Ambulation

the ability to move from place to

place with or without assistive
device
Mobility
 the ability to move in one’s
environment with ease and
without restriction
 Levels of Mobility Difficulties

1. None
No difficulty with walking and
climbing stairs and standing and not
using any mobility aid
2. Minor
Some difficulty with walking or
climbing stairs or standing or using a
cane or crutches
3. Moderate
A lot of difficulty with walking or
climbing stairs or standing or using a
walker
4. Major
Unable to perform walking or
climbing stairs or standing or using a
manual or electric wheelchair or
scoote
 Adults Reporting Mobility
Difficulties (%)
 Causesreported for at least 1 % of all persons
by extent of mobility difficulty
 Among the Filipino elderly population
 ~ 60 % visually impaired
 ~ 40 % hearing impaired
 Physical Changes that can limit
Mobility
Arthritis in the joint
Decrease ability to stretch and bend
Slower reflexes
Decrease physical energy
 Loss of bone tissue
Do Flexibility,
Strengthening, Endurance and
Balance Exercises
 Effects of Bed Rest on
Various Organ Systems
a. Cardiovascular
 decrease Cardiac output
 decrease Stroke volume
 Orthostatic hypotension
b. Respiratory
 decrease Chest excursion
 decrease O2 Uptake
 increase risk for
Atelectasis
c. Gastrointestinal
 Malnutrition
 Anorexia
 Constipation
d. Muscular
 Decrease Muscle Blood
Flow
 Decrease Muscle
Strength
Watch out for

 Psycho- social depression

 Anger
 Pain coping
 Self-image
 Family relations
Nursing Practice Implications

 Address Decreased Mobility & Functional

Decline
 Use various practice guidelines to avert
potential risks
 Integrate protocols to improve rest and
sleep
 Promote participation in self care activities
 Regularly assess for cognitive status
changes to address delirium/confusion
Expected Nursing Outcomes

 Patient
is free from complications of
immobility
 Patient is able to ambulate
independently with an assistive
device
Evidence based
measures of balance
and mobility in older
people
EB balance test: FUNCTIONAL
REACH (FR)
Rationale
 Test an individual’s limits of stability
or control of forward translation of
the body mass over a fixed base of
support
Required equipment and
procedure
Meterstick (or measuring tape),
masking tape, small sticker
markers
Basic setup:
 Patient stands unsupported near a wall with
feet parallel (10 cm apart), shoulder in 90
degrees flexion, and arm outstretched
(palm facing medially); meterstick is
mounted on the wall at the level of the
acromion process / shoulder; landmark for
measurement is the tip of the 3rd digit
 Instructions:

 Trialstarts when the tester says “go”; patient

reaches as far forward as possible without
leaning against the wall, moving the feet, and
losing balance (grabbing for support)
 Trial ends with completion of the test (maximum
distance reached), loss of balance, or change in
position of the feet
 Practice trial = 1; test trials = 2
Scoring
Maximum distance reached in the direction being tested, in
cm; best score over 2 trials
Interpretation
Reference data, community-dwelling older people (ages >
65 yr, n = 27 each group) (Dite & Temple 2002)
>Non-fallers, median (IQR) = 32 cm (28 – 36 cm)
>Nonmultiple fallers, median (IQR) = 26 cm (19 – 29 cm)
>Multiple fallers, median (IQR) = 21 cm (15 – 26 cm)
Score < 25 cm may identify multiple fallers with 63%
sensitivity
EB balance test: STEP TEST (ST)

 Rationale

Test an individual’s control of a dynamic single limb

stance and a lateral weight shift; test postural control
during transition between bilateral and unilateral
stance
Required equipment and procedure
 Stopwatch,1 step (7.5 cm high; ideally,
~41 cm wide and 30 cm deep)
 Basic setup:
Patient stands unsupported with feet parallel
(10 cm apart) and the block 5 cm directly
in front
Instructions:

 “We will start testing with the _____ leg as the stepping
leg. When I say “go,” place your _____ foot onto the
block, then return it fully back down to the floor, as
many times as you can until I say “stop.” Make sure that
all your foot contacts the block each time. Try not to
move the other foot while stepping with the _____ foot.”
 Trial starts when the tester says “go”
 Trial ends with completion of the test (15 s have
elapsed), loss of balance or shifting of the support foot
 Practice trial = 1; test trials = 2
Scoring
Number of times the test foot is moved from the floor
onto, then down off block in 15 s; best score over 2
trials
Interpretation
Reference data, community-dwelling older people and
inpatients with stroke (mean age = 72.5 yr, n = 41 each
group)
Healthy, mean (SD, range) = 17.67 steps (3.22, 12 –
25), right; 17.35 steps (3.03, 12 – 24), left
Inpatients, mean (SD, range) = 6.95 steps (4.55, 0 –
16), unaffected; 6.39 steps (4.53, 0 – 14), affected
EB mobility test: TIMED UP & GO (TUG)

Rationale
 Test the ability to make postural transitions
(standing from a seated position and sitting
from a standing position) and remain upright
with a moving / changing base of support
(walking over a short distance and turning
while walking); screen for mobility deficits
and risk of falls
Required equipment and procedure
 Standard chair, stopwatch, meterstick (or
measuring tape), colored tape or plastic cone
Basic setup:
 Patient sits on a chair; masking or colored tape
is placed on the floor to line the 3m walkway;
colored tape or plastic cone is placed at the
end of 3m; the use of a gait aid may be
allowed, if required
Instruction:
 “When I say ‘go’ I want you to stand up and walk
to the cone / floor marker, turn and then walk back
to the chair and sit down again. Walk at your
normal pace.”
 Trial starts when the tester says “go”
 Trial ends with completion of the test (the patient
has returned to sitting on the chair) or failure to
complete the test successfully due to loss of
balance or fatigue
 Practice trial = 1; test trials = 2
Scoring
Time (in s) needed to complete the task; best score over 2
trials
If the patient requires an assistive device, the type of device
should be recorded
Interpretation
Reference data, community-dwelling older people (n =
4395, combined [from meta-analysis])(Bohannon 2006)
[n = 4395] 60 – 99 yr, mean (95% CI) = 9.4 s (8.9 – 9.9 s)
[n = 176] 60 – 69 yr, mean (95% CI) = 8.1 s (7.1 – 9.0)
[n = 798] 70 – 79 yr, mean (95% CI) = 9.2 s (8.2 – 10.2 s)
[n = 1102] 80 – 99 yr, mean (95% CI) = 11.3 s (10.0 – 12.7
s)
EB mobility test: 10 METER
WALK TEST (10MWT)

Rationale
Test the ability to remain upright with a
moving base of support; screen for
mobility deficits and risk of falls
Required equipment and procedure
 Stopwatch,meterstick (or measuring
tape), masking tape (or any colored
floor marker
Basic setup:
Patient stands unsupported at the start of a
10-m walkway; a chair (or floor marker) is
placed at the end of 10 m; the use of a gait
aid may be allowed, if required
Instruction:
“Walk to the chair at the end of the
walkway using your comfortable walking
speed.”
Trial starts when 1 of the patient’s feet
crosses the 2 m mark
Functional
reach
Duncan, Studenski,
Chandler, Prescott
1992
Step test
Timed Up & Go (TUG) Test
Podsiadlo & Richardson 1991