Part of every exam for neuropathy, is asking the question, “so… how are your balance issues? How is your walking gait?” Most patients will indicate that they have, at least some, balance issues. Even more, indicate that they cannot get up out of a chair without arms, at least, without some assistance. (This, is one reason, we don’t have arms on the chairs in our waiting room… they become part of the test!) But, if the patient indicates they “fall over or down a lot, stagger or have difficulty getting up and down,” we will give them what is known as a Berg Balance Test.
Developed by Katherine Berg (of whom it is named) and others, the test tests the static and dynamic balance abilities, of the patient. Scoring will indicate how ‘likely’ the patient is to end up in a wheelchair, or if they need to walk with assistance or can walk without much risk of falling. (Research shows, that if a patient – especially, an elderly one – falls and can get back up on their own within 15 minutes or less, they are more likely to be able to continue to live on their own. The longer it takes for the patient to get up, or if they need assistance, the more likely they will end up in assisted living or convalescent care).
The patient, depending upon their age, is scored on their ability to:
- Sitting to standing
- Standing unsupported
- Sitting unsupported
- Standing to sitting (without using arms on a chair or pushing up with hands on knees)
- Standing with eyes closed
- Standing with feet together
- Reaching forward with outstretched arm
- Retrieving object from floor
- Turning to look behind
- Turning 360 degrees
- Placing alternate foot on stool
- Standing with one foot in front
- Standing on one foot
Each task must be completed within a certain amount of time; and, is scored accordingly. These scores helps the neuropathist judge, not only what the ‘risk of falling’ is for the patient, but the extent of their neuropathy as well; in other words, the lower the score, the more likely to fall; and, most likely, the more severe the neuropathy.
Taking these scores and combining them with Toronto Clinical Scoring results, as well as examination of other parts of the body and information from Intake, all help determine the type of neuropathy the patient has; and ‘WHAT‘ issues need to be addressed first and foremost! For example, if a patient scores really well on the Berg test, we are not as concerned with treating muscle atrophy as we would someone with a low score. In the same sense, if Intake and examination indicate possible diabetic neuropathy, but the patient has stated he “trips over his own feet and falls a lot,” we might wish to look at drop foot or even send the patient to be checked for MS; if the muscles have not noticeably atrophied.
In other words, if we see a neuropathy with certain symptoms which are not common, we may refer out to neurologists to ‘look’ for other reasons besides, simple neuropathy for the symptoms.
Next Blog: Patient Compliance.