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Physical Medicine and Rehabilitation... Nov 2017There are normal physiologic changes that occur as people age. Gait and mobility are altered with aging, and these changes are a combination of alterations in the gait... (Review)
Review
There are normal physiologic changes that occur as people age. Gait and mobility are altered with aging, and these changes are a combination of alterations in the gait pattern and in the function of organs. Changes in gait are associated with functional decline, less independence, and impaired quality of life. Reduced walking speed is the most consistent age-related change, but there are other contributors to an altered gait: impaired balance and stability, lower extremity strength, and the fear of falling.
Topics: Aged; Aging; Gait; Humans; Mobility Limitation
PubMed: 29031338
DOI: 10.1016/j.pmr.2017.06.005 -
American Family Physician Jun 2021Many individuals need a mobility assistive device as they age. These devices include canes, crutches, walkers, and wheelchairs. Clinicians should understand how to... (Review)
Review
Many individuals need a mobility assistive device as they age. These devices include canes, crutches, walkers, and wheelchairs. Clinicians should understand how to select the appropriate device and size for individual patients (or work with a physical therapist) and prescribe the device using the patient's health insurance plan. Canes can improve standing tolerance and gait by off-loading a weak or painful limb; however, they are the least stable of all assistive devices, and patients must have sufficient balance, upper body strength, and dexterity to use them safely. Older adults rarely use crutches because of the amount of upper body strength that is needed. Walkers provide a large base of support for patients who have poor balance or who have bilateral lower limb weakness and thus cannot always bear full weight on their legs. A two-wheel rolling walker is more functional and easier to maneuver than a standard walker with no wheels. A four-wheel rolling walker (rollator) can be used by higher-functioning individuals who do not need to fully off-load a lower limb and who need rest breaks for cardiopulmonary endurance reasons, but this is the least stable type of walker. Wheelchairs should be considered for patients who lack the lower body strength, balance, or endurance for ambulation. Proper sizing and patient education are essential to avoid skin breakdown. To use manual wheelchairs, patients must have sufficient upper body strength and coordination. Power chairs may be considered for patients who cannot operate a manual wheelchair or if they need the features of a power wheelchair.
Topics: Aged; Canes; Crutches; Female; Humans; Male; Mobility Limitation; Self-Help Devices; Walkers
PubMed: 34128609
DOI: No ID Found -
Journal of Pediatric Rehabilitation... 2020The Spina Bifida Association (SBA) is the organization that represents the needs of the population with spina bifida (SB). They are tasked with advocacy, education,... (Review)
Review
The Spina Bifida Association (SBA) is the organization that represents the needs of the population with spina bifida (SB). They are tasked with advocacy, education, optimizing care, and providing a social voice for those with spina bifida. In response to the tenet of optimizing care they were tasked with developing up to date clinical care guidelines which address health care needs for those impacted by spina bifida throughout their lifespan. This article will discuss the SB Mobility Healthcare Guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida.
Topics: Adolescent; Adult; Child; Child, Preschool; Dependent Ambulation; Female; Humans; Infant; Infant, Newborn; Male; Mobility Limitation; Practice Guidelines as Topic; Spinal Dysraphism; Young Adult
PubMed: 33325411
DOI: 10.3233/PRM-200744 -
Therapeutische Umschau. Revue... Apr 2015Felix Platter Hospital, University Center for Medicine of Aging, Basel, Switzerland; There is a strong association between cognition and mobility. Older adults with gait... (Review)
Review
Felix Platter Hospital, University Center for Medicine of Aging, Basel, Switzerland; There is a strong association between cognition and mobility. Older adults with gait deficits have an increased risk of developing cognitive deficits, even dementia. Cognitive deficits, on the other hand, are associated with worsening gait. Cognitive as well as mobility deficits are associated with an increased fall risk. Assessments of cognition, particularly the executive functions, and functional mobility should therefore be an integral part of every comprehensive geriatric assessment. Some quick screening tests for mobility disorders can be performed in a clinical praxis. If those assessments provide pathological results, then consider patient referral for an in-depth gait analysis. Gait analyses that utilize dual task paradigms (walking and simultaneously performing a second task) are particularly meaningful for early detection of mobility and cognitive deficits. Early detection permits timely implementation of targeted interventions to improve gait and brain function.
Topics: Aged; Algorithms; Alzheimer Disease; Cognitive Dysfunction; Comorbidity; Disability Evaluation; Humans; Mass Screening; Mental Status Schedule; Mobility Limitation; Neuropsychological Tests
PubMed: 25791044
DOI: 10.1024/0040-5930/a000668 -
Osteoarthritis and Cartilage Jan 2017To examine the effect of Osteoarthritis (OA)-related difficulty walking on risk for diabetes complications in persons with diabetes and OA.
OBJECTIVES
To examine the effect of Osteoarthritis (OA)-related difficulty walking on risk for diabetes complications in persons with diabetes and OA.
DESIGN
A population cohort aged 55+ years with symptomatic hip and knee OA was recruited 1996-98 and followed through provincial administrative data to 2015 (n = 2,225). In those with confirmed OA (examination and radiographs) and self-reported diabetes at baseline (n = 359), multivariate Cox regression modeling was used to examine the relationship between baseline difficulty walking (Health Assessment Questionnaire (HAQ) difficulty walking score; use of walking aid) and time to first diabetes-specific complication (hospitalization for hypo- or hyperglycemia, infection, amputation, retinopathy, or initiation of chronic renal dialysis) and cardiovascular (CV) events.
RESULTS
Participants' mean baseline age was 71.4 years; 66.9% were female, 77.7% had hypertension, 54.0% had pre-existing CV disease, 42.9% were obese and 15.3% were smokers. Median HAQ difficulty walking score was 2/3 indicating moderate to severe walking disability; 54.9% used a walking aid. Over a median 6.1 years, 184 (51.3%) experienced one or more diabetes-specific complications; 191 (53.2%) experienced a CV event over a median 5.7 years. Greater baseline difficulty walking was associated with shorter time to the first diabetes-specific complication (adjusted HR per unit increase in HAQ walking 1.24, 95% CI 1.04-1.47, P = 0.02) and CV event (adjusted HR for those using a walking aid 1.35, 95% CI 1.00-1.83, P = 0.04).
CONCLUSIONS
In a population cohort with OA and diabetes, OA-related difficulty walking was a significant - and potentially modifiable - risk factor for diabetes complications.
Topics: Aged; Diabetes Complications; Female; Humans; Male; Mobility Limitation; Osteoarthritis, Hip; Osteoarthritis, Knee; Proportional Hazards Models; Risk Factors; Surveys and Questionnaires; Walking
PubMed: 27539890
DOI: 10.1016/j.joca.2016.08.003 -
The Lancet. Neurology May 2020Mobile health technologies (wearable, portable, body-fixed sensors, or domestic-integrated devices) that quantify mobility in unsupervised, daily living environments are... (Review)
Review
Mobile health technologies (wearable, portable, body-fixed sensors, or domestic-integrated devices) that quantify mobility in unsupervised, daily living environments are emerging as complementary clinical assessments. Data collected in these ecologically valid, patient-relevant settings can overcome limitations of conventional clinical assessments, as they capture fluctuating and rare events. These data could support clinical decision making and could also serve as outcomes in clinical trials. However, studies that directly compared assessments made in unsupervised and supervised (eg, in the laboratory or hospital) settings point to large disparities, even in the same parameters of mobility. These differences appear to be affected by psychological, physiological, cognitive, environmental, and technical factors, and by the types of mobilities and diagnoses assessed. To facilitate the successful adaptation of the unsupervised assessment of mobility into clinical practice and clinical trials, clinicians and researchers should consider these disparities and the multiple factors that contribute to them.
Topics: Activities of Daily Living; Humans; Mobility Limitation; Movement Disorders; Telemedicine
PubMed: 32059811
DOI: 10.1016/S1474-4422(19)30397-7 -
Archives of Physical Medicine and... Jul 2016To identify the self-administered instruments to assess mobility in adults with disability, to link the mobility assessed by these instruments to the International... (Review)
Review
OBJECTIVES
To identify the self-administered instruments to assess mobility in adults with disability, to link the mobility assessed by these instruments to the International Classification of Functioning, Disability and Health (ICF), and to evaluate their methodological quality.
DATA SOURCES
Scopus, Science Direct, and Web of Science were systematically searched up to July 2015.
STUDY SELECTION
Studies on the development and validation of self-administered questionnaires in which at least half of the items were related to movement or mobility were included.
DATA EXTRACTION
The mobility assessed by the instruments was classified according to the ICF categories. The methodological quality was assessed according to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist.
DATA SYNTHESIS
Of 5791 articles, 34 studies were eligible for inclusion. Only 10 of the instruments contained items that exclusively assessed mobility. The most frequently linked ICF categories were "changing basic body position" (19.4%), "walking" (14.8%), and "moving around" (13.5%). Measurement properties evaluated included internal consistency (5 studies), reliability (5 studies), measurement error (1 study), content validity (9 studies), structural validity (4 studies), hypotheses testing (6 studies), and responsiveness (1 study). Only content validity obtained the highest quality, probably because the studies included in the review reported the development and initial validation of the instruments.
CONCLUSIONS
Self-administered mobility questionnaires published in the scientific literature assess mobility activities rather than functions related to movement, and do so from the perspective of disability, frequently including self-care and domestic life as domains for assessment. The instruments that presented the highest methodological quality were the Outpatient Physical Therapy Improvement in Movement Assessment Log, the Movement Ability Measure, and the Mobility Activities Measure for Inpatient Rehabilitation Settings.
Topics: Disability Evaluation; Disabled Persons; Humans; Mobility Limitation; Physical Therapy Modalities; Reproducibility of Results; Self Report
PubMed: 26898389
DOI: 10.1016/j.apmr.2016.01.025 -
Clinical Nursing Research Mar 2020
Topics: Aging; Cognition; Delivery of Health Care; Humans; Medication Adherence; Mobility Limitation; Patient-Centered Care
PubMed: 32036695
DOI: 10.1177/1054773820906667 -
Orthopedic Nursing 2018
Topics: Canes; Humans; Mobility Limitation; Orthopedic Nursing; Orthopedics
PubMed: 29782459
DOI: 10.1097/NOR.0000000000000453 -
BMJ (Clinical Research Ed.) May 2022
Topics: Aged; Aging; Humans; Independent Living; Mobility Limitation
PubMed: 35545267
DOI: 10.1136/bmj.o1084