Tinetti gait & balance evaluation

Introduction

An assessment of gait & balance that gives a numerical score.

Procedure

The components are:

• Tinetti balance evaluation (16 points)
• Tinetti gait evaluation (12 points)

A total of 28 points.

A score of < 20 generally associated with significant risk of falls.

Tinetti balance evaluation

The patient is seated in a hard, armless chair. The following maneuvers are tested.

• sitting balance [0 or 1 point]
  • 0: leans or slides in chair
  • 1: steady, safe
• arise [0-4 points]
  • 0: unable without help
  • 1: able, but uses arms to help
  • 1: able, but requires more than 1 attempt
  • 2: able without use of arms
  • 2: able to arise with 1 attempt
• immediate standing balance (1st 5 seconds) [0-2 points]
  • 0: unsteady (staggers, moves feet), marked trunk sway
  • 1: steady, but uses walker or cane or grabs other objects for support
  • 2: steady without walker or cane or other support
• standing balance [0-2 points]
  • 0: unsteady
  • 1: steady, but wide stance (heels > 4 inches apart) or uses cane or other support
  • 2: narrow stance without support
• nudge (subject stands with feet as close together as possible), examiner pushes lightly on patient's sternum with palm of hand 3 times [0-2 points]
  • 0: begins to fall
  • 1: staggers, grabs, but catches self
  • 2: steady
• eyes closed (same position as in #6) [0 or 1 point]
  • 0: unsteady
  • 1: steady
• turn 360 degrees [0-2 points]
  • 0: discontinuous steps
  • 1: continuous
  • 0: unsteady (grabs, staggers)
  • 1: steady 1
• sit down [0-2 points]
  • 0: unsafe, misjudged distance, falls into chair
  • 1: uses arms or not a smooth motion
  • 2: safe, smooth motion

Maximum of 16 points.

Tinetti gait evaluation

The patient stands with the examiner, walks down the hallway or across the room (about 25 feet) at his/her 'usual' pace, then back at a 'rapid but safe' pace.

• initiation of gait (immediately after told to 'go')
  • 0: any hesitancy or multiple attempts to start
  • 1: no hesitancy
• step length & height
  • right swing foot
    • 0: does not pass left stance foot with step
    • 1: passes left stance foot with step
    • 0: right foot does not clear floor completely with step
    • 1: right foot completely clears floor
  • left swing foot
    • 0: does not pass right stance foot with step
    • 1: passes right stance foot with step
    • 0: left foot does not clear floor completely with step
    • 1: left foot completely clears floor
• step symmetry
  • 0: right & left step length unequal
  • 1: right & left step length appear equal
• step continuity
  • 0: stopping or discontinuity between steps
  • 1: steps appear continuous
• path (observe excursion of 1 foot over about 10 feet)
  • 0: marked deviation
  • 1: mild/moderate deviation or uses walking aid
  • 2: straight walking without walking aid
• trunk
  • 0: marked sway or uses walking aid
  • 1: no sway but flexion of knees or back or spreads arms out while walking
  • 2: no sway, flexion, abnormal arm spread or walking aid
• walk stance:
  • 0: heels apart
  • 1: heels almost touching while walking

Maximum of 12 points.

More general terms

• balance evaluation
• gait evaluation
• numerical rating scale (NRS)

Additional terms

• falls in the elderly
• Tinetti, Mary