Tinetti Balance Form PDF Details

Do you know what the Tinetti Balance Form is and why it’s an essential tool for health professionals? If not, then you are in luck! This post is designed to help explain the Tinetti Balance Form, so you can understand its important role in monitoring balance and gait in patients. From assessing risk of falling to tracking progress during interventions, this form has been a staple assessment tool used by physical therapists since 1988. Read on to discover how it works, as well as some of the benefits that come with using the Tinetti Balance Form when evaluating patients' stability at any age.

QuestionAnswer
Form NameTinetti Balance Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namestinetti balance assessment, tinetti balance, tinetti balance test, tinetti balance test calculator

Form Preview Example

TINETTI BALANCE ASSESSMENT TOOL

Tinetti ME, Williams TF, Mayewski R, Fall Risk Index for elderly patients based on number of chronic dis- abilities. Am J Med 1986:80:429-434

PATIENTS NAME ______________________ D.o.b. ___________ Ward ______

BALANCE SECTION

Patient is seated in hard, armless chair;

 

 

DATE

 

 

 

 

 

 

 

Sitting Balance

Leans or slides in chair

= 0

 

 

Steady, safe

= 1

 

 

 

 

 

 

 

 

 

 

 

Unable to without help

= 0

 

 

Rises from chair

Able, uses arms to help

= 1

 

 

 

Able without use of arms

= 2

 

 

 

 

 

 

 

 

Unable to without help

= 0

 

 

Attempts to rise

Able, requires > 1 attempt

= 1

 

 

 

Able to rise, 1 attempt

= 2

 

 

 

 

 

 

 

Immediate standing

Unsteady (staggers, moves feet, trunk sway)

= 0

 

 

Steady but uses walker or other support

= 1

 

 

Balance (first 5 seconds)

 

 

Steady without walker or other support

= 2

 

 

 

 

 

 

 

 

Unsteady

= 0

 

 

Standing balance

Steady but wide stance and uses support

= 1

 

 

 

Narrow stance without support

= 2

 

 

 

 

 

 

 

 

Begins to fall

= 0

 

 

Nudged

Staggers, grabs, catches self

= 1

 

 

 

Steady

= 2

 

 

 

 

 

 

 

Eyes closed

Unsteady

= 0

 

 

Steady

= 1

 

 

 

 

 

 

 

 

 

 

 

Discontinuous steps

= 0

 

 

 

Continuous

= 1

 

 

Turning 360 degrees

 

 

 

 

Unsteady (grabs, staggers)

= 0

 

 

 

 

 

 

Steady

= 1

 

 

 

 

 

 

 

 

Unsafe (misjudged distance, falls into chair)

= 0

 

 

Sitting down

Uses arms or not a smooth motion

= 1

 

 

 

Safe, smooth motion

= 2

 

 

 

 

 

 

 

BALANCE SCORE

/16

/16

 

 

 

 

 

P.T.O.

TINETTI BALANCE ASSESSMENT TOOL

GAIT SECTION

Patient stands with therapist, walks across room (+/- aids), first at usual pace, then at rapid pace.

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

Indication of gait

Any hesitancy or multiple attempts

= 0

 

 

 

 

(Immediately after told to ‘go’.)

No hesitancy

= 1

 

 

 

 

 

 

 

 

 

 

 

 

Step to

= 0

 

 

 

 

Step length and height

Step through R

= 1

 

 

 

 

 

Step through L

= 1

 

 

 

 

 

 

 

 

 

 

 

 

Foot drop

= 0

 

 

 

 

Foot clearance

L foot clears floor

= 1

 

 

 

 

 

R foot clears floor

= 1

 

 

 

 

 

 

 

 

 

 

 

Step symmetry

Right and left step length not equal

= 0

 

 

 

 

Right and left step length appear equal

= 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Step continuity

Stopping or discontinuity between steps

= 0

 

 

 

 

Steps appear continuous

= 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Marked deviation

= 0

 

 

 

 

Path

Mild/moderate deviation or uses w. aid

= 1

 

 

 

 

 

Straight without w. aid

= 2

 

 

 

 

 

 

 

 

 

 

 

 

Marked sway or uses w. aid

= 0

 

 

 

 

Trunk

No sway but flex. knees or back or

 

 

 

 

 

uses arms for stability

= 1

 

 

 

 

 

 

 

 

 

 

No sway, flex., use of arms or w. aid

= 2

 

 

 

 

 

 

 

 

 

 

 

Walking time

Heels apart

= 0

 

 

 

 

Heels almost touching while walking

= 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GAIT SCORE

 

/12

/12

 

 

 

 

 

 

 

 

BALANCE SCORE CARRIED FORWARD

 

/16

/16

 

 

 

 

 

 

 

 

TOTAL SCORE = BALANCE + GAIT SCORE

 

/28

/28

 

 

 

 

 

 

 

RISK INDICATORS:

 

 

 

 

 

 

 

TINETTI TOOL SCORE

RISK OF FALLS

 

 

≤18High

19-23Moderate

≥24Low

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1. You should complete the tinetti poma properly, therefore be attentive when filling in the sections comprising all these blank fields:

Completing segment 1 in tinetti pdf

2. Your next step is to fill in these blank fields: Nudged, Eyes closed, Turning degrees, Begins to fall Staggers grabs, Unsteady Steady, Discontinuous steps Continuous, Unsteady grabs staggers Steady, Sitting down, Unsafe misjudged distance falls, Balance score, and PTO.

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3. Completing Indication of gait Immediately, Any hesitancy or multiple attempts, Step length and height, Foot clearance, Step symmetry, Step continuity, Path, Trunk, Step to Step through R Step, Foot drop L foot clears floor R, Right and left step length not, Stopping or discontinuity between, Marked deviation Mildmoderate, Marked sway or uses w aid No sway, and Date is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Stopping or discontinuity between, Foot clearance, and Step continuity in tinetti pdf

People generally make errors while filling out Stopping or discontinuity between in this section. Ensure that you read again what you enter here.

4. Filling in Walking time, Heels apart Heels almost touching, Gait score, Balance score carried forward, Total Score Balance Gait score, Risk Indicators, Tinetti Tool Score, Risk of Falls, High, Moderate, and Low is essential in this fourth section - ensure to invest some time and take a close look at every single blank!

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