Assessment of Falling Risk(s)

Risk Factors for Falling Yes /No

Have you suffered previous falls?

Do you have problems with your balance

or walking?

Do you take _ 4 of the following medications?

■ Antipsychotics–Thorazine, Haldol
■ Tricyclic antidepressants–Elavil, Prozac
■ Antianxiety–Valium, Xanax
■ Hypnotics–Seconal, Butulan, Doral
■ Antihypertensives

Do you have problems with your vision?

Do you get dizzy when you change positions?

Do you ever experience light-headedness?

Are you afraid of falling?

Do you have problems with your feet?

Are there hazards around your home that

could increase your risk of falling?

Are your legs weak?

Is your motion limited in your legs?

Do you have problems with sensation in

your legs?

Do you have problems thinking clearly?

Do you have any problems with the

following:
■ High blood pressure
■ Arthritis
■ Diabete
■ Heart disease

Gait Abnormality Rating Scale–Modified (GARS-M)

Instructions: walk 10 meters at normal pace

Staggering (Partial loss of balance laterally)

No loss of balance to the side 0
A single lurch to the side 1
Two lurches to the side 2
Three or more lurches to the side 3
Arm-Heel Strike Synchrony (Extent of limbs out of phase)
Good contralateral arm & leg mov’t 0
Arm & leg control out of phase 25% of time 1
Arm & leg control out of phase 25–50% of time 2
Little to no synchrony present 3

Variability (Consistency & rhythm of steps & arm mov’ts)

Fluid & predictably paced limb mov’t 0
Occasional changes in velocity (_ 25% of time) 1
Unpredictability of rhythm (25–75% of time) 2
Random timing of limb mov’ts 3

Foot Contact (Heel before forefoot)

Very obvious angle of impact of heel 0
Barely visible impact of heel 1
Entire foot striking the ground 2
Anterior foot striking ground before the heel 3
Hip ROM
Obvious hip extension (10_) at double stance 0
Just barely visible hip extension 1
No hip extension 2
Thigh flexion during double stance 3

Shoulder Extension
15_ shoulder flexion & 20_ shoulder extension 0
Shoulder flexion slightly anterior only 1
Shoulder coming to 0_ only with flexion 2
Shoulder staying in extension through the arm swing 3

Guardedness (Hesitancy, slowness, ↓propulsion)

Good forward momentum & no apprehension 0

COG of HAT (head, arms, trunk) slightly forward in pushoff but good arm-leg coordination
1

HAT held anterior over stance foot; moderate loss of reciprocation 2

HAT held posterior over stance feet; great tenativity in stepping 3

Score of 9.0 _ history of falling & 3.8 = no history of falling