Improving physical function should be one of the primary objectives of working with your older clients. Because older adults vary widely in their physical abilities, conducting some initial functional assessments on each individual is necessary for you to be able to design the most effective programs for your clients.
The first two assessments described below are part of the Senior Fitness Test battery, which uses population-based norms for age and gender. This means that an individual’s scores are compared to thousands of other scores. The norm tables can be found in the Senior Fitness Test Manual, published by Human Kinetics.
30-second Chair Stand
This is an assessment of functional lower-body strength. The goal is to see how many times a person can stand up without using his or her hands over a period of 30 seconds. This test has been validated for older adults against a one-repetition maximum leg press.
Using a standard-height chair, have the client sit up straight with the feet shoulder-width apart and arms crossed over the chest. The client should be positioned in the middle of the chair so his or her back is away from the back of the chair. On the count of “Ready, set, go!” the client should stand up and sit down as many times as possible in 30 seconds. (Note: The timer should start when you say “go” instead of waiting for the client to move.) During the 30 seconds, the client may stop and rest but the timer will keep running. Count the number of times the client stands up. You may count the last repetition if the client is more than halfway up when the timer ends. Watch that the client keeps the arms pinned close to the chest at all times. The tendency is for people to “throw” the elbows out to help them stand up.
8’ Up and Go
This is an assessment of dynamic balance and agility.
Place a standard-height chair with its back against a wall and place a cone exactly 8 feet from the front edge of the chair to the back edge of the cone. Have the client sit in a “ready” position, meaning that he or she can scoot to the front edge of the chair with feet in a staggered position and hands on the thighs. First, demonstrate the position and task by sitting in the chair, standing up, walking around the cone and returning to a seated position in the chair. Then have the client practice by walking the course just as you did. You will then perform two timed trials. Instruct the client that he or she is to perform the task “as quickly and safely as possible.” Use the command “Ready, set, go,” and start the timer on the word “go.” Stop the timer when the client’s bottom touches the chair.
Because this is an assessment of dynamic balance, the risk of a client falling is increased. Therefore, it is critical that you monitor the client carefully. Follow alongside the client as he or she walks around the cone. The idea is to stay in close proximity in case the client loses his or her balance, but not so close that you get in the way. Perform two trials with about a 30-second to one-minute rest in between.
Modified Clinical Test of Sensory Interaction in Balance (mCTSIB)
Although this is an assessment of how well the sensory systems (vision, somatosensation, vestibular) contribute to balance, it is most practical for assessing the vestibular system. This test requires two high-density foam pads (such as Airex) stacked on top of each other. Your client will be tested under four conditions: eyes open, stable surface; eyes closed, stable surface; eyes open, unstable surface; and eyes closed, unstable surface. It is the last condition that assesses the contribution of the vestibular system, because visual and somatosensory input are both compromised. Each condition lasts up to 30 seconds. Subjects are given up to three trials to reach the full 30 seconds.
This test is typically performed in regular athletic shoes, although it can also be performed in bare feet. The stable surface conditions are performed on the floor, while the unstable conditions are performed on the stacked balance pads. It is advisable to do this test in the corner of a room in case the client loses his or her balance and experiences a fall. Extreme caution should be taken during the unstable conditions, as this is when clients are most likely to fall. If a person cannot maintain the eyes-closed, unstable-surface condition, he or she will likely have some degree of vestibular dysfunction.
Using the Results
The results of these three assessments can be used to determine the types of training that you will want to include in each client’s program. For example, someone who scores low on the vestibular condition of the mCTSIB would benefit from performing static and dynamic movements on a foam pad with eyes closed. These formal quantitative assessments can be very beneficial in this regard. However, it should be stressed that you should seek to learn from your clients each and every session. By continuing to challenge them in different ways, you will discover areas of weakness or deficiency that will need to be addressed.
ACE has partnered with the Functional Aging Institute to bring you the highest quality education from an organization solely dedicated to maximizing the physical functioning of active agers. By becoming a Functional Aging Specialist, you can position yourself as the go-to expert in safely and effectively training the fastest growing client base in the world.