Mobility definition by WHO
moving by changing body position or location or by transferring from one place to another, by carrying moving or manipulating objects, by walking running or climbing, and by using carious forms of transportation
Mobility Problem definition by Stats Canada
Someone requiring an assistive device to get around or could not walk, needing help to walk
persons w/ impaired mobility are more likely to experience _________
falls (and be discharged to a long term care centre)
optimizing mobility involves…
- addressing and maximizing physical and sensory-motor function
- treating underlying diseases/conditions
- compensating for loss (assistive devices)
- advocating social policy and change
-> as rehab professionals we need to be advocates for social and health policy (e.g. patient wants to be discharged despite their high risk of falls -> they should be able to)
basic mobility -> rolling
- most healthy young adults do not show rotation b/w the shoulders and pelvis when rolling (when rolling from supine to prone)
- b/c rolling and supine to stand are primarily initiated by movement of the head, upper trunk, and shoulders, impairments that affect these structures will limit performance
basic mobility -> rising from bed
propulsion (need to generate momentum to move the body to vertical)
stability requirements: need to control COM as it changes from within the support base defined by the horizontal body to that defined by the buttocks and feet
adaptation: need to adapt how one moves to the characteristics of the movement
basic mobility research
since healthy adults all perform these basic mobility tasks differently, therapists should not teach any given sequence of performing these tasks (there is lots of variability)
getting up from floor requires …
substantial range of motion and strength
rising from a chair -> impact on hospital stays
chair rise ability in first 24 hrs of hospital stay was significantly associated w/ length of stay (patients who could not perform the chair rise task had longer lengths of hospital stay)
temporal parameters -> time taken for sit to stand
the time taken to stand is 1.5-2 seconds for healthy older subjects when performed in a self-paced manner in normal subjects and is increased in individuals w/ neurological conditions
kinematics-> pre-extension phase
initiation of movement until point of thighs off
trunk and pelvis= rotate forward at hips and the body mass is propelled forward (mass moves over feet)
kinematics -> extension phase
vertical movement occurs from extension at hips, knee and ankles
knees extend before the hips and ankles w/ some forward COM movement as well
most unstable
kinematics -> stabilization phase
Co-contraction of muscles in those with poor balance
effects of initial position/posture
- 75 degree dorsiflexion (b/w floor and shank) is most biomechanically effective position
- foot placement -> anterior foot placement requires greater hip flexion angle and hip moments
- forward trunk flexion at the hips contributes to the horizontal momentum of the body mass
-> older adults use more trunk flexion
-> need to have smooth transition to optimize transfers of momentum from horizontal to vertical - seat height: as you reduce the seat height, the knee extensor moment is most challenged (start in a more flexed position; extension into standing is more challenged)
- arm rests: knee joint and muscle forces are considerably reduced when rising w/ the aid of arms
stabilization strategy
patient sits on edge of chair (gets base of support right under centre of mass)
increases knee and hip flexion (more stable)
momentum strategy
patient sits normally in chair (base of support is anterior to centre of mass)
more and faster trunk flexion-> uses momentum
recovery biomechanics
- slipping - during heel contact or push-off phase when shear forces are highest
- increase slip during down slope, sharper turn, reduced friction of shoe or surface (ice)
- tripping - toe clearance of 1 cm, but less in older adults and more variability
- coordinated postural reflexes in response to a trip or slip
- some potential for training the task, but carry-over has not been evaluated
stair biomechanics
near maximal plantarflexor and knee extensor going up (little reserve to correct for mistake)
potential for mistep (trip) and slip
75% of stair falls occur while going down
functional independence measure (FIM)
a measure of disability or burden of care; it measure how much assistance is required to carry out activities of daily living
- 18 items, max score of 126
- it has 6 functions (self-care, sphincter control, mobility, locomotion, communication and social cognition)
“gold standard” of disability -> mandatory to collect for Canadian rehab centres (admission/discharge criteria) etc.-> not used as much by clinicians
Community Mobility and Balance Scale (CMBS)
- challenging (especially in comparison to Berg)
- can be used if we expect a lot of progression (for example, we expect that a patient will reach the ceilling of Berg on week 3 of rehab and we want to follow their progress for longer)
TUGS (time and go test)
common single item measure for mobility
sit w/ back touching the chair back; stand up, at your comfortable pace, walk 3 meters, turn around and sit back in the chair-> time when back touches chair (fall risk > 14 sec)
SPPB - short performance physical battery
frailty (3 or more of fatigue, weight loss, loss of strength, slow walking speed, low activity level) is associated w/ all-cause mortality
- frailty is not an inevitable part of aging -> its a medical condition that affects the health and function of older adults
- a score of less than or equal to 8 is often used to identify frailty (includes balance tests, gait speed test, chair to stand test)
