NeuRA Fallscreen Help

The NeuRA FallScreen risk assessment has three forms: a short form, a long form and the physical outcomes form.

The short form is designed as a screening instrument suitable for General Practice surgeries, acute hospitals, and long-term care institutions. It takes only 15 minutes to administer and contains five items: a single assessment of vision, peripheral sensation, lower limb strength, reaction time and body sway.

The long form is designed as a comprehensive instrument suitable for Rehabilitation and Physical Therapy and Occupational Therapy settings and for dedicated Falls Clinics. It takes 45 minutes to administer and contains 16 items: four assessments of vision (high and low contrast visual acuity, edge contrast sensitivity and depth perception), three assessments of peripheral sensation (tactile sensitivity, vibration sense and proprioception), assessments of three lower limb muscle groups (knee extensors, knee flexors and ankle dorsiflexors), assessments of both hand and foot reaction time, there are four assessments of body sway (sway on floor and foam with eyes open and closed) and dynamic or leaning balance (maximal balance range and coordinated stability tests).

The physical outcome form is an extended version of the short form designed for physiotherapists. In addition to the short form the physical outcomes form includes foot reaction time, all four sway measures and the maximal balance range test, there is a focus on strength with the three main lower limb muscle groups being assessment in both legs, (knee extensor, knee flexors and ankle dorsiflexors measures).

A recently developed screening assessment tool is the "Clinical Falls Risk Assessment". Ideal for clinicians, this is a simple and quick set of questions and tests that identify risk factors for falling with minimal equipment and fuss. Contact Vicky Smith (fallscreen@unsw.edu.au) if you are interested in finding out more.

These assessments are simple, "low-tech", and readily accepted by older subjects. All have high external validity and test-retest reliability and are described in detail in our published papers (1-7). When combined in multivariate discriminant analyses, we have found that these tests can predict those at risk of falling with 75% accuracy in both community and institutional settings.

Visual function is measured using a dual contrast visual acuity chart, the "Melbourne Edge Test and a device for measuring depth perception. Lower limb sensation is assessed with tests of proprioception, touch sensitivity and vibration sense. The strength of three muscle groups in the legs is measured: the knee flexors and extensors and ankle dorsiflexors. Simple reaction time is assessed using movement of the finger as the response and/or movement of the foot. Body sway on a firm and compliant (foam rubber) surface with eyes open or closed, it is assessed using a swaymeter that measures displacements of the body at the level of the waist.

The data for each test are entered / converted to the following units in the FallScreen output

Test	Units
Edge Contrast Sensitivity	dB
Visual Acuity: Low and High Contrast	Minimum angle resolvable in detecting chart letter segments in minutes of arc
Depth Perception	Error in aligning the rods in centimetres
Vibration Sense	Microns of motion perpendicular to the body surface
Touch Thresholds	Pressure in Log10 0.1 mg
Proprioception	Error in aligning the great toes in centimetres
Knee Extension (Quadriceps) Strength	Force in kilograms
Knee Flexion (Hamstring) Strength	Force in kilograms
Ankle Strength	Force in kilograms
Reaction Time – Hand	Milliseconds
Reaction Time – Foot	Milliseconds
Sway	Millimetre squares traversed by pen on swaymeter
Coordinated Stability	Error score (5 for each outside corner not negotiated and 1 for each additional time pen leaves path
Maximal Balance Range	Range in centimetres
Multifocal	yes; the patient wears bifocal or multifocal glasses no; the patient does not wear bi/multipfocal glasses

For each of the forms, a computer software program assess each person's performance in relation to the normative database complied from large population studies (6,7). The program produces a falls risk assessment report for each subject which includes the following four components:

• a graph indicating the person's overall falls risk score,
• a profile of individual test performance results,
• a table indicting individual test performances in relation to age-matched norms,
• a written report which explains the results and makes recommendations for improving performances and compensating for any deficit areas identified.

The graph indicating the person's overall falls risk score is a single index score based on a discriminant function analysis developed for our research studies which accurately discriminates between elderly fallers and non-fallers. This graph presented the person's falls risk score in relation to persons of the same age and in relation to falls risk criteria ranging from low to extreme.

The profile of test performance results presents the subject's scores in each of the tests in standard (z score) format. As the scores have been standardised the test results can be compared with each other.

The table indicting individual test performances in relation to age-matched norms also identifies deficit areas

Finally, the written report summarises the findings and makes individual recommendations for reducing falls risk. It provides an excellent basis for targeting interventions to improve or compensate for impairments in the following physiological domains: strength, balance, speed and co-ordination, vision, peripheral sensation and therefore reduce the risk of falling in older people.

In addition to providing the output, the de-identified data can be downloaded from the server in database form at anytime. To do this, select"Download Data" for the form you use – Short Form, Long Form, Physical Outcomes. The data is in CSV format and will open in automatically in most spreadsheet programs.

The FallScreen website is a secure site, in that data are encrypted during transmission to and from the server when users are on line.

Each FallScreen user’s patient datbase is password protected.

The user can choose whether personal information regarding patients is stored in the database. If chosen no personal identifying information is stored on the server and as such personal information will need to be reentered each time a user wished to reprint the results of a patient.

1. Lord SR, Clark RD, Webster IW. Postural stability and associated physiological factors in a population of aged persons. Journal of Gerontology: Medical Sciences 1991;46:M69-76.
2. Lord SR, Castell S. The effect of a physical activity program on balance, strength, neuromuscular control and reaction time in older persons. Archives of Physical Medicine and Rehabilitation 1994;75:648-652.
3. Lord SR, Clark RD, Webster IW. Physiological factors associated with falls in an elderly population. Journal of the American Geriatrics Society 1991;39:1194-1200.
4. Lord SR, McLean D, Stathers G. Physiological factors associated with injurious falls in older people living in the community. Gerontology 1992;38:338-346.
5. Lord SR, Clark RD. Simple physiological and clinical tests for the accurate prediction of falling in older people. Gerontology 1996;42:199-203.
6. Lord SR, Ward JA, Williams P, Anstey K. Physiological factors associated with falls in older community-dwelling women. J Am Geriatr Soc 1994;42:1110-1117.
7. Lord SR, Sambrook PN, Gilbert C, Kelly PJ, Nguyen T, Webster IW, Eisman JA. Postural stability, falls and fractures. Results from the Dubbo Osteoporosis Epidemiology Study. Medical Journal of Australia 1994;160:684-691.