1. Tinetti balance and gait evaluation Scores:../28 Seyed Kazem Malakouti, MD Faculty of Iran University of Medical Sciences Seyed Kazem Malakouti, MD

2. Score:../16 Sit the patient on a hard without arms chair 1.Sitting balance (0,1) 2.Arising (0,2) 3.Attempt to rise (0,2) 4.Immediate standing in 5 second (0,2) 5.Standing balance (0,2) 6.Nudging (0,2) 7.Eye closed (0,1) 8.Turning 360 degrees (0,2) 9.Sitting down (0,2) Seyed Kazem Malakouti, MD

3. Gait evaluation: score../12 1.Initiation of gait (0,1) 2.Step length and height (lt foot) (0,2) 3.Step length and height (rt foot) (0,2) 4.Step symmetry (0,1) 5.Step continuity (0,1) 6.Path about 3 meters (0,2) 7.Trunk (0,2) 8.Walking stance (0,1) Seyed Kazem Malakouti, MD

4. Comprehensive assessment of fall TypeExamRed flag Vital signOrthostatic BP> 20 mm gh drops in SBP or > 15 increase in pulse from lying to standing x 3 min TEMPERATUREHypothermia and fever EyeSnellen chartVisual acuity imp. Visual field examVisual field imp. Dix-hallpike manuerNystagmus EarWhisper testUnable to hear whisper Weber rinnie testConduction vs neurosensory deficit Otoscopic examCerumen impaction, perforation NeckCarotid auscultationBruit HeartauscultationArrythmia, murmur Seyed Kazem Malakouti, MD

5. Comprehensive assessment of fall TypeExamRed flag MusculoskeletalObservation of leg, hand..Deformity of joint Range of motionLimitation and deformity NeurologicalSensoryDecrease pinprick vibration RombergInstability MMSECog. Imp. GDSClinical dep. ToneRigidity strengthMuscle weakness Functional gaitGet up and go test (rise from the chair, walk 3 meters forward, turn around walk back to the chair and sit down) Abnormal = takes > 10 sec. to complete the test Seyed Kazem Malakouti, MD

6. balanceSide by side stance, narrow stance x 10 seconds Instability Semi tandem stance (one foot half in front of other with feet touching) x 10 sec Instability Full tandem stance (one foot in front of other ) x 10 sec Instability Pull test (Gentle pull back at waist from behind while standing) Postural Instability mobilityObservation of use of cane, walker, personal assistance, if any Instability And inability to use assistive device Presence of restraints if any Limitation of morbidity Footwear evaluationUnfit shoes Seyed Kazem Malakouti, MD

8. Fall due to drug side effects MedicationSide effects to cause falling Antidep. Cafferine, neuroleptic, stimulants Agitation AntiarrthmicsArrhythmia BDZ, narcotic, anticholinergic Cog. Imp. AnticonvulsantDizziness, orthostatic hypo. Antidep. Neuroleptic Gait dis. extrapyramidal DiureticsUrinary incontinence Anticonvul. BDZ, neurolepic Postural dis. Balance Betablocker, nitrate, vasodilator Syncope Neuroepic, anticholinegic Visual dis. Seyed Kazem Malakouti, MD