Mobility Chap 15

• Sarcopenia
• narrower stand­ing base
• temporary or permanent consequences of illness
• immobilized by the fear of falling

orthope­dic impairments

• near falls not usually reported important in assessing fall risk.
• must be reported to the Centers for Medicare & Medicaid Services (CMS).
• Falls are a symptom of a problem
• iatrogenic factors such as limited staffing, lack of toileting programs, and restraints andside rails

sudden and unexpected fall to the ground without loss of consciousness in an otherwise healthy indi­vidual

can cause hip tro­chanter cracks, femur fractures

primary causes of most falls found to be cardiovascular (vasovagal syncope, orthostatic hypoten­sion, carotid sinus hypersensitivity)

• followed by neurologi­cal causes (primarily vestibular disorders), gait and balance disturbances, and
• drug-related causes.

• visual acuity, cognitive impairment, postural
• hypotension, cardiac arrhythmias,
• uncontrolled diabetes, depressive symptom
• four or more prescription medications

• Muscle weakness experienced in hyperthyroidism, hypothyroidism, hypokalemia, hy­perparathyroidism,
• osteomalacia, and hypophosphatemia
• The swing phase of gait ivulnerable because only one
• foot is in contact with ground

• The client is asked to rise from a straight-back chair, stand briefly, walk
• forward about 10 feet, turn, walk back
• to the chair, turn around, and sit down. Performance
• is graded on a 5-point scale from 1 (normal) to 5 (severely abnormal). The quality of the movement is as­sessed for impaired balance

• Wide-based gait with frequent side-stepping
• defective muscular coordination when voluntary muscular movements are attempted

• Associated with stooped posture;
• hip and knee flexion; di­minished arm swing; stiffness in turning; broad-based,
• small steps with poor gait intention

• Poor arm and leg swing, affected
• limb does not bend at knee; ankle fixed and
• inverted as leg swings in wide cir­cle; foot tends to drag

• Ill-defined skeletal
• pain; pain on weight bearing; unstable, waddling gait

• porous bone characterized by low bone mass (or bone
• mineral density) and subsequent deterioration of the
• bone structure.
• Primary osteoporosis is associated with the normal changes of aging
• Sec­ondary osteoporosis, accounting for 15% of cases, is
• caused by another disease state or medications
• (hyperthyroidism, hyperparathyroidism,
• gastrointestinal [GI] disorders, neo­plasms,
• alcoholism).
• health consequence of OP is the fall- related morbidity
• and mortality

• fast­est overall loss of BMD is in the 5 to 7 years
• immediately after menopause
• Low calcium intake
• Estrogen deficiency
• Low testosterone

• Inadequate exercise or activity Use of steroids or
• anticonvulsants Excess coffee or alcohol intake Current cigarette smoking

• Osteoporotic­related hip fractures have the most serious
• consequences
• Vertebral fractures are the most common
• osteoporotic­related fracture.

• disorders of joints and connective tissue
• rheumatic disorders bursitis, polymyalgia rheumatica, gout,rotator cuff tears, tendinitis, frozen shoul­der, low back pain, acute disk herniation, chronic disk

• generation, lumbar
• spinal stenosis, rheumatoid arthritis,

• degenerative joint disorder (DJD)
• including increased age, genetic predisposition, obe­sity, cellular and biochemical processes, and
• repetitive use or trauma to the joint.cartilaginous lining becomes thin and damaged
• crepitus may be heard an in­dication of the deterioration of the synovial covering of the joints.
• Spinal involvement common 5, T8, and L3, areas of greatest flexibil­ity.
• Osteophytes (bony outgrowths) in the lumbar
• region can become spinal
• stenosis if encroaching in the foramina and spinal cord and can result in radiating low back pain

• acetaminophen (Tylenol) remains the drug of choice
• the next choice is one of the NSAIDs, such as aspirin or ibuprofen;with signifi­cant risk for GI problems such as bleeding
• Other pharmacological agents often used in OA
• manage­ment include topical
• capsaicin made from pepper plants and available over the counter in two strengths
• surgical replacement of the joint (arthroplasty)

• chronic, sys­temic inflammatory joint disorder.
• autoimmune disease in which an inflamed synovium (lining
• of the joint)
• normally affects the small joints of the wrist, knee, ankle, and hand, although it affects large joints as well.

• affects many organ systems in addition to the joints
• Rheu­matoid nodules mayarise within tendons or ligaments and can cause rupture or joint dysfunction
• lungs, the sclera, and the vocal cords
• RA can develop Sjogren's syndrome,

• stiffness and pain in the muscles of the neck, shoulders, lower back, buttocks, and thighs
• also may have coexistent OA
• Although it is some­times difficult to differentiate PMR from OA,
• important since PMR isreversible and requires different treatment.

• soft tissue rheumatic syndromes
• in the tissues and structures such as ligaments, tendons, bursae, and mus­cles. Because the problem is so near a joint, it is often con­fused with arthritis.

• inflammation of the tissues or synovial sheaths around a
• tendon
• It usually occurs from overuse, unaccustomed activity, or exercise

• occurs with repetitive physical stresses.
• occurs mainly in subacromial bursae (shoulder) and olecranon bursae (elbow). In the lower extremity, it
• occurs in the tro­chanteric, prepatellar,

• inflammatory arthritis that results from accumulation of
• uric acid crystals (tophi) in a joint
• one-time acute illness, or chronic condition with acute attacks
• the great toe is the most typical site
• exquisite pain in the affected joint, often starting in the middle of the night during sleep
• avoiding drugs or foods that are high in purine and alcohol,
• both of which increase uric acid levels

• is a progressive disease of the basal ganglia corpus striatum) and involves the dopaminergic nigrostriatal
• pathway.
• disorder produces a syn­drome of abnormal movement called parkinsonisrn that leads to difficulty with mobility
• bradykinesia (slow movement);resting tremor; rigidity; abnormalities of pos­ture, balance and gait; and deficiency of the neurotransmit­ter dopamine.
• Parkinson's disease is called
• primary parkinsonism or idiopathic.
• Idiopathic (for which no cause been found)