Instructions on Measuring LT-FS

The balance test consists of the different feet positions:

1. Side -by-side (feet together)

2. Semi-Tandem

3. Tandem.

1. Side-By-Side (Feet Together)

• Begin by demonstrating the side-by-side position using the following script: “Now I’ll show you the first movement. I want you to try to stand with your feet together side-by-side for about 10 seconds. You may use your arms, bend your knees, or move your body in order to keep balance, but try not to move your feet. Try to hold this position until I tell you to stop.”
• After demonstrating the first position, have the patient attempt the maneuver themselves. Subjects may use a wall or other surface to setup their position, but do not begin recording until they are in the position free of any support. Record the time in seconds for the side-by-side stand using a stopwatch.
• If the patient is able to successfully complete the side-by-side stand for 10 seconds, proceed to the Semi-tandem position.
   

2. Semi-Tandem

• Begin the second part of the balance test by demonstrating the semi-tandem position using the following script: “Now I’ll show you the second movement. I want you to try to stand with one foot back slightly so that the heel of the forward foot is adjacently touching the back foot just behind the toes. You may use your arms, bend your knees, or move your body in order to keep balance, but try not to move your feet. Try to hold this position until I tell you to stop.”
• After demonstrating this position, have the patient attempt the maneuver themselves. Subjects may use a wall or other surface to setup their position, but do not begin recording until they are in the position free of any support. Record the time in seconds for the tandem stand using a stopwatch.
• If the patient is able to successfully complete the semi-tandem stand for 10 seconds,
  proceed to the Tandem position.

3. Tandem

• Begin the final part of the balance test by demonstrating the tandem position using the
  following script: “Now I’ll show you the third movement. I want you to try to stand with
  one foot directly behind the other. You may use your arms, bend your knees, or move
  your body in order to keep balance, but try not to move your feet. Try to hold this
  position until I tell you to stop.”
• After demonstrating the first position, have the patient attempt the maneuver
  themselves. Subjects may use a wall or other surface to setup their position, but do not
  begin recording until they are in the position free of any support. Record the time in seconds for the
  side-by-side stand using a stopwatch.

The following section will include data collected from the grip strength testing. Perform the test using the Jamar Hydraulic Hand Dynamometer with the dominant arm bent at the elbow in a 90 degree angle. Instruct the patient to squeeze the dynamometer with the dial facing away from them for 5 seconds. Instruct patients to breathe normally while performing the test, and to not instinctively hold their breath. The patient should complete 3 trials with appropriate breaks in between each trial

Grip Strength 1st Try (kg)
Time them for 5 seconds. Record the measured grip strength from the 1st trial in kilograms.

Grip Strength 2nd Try (kg)
Time them for 5 seconds. Record the measured grip strength from the 2nd trial in kilograms.

Grip Strength 3rd Try (kg)
Time them for 5 seconds. Record the measured grip strength from the 3rd trial in kilograms.

<Insert picture of grip strength device>

Measure out a total length of 20 feet. Further divide this length into three sections:

1. Acceleration zone that is 5 feet

2. Timed zone that will be 15 feet

3. Deceleration zone that is also 5 feet. Start timing the patient when their foot crosses the line of the designated “timed zone” and stop timing when the patient crosses the line at the other end of the “timed zone”. The diagram below depicts the 4.57 meter gait speed test. If patients are using supplemental oxygen, have them carry their oxygen tanks themselves during the gait speed test.

Frailty 4.57m 1st Gait Speed Test (seconds)
Record the time it takes for the patient to walk 4.57 meters in seconds. Enter the 4.57 m walk time from the 1st trial.

Frailty 4.57m 2nd Gait Speed Test (seconds)
Record the time it takes for the patient to walk 4.57 meters in seconds. Enter the 4.57 m walk time from the 2nd trial.

Before your analysis, remember to fully charge the battery for your InBody device¹.

1. Set up the Device

• Connect the electrodes to the corresponding ports on the InBody device
• Connect the adapter cable to the power input port
• Turn the system switch on and allow the system to warm up
• Make sure that you are taking measurements on non-conductive flooring (ex: wood, tile, etc)

2. Complete the Device Settings and Study Profile

• Create a study profile for the patient, entering:
  • Study ID
  • Weight (in kg)
  • Height (in cm)
  • Gender
  • Age
• Select the type of electrode (adhesive or touch type)
• Select the patient's posture type (seated or lying down)
• Enable or disable dialysis mode

3. Attach the Electrodes to the Subject

• Use alcohol wipes to prepare the skin of the fingers and ankles that the electrodes will contact
• Connect the four hand electrodes to the corresponding hand and finger

• Connect the ankle electrodes to the feet so that the electrode is in contact with as much skin as possible. The part marked in red should be positioned on the inner ankle. If the electrode is too small to accommodate the patient's ankle, the electrode can be positioned around the back of the foot instead of the top of the foot, as shown in the second image below.

• Before starting the analysis, make sure that the subject:
  • Has their upper arms separated from their trunk and their thighs separated
  • Does not have their back touching the chair. A cushion can provide support.
  • Has been at rest for around fifteen minutes so that water can disperse evenly
  • No leads are touching the floor
  • Has arms extended, not bent

4. Run the Analysis

• Once the set-up is complete, press "Enter" to start the test.
• Make sure that the patient maintains their position throughout the test
• After the test is complete, "Test Complete" will appear on the screen
• Record the results for muscle mass (kg) from the:
  • Right arm
  • Left arm
  • Right leg
  • Left leg

• The sum total of muscle mass (kg) in the patient's arms and legs (right arm + left arm + right leg + left leg) is the Appendicular Skeletal Muscle Mass (kg) that you will enter into the LT-FS-Body Composition Calculator

5. Transfer Data to Data Analyst

• Make sure InBody is completely on before inserting flash drive
• Click "DB" (Data Base) → Select All →  Copy
• The transfer will initiate. Depending on the amount of readings, it can take up to 30 minutes.
• When it is complete, simply remove the flash drive and turn off the InBody machine.

Common Mistakes

You may see issues like reversals, extremely-low-body fat measurements, or otherwise unrealistic readings.  Common causes include:

• Edema
• Medications
• Menstruation
• Improper probe placement
• Improper body position
• Improper conductive surfaces
• Extremity disfigurement
• Incorrect height and weight, or incorrect units

Quick ways to correct these issues include:

• Checking body position
• Checking surfaces
• Re-administering/wiping probes
• Checking for pitting edema
• Altering finger or ankle placement
• Redoing the test at another date

Use your best judgement to make sure that the data generated makes sense and always re-measure when in doubt

References:

1. InBody S10 User's Manual [PDF]. Retrieved from https://inbodyusa.zendesk.com