This 30-40-minute instructional activity is designed for small group team-based activity to apply basic information learned about assistive devices. The teams discuss the rationale for their matches and with input from the group members, make needed changes to the selected assistive devices. The facilitator encourages further group discussion to clarify any misconceptions or mismatches. We also suggest that you look at this review article: Mobility Assistive Device Use in Older Adults
Mobility problems are pervasive in older adults. Mobility limitations affect personal independence, need for human help, and quality of life. Limited mobility predicts future health, function, and survival. Like other geriatric syndromes, mobility disorders are often caused by diseases and impairments across many organ systems, so evaluation and management require multiple perspectives and disciplines. Physicians should be able to assess and treat mobility problems and be able to measure and interpret clinical indicators of mobility such as gait speed and the performance-oriented mobility assessment. They should know the physiologic and biomechanical mechanisms underlying normal and abnormal mobility, the differential diagnosis of the causes of mobility disorders, and the approaches to management of mobility problems.
| Type of Gait | Description | Associated Signs | Causes |
|---|---|---|---|
| Antalgic | Limited range of motion; limping; slow and short Steps; unable to bear full weight | Pain worsening with movement and weight bearing | Degenerative joint disease; trauma |
| Cautious | Arms and legs abducted; careful; en bloc turns; like walking on ice; slow; wide-based | Associated with anxiety, fear of falling, or open spaces | Deconditioning; post-fall syndrome; visual impairment |
| Cerebellar ataxia | Staggering; wide-based | Dysarthria; dysdiadochokinesia; dysmetria; impaired check; intention tremor; nystagmus; postural instability; rebound; Romberg sign present; titubation | Cerebellar degeneration; drug or alcohol intoxication; multiple sclerosis; stroke |
| Choreic | Dance-like; irregular; slow; spontaneous knee flexion and leg rising; wide-based | Choreoathetotic movements of upper extremities | Huntington disease; levodopa-induced dyskinesia |
| Frontal gait disorder (gait apraxia) | Magnetic; start and turn hesitation; freezing | Dementia; frontal lobe signs; incontinence | Frontal lobe degeneration; multi-infarct state; normal-pressure hydrocephalus |
| Hemiparetic | Extension and circumduction of weak and spastic limb; flexed arm | Extensor plantar response; face, arm, and leg weakness; hyperreflexia | Hemispheric or brainstem lesion |
| Parkinsonian | Short-stepped; shuffling; hips, knees, and spine flexed; festination; en bloc turns | Bradykinesia; muscular rigidity; postural instability; reduced arm swing; rest tremor | Parkinson disease; atypical or secondary forms of parkinsonism |
| Sensory ataxia | Unsteady; worse without visual input, particularly at night | Distal sensory loss; impaired position and vibratory sensation; Romberg sign present | Dorsal column dysfunction; sensory neuropathy |
| Steppage | Resulting from foot drop; excessive flexion of hips and knees when walking; short strides; slapping quality; tripping | Atrophy of distal leg muscles; distal sensory loss and weakness foot drop; loss of ankle jerk | Motor neuropathy |
| Vestibular ataxia | Unsteady; falling to one side; postural instability | Nausea; normal sensation, reflexes, and strength; nystagmus; vertigo | Acute labyrinthitis; Meniere disease |
| Waddling | Lumbar lordosis; swaying; symmetric; toe walk; wide-based | Hip dislocation; proximal muscle weakness of lower extremities; use arms to get up from chair | Muscular dystrophy; myopathy |
A 79-year-old man comes to the office because he is concerned about falling. Four days ago, he missed a step and slid down 5 or 6 steps. He had no injury other than bruising over his buttocks. He purchased a medical alert necklace after the fall, and he is thinking about moving his bedroom to a spare room downstairs. He last fell 1 year ago, when he got out of bed to go to the bathroom. He would like to get his eyes examined, because he believes his vision has deteriorated. He lives alone. History includes heart failure with preserved ejection fraction, gout, and chronic insomnia. Current medications are furosemide, carvedilol, Lisinopril, aspirin, allopurinol, and temazepam. At his last eye examination 2 years ago, findings were normal except for presbyopia and myopia in both eyes.
On physical examination, he completes the Timed Up and Go test in 20 seconds. Using the Snellen eye chart, his visual acuity is 20/40 in both eyes when he wears his glasses. Neurologic and cardiovascular findings are unremarkable.
Which one of the following would most likely reduce this patient’s fall risk? (To check your answer, click on the option you think is correct).
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