PHLT 9212

FITNESS ASSESSMENT FOR

SPECIAL POPULATIONS

LAB MANUAL

Name: _________________________________

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 LAB PROTOCOLS
LAB TOPIC AND DOCUMENT PAGE #
CARDIOVASCULAR ASSESSMENT 4
VO2 max Protocols 6
Cardiovascular Assessment Normative Data 6
LAB ACTIVITY #1A 8
LAB ACTIVITY #1B 10
ECG ANALYSIS AND INTERPRETATION 12
Main ECG Abnormalities 14
ECG Placement 15
Using ECG to Determine Heart Rate 16
ABI Assessment 17
LAB ACTIVITY #2 18
PULMONARY FUNCTION ASSESSMENT 22
Pulmonary conditions special considerations 24
LAB ACTIVITY #3 26
METABOLIC ASSESSMENT 30
Resting Metabolic Rate 32
Blood Glucose 33
LAB ACTIVITY #4 34
CANCER, ARTHRITIS AND RANGE OF MOTION ASSESSMENT 36
Working with Patients with Cancer 38
DAS 28 40
Goniometry Measurement procedures 39
Posture Assessment 44
LAB ACTIVITY #5 48
OLDER ADULTS ASSESSMENT 56
Senior Fitness Test 58
LAB ACTIVITY #6A 58
STROKE AND CEREBRAL PALSY ASSESSMENT 62
Cerebral Palsy Assessment 64
Stroke 65
Soda Pop Test 68
Short Physical Performance Battery 69
LAB ACTIVITY #6B 70
DEMENTIA, MULTIPLE SCLEROSIS AND PARKINSON’S DISEASE ASSESSMENT 74
Cognitive Assessments 76
Balance Assessments 79
LAB ACTIVITY #7 80
VISION AND HEARING ASSESSMENT 86
Hearing and Vision Impairments 88
LAB ACTIVITY #8 90

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CARDIOVASCULAR
ASSESSMENT

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 VO2 Max Protocols

The following are four protocols we will be completing in lab over the next two weeks and that
you will need to be familiar with for future testing and work with clients. The protocols are used
mostly for the chronic populations during graded exercise testing/stress testing assessments.

Balke and Ware Protocol:

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 Lab Activity #1A: Exercise HR and BP Lab Activity

Name: _______________________

For this lab, you will be working in groups of 3. One person will be the client, one person will be
the CEP and one person will be the evaluator

Activity 1: BIKE

You will put your client on the bike for 6 minutes. They will complete 2 minute workloads. First
at 0.5kg, second at 1.0kg and third at 1.5kg. You will take HR every minute and BP during the
second minute of each workload.
The evaluator will record your response as well as their own, the time it takes you to complete
each workload and the total time for 3 workloads.
Exercise Heart Rate and Blood Pressure on Bike
CEP: Evaluator: Workload Time
Heart Rate 1
Blood Pressure 1
Heart Rate 2
Heart Rate 3
Blood Pressure 2
Heart Rate 4
Heart Rate 5
Blood Pressure 3
Heart Rate 6
Total Running Time

Activity 2: TREADMILL

You will put your client on the treadmill for 6 minutes. They will complete 2 minute workloads.
All will be at a walking pace of 3.5mph. First at an incline of 0%, second at 3% and third at 6%.
You will take HR every minute and BP during the second minute of each workload.
The evaluator will record your response as well as their own, the time it takes you to complete
each workload and the total time for 3 workloads.
Exercise Heart Rate and Blood Pressure on Treadmill
CEP: Evaluator: Workload Time
Heart Rate 1
Blood Pressure 1
Heart Rate 2
Heart Rate 3
Blood Pressure 2
Heart Rate 4
Heart Rate 5
Blood Pressure 3
Heart Rate 6
Total Running Time

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 Lab Activity #1B: Cardiovascular Protocols

Name: ___________________________________

You will be working with your group practical team (group of 3) for this lab activity.

In Class Tasks:
1. Complete a pre-screening on your client – include height, weight, waist circumference,
resting HR/BP and risk stratification
2. Complete the Bruce Protocol on your client using direct analysis.
3. Complete the Balke Protocol on your client
4. Complete the Naughton Protocol on your client
5. Complete the ACSM Cycle Protocol on your client
6. Go through the sample client package provided role-playing the roles you will assume
for your practical exam. Properly screen your client and then complete the most
appropriate test given the client’s needs/condition.

Client Information

Name _________________________________ Date ________________

Age _______ yrs Gender ________ Weight _______ kg Height _______ cm

Rest HR ______ bpm Rest BP ___________ mm/Hg PAR-Q Pos / Neg

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 BALKE AND WARE
Stage Speed Grade HR RPE BP Angina or VO2 Comments
(mph) % (bpm) (6-20) mmHg Dyspnea (ml/kg/min)*
1 /
2 /
3 /
4 /
5 /
6 /
7 /
8 /
9 /
10 /

Final Time: _____ min _____ sec Passive Recovery:

Time HR BP
Peak/Max. HR: _______ bpm (min) (bpm) (mmHg)
1
Peak/Max. VO2: ______ ml/kg/min 2
3
4
5

BRUCE
Stage Speed Grade HR RPE BP Angina or VO2 Comments
(mph) % (bpm) (6-20) mmHg Dyspnea (ml/kg/min)*
1 /
2 /
3 /
4 /
5 /
6 /
7 /
8 /
9 /
10 /

Final Time: _____ min _____ sec Passive Recovery:

Time HR BP
Peak/Max. HR: _______ bpm (min) (bpm) (mmHg)
1
Peak/Max. VO2: ______ ml/kg/min 2
3
4
5

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 NAUGHTON
Stage Speed Grade HR RPE BP Angina or VO2 Comments
(mph) % (bpm) (6-20) mmHg Dyspnea (ml/kg/min)*
1 /
2 /
3 /
4 /
5 /
6 /
7 /
8 /
9 /
10 /

Final Time: _____ min _____ sec Passive Recovery:

Time HR BP
Peak/Max. HR: _______ bpm (min) (bpm) (mmHg)
1
Peak/Max. VO2: ______ ml/kg/min 2
3
4
5

ACSM STRESS TEST CYCLE

Stage Kg/ RPM HR RPE Angina or BP VO2 Comments
Watts (bpm) (6-20) Dyspnea mmHg ml/kg/min
1 / /
2 / /
3 / /
4 / /
5 / /
6 / /
7 / /
8 / /

Final Time: _____ min _____ sec Passive Recovery:

Time HR BP
Peak/Max. HR: _______ bpm (min) (bpm) (mmHg)
1
Peak/Max. VO2: ______ ml/kg/min 2
3
4
5

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Write up Questions:

1. Calculate VO2 for each of the protocols using the ACSM walking or cycle equations.
ACSM Walking Equation
VO2 = 0.1 (speed) + 1.8 (speed) (grade) + 3.5 (where speed = mph *26.8)

ACSM Cycle Equation

VO2 = Watts/Mass * 10.8 + 7

BRUCE –

BALKE–

NAUGHTON –

CYCLE -

2. Explain the potential variance seen among the tests. Why do you think these occur?

3. Compare the Bruce direct test results to the result you would get using the indirect
equation above and using this link https://www.trainermetrics.com/fitness-assessment-
calculations/vo2max-bruce-protocol/ . How do they compare? Why do you think you are
seeing any potential variations?

4. Read the article below on the ACSM prescreening stratification changes and provide a
summary of the findings and how it relates to the how you will properly prescreen your
clinical clients.
https://www.acsm.org/docs/default-source/files-for-resource-library/
updating_acsm_s_recommendations_for_exercise-28-(1).pdf?sfvrsn=3aa47c01_4

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ECG ANALYSIS AND
INTERPRETATION

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 Main Reasons to Terminate Exercise Based on the ECG

1. PVC – the ventricles are firing prematurely which does not allow the heart to properly fill and
can affect cardiac output. If you see two PVC that look different (Multi Focal) or more than 3 PVC
that look the same (Uni Focal) you must terminate exercise

2. ST segment depression – Key indicator of myocardial ischemia. If ST segment remains 2mm

below baseline as repolarization occurs, you must terminate exercise.

3. ST segment elevation – Terminate exercise if the ST segment remain more than 1mm (1 small
square) above baseline after ventricular contraction.

4. Sustained ventricular tachycardia – this is a type of regular fast heart rate. We expect the heart
rate to be fast during exercise but when you see a formation that where the various ECG
components are unidentifiable you must terminate exercise. This can lead to ventricular
fibrillation if left untreated.

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ECG Lead Placement

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 Using ECG to Determine HR

1. Triplicate Method 2. R-R Method

This is the LEAST accurate method. This is the MIDDLE accurate method.
Use the strip and find a top of a QRS complex that lines up with a Use the strip and find a top of a QRS complex that lines up
big box square line. with a big box square line.
Count the number of big boxes until the next QRS complex. Count the number of small boxes until the next QRS complex.
1 box = 300bpm; 2 boxes = 150bpm; 3boxes = 100bpm Each small box is 0.04seconds and each large box is 0.2
4 boxes = 75bpm; 5 boxes = 60bpm; 6 boxes = 50bpm seconds
Ex. 3.5 large boxes = approx….88bpm Divide the total time between the two R points into 60
seconds
Ex. 3 large boxes and 2 small boxes = .68 seconds; 60/.68 =
88bpm

3. 1,500 Method 4. IF IRREGULAR – USE 10 SECOND STRIP

This is the MOST accurate method. This method must be used if you have an irregular heart rate.
Use the strip and find a top of a QRS complex that lines up with Count the number of QRS complexes in the 10 second strip
a big box square line. and multiple by 6.
Count the number of small boxes until the next QRS complex. Ex. 7 QRS in 10 seconds = 42bpm
Divide the total number of small boxes between the two R
points by 1,500
Ex. 17 small boxes = 1500/17 = 88bpm

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 Lab Activity #2: ECG Analysis

Name: ______________________

In Class Tasks:
1. Complete the ECG Video Worksheet as you watch the ECG video (prior to lab)
https://drive.google.com/file/d/1BMLdurUcQSiQIAD0tgsBxshzdN9XMPEq/view?usp=sharing
2. Practice placing ECG electrodes on 3 different clients
3. Record Video of your placing of the ECG electrodes on one your clients.
4. With 1 client, complete a GXT of your choice while monitoring the ECG as they exercise.
5. Complete the ECG recognition practice booklet
https://drive.google.com/file/d/1GX92DLXqyNXP5KZssr7Z0dknDqO0fyQb/view?usp=sharing
6. Complete the final GXT case study for group practical practice
7. https://www.skillstat.com/tools/ecg-simulator - for extra practice and to get really
frustrated at a screen 

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 ECG Introduction Video
List the required materials:
- -
- -
- -

How do you ensure skin is prepared for the ECG?

How many electrodes are placed on the body?

Why is it called a 12 lead ECG?

Precordial Placement
What are the 4 ground leads called?

Where are the arm leads placed?

Where are the leg leads placed?

Explain where you place the following leads:

V1:

V2:

V3:

V4:

V5:

V6

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ECG Interpretation:

What is the first step in the interpretation? What makes this regular vs. irregular?

The 2nd step is to calculate the HR. What are the 3 methods you can use?

One small square = ____ seconds

One large square = _____ seconds

Which method is the most accurate?

What is the third step? What are we looking for to ensure regularity?

The 4th step is looking at the PR interval. What is the PR interval?

What is the normal duration of the QRS complex?

What is a PVC?

Does a unifocal PVC warrant a stop in exercise?

What makes a multifocal PVC? Does it warrant a stop in exercise?

What is happening in the heart during the ST segment? What can changes in the ST segment
indicate?

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Write Up Questions:

1. Comment on your ECG placement video. Did you complete all the proper prep steps?
Were all of your electrodes in the correct place? What do you need to remember to do
next time to ensure a successful ECG?

2. How did you find monitoring and ECG during exercise? Did you notice anything about
the reading compared to when the person was at rest? How could you explain expected
ECG exercise responses to your client?

3. Mark your ECG recognition package with the posted answers. How did you do? What
areas do you need to focus on for improvement? How do you plan to improve your
score?
https://drive.google.com/file/d/1rHzZ4HvIQeLqGgPjQMRn_Z_PuP6zpzDB/view?usp=sharing

4. Read the following article and summarize its findings. What will you take away from this
article when working with clients in the future?
https://jamanetwork.com/journals/jama/fullarticle/193090

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PULMONARY
FUNCTION
ASSESSMENT

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 Pulmonary Conditions

There are two types of pulmonary conditions to differentiate between

1. Obstructive Conditions – these conditions cause the person to have problems getting
the air OUT of their lungs. Their total lung capacity is likely unaffected, but their ability
to expel that air is the problem
Obstructive conditions include: COPD, Emphysema, Asthma, and Cystic
Fibrosis

2. Restrictive Conditions – these conditions cause a person to have problems fully

expanded their lungs and getting air. Their total lung capacity will be significantly
reduced however they have no issue getting that air that is in their lungs out.
Restrictive conditions include: pulmonary fibrosis, scoliosis and ALS

Exercise Induced Bronchoconstriction:

For clients with exercise induced bronchoconstriction, diagnosis can be made if FEV1 decreases
>15% from baseline after exercise.

Recommended to give these clients their short-term inhaled bronchodilator prior to testing. 10-
15 minute of vigorous or variable intensity warm-up period is also recommended.

Pulse Oximetry Assessment:

Values:
Normal Supplemental O2 required
SaO2 75-100 mmHg <55mmHg
SpO2 95-100% <88%

Measurement must be taken prior to beginning and upon completion of the exercise
assessment/session. It is also advised to keep device on client throughout the assessment if
value prior to assessment was below normal.

During exercise a drop in 5% on the pulse oximeter would be a reason to terminate the test. In
all clients a SpO2 of <80% should be used as test termination criteria.

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 Lab Activity #3
Name: ______________________

You will be working in a group of 2 or 3 to complete this lab activity. Each person must submit
their own completed lab activity for marks.

In Class Tasks:
1. Complete the ECG bell ringer; you will be required to complete an analysis of ten ECG
readings.
2. Complete the pulmonary function case provided to your group. You must be able to
identify the condition the client has, explain why you came to that conclusion using the
test results and client information provided and determine the severity of the condition.
You will post your case and your interpretation on the chart paper provided and post on
the wall.
3. Record Video of your explanation and execution of the FVC test with your client
4. Complete the Exercise Challenge test and measure your client’s post-exercise FVC at
min 2, 5, 8, and 11.

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 Pulmonary Function Testing

Name: __________________ Age: ___________ Height: _____________ cm

Predicted Force Vital Capacity (FVC) = _______________________ litres

Measured FVC Corresponding FEV1

Pre Ex Trial 1

Pre Ex Trial 2

Pre Ex Trial 3

Post Ex min 2

Post Ex min 5

Post Ex min 8

Post Ex min 11

Expected lung volume for age, height and gender:

Measured FVC (litres)

Predicted FVC (litres)

X 100 = ___________%

Measured FEV1 (litres)

Measured FVC (litres)

X 100 = ___________%

Pulse Oximetry:

Heart Rate O2 Saturation

Pre exercise

Post exercise

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Write Up Questions:

1. Reflect on your ECG simulated bell ringer. How did using the simulator compare to
working on a classmate? What did you get for the answers to the 10 strips we analyzed?

2. Give a brief overview of your case study. Explain and rationalize your interpretation of
the case? How did you come up with your response?

3. Provide a reflection of your FVC video. What did you do well with your client? What
would you add in next time? Include the print out of your client’s results. How would
you interpret the results to the client?

4. How did the exercise challenge test go for your client? Was there a change in FVC
and/or FEV1/FVC ratio? How would you explain the results to your client?

5. Read the article below on Coaching During PFT and provide a summary of the findings
and how it relates to the protocols completed in lab.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530837/

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METABOLIC ASSESSMENT

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 Assessing the Resting Metabolic Rate
How Do I Calculate RMR?

There are two main ways to determine how many calories you or your client burns in a given
day. A relatively accurate (but more difficult) method is called indirect calorimetry, which uses
expired gases to calculate the amounts and types of fuel being utilized.

The Weir equation below can be used to calculate the number of calories burned per minute.
Thus, to work it up to a full 24-hour day, simply multiply the total by 1,440.

The respiratory quotient (RQ) is helpful in determining what type of fuel is being catabolized for
energy. RQ values are typically in the mid-70s when an individual is at rest; this figure will
increase to the 90s as activity level increases.

Abbreviated Weir Equation:

REE = [3.9 (VO2) + 1.1 (VCO2)] 1440

VO2 = volume of oxygen uptake (L/min)
VCO2 = volume of carbon dioxide output (L/min)

Respiratory quotient (RQ) = VCO2/VO2

 fat 0.70
 underfeeding <0.71
 protein 0.80
 mixed energy 0.85
 carbohydrate 1.00
 fat storage >1.00
 ketosis <0.70

A less accurate, but much easier, method for determining RMR is to use one of several different
formulas below. Keep in mind, however, that some sources claim these formulas can be off by
as much as 1,000 calories, with the majority of error or variation occurring in the calculation of
daily energy expenditure.

Estimated RMR Formulas

1. Revised Harris-Benedict BMR Equations (calories/day): https://manytools.org/handy/bmr-calculator/

Male: (88.4 + 13.4 x weight) + (4.8 x height) – (5.68 x age)
Female: (447.6 + 9.25 x weight) + (3.10 x height) – (4.33 x age)
weight in kilograms, height in centimeters, age in years
2. Mifflin-St Jeor Equation (calories/day): https://wpcalc.com/en/mifflin-st-jeor/
Male: 9.99 x weight + 6.25 x height – 4.92 x age + 5
Female: 9.99 x weight + 6.25 x height – 4.92 x age – 161
weight in kilograms, height in centimeters, age in years

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 Assessing Blood Glucose

Markers to be assessed:

Blood glucose

This is a risk factor/marker for current and or future metabolic disease.

Often these are tested with a full venous blood sample but we can also check them with a
capillary finger-prick sample and use the Accu-Chek Machine.

Use lancet and capillary blood collector to collect sample then place in Accu-Chek machine for
reading.

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 Lab Activity #4
Name: ______________________

You will be working with a partner to complete this lab activity. Both partners will be complete
both the RMR and Blood Glucose components of the lab

In Class Tasks:
1. Complete the glucose test. As soon as you are finished, have the client take 75grams of
provided sugar. Start 2 hour timer
2. Have the first person lie down for 10 minutes. They should not talk or move (sleep is
ideal!)
3. After 10 mins, hook the partner up to the metabolic cart and run a test for 15 minutes.
4. Discard the first 5 minutes of data and then average out the VCO2 and VO2 for the last
10 minutes of the test (depending what cart you are using)
5. While the one partner is resting, the other uses the In Body to get a printout including
their predicted RMR
6. Switch partners and repeat steps 2-5
7. Research the results of the test. Site your reference and interpret your client’s results in
the follow up questions.

Client Information

Name ___________________ Age _______ yrs Gender ______

Weight _______ kg Height _______ cm W.C ________cm

Blood Analysis Results:

Fasting Glucose 2Hr Glucose

Result

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 RMR Results

Measured Value (L/Min) RMR Equation Calculated cal/day

Average 10 min VCO2 Abbreviated Weir

Average 10 min VO2 Revised Harris-Benedict

Average RHR Mifflin-St Jeor

Average RER
In Body

Write Up Questions:

1. What is expected to occur following the 2 hour Glucose tolerance test in the non-
diabetic population? What would occur with a diabetic? How did your client respond to
the test? Explain your findings.

2. What is Metabolic Syndrome? What are the risk factors? Do your client possess the risk
factors? What other information would you need? Explain

3. What was the client’s results for the various calculated RMR? If there was a variance,
why would this be? How and why might the equations provide a score that is different
from the score using the metabolic cart value?

4. How would you change the procedure of the metabolic cart analysis of RMR to ensure
the most accurate results? Why?

5. Read one of the following articles (PDF also posted on blackboard). Summarize the
article and discuss its findings. How might you use the information from the lab and the
findings of the article to assist the client with training or diet with respect to their RMR?
a. Seay, R. F., Schubert, M. M., Clarke, H. E., & Spain, K. K. (2017). Impact of 4
weeks of interval training on resting metabolic rate, fitness, and health-related
outcomes. Applied Physiology, Nutrition, and Metabolism, 42(10), 1073-1081.
b. Gomez-Arbelaez, D., Crujeiras, A. B., Castro, A. I., Martinez-Olmos, M. A., Canton,
A., Ordoñez-Mayan, L., Casanueva, F. F. (2018). Resting metabolic rate of obese
patients under very low calorie ketogenic diet. Nutrition & Metabolism, 15(1), 18.
c. Kenny, G. P., Gougeon, R., Hadjiyannakis, S., Sigal, R. J., Wells, G. A., Goldfield,
G. S., Prud’homme, D. (2017). Does exercise training affect resting metabolic rate in
adolescents with obesity? Applied Physiology, Nutrition, and Metabolism, 42(1), 15-
22.

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CANCER, ARTHRITIS AND
RANGE OF MOTION

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 Working with Patients with Cancer
Many factors will affect how you work and treat clients and patients who have cancer.

This will depend on:

Type of Cancer
Where they are at in their treatment
The treatment they are receiving
Age and Gender
Medications
Other present chronic disease

One of the largest reported issues those with cancer experience is a reduced physical function
and fatigue.

In this activity you will examine the commonly used questionnaires and analyze each with the
findings in the provided article.

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TASK 1: Cancer Analysis

a. Cancer IQ - https://www.mycanceriq.ca/
b. Brief Fatigue
c. Patient Specific Functional scale
d. Lymphedema Wrapping

ARTHRITIS ASSESSENT

Working with clients with arthritis will vary depending on their joint damage, pain level and
overall functioning.

Therefore we must assess their pain level and determine which joins are tender and swollen

Task #2 - The DAS 28

http://www.4s-dawn.com/DAS28/

Complete the tool on your two clients using fictitious data; or real data if one client is
experience pain.

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 RANGE OF MOTION ASSESSMENT
GONIOMETRY: DETERMINING END FEEL
Physiologic (Normal) End-Feels
END-FEEL STRUCTURE EXAMPLE
Soft Soft Tissue Approximation Knee Flexion (contact between soft tissue of posterior leg and posterior thigh)
Firm Muscular Stretch Hip flexion with the knee straight (passive elastic tension of hamstring muscles)
Capsular Stretch Extension of metacarpophalangeal joints of fingers (tension in the anterior capsule)
Ligamentous Stretch Forearm supination (tension in the palmar radioulnar ligament of the inferior radioulnar joint, interosseous
membrane, oblique cord)
Hard Bone Contacting Bone Elbow Extension (contact between olecranon process of the ulna and the olecranon fossa of the humerus)

Pathologic (Abnormal) End-Feels

END-FEEL EXAMPLES
Soft Occurs sooner or later in the ROM than usual; or in a joint that normally has a Soft tissue edema
firm or hard end-feel. Feels “boggy” Synovitis
Firm Occurs sooner or later in the ROM than usual; or in a joint that normally has a Increased muscular tonus
soft or hard end-feel Capsular, muscular, ligamentous shortening
Hard Occurs sooner or later in the ROM than usual; or in a joint that normally has a Chondromalacia
soft or firm end-feel Osteoarthritis
A bony grating or bony block is felt Loose bodies in joint
Myositis ossificans
Fracture
Empty No real end-feel because end of ROM is never reached because of pain. No Acute joint inflammation
resistance is felt except for patient’s protective muscle splinting or muscle pain Bursitis
Abscess
Fracture

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TASK #3 – DETERMINING THE END OF THE ROM AND END-FEEL
This exercise is designed to help you determine the end of the range of motion and to differentiate among the 3 different end-feels: soft, firm, and
hard.
ELBOW FLEXION – SOFT END-FEEL
1. Position your partner supine with the arm placed close to the side of the body. A pad is placed under the distal end of the humerus to allow full
elbow extension. The forearm is placed in full supination with the palm of the hand facing the ceiling. Move the subject’s forearm toward the
humerus (flex elbow).
2. With one hand, stabilize the distal end of the humerus (proximal joint component) to prevent flexion of the shoulder.
3. With the other hand, slowly move the forearm through the full passive range of elblow flexion until you feel resistance limiting the motion.
4. Gently push against the resistance until no further flexion can be achieved. Carefully note the quality of the resistance. This soft end-feel is
caused by compression of the muscle bulk of the anterior forearm with that of the anterior upper arm.

ANKLE DORSIFLEXION – FIRM END-FEEL

1. Place your partner sitting so that the lower leg is over the edge of the supporting surface and the knee is flexed at least 30 degrees.
2. With one hand, stabilize the distal end of the tibia and fibula to prevent knee extension and hip motions
3. With the other hand on the plantar surface of the metatarsals, slowly move the foot through the full passive range of ankle dorsiflexion until
you feel resistance limiting the motion.
4. Push against the resistance until no further dorsiflexion can be achieved. Carefully note the quality of the resistance. This firm end-feel is
caused by tension in the Achilles tendon, the posterior portion of the deltoid ligament, posterior talofibular ligament, the calcaneofibular
ligament, and the posterior joint capsule.

ELBOW EXTENSION – HARD END-FEEL

1. Position your partner supine with the arm placed close to the side of the body. A pad is placed under the distal end of the humerus to allow full
elbow extension. The forearm is placed in full supination with the palm of the hand facing the ceiling. Move the subject’s forearm toward the
humerus (flex elbow).
2. With one hand, stabilize the distal end of the humerus (proximal joint component) to prevent extension of the shoulder.
3. With the other hand, slowly move the forearm through the full passive range of elbow extension until you feel resistance limiting the motion.
4. Gently push against the resistance until no further extension can be attained. Carefully note the quality of the resistance. When the end-feel is
hard, it has no give to it. This hard end-feel is caused by contact between the olecranon process of the ulna and the olecranon fossa of the
humerus.

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TASK #4 – EXPLANATION OF GONIOMETRY USING MEASURES ASSIGNED IN LAB HANDOUT
1. Introduce yourself and explain the purpose of goniometric testing. Demonstrate a joint range of motion on yourself.
2. Show the goniometer to your subject and demonstrate how it is used to measure a joint ROM.
3. Explain why bony landmarks must be located and palpated. Demonstrate how you would locate a bony landmark on yourself and explain
why clothing may have to be removed.
4. Explain and demonstrate why changes in position may be required.
5. Explain the subject’s role in the procedure. Explain and demonstrate your role in the procedure.
6. Obtain confirmation of the subjects understanding of your explanation.

TESTING PROCEDURE
1. Stabilize the proximal joint component.
2. Move the distal joint component through the available ROM. Make sure that the passive ROM is performed slowly and that the end of
the range is attained and end-feel determined.
3. Make a clinical estimate of ROM.
4. Return distal joint component to the starting position.
5. Palpate bony anatomic landmarks.
6. Align the goniometer.
7. Read and record the starting position. Remove the goniometer.
8. Stabilize proximal joint component.
9. Move distal component through the full ROM
10. Replace and realign goniometer.
11. Read and record ROM.

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 GONIOMETRY – Measurement Procedures

Test Joint Body Position Axis of Rotation Stationary Arm Moving Arm
Spinal Rotation Spine Seated in chair with arms relaxed on thighs; Centred over superior Parallel to imaginary line Align moving arm
(Cervical pelvis must remain stable; feet must remain flat aspect of client’s head between acromion with nose
Region) on floor (thoracic and lumbar spines do not processes
rotate)
Spinal Rotation Spine Seated in chair with arms crossed at level of Centred over superior Parallel to imaginary line Align moving arm
(Thoracic and xiphoid process; pelvis must remain stable; feet aspect of client’s head between tubercles of with nose
Lumbar must remain flat on floor; cervical spine does not iliac crest
Regions) rotate
Shoulder Shoulder Supine; arm abducted to 90o; forearm Olecranon process Perpendicular to floor Styloid process of
Internal & perpendicular to support surface; humerus rests ulna
External on pad
Rotation
Hip Internal & Hip Seated with hip and knees flexed at 90o Anterior aspect of Perpendicular to floor Anterior midline
External patella of lower leg
Rotation
Plantar Flexion Ankle Seated with legs dangling with ankle at 90o Lateral aspect of Lateral midline of fibula, Parallel to lateral
& Dorsiflexion lateral malleolus using head of fibula for aspect of fifth
reference metatarsal

Normative Data
Measurement Range of Motion (Degrees)

Spine Cervical Rotation 60 - 80

Spine Thoracic and Lumbar Rotation 30 - 45
Shoulder Internal Rotation 70 – 90
Shoulder External Rotation 90
Hip Internal Rotation 40 – 45
Hip External Rotation 45 – 50
Plantar Flexion 40 – 50
Dorsiflexion 20

44
Task #5: NEW YORK POSTURE TEST (Johnson & Nelson, 1986)

This assessment attempts to evaluate posture by comparing an individual’s alignment and

deviation to a ‘normal’ posture. A plumb line is used to assess a lateral and posterior view. A
number of schematics are given with each body part alignment, which vary in the degree of
deviation. The observer must then rate the individual accordingly.

Objective:
 To determine current body alignment

Equipment:
 Plumb line
 2 large mirrors (optional)
 Camera (optional)
 Pen/pencil
 Recording sheet

Protocol:

1. Suspend a heavy, clearly visible plumb line from a stationary support in front of an
appropriate screen so that the ‘bob’ almost touches the floor. Directly under the ‘bob’,
provide a straight line using one-inch masking tape. This line should begin at a point on
the floor three feet from the ‘bob’ toward the screen, pass directly under the ‘bob’, and
extend ten feet on the examiner’s side of the ‘bob’. The plumb line is used to determine
whether the points of reference of the individual being tested are in the same alignment as
are the corresponding points in the standard posture.

2. To conduct the posture analysis, males should wear shorts only. Females should wear
shorts and a tank top. Shoes must be removed for this test.

3. Rate the individual’s posture in a posterior and lateral view according to the chart
provided.

4. The posterior view is assessed first. The client assumes a comfortable and natural
standing position between the plumb ‘bob’ and the screen, straddling the floor line and
facing the screen. The posterior view, begins midway between the heels, it extends
upward midway between the lower extremities, through the midline of the pelvis, spine,
sternum, and skull. The right and left halves of the skeletal structures are essentially
symmetrical.

5. The lateral view is assessed next. The fixed reference point is slightly anterior to the
outer malleolus and represents the base point of the mid-coronal plane of the body in
ideal alignment. The lateral view attempts to divide the body into front and back sections
of equal weight. These sections are not symmetrical and there is no obvious line of
division on the basis of anatomical structures.

45
46
 IDEAL POSTURAL ALIGNMENT

ALTERED POSTURAL ALIGNMENT

47
48
 Lab Activity #5

Name: ______________________

In Class Tasks:
1. Record baseline information for your partner.
2. Complete tasks 1-6 with your partner
3. Practice lymphedema wrapping
4. Complete the lab follow-up questions

Client Information #
Name _________________________________ Date ________________

Age _______ yrs Gender ________ Weight _______ kg Height _______ cm

Rest HR ______ bpm Rest BP ___________ mm/Hg PAR-Q Pos / Neg

Task#1 Cancer Analysis

Results of Cancer IQ
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

49
50
Lymphedema Wrapping
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

51
 Task #2: End Feel

End Feel Soft Firm Hard

Structure

Comments

Task #3: Goniometry

Name _________________________________ Date ________________

Measurement Manual Implication/Comments

Left _____
Spine Cervical Rotation
Right _____
Spine Thoracic and Lumbar Left _____
Rotation Right _____
Left _____
Shoulder Internal Rotation
Right _____
Left _____
Shoulder External Rotation
Right _____
Left _____
Hip Internal Rotation
Right _____
Left _____
Hip External Rotation
Right _____
Left _____
Plantar Flexion
Right _____
Left _____
Dorsiflexion
Right _____

52
 Task #4: DAS 28

Score Observations
Client

53
Task #5: Posture

54
55
Write Up Questions:

1. Complete the Cancer IQ Risk analysis on yourself. Why did you chose the cancer type
you did? What was your risk level? What questions were asked to assess your risk?
Which made you score the risk level that you did? Which cancer did your partner chose?
Where there different questions asked of them? With connections to each form of
cancer, explain why there may be a variance in the questions asked and risk factors.

2. Did you notice any differences in the end feel points? Any abnormalities?

3. Explain how the results of the goniometry as compared to the normative data. How
would you explain these to the client? What might you suggest for areas that have a
variance from the normative data?

4. What would be the benefit of using the DAS 28 for your client? How would this
information help you work with the client?

5. Provide a detailed analysis of the posture of your clients. How would you explain results
to the client? Provide three recommendations for things to be altered/added the client’s
daily routine to assist with their posture.

6. Read the following article and discuss the findings? How might various cancer related
tools be useful? Would you have any other/better recommendations to use with a client
with cancer? Include reference to one outside tool you have found

https://jamanetwork.com/journals/jamaoncology/fullarticle/2606439

56
OLDER ADULT

57
58
 Lab Activity #6A

Name: ______________________

You will be working with a partner to complete this lab activity. Each partner must submit their
own lab activity with their results and analysis.

In Class Tasks:
1. Watch the Senior Fitness Test Video
2. Complete the SFT on your client. Your client is a 77 year old.
Part 1: Seniors Fitness Test Video
1. ______ Second Chair Stand Test
Goal - To assess lower body _____________________ required for tasks such as climbing stairs, walking, getting out of a chair
Equipment
1. Chair against wall
2. ___________________
Procedure
 Instruct the client to sit in the middle of the chair with a straight back, and feet flat ____________apart
 With the arms crossed at the ___________ and placed on the________, the older adult stands from a seated position as many times
as possible within 30 seconds
 Have the participant practice a few trials to ensure proper form
Score
- Count the number of ________ stands in the 30 seconds on the score card
- If the participant is more than _______ up, it counts as a full stand
Safety Considerations
- Brace chair against wall
- Watch for _____________ problems
- Stop if participant complains of _____________

2. Arm Curl Test

Goal: To assess the ____________ of the upper body that is required for activities such as carrying items (eg. groceries, suitcases or
grandchildren)
Equipment
- Chair
- Hand weights - _____lbs for women, _____ lbs for men
- Stopwatch
Procedure
 Instruct the client to sit on the chair in an upright position, feet flat on the floor and __________ side near the edge of the seat
 Have the client place the weight in the ______________ hand, in a ____________ grip
 Starting in the down position, with arm perpendicular to the floor, instruct the client to curl the weight up and to a full flexion, the
palm of the hand facing the _______
 It is important that the _____________________ remain stationary
 Bracing the elbow against the _______ can help so only the upper arm moves
 Have the participant practice a few repetitions to ensure proper form
 On the go signal, the participant curls the weight through full range of motion as many times as possible in 30 seconds
Scoring
 The score is recorded as the number of completed curls in _______sec
 If the arm is ________ than half way up through the curl at the end of 30 seconds, count the curl towards the total
Adaptations – If the weight is too heavy, choose an alternative weight and do not use the norm tables for scoring
Safety Considerations
- Stop the test immediately if the participant complains of pain
3. ____ Minute Step Test

Goal - To assess __________________________

59
Equipment
- ___________
- Stopwatch
- Mechanical counter
- _____________________________
Set-Up
 Identify the half-way point between the ________________________ and the middle of the ____________________
 Mark this height on the wall
 This mark is used to monitor _________________
Procedure
 On the go signal, the participant begins stepping with the ________ leg as many times as possible in _____ minutes
 The client must raise each knee to the marked point on the wall
 The score is the number of times the client raises their ________ knee within the 2 minute limit
 If the knee height cannot be maintained, ask the participant to _______________or stop until proper form is regained
 If the client has stability issues he/she may use a chair for balance
 If the client can not lift to proper height, allow comfortable height and indicate the modification on the score card and do not
compare to norm tables
Scoring
 The score is number of fully completed steps on right side
Safety Considerations
- Watch for balance problems and if so, put the client near the wall
- __________ or rest if difficulty with step height
- Monitor for signs of ________________
- Walk around for one minute to cool down

4. Chair Sit and Reach

Goal - To assess functional ________________ flexibility of the ______________.

Equipment
- Chair against the wall – angled chair legs are best
- ________________________
Procedure
 Instruct your client to _____ at the front of a chair with one leg extended, foot flexed at ______and the other leg ________ with the
foot flat on the floor
 Place one hand on top of the other and middle fingers _________
 Instruct the client to flex at the ________ and lean forward reaching from the hips towards the toes.
 Make sure the knee of the extended leg remains _________________
 The distance is then measured between the extended fingers and the toes (inches)
Scoring
 The ___________________ leg is used for scoring
 The distance from the tips of the _______________ finger to the top of the _______________ is recorded
 If the participant does not reach their toes, it is a ________________ score
 If the participant just reaches the toe, their score is _____________
 If the participant reaches past their toes, it is a _______ score
Safety Considerations
- Brace the chair against the wall and check for tipping
- _________ as they bend, avoid bouncing
- Do not stretch if they feel ______________
- Do not test the client if they have osteoporosis

5. Back Scratch Test

Goal - To assess _________________ body flexibility of the _________________
Equipment
- ________________________________
Procedure
 Instruct the client to place one hand over the same shoulder with the palm facing _________________, fingers down and elbow high
 Place the other hand ______________ the back with the palm facing _____
 Use the preferred side for scoring
 Check to see if the _______________ fingers are directed towards each other
 If not they are not, direct, do not move, middle fingers to best alignment
Scoring
 The participant gets ____ test trials
 Record the score to the nearest half ___________________
 If fingers do not touch, record the score as a ___________________
 If the fingers touch, record the score as ______________
 If the fingers overlap, it is a _________________

60
Safety Considerations
- Stop the test if they feel pain
- Avoid ___________ or rapid movements

6. 8 Foot Get Up and Go

Goal - To assess _________________ and dynamic ___________________
Equipment
- Chair against the wall
- ____________________________
Procedure
 Place a ________________ against a wall with a cone ___ feet in front
 Instruct the client to sit in the chair, with one foot _________ of the other and hands on thighs
 On the go signal, the instruct the participant to get up and go as quickly as possible around the _________ and sit back down on the
chair
 Start the timer on the go signal, whether or not the participant has started to ________________
 ______ test trials are given
 Record to the nearest __________ of a second
Scoring
 The participants score is the time beginning from the ______________ until the participant _________ back down
Safety Considerations
- Position yourself between the chair and the cone to assist with ________
- Watch to make sure a frail participant stands up and sits down safely

7. _____ Minute Walk Test

Goal - To assess functional __________________
Equipment
- ____cones - masking tape
- Long tape measure - popsicle sticks
- Name tags - stopwatches
- Marker
Setup
 For the course you required a 50 yard rectangular area
 The length is ______ yards and width______
 Mark the inside corners with __________
 Mark each ____ yard (4.57) lines with tape or chalk
Procedure
 On the go signal, the participant ________, not runs, the course, covering as much distance as possible in ______minutes
 _____________ can be used to keep track of laps (or score cards)
 Let the client/participant know when they are at the ________point and when ____ minutes are remaining
 Participants can stop and rest on __________ provided, however, the time keeps running
 When 6 minutes have been complete, instruct the client to stop and move to the nearest _____ yard marking
 The participant can slowly walk in place for 1 minute to cool down
Scoring
 Each popsicle represents _______
 If 8 laps have been completed and the client stops at 45 yard marke,r the distance covered is: __________
 If 7 laps have been completed and the client stops at the 10 yard marker, the distance covered is: _________

Safety Considerations
- Use a well-lit, non slip room
- Position chairs along the _______________
- Discontinue if they show signs of overexertion
- Cool down for one minute

61
Part 2: Senior’s Fitness Test

62
 G

STROKE AND CEREBRAL PALSY

ASSESSMENT

63
64
 Working with Client’s with Compromised Brain Function

Must keep in mind the nature of the compromise to function and the level of functioning

Cerebral Palsy
Most assessments go through a variety of procedures. First a questionnaire to assess ability and
then fitness assessments will be used to determine if training has been/or can be effective
1. Questionnaire assessing fatigue and severity
o https://www.google.com/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwiJmZ_V193dAhVL5oM
KHYcwCA4QFjAAegQICRAC&url=https%3A%2F%2Fwww.physiotherapyalberta.ca
%2Fcourse_materials
%2Ffinal_fissa_w_footer.pdf&usg=AOvVaw3VSh06Q1zE1pgZI5u41Nua
2. Classification of condition – Based on Gross Motor Function
o http://templatelab.com/GMFCS-ER/
3. Six-minute walk test (or 6-minute push test) - measures the distance an individual is able to
walk over six minutes on a hard, flat surface
o In the Six Minute Walk and Push Tests, the assessor will measure the distance
the person can walk or self-propel in a manual wheelchair. The surface they are
tested on should be hard and flat. The aim is for the participant to cover as much
distance as possible in the six minutes. They should self-pace throughout the
assessment and can take breaks if needed.
4. Modified shuttle run test - measures performance on a 15 level scale of increasing speeds
over a 10 metre course. There is a version for manual wheelchair users also – 10-metre
shuttle ride test
o The 10m multi-stage fitness test is an aerobic fitness test designed for children
with cerebral palsy (CP) classified at Level I or Level II on the Gross Motor
Function Classification System
o There are separate protocols for children at each CP GMFCS level (SRT-1 and
SRT-2). The Level I shuttle run test (SRT-I) is for children classified at GMFCS Level
1 (ie, able to walk indoors and outdoors without restrictions). The SRT-I starts at
5 km/h. The Level II shuttle run test (SRT-II) is for children classified at GMFCS
Level 2 (ie, able to walk indoors and outdoors with restrictions). The SRT-II starts
at 2 km/h. The speed increases by 0.25 km/h every level (minute) for both tests
5. Strength, Flexibility and ROM – measures strength of individual muscle groups, flexibility,
goniometry to measure ROM and balance

65
 Stroke (Cerebrovascular Accident)

Loss of physical stamina, mood disturbances and adoption of sedentary behaviours are all
common in stroke survivors therefore proper exercise assessment and prescription are crucial.

O2 consumption is higher at a fixed submaximal level and reduced at peak effort in stroke
survivors. Cardiovascular assessments should increase by very small work rate (0.5-1 METS per
2-3min stage). The 6 minute walk test or modified Bruce are often used.

Commonly used Stroke Assessment

https://www.google.com/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=2ahUKEwjQut3VhbLhAhWrrVkKHeyPD54QFjADegQIARAC&url=https%3A%2F
%2Fpdfs.semanticscholar.org%2F5762%2F03782173f94d3dfe779f7157645c990242f0.pdf&usg=AOvVaw3I4QwPecEic-xOK2kpCcUb

66
67
68
69
 The Soda Pop Test
A test that is commonly used in patients with compromised brain function to assess fine motor
skills is the Soda Pop Test.

Purpose: to measure manual dexterity and hand-eye coordination

Equipment required: stopwatch, three full 12 oz. (355ml) soda pop cans, a cardboard platform
32 in. (81.28 cm) in height and 5 in. (12.7 cm) wide. Six circles, 3.25 in. (8.26 cm) in diameter,
are drawn in a straight line centered on the cardboard 1.5 in. (3.81 cm) apart

Procedure:
 The soda pop cans are placed in every other circle starting from the side of the hand
being tested.
 The participant, seated at the table, begins the test by placing the hand “thumb up,”
with the elbow joint bent at about 100-120°, grasping the first can with the hand being
tested.
 On the signal “Go,” the stopwatch is started and the participant begins.
 Each can is then turned upside down into the adjacent empty circle within the drawn
line.
 The participant then returns to the first can turned, replaces it in the original position
and proceeds with the other two cans. This whole process is repeated twice.

Scoring: The time of each test is recorded to the nearest tenth of a second. The participant is
allowed two practice trials, then two actual trails. The best score is recorded.

70
 Short Physical Performance Battery

The short physical performance battery (SPPB) is a group of measures that combines the
results of the gait speed, chair stand and balance tests (Guralnik et al., 2000).
It has been used as a predictive tool for possible disability and can aid in the monitoring of
function in older people

71
 Lab Activity #6B

Name: ______________________

In Class Tasks:

1. Complete the 6 Minute Walk Test

2. Complete the ENTIRE Motor Assessment Scale
3. Complete the Soda Pop Test
4. Complete the Short Physical Performance Battery
5. Record all results and complete lab follow up questions.

Client Information

Name _________________________________ Date ________________

Age _______ yrs Gender ________ Weight _______ kg Height _______ cm

Rest HR ______ bpm Rest BP ___________ mm/Hg PAR-Q Pos / Neg

Task #1

6 minute walk test Distance: ___________________________

Normative score: _________________________________________

% ________________________________________________

Men - 6 MWD = (7.57 × Height cm) – (1.76 × weight kg) – (5.02 × age) – 309 m

Women - 6 MWD = (2.11 × Height cm) – (2.29 × weight kg) – (5.78 × age) + 667 m

Task #2

Soda Pop Trail #1: ______________________________

Soda Pop Trail #2: ______________________________
Soda Pop Best Test Time: ________________________

72
Task #3

Task #4

Side by Side Semi-Tandem Tandem Gait Speed Chair Stands

73
Write Up Questions:

1. How did your partner’s 6MWD compare to the expected normative score? How do you
think a person having compromised brain function would be impacted, and how would
that relate to their 6MWD?
-

2. Read the following article and use its finding to discuss the useful of the 6 minute walk
test for these populations. What are its benefits? What are its limitations?
http://jxym.amegroups.com/article/view/4832

3. Did your client have any issues with the MAS? What were they? How might issues other
than compromised brain function, such as a lack of flexibility, etc., affect these scores?
Do you think this test could be useful with a healthy population?

4. How did the client find the Soda Pop test? What was your time? Was there a difference
in your dominant vs non-dominant hand? Were there any noted difficulties? How do
you think a client with a brain injury would be impacted during this test?

5. How did your client perform on the SPPB? Connect to research to explain their results
and what scores would indicate a concern for any client

74
75
 DEMENTIA, MULTIPLE
SCLEROSIS AND PARKINSON’S
DISEASE ASSESSMENTS

76
77
Cognitive Assessments:

We will examine two commonly used cognitive assessments for a person who has
Dementia/Alzheimer’s.

The first is the MOCA. Protocol and instructions can be found in this week’s folder on blackboard.

The second is the General Practitioner Assessment of Cognition (GPCOG). The GPCOG is a reliable, valid
and efficient instrument to screen for dementia specifically in a primary care setting. It can be found
online with a version to use directly with the client at http://gpcog.com.au/index/patient-assessment

GPCOG Protocol:
 Read out each question as it is presented on the screen.
 Unless specified, each question should be asked only once.
 Make sure that the patient wears glasses and hearing aids if needed, and that there are no interruptions
or noises during testing.

Brain Age:
There are many proven reasons to stimulate the brain each day just as we are encouraged to
stimulate our physical body. Nintendo DS created a game called Brain Age.

Users complete a brain age check and then are encouraged to complete daily brain training
activities to help keep their mind sharp!

Balance Assessments:
The Four-Stage Balance Test:

The Four-Stage Balance Test, in conjunction with other measures such as the 30 Second Chair Stand Test
and Timed Up and Go (TUG) Test and an assessment of postural hypotension can help to indicate if a patient
is at risk of falling.

Patient are asked to perform four progressively more challenging positions. Patients should not use an
assistive device and should keep their eyes open.

Protocol to say to client:

 “I’m going to show you four positions.”

 “Try to stand in each position for ten seconds. You can hold your arms out or move your body to help keep
your balance but don’t move your feet. Hold this position until I tell you to stop.”
 Describe and demonstrate each position. Stand next to the patient, hold their arm and help them assume the
correct foot position.
 When the patient is steady, let go, but be ready to catch them if they lose their balance.
 For each stage, say “Ready, begin” and begin timing.
 After 10 seconds, say “Stop.”

78
  If the patient can hold the position for ten seconds without moving their feet or needing support, proceed to
the next position.
 If not, stop the test.
Y Balance Test:

1. Participants should thoroughly warm-up prior to the commencement of the test. Warm-ups should
correspond to the biomechanical and physiological nature of the test. In addition, sufficient recovery (e.g.
3-5 minutes) should be administered following the warm-up and prior to commencement of the test.
2. The athlete should be wearing lightweight clothing and remove their footwear. After doing so, they are
the required to stand on centre platform, behind the red line, and await further instruction. Measure leg
limb length (ASIS to medial malleolus).
3. The test should be performed in the following order:
1. Right Anterior
2. Left Anterior
3. Right Posteromedial
4. Left Posteromedial
5. Right Posterolateral
6. Left Posterolateral
4. With their hands firmly placed on their hips, the athlete should then be instructed to slide the first box
forward as far as possible with their right foot and return back to the starting upright position.
5. Reach distances should be recorded to the nearest 0.5cm (9).
6. They should then repeat this with the same foot for a total of 3 successful reaches. After they have
completed 3 successful reaches with their right foot, they are then permitted to repeat this process with
their left foot.
7. Once the athlete has performed 3 successful reaches with each foot, they can then progress onto the next
test direction (i.e. posteromedial).
8. The test administrator should be recording the reach distance of each attempt in order to calculate the
athletes YBT composite score.

Romberg Test:

The Romberg test is an appropriate tool to diagnose sensory ataxia, a gait disturbance caused by
abnormal proprioception involving information about the location of the joints. It is also proven to be
sensitive and accurate means of measuring the degree of disequilibrium caused by central vertigo,
peripheral vertigo and head trauma

Romberg Test Protocol:

1. The patient is asked to remove his shoes and stand with his two feet together. The arms are held next to
the body or crossed in front of the body.
2. The clinician asks the patient to first stand quietly with eyes open, and subsequently with eyes closed. The
patient tries to maintain his balance. For safety, it is essential that the observer stand close to the patient
to prevent potential injury if the patient were to fall. When the patients closes his eyes, he should not
orient himself by light, sense or sound, as this could influence the test result and cause a false positive
outcome.
3. The Romberg test is scored by counting the seconds the patient is able to stand with eyes closed.

79
 Lab Activity #7
Name: ______________________

In Class Tasks:
For this lab you will be working in a group of 2.
1. Complete tasks #1-6
2. Record all results and complete lab follow up questions.

Client Information

Name _________________________________ Date ________________

Age _______ yrs Gender ________ Weight _______ kg Height _______ cm

Rest HR ______ bpm Rest BP ___________ mm/Hg PAR-Q Pos / Neg

Task 1: Brain Age

What was your brain age score?

80
Task 2: MOCA

81
Task 3: GPCOG

82
Task #4: Four-Stage Balance Test

83
Task #5: Romberg’s Balance Test
Romberg’s Test

Time:

Comments:

Task 6

84
85
86
Write Up Questions:

1. How did your client perform on the cognitive assessments? As someone who is healthy
in their cognitive state, did they still have difficulties? How do you think this test may be
perceived and performed by someone who is experiencing Dementia?

2. How did the client do on the Brain Age check? What was the difference between their
biological age and their brain age? What are three ways you could encourage the client
to stimulate their brain each day?

3. Which of the Balance tests posed the most difficulty for your client? What was the
reason behind this experienced challenge? What client characteristics, symptoms, etc
would make you chose each of the three tests over the other? Explain your decision
with references.

4. Read the following article and explain the finding as they relate to the conditions
discussed this week - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304302/

5. Complete your required virtual dementia training and reflect on your experience

87
88
VISION AND HEARING
ASSESSMENTS

89
Working with the Clients with

90
 Hearing and Visual Impairments

Working with someone with a visual or hearing impairment can be challenging as they are
normally completely “able-bodied” and often the impairment is not immediately evident.

You must be sensitive to these populations and ensure you are modifying your assessments as
appropriate. Ensure you use large fonts, a loud clear voice and explain everything both verbally
and through demonstrations.

Hearing Impairments:

When a loss of hearing is experienced, not only is hearing itself impacted, but also quite often, a
loss of balance as well depending on the impairment.

Hearing loss can occur at different decibels levels as well as different pitch frequencies.
Hearing tests are most often completed by an audiologist and include various components.

Visual Impairments:
These impairments can be very widespread from short distance and long distance being
impacted, to colour vision limitations to issues with depth perception. Each of these cases
would require varied modifications to your assessments and working with the client.

Most clients would have performed a basic vision test during their lives, but colour vision and
depth perception are also important assessments to be completed. Some occupations (such as
a firefighter) require these assessments for the job and those who do not pass cannot be hired.

Assessments:

There are fortunately a large number of high-level online screening tests that can be completed
with the client to determine if follow-up with an audiologist or an optometrist may be required.

91
Lab Activity #8: Vision and Hearing Analysis
92
Name: ______________________

You will be working in partners to complete this lab activity.

In Class Tasks:
1. Complete the Depth Perception Test
2. Complete the Colour Vision Tests (online and in class book)
3. Complete the 3 Hearing Tests
4. Record all results and answer the lab follow up questions

Task #1: Depth perception

https://www.mediacollege.com/3d/depth-perception/test.html

Result: ________________________________________________

Task #2 Colour Vision Test

https://enchroma.com/pages/color-blindness-test

Result: ________________________________________________

Result: ________________________________________________

Task #3: Hearing Tests

https://www.beltonehearingtest.com/
Result: ________________________________________________

https://hearingtest.online/
Result: ________________________________________________

https://global.widex.com/en/online-hearing-test
Result: ________________________________________________

***** ensure you save and print all results*****

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Write-Up Questions:

1. After completing the colour and depth vision assessments, did your client have any noted
deficiencies? How would you work with a client who has a vision impairment? Explain one
modification/adaptation you would make or ensure you do, when working with someone with
a) vision loss
b) colour vision loss
c) depth perception impairment

2. After completing the three hearing assessments, did your client have any noted deficiencies?
Was there any discrepancy in results between the three tests? How would you work with a
client who has a hearing impairment? Explain three modifications/adaptations or assessments
you would make or ensure you do, when working with someone with hearing loss?

3. Read the articles below. Summarize the key findings/reports in each article. How would the
information in the articles impact how you would work with a client with
a) Hearing Impairment
b) Vision Impairment

Article #1:
https://www.nchpad.org/966/5157/Communication~~~The~Key~to~Success~for~Fitness~Professionals
~Working~with~Individuals~with~Hearing~Impairments

Article #2:

https://www.nchpad.org/838/4261/Guidelines~for~Trainers~with~Clients~with~Visual~Impairments

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This laboratory manual contains information compiled solely for use by students enrolled
within the EXERCISE SCIENCE FOR HEALTH AND PERFORMANCE program at Niagara College
Canada.

This laboratory manual (or any portion of this laboratory manual) is not intended for re-sale
and/or re-print.

Every effort has been made to trace and reference the copyright holders for borrowed
material contained within this lab manual.

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