♪ Bob and Brad ♪ ♪ The two most famous ♪ ♪ Physical therapists on the internet ♪ - Hi folks, I'm Bob
Schrupp, physical therapist. - Brad Heinick, physical therapist. - And together the most
famous physical therapist on the internet. - In our opinion of course, Bob. - Brad, today you wanted to
talk about the Tinetti test. This is a gold standard
for therapist, I would say. And we're measuring balance and it's good for students
and professionals obviously. And even the lay person,
I think could do some of these things to see where they're at. - And at least you understand
what we're looking for. If you have someone in your watch or they're doing a Tinetti test on you or give you some insight. So it's a gate and balance test. But the primary, after doing
a lot of research on this the primary, what we're
looking for is fall risk. You know, what is this? Person's risk for fall
when they return home from the hospital or from a rehab center or whatever it may be. So we should get on to. There are people out there. I can see there's new people on here-
- Hi. - wondering what we're about. - Yeah. If you're new to our channel please take a second to subscribe to us. We provide videos. Oh yeah, it's over here. We provide videos on stay
healthy, fit, pain free and we upload every day. - Excellent, Bob. Okay. Tinetti, where'd this come from? Mary Tinetti, Doctor Mary Tinetti. She's graduated at Michigan
in 1978 with her MD and now she's at Yale and doing research. And she's incredible. She's gotta be very-
- Doctor Tinetti, by the way if you get this, make sure you contact us. Let's know what we were doing wrong. 'cause a lot of this is gonna
be based on our opinion, Brad. We'll talk about it. - You're right. You'll see. But we feel we've got a good handle on it. But the research, what I've looked at there's different ways to perform the test, little variations. - Little variations.
- Not big. There's little ones. We better get on with the test box.
- Okay, sounds good. - Okay, so the first thing you'll do, Bob's gonna be the patient. Have a seat please. - Okay. - The person should be
in a firm, upright chair. I like to do it with
armrest on the chair, okay? I know the one source I found
it said without armrest. I'm gonna do it with armrest. That's the way I always do it, 'cause a lot of people
are in wheelchair, right? You're stuck with armrest, okay? So the first thing I'll
have the person do now for consistency, this
is the way I do it, Bob. I have 'em put their hands
together gently like this. And I'll ask him, can you stand up? Okay. And he's not able to stand. So then I'll say, go
ahead and use the armrest. Can you stand up from there? And there he goes. And he made it. He stood up, okay? Now, immediate standing balance. Bob was wobbly a little bit there, okay? So that's all things we want
to take into consideration. Have a seat again, Bob. - By the way, if you Google Tinetti, I'm sure one of the
the forms will come up. You can see what form we're using. - Exactly. We've got a form right here.
- T-I-N-N-E-T-T-I. So I'll put down below. - Okay, so if the person needs... If they're not steady that's
gonna change the point. And you'll see it on the form you get. - Right, they're considered unsteady. - Exactly. Why don't you go through it again, Bob. So we know the person needs
to stand up, use an armrest. He's unsteady here, okay? But let's say the person's
steady when they stand up for the first five seconds. - Sure.
- Okay? And then they're steady. Now the next thing I'm
gonna have you do, Bob is bring your feet close together. Now you're gonna find out with some people-
- Can you see that line? - his heels are touching but his forefeet are not touching, okay? Depends on what the person. If the person, I'll have a person if they can bring their
feet together, I'll do that. Some people, because of
the shape of their legs, their knees, whatever
sometimes they can't even get their feet together.
- [Bob] Exactly. - Because their knees touch first. - And what do you do? - That's it.
- That's gotta count, right? - Right, so- - Because some of 'em are, like you said, they're this far apart. - Right. They got that genu valgus and that's the anatomy.
- That's as close as they can get. - Yep. So bring your feet together, Bob. And at this point, look
straight ahead, stand tall, check the balance. If they're wobbly, we're gonna take note on that with the score. If they're steady, that's better, okay? Now hold on, Bob. Now I'll stand right here. If the person's really wobbly, I'll have another person stand on that side to be safe, okay? Can you close your eyes, Bob? A lot of times this will
throw people way off and you gotta grab. - Don't you use your belt
usually with, Brad or? - Yeah. I'll always have a belt on. Matter of fact, maybe we should do that to make sure that it's clear. - Symbolic that we-
- We're following the rules. - But you know, even the
unsteady steady thing, Brad I have a little trouble with that because let's say somebody gets up and they do this and then they're steady. I mean, or they go a little bit. Is that unsteady or, you know. - I've got an answer for that, Bob in this video.
- All right, okay. I'm glad you do. - Okay. So I'm holding onto the belt. Bring your feet together again, Bob. We're going through the next phase. He closed his eyes, he lost
his balance with that, okay? Now the next thing is I'm
gonna nudge right here. And I always tell the person,
I'm gonna nudge you right on the sternum right here three times and see if you can hold your balance. I'm gonna have my hand on your backside so you're gonna be safe. Make sure they're comfortable with it. Usually this one goes pretty good unless they're one of those people that tend to tip backwards. Then you'll do this and all of a sudden they'll start going backwards and backwards and then you gotta grab 'em. - Is that the standard here? Because I tend to push
multiple directions. - Well, I'll do that too but
the tests that I've read, they say they're just there. - Okay. So I've learned something. - So Dr. Tinetti, we need this
official form from her, okay? Good point, Bob. All right, now the next one is if they're holding onto a walker or they're unable to
stand without a walker, then I'll say, can you
let go of the walker and push the walker out of the way? And this is the 360 degree turn. And oftentimes if it's someone older, I'll demonstrate to 'em,
'cause people don't know what a 360 degree turn is sometime. - I also tell 'em to make sure they put their legs apart
again because sometimes their legs come together and I tell 'em to put their legs apart. - Exactly. - Now there's two things that get graded on this, right Brad? Can you do it and can you do
it continuous steps, right? - Right. Exactly. - Turning discontinuous steps- - Discontinuous. - or unsteady? Which to me they're kind of the same. I have a hard time
between those two points. - Exactly. - What I do if they can make
it around with good confidence and they're steady, I'll give
'em one point for each, okay? If they make it around but
they're a little wobbly but you don't have to grab
'em, then I'll give a total of one point instead of two.
- Two points. - And then at the end
I'll show you the deal that the way I score
that makes it very clear instead of, I'm kind of
being fuzzy right now. All right. Now the next one is, can you sit down with your hands together like this without touching this, okay? With good control. Good. So he went down and he plopped down. So he didn't do it with good control. Why don't you... And then I'll have him get
it up again if I'm not sure. And they're able to now
say, if you can grab here and sit down with good control, that's a different point, okay? So we just went through
the balance portion of the test, right? - Yeah. There's one section
that is balance alone. And that is what we just did. - Right. And the next one is gate, okay? - Which is walking. - Now while you're doing this, you have to go through this with each section that we just did, okay? Normally we'd have to have
a walker here in front if the person needs one. In this case Bob didn't need one. So we didn't have that. Well don't you stand up again, Bob. The next one is you start
from a standing position. You're gonna have the person
walk 15 feet out, turn around. - I'll go this way, Brad. - Okay. Actually well
just stop, Bob 'cause... - Okay - I'm just gonna go walk through this. You're gonna go forward, turn around and come back to the chair. - Okay. Do you want me to do that? - Nope. Not yet. See the red line down here, Bob or Lonnie? One of the gate things
is you look at their gate and are their feet almost touching or are they have a wide base of support? So we've got the line here
just for a reference point and go ahead and walk, Bob. - [Bob] So what would you consider this? - [Brad] That would be wide. So that is zero points there. And this is the thing. How close is almost touching is it a half inch, is it an inch? - [Bob] Again a good point. Does it look normal to me? That's what one thing I think about. Does it look like a normal or. 'Cause if a person has bad
balance what they're gonna do is give themself more of a stable base. And that's why they put
their feet out like this. - [Brad] Yeah. Exactly. Let's face this way once, Bob. Another one of the gate ones is are their feet are
crossing the next foot is a swing through? Now what I do is I have an
imaginary line pass the toe and if the foot does not pass
this line there, that's good. And if it's-
- [Bob] This is bad. - Right, so I imagine
that line right at the toe and a heel has to completely
cross that imaginary line in order to get that point, okay? - [Bob] And on both, well they
get a point for each side. - [Brad] There's a point for each foot. So you look at each foot,
you gotta keep an eye out as a therapist and see
what's going on here. - [Bob] So, and like Brad
and I were talking earlier, what happens when they do it sometimes and sometimes they don't? - That's where the magic formula comes in. - [Bob] Right. Exactly. - It cures all these problems. - [Bob] And another
thing, by the way, Brad what happens if they can
do it, when you cue 'em say can you take longer steps? And I'll have people that can. But then they go back
to their normal walking, which is like that. So do you give 'em a point there? - Well what I've read is
the cue is the walking pace should be a brisk walk but
not fast so you're on steady. So it actually-
- They do get cues. So they're not-
- The cue is can you walk a fast pace? But you know when I'm rushing it's a little faster than a slow pace. - So you don't want to cue
'em and say take long steps. That's a wrong cue to give 'em. - Right. That's the way I understand it. - Gotcha. - One is when they take off, do they stutter a little bit? They lose a point for that. If they come off smoothly
then they're fine. You get the point there. Foot clearance and this one I'm... If they're wearing slippers and their slipper comes
off the back of their heel and they come to and that slipper drags, do you count it or not? - [Bob] I would say in that case probably you would not count it because- - [Brad] In a skilled
nursing facility or rehab people aren't always wearing their shoes 'cause their feet are too swollen. - [Bob] Exactly. - So, but anyways, I just
take it, it has to clear. If I hear any rubbing,
they don't get the points for that foot clearance. Continuity is a person walking steady or do they have a shift or step-to gait? - [Bob] Is it one step after another or is it one step, stop, one step, stop? I mean is there continuous flow? - This is where after you
do this a few hundred times you really get a feel
for what you want to do and to get consistency between yourselves. Okay. Did I miss any? I think, oh the other one, if
they're using a gaiter or not. If they're using a cane, a walker, you automatically lose three
points off the whole test. - Yep. There's no way
around it that you're, I mean because there's some
tests, some parts of the test where if you have a gaiter, it's gonna automatically stop. We have about a minute left, Brad. - Okay. All right, Bob. So the big thing, how do
you correct the problems where it's in the gray zone? You're not sure if they're
like getting up sometimes and other times they can't. Their heels are almost touching sometimes and other times they're not. Simple use half points. And I've been told that-
- You're not supposed to use half points.
- not supposed to do it. But when I do it with myself and if you have a physical
therapy department everyone's trained to do this the same way and they're using half
points, then you know it's like oh that means
he was able to walk steady part of the time but then he would stutter and then he'd take off
again and then half and half it's one of those gray areas and you have a very
clear sense of where the- - When I see it, I know
what they're saying. - Exactly.
- Exactly. - And to me it's worked pretty well in giving me a sense of
where people are at so. - And the Tinetti test, the score 28 as high as you can get, okay? If you're 19 is that gray area. If you're above 19 they're saying, ah you're pretty safe for
your fall risk for going home if you're below 19-
- Walker. - But we both know Bob,
you could have some people that are 17 and they're solid as a rock as long as they got that walker. - Yeah. And they got good judgment. And then we have people that are at 22, 23 that have really poor judgment
and I'm worried about 'em. So that all comes into play too. So all right. Thanks
everybody for watching. - I hope we didn't confuse
you too much on this.
