The Activities specific Balance Confidence (ABC) Scale For each of the following activities,

please indicate your level of self-confidence by choosing a corresponding number from the following
rating scale.
0% 10 20 30 40 50 60 70 80 90 100%
No Confidence Completely Confident
How confident are you that you will not lose your balance or become unsteady when you
The Activities specific Balance Confidence (ABC) Scale For each of the following activities,
please indicate your level of self-confidence by choosing a corresponding number from the following
rating scale. 10-100%
How confident are you that you will not lose your balance or become unsteady when you
1. Walk around the house? 10%
2. walk up or down stairs? 0%
3. bend over and pick up a slipper from the front of a closet floor? 10%
4. reach for a small can off a shelf at eye level? 80%
5. stand on your tiptoes and reach for something above your head? 0%
6. stand on a chair and reach for something? 40%
7. sweep the floor? 0%
8. walk outside the house to a car parked in the driveway? 10% (with wheelchair)
9. get into or out of a car? 10%
10. walk across a parking lot to the mall? 70% (with assistance) 50% (without assistance)
11. walk up or down a ramp? 10%
12. walk in a crowded mall where people rapidly walk past you? 0%
13. are bumped into by people as you walk through the mall? 0%
14. step onto or off an escalator while you are holding onto a railing? 30%
15. step onto or off an escalator while holding onto parcels such that you cannot hold onto the
railng? 0%
16. walk outside on icy sidewalk? 0%
II. Your critical observation
1. Posture
Patient RS has a posture of Kyphosis, which is a rounded thoracic convexity of a
posterior thorax. This is commonly seen in older adults. It results from a loss of lung
resiliency and a loss of skeletal muscle; it may be a normal finding.

2. Skin Color
Patient RS has a brown (kayumanggi) skin color and according to her this is her natural
color since she was young.
3. Quality of movement
Patient RS has a difficulty in moving such as turning side to side, standing alone, or
sitting and/or walking. This maybe because of her condition which she had stroked
twice and the left part of her body was affected.
4. Scars
Patient RS has scars on her abdomen. This was cause by a surgical that she was
undergone such as Cholecystectomy, Salphynggo Oophorectomy and Appendectomy.
5. Cleanliness/clothes
During the interaction with Patient RS, she is well-groomed and wearing a T-shirt and a
pajama which where she was feel comfortable.
6. Ambulation Devices
Patient RS is using wheel chair, and/or cane for her to easily walk or move inside and
outside the house.
7. Obvious difficulty with moving self
Patient RS has a difficulty in moving by herself. Sometimes she needs assistance to
stand, to sit, and to walk.
8. Vision/Hearing deficits
Patient RS is wearing eye glasses because she had a grade of 350 on the left eye and 250
in right eye. She has no difficulty in terms of hearing.




Name: Rosario Saria DOB: March 11, 1644 Date: July 14, 2014
Age: 70 years old Living Alone: NO Their partners health:
Homephone: Emergency contact:
Physician: Dra. Argit Dominguez/ Dr.Estabilio
I. Medical History
A. Health Status:
Enlargement of the heart
Hypertension
Blood pressure of 150/90 mmHg

Chest pain
With chest pain when lying on her left side.

Stroke
January 1, 2005 First stroke experience
September 7, 2013 Second stroke experience
With vertigo

Diabetes
Medication: Metformin
Family History of DM

Surgeries
Cholecystectomy
Salphyngo Oophorectomy
Appendectomy

B. Medications
Amlodipine Besilate 10 mg Tablet Calcium Channel Blocker Anti-hypertensive
Fenofibrate Lipiduce 350 mg Antilipidemia
Sitagliptin Phosphate Metformin HCl 50mg|1g film coated tablet - Antidiabetic
Metformin HCl Glomet 1g tablet / oral hypoglycemic- Antidiabetic
Vitamins: Revicon, Enervon
Quetiapine Anit-Psychotic


C. Exercise History
Jogging every mornin at 5am before she had