Vol. 17 Issue 6
One-Legged (Single Limb) Stance Test
The One-Legged Stance Test (OLST)1,2 is a simple, easy and effective method to screen for balance impairments in the older adult population.
You may be asking yourself, "how can standing on one leg provide you with any information about balance, after all, we do not go around for extended periods of time standing on one leg?"
True, as a rule we are a dynamic people, always moving, our world always in motion, but there are instances were we do need to maintain single limb support. The most obvious times are when we are performing our everyday functional activities.
Stepping into a bath tub or up onto a curb would be difficult, if not impossible to do without the ability to maintain single limb support for a given amount of time. The ability to switch from two- to one-leg standing is required to perform turns, climb stairs and dress.
As we know, the gait cycle requires a certain amount of single limb support in order to be able to progress ourselves along in a normal pattern. When the dynamics of the cycle are disrupted, loss of balance leading to falls may occur.
This is especially true in older individuals whose gait cycle is altered due to normal and potentially abnormal changes that occur as a result of aging.
The One-Legged Stance Test measures postural stability (i.e., balance) and is more difficult to perform due to the narrow base of support required to do the test. Along with five other tests of balance and mobility, reliability of the One-Legged Stance Test was examined for 45 healthy females 55 to 71 years old and found to have "good" intraclass correlations coefficients (ICC range = .95 to .099). Within raters ICC ranged from 0.73 to 0.93.3
To perform the test, the patient is instructed to stand on one leg without support of the upper extremities or bracing of the unweighted leg against the stance leg. The patient begins the test with the eyes open, practicing once or twice on each side with his gaze fixed straight ahead.
The patient is then instructed to close his eyes and maintain balance for up to 30 seconds.1
The number of seconds that the patient/client is able to maintain this position is recorded. Termination or a fail test is recorded if 1) the foot touches the support leg; 2) hopping occurs; 3) the foot touches the floor, or 4) the arms touch something for support.
Normal ranges with eyes open are: 60-69 yrs/22.5 ± 8.6s, 70-79 yrs/14.2 ± 9.3s. Normal ranges for eyes closed are: 60-69 yrs/10.2 ± 8.6s, 70-79 yrs/4.3 ± 3.0s.4 Briggs and colleagues reported balance times on the One-Legged Stance Test in females age 60 to 86 years for dominant and nondominant legs.
Given the results of this data, there appears to be some difference in whether individuals use their dominant versus their nondominant leg in the youngest and oldest age groups.
When using this test, having patients choose what leg they would like to stand on would be appropriate as you want to record their "best" performance.
It has been reported in the literature that individuals increase their chances of sustaining an injury due to a fall by two times if they are unable to perform a One-Legged Stance Test for five seconds.5 Other studies utilizing the One-Legged Stance Test have been conducted in older adults to assess static balance after strength training,6 performance of activities of daily living and platform sway tests.7
Interestingly, subscales of other balance measures such as the Tinetti Performance Oriented Mobility Assessment8 and Berg Balance Scale9 utilize unsupported single limb stance times of 10 seconds and 5 seconds respectively, for older individuals to be considered to have "normal" balance.
Thirty percent to 60 percent of community-dwelling elderly individuals fall each year, with many experiencing multiple falls.10 Because falls are the leading cause of injury-related deaths in older adults and a significant cause of disability in this population, prevention of falls and subsequent injuries is a worthwhile endeavor.11
The One-Legged Stance Test can be used as a quick, reliable and easy way for clinicians to screen their patients/clients for fall risks and is easily incorporated into a comprehensive functional evaluation for older adults.
1. Briggs, R., Gossman, M., Birch, R., Drews, J., & Shaddeau, S. (1989). Balance performance among noninstitutionalized elderly women. Physical Therapy, 69(9), 748-756.
2. Anemaet, W., & Moffa-Trotter, M. (1999). Functional tools for assessing balance and gait impairments. Topics in Geriatric Rehab, 15(1), 66-83.
3. Franchignoni, F., Tesio, L., Martino, M., & Ricupero, C. (1998). Reliability of four simple, quantitative tests of balance and mobility in healthy elderly females. Aging (Milan), 10(1), 26-31.
4. Bohannon, R., Larkin, P., Cook, A., & Singer, J. (1984). Decrease in timed balance test scores with aging. Physical Therapy, 64, 1067-1070.
5. Vellas, B., Wayne, S., Romero, L., Baumgartner, R., et al. (1997). One-leg balance is an important predictor of injurious falls in older persons. Journal of the American Geriatric Society, 45, 735-738.
6. Schlicht, J., Camaione, D., & Owen, S. (2001). Effect of intense strength training on standing balance, walking speed, and sit-to-stand performance in older adults. Journal of Gerontological Medicine and Science, 56A(5), M281-M286.
7. Frandin, K., Sonn, U., Svantesson, U., & Grimby, G. (1996). Functional balance tests in 76-year-olds in relation to performance, activities of daily living and platform tests. Scandinavian Journal of Rehabilitative Medicine, 27(4), 231-241.
8. Tinetti, M., Williams, T., & Mayewski, R. (1986). Fall risk index for elderly patients based on number of chronic disabilities. American Journal of Medicine, 80, 429-434.
9. Berg, K., et al. (1989). Measuring balance in the elderly: Preliminary development of an instrument. Physio Therapy Canada, 41(6), 304-311.
10. Rubenstein, L., & Josephson, K. (2002). The epidemiology of falls and syncope. Clinical Geriatric Medicine, 18, 141-158.
11. National Safety Council. (2004). Injury Facts. Itasca, IL: Author.
Dr. Lewis is a physical therapist in private practice and president of Premier Physical Therapy of Washington, DC. She lectures exclusively for GREAT Seminars and Books, Inc. Dr. Lewis is also the author of numerous textbooks. Her Website address is www.greatseminarsandbooks.com. Dr. Shaw is an assistant professor in the physical therapy program at the University of South Florida dedicated to the area of geriatric rehabilitation. She lectures exclusively for GREAT Seminars and Books in the area of geriatric function.
APTA Encouraged by Cap Exceptions
New process grants automatic exceptions to beneficiaries needing care the most
Calling it "a good first step toward ensuring that Medicare beneficiaries continue to have coverage for the physical therapy they need," Ben F Massey, Jr, PT, MA, president of the American Physical Therapy Association (APTA), expressed optimism that the new exceptions process will allow a significant number of Medicare patients to receive services exceeding the $1,740 annual financial cap on Medicare therapy coverage. The new procedure, authorized by Congress in the recently enacted Deficit Reduction Act (PL 109-171), will be available to Medicare beneficiaries on March 13 under rules released this week by the Centers for Medicare and Medicaid Services (CMS).
"APTA is encouraged by the new therapy cap exceptions process," Massey said. "CMS has made a good effort to ensure that Medicare beneficiaries who need the most care are not harmed by an arbitrary cap."
As APTA recommended, the process includes automatic exceptions and also grants exceptions to beneficiaries who are receiving both physical therapy and speech language pathology (the services are currently combined under one $1,740 cap).
"We have yet to see how well Medicare contractors will be able to implement and apply this process. Even if it works well, Congress only authorized this new process through 2006. Congress must address this issue again this year, and we are confident that this experience will demonstrate to legislators that they must completely repeal the caps and provide a more permanent solution for Medicare beneficiaries needing physical therapy," Massey continued.
The therapy caps went into effect on Jan. 1, 2006, limiting Medicare coverage on outpatient rehabilitation services to $1,740 for physical therapy and speech therapy combined and $1,740 for occupational therapy.
The American Physical Therapy Association is a national professional organization representing more than 65,000 members. Its goal is to foster advancements in physical therapy practice, research and education.
New Mouthwash Helps With Pain
Doctors in Italy are studying whether a new type of mouthwash will help alleviate pain for patients suffering from head and neck cancer who were treated with radiation therapy, according to a new study (International Journal of Radiation Oncology*Biology*Physics, Feb. 1, 2006).
Fifty patients, suffering from various forms of head and neck cancer and who received radiation therapy, were observed during the course of their radiation treatment. Mucositis, or inflammation of the mucous membrane in the mouth, is the most common side effect yet no additional therapy has been identified that successfully reduces the pain.
This study sought to discover if a mouthwash made from the local anesthetic tetracaine was able to alleviate the discomfort associated with head and neck cancer and if there would be any negative side effects of the mouthwash. The doctors chose to concoct a tetracaine-based mouthwash instead of a lidocaine-based version because it was found to be four times more effective, worked faster and produced a prolonged relief.
The tetracaine was administered by a mouthwash approximately 30 minutes before and after meals, or roughly six times a day. Relief of oral pain was reported in 48 of the 50 patients. Sixteen patients reported that the mouthwash had an unpleasant taste or altered the taste of their food.