Assessment of poor mobility and promotion of an independent life

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Problems with walking or unsteadiness are a common presenting complaint, especially in older patients. It may be a trivial complaint with no underlying pathology or herald a more serious illness.

Patients can be described as ‘off legs’ which usually refers to elderly patients, who were previously mobile and active, with a sudden deterioration. The cause of ‘off legs’ is usually an acute illness – for example, chest infection, urinary tract infection.

Those who reduce their ability to be independent are less likely to remain in the community, have a higher rate of other diseases, have a reduced quality of life and an increased likelihood of social isolation and loneliness.

This blog will focus on walking difficulties in adults

The following are risk factors for mobility impairment

  • Older age
  • Low physical activity
  • Obesity
  • Strength or balance impairment
  • Chronic diseases such as diabetes or arthritis

Statistics show that walking disorders effect around 10% of adults between the ages of 60 and 69 years and more than 60% in those over 80 years old.

In 2016-2017 there were around 210,553 falls related emergency hospital admissions among people aged 65 years and over, with around 67% of these people aged 80 or over.

Assessment

  • Patient history- Patients may complain directly to you, explaining their problems with walking or unsteadiness
  • Clarify how the patient feels- which aspect of walking is difficult
  • Ask about falls, establish when the last fall occurred, how frequently they are, where iin the house they are falling and what time of day.
  • Determine the duration of the problems
  • Complete a full review of the symptoms and try and establish if there are any cardiac or neurological concerns.
  • Ask specifically for features suggestive of cord compression, for example urinary retention, sensory and/or motor loss.
  • Take into consideration the patients’ medications, especially as the etiology may relate to polypharmacy or drug induced side effects

Examination

  • Feel their pulse, looking at their rate and volume. Request a blood pressure check, specifically looking at potential postural hypotension
  • If you have concerns about the patient cardiac or neurological condition, then consider taking them to their medical doctor where assessments can be carried out of appropriate
  • Do not forget the possibility of fractures and injuries- look for leg asymmetry and test the spine and lower legs for tenderness
  • Examine the patient walking- asymmetrical or symmetrical problems, presence of waddling gait, scissoring gait (bilateral leg spasticity), or ataxia. If unsure and you would like a professional to assess the patients gait then we have senior orthotists at total body orthotics who can provide an assessment at our clinic- contact us.
  • Consider watching them do an ‘up and down’ test- you time the person getting up from a chair without using their arms, walking three meters, turning around, returning to the chair, and sitting down. If the person usually uses a walking aid, this can be used during the test.
  • A score of 12-15 seconds or more usually has been shown to indicate high risk of falls in older people
  • Also consider the ‘180 turn’ teat where you ask the person to stand up and step around until they are facing the opposite direction. If the person takes more than four steps, further assessment should be considered.

Potential causes of reduced mobility and causes of difficulties in walking

Vascular- Arrhythmias, hypotension, postural hypotension, transient ischemic attacks, cerebrovascular accident,

Neurological- Multiple sclerosis, cord compression, motor- neuron disease, syringomyelia, spinal cord tumors, B12 deficiency, syphilis, tardive dyskinesia, akathisia, Parkinson’s disease, parkinsonism (e.g. drug-induced). Cerebellar tumors, any ataxia (e.g. friedreich’s ataxia), wernickes encephalopathy, peripheral neuropathy and Chorea

Orthopedic- Arthrodesis of hip joints, Arthritides- e.g. osteoarthritis, rheumatoid arthritis, spinal disease, e.g. stenosis, Fractures (in elderly patients they may not be able to communicate that they are in pain), foot problems- e.g. corns, bunions, ill-fitting shoes

Balance and co-ordination- Alzheimer’s dementia, labyrinthitis, degenerative changes in the inner ear

Muscles- Myopathies

Metabolic- Diabetes mellitus- e.g. autonomic neuropathy or foot drop, thyroid disorders

Others- Toxins/drugs- Anti-hypertensive medication, sedatives, antipsychotics, ethanol, anticonvulsants, Psychological- loss of confidence, including depression.

Causes for patients to be ‘off their legs’

As mentioned before, ‘off their legs’ usually present in elderly patients and can be interpreted in different ways. This ranges from unsteadiness and difficulty with walking to dizziness or lethargy. The exact meaning should be sought during the assessment of the patient.

The causes of ‘off legs’ can include

  • Urine or chest infections
  • Dehydration
  • Neurological causes– e.g. head injury, cord compression/cauda equina syndrome.
  • Orthopedic causes– e.g. fractures (consider especially in elderly patients with osteoporosis who can fracture their neck of femur without major trauma)
  • Metabolic abnormalities– e.g. hyponatraemia, hypercalcaemia, hypoglycaemia or hyperglycaemia.
  • Alcohol, drug or medication, especially as there are risks of polypharmacy in elderly patients
  • Hypoxia (reduced oxygen levels).

Potential investigations

These should be guided by the history and examination and may include cerebral imaging (e.g. CT or MRI scanning) and blood tests (e.g. TFT’s, Syphilis serology etc).

Management

This is directed towards the underlying cause. If the cause is multifactorial than a multidisciplinary approach may be appropriate- e.g. physiotherapist, occupational therapist and allied healthcare professionals. If you are interested in seeing an orthotist for gait assessment, then please contact us to arrange an assessment in our total body orthotics clinic.

To enable a safe approach to falls prevention and management for your patient or loved one at home then consider purchasing mobility aids.

Click here to see our full range of mobility aids at total body orthotics

Click here for Total body orthotics Pedal exerciser

Click here for Total body orthotics adjustable height trolley

Click here for Total body orthotics adjustable elbow crutches

Click here for Total body orthotics quad walking aid

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Click here for Total body orthotics Rollator quatro                                             Click here for Total body orthotics Globe trotter plus crutch

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Total Body Orthotics provides a range of orthotic solutions for a variety of medical conditions. If you would like any further information on our any of our braces then you can contact us by calling us to speak with one of our orthotists on 07751 370949, visit our website at www.totalbodyorthotics.com or visit us at our clinic based in The Arcade, High Street, Eccleshall. Our experienced clinicians are able to offer a full lower limb assessment and provide treatment advice on the best orthotic device to suit your individual needs.

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