Mrs Tripp a fall risk? Next step?
No need to do STEADI due to negative screen for falls.
Refer to SAIL or community based program.
3 functional outcome measures in STEADI tool
TUGT, 30 Second Chair Stand Test and 4 Stage Balance Test
Norms for 30 Second Chair Stand Test are based on?
Age and Gender
Equipment in our clinic that you can use to maximally challenge a pt's balance without worrying about pt falling
Lite Gait with harness
The third question of 3 to screen adults for falls
Do you worry about falling?
Mr Klutz reports no falls in the past 12 months and has a steady gait but reports worried about falling. Is Mr Klutz a fall risk? Next step?
Yes - automatic fall risk due to worried about falling.
Perform STEADI process: TUGT, 30 Second Chair Stand and 4 Stage Balance.
Modified CTSIB
A. Best test for assessing sensory integration
B. Assesses vision, somatosensory and vestibular function
C. Uses dome around pt's head
D. A and B
Cutoff score in TUGT
Greater than or equal to 12 seconds
Recovering from an unexpected perturbation AFTER balance has been disturbed
A. Reactive Control
B. Anticipatory Control
C. Stepping Strategy
D. Steady State
The STEADI process for screening for falls
Screen subjectively - ask 3 questions
Evaluate objectively - TUGT, 30 Chair Stand, 4Stage Balance
Treat impairments
Reassess strength, gait and balance
Mr Walker denies falling, uses a walker and is not worried about falling. Should Mr Walker be screened for falls? Next step?
Yes! Automatic fall risk due to unsteady requiring use of a walker!
Perform STEADI: TUGT, 30 Second Chair Stand Test and 4 Stage Balance Test.
Test allows pt to use assistive device
TUGT
Cutoff scores in 4 Stage Balance Test
10 seconds in each category;
Less than 10 seconds in Stage 3 = increased fall risk
Why is the BESTest the best?
BEST Test addresses: