Purpose
Assess postural instability early and in concurrence with patient complaints.
May assist in identifying patients with balance impairments before they experience a fall.
Acronym
P&R
Assessment Type
Performance Measure
Administration Mode
Paper & Pencil
Cost
Free
Diagnosis/Conditions
- Parkinson's Disease & Movement Disorders
- The Push and Release Test was developed as an alternative to the "Pull Test" now included in the United Parkinson’s Disease Rating Scale (UPDRS, Item #30).
- The patient leans back pressing on the hands of the examiner; the examiner then suddenly removes their hands. Scores are based on the patient's correctional response when trying to regain balance.
- Scoring criteria are as follows:
0 = Recovers independently with 1 step of normal length and width
1 = Two to three small steps backward, but recovers independently
2 = Four or more steps backward, but recovers independently
3 = Steps but needs to be assisted to prevent a fall
4 = Falls without attempting a step or unable to stand without assistance.
- A full description of the Push and Release Test can be found in Jacobs, et al. (2006). Specific steps of administration:
1) Subject stands in a comfortable stance with eyes open
2) Examiner stands behind the subject
3) Examiner instructs subject to do whatever necessary including taking a step to regain balance
4) Subject pushes backward against palms of examiner’s hands placed on subject’s scapulae while examiner flexes elbows to allow backward movement of trunk and supports subject’s weight with hands
5) Force of the subject’s push is not strong enough to cause heels to come off ground and subject cannot passively lean back into examiner’s hands: Passive lean allows subjects to be less hesitant to perform test and adds reliability by eliminating variance to test Consistency of perturbation forces applied to subject unlike Pull Test
6) When subject’s shoulders and hips move to a stable position just behind heels, examiner suddenly removes hands, requiring subject to take a backward step to regain balance.
7) Subject has to take a step for test to be properly executed. A step is counted only if it is required for subject to maintain balance not to reorient feet.
8) Time at which examiner releases hands from subject vary to ensure subject cannot anticipate release.
Required Training
No Training
Instrument Reviewers
Initially reviewed byJulie Gupta, PT, DPT in 9/2011
ICF Domain
Activity
Measurement Domain
Motor
Professional Association Recommendation
Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.
For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations
Abbreviations:
|
|
HR
|
Highly Recommend
|
R
|
Recommend
|
LS / UR
|
Reasonable to use, but limited study in target group / Unable to Recommend
|
NR
|
Not Recommended
|
Recommendations Based on Parkinson Disease Hoehn and Yahr stage:
|
I
|
II
|
III
|
IV
|
V
|
PD EDGE
|
LS/UR
|
R
|
R
|
R
|
LS/UR
|
Recommendations for entry-level physical therapy education and use in research:
|
Students should learn to administer this tool? (Y/N)
|
Students should be exposed to tool? (Y/N)
|
Appropriate for use in intervention research studies? (Y/N)
|
Is additional research warranted for this tool (Y/N)
|
PD EDGE
|
No
|
No
|
Yes
|
Not reported
|
Considerations
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