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Tinetti Gait / Balance Scale

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Question 1 of 19

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Question 2 of 19

Sitting Balance

A

Leans or slides in chair (0)

B

Steady / Safe (1)

Question 3 of 19

A

Unable without help (0)

B

Able, but uses arms to help (1)

C

Able, but without using arms (2)

Question 4 of 19

Attempts to Arise

A

Unable without help (0)

B

Able, requires more than 1 attempt (1)

C

Able to rise with 1 attempt (2)

Question 5 of 19

A

Unsteady (staggers, moves feet, trunk sway) (0)

B

Steady, but uses cane/walker/furniture for support (1)

C

Steady without any support (2)

Question 6 of 19

 

A

Unsteady (0)

B

Steady, but wide stance (heels >4” apart) or uses support (1)

C

Narrow stance without any support (2)

Question 7 of 19

A

Begins to fall (0)

B

Staggers, grabs, or catches self (1)

C

Steady (2)

Question 8 of 19

A

Unsteady (0)

B

Steady (1)

Question 9 of 19

 

A

Discontinuous steps (0)

B

Continuous steps (1)

Question 10 of 19

Turning 360 Degrees - Stability

 

A

Unsteady (grabs/staggers) (0)

B

Steady (1)

Question 11 of 19

Sitting Down

 
 

A

Unsafe (misjudged distance, falls into chair) (0)

B

Uses arms or choppy motion (1)

C

Safe, smooth motion (2)

Question 12 of 19

Initiation of Gait (Walking)

 

A

Any hesitancy or multiple attempts to start (0)

B

No hesitancy (1)

Question 13 of 19

Step Length - (Right / Left Foot)

 
 

A

Does NOT pass left stance foot (0)

B

Passes left stance foot (1)

C

Does NOT pass right stance foot (0)

D

Passes right stance foot (1)

Question 14 of 19

Step Height - (Right / Left Foot)

 
 

A

Right foot does NOT completely clear floor (0)

B

Right foot completely clears floor (1)

C

Left foot does NOT completely clear floor (0)

D

Left foot completely clears floor (1)

Question 15 of 19

Step Symmetry

 
 

A

Right and left step length appear unequal (0)

B

Right and left step length appear equal (1)

Question 16 of 19

Step Continuity

 
 

A

Stopping or discontinuity between steps (0)

B

Steps appear continuous (1)

Question 17 of 19

 
 

A

Marked deviation (0)

B

Mild/moderate deviation or uses walking aid (1)

C

Straight path without walking aid (2)

Question 18 of 19

 
 

A

Marked sway or uses walking aid (0)

B

No sway, but flexion (knees/back) or spreads arms for balance (1)

C

No sway, no flexion, no use of arms/aid (2)

Question 19 of 19

A

Heels apart while walking (0)

B

Heels almost touching while walking (1)

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