From the Guidelines
To assess difficulty walking, the most effective approach is to use the Timed Up and Go (TUG) test, which measures the time it takes for a person to rise from a chair, walk 3 meters, turn around, walk back, and sit down again, with a recorded time of >12 seconds associated with increased fall risk, as recommended by the most recent and highest quality study 1.
Assessment of Walking Difficulty
When evaluating difficulty walking, it is essential to consider various factors, including gait pattern, balance, and speed. The following steps can be taken:
- Observe the person's gait pattern, balance, and speed while they walk normally, on heels and toes, and in tandem (heel-to-toe)
- Note any limping, shuffling, unsteadiness, or use of assistive devices
- Ask about pain, weakness, numbness, dizziness, and when symptoms began
- Perform a physical examination including muscle strength testing, joint range of motion, sensation assessment, and reflexes
Use of Standardized Tests
Standardized tests, such as the TUG test, can provide valuable information about a person's walking ability and fall risk. The TUG test is a widely used and well-established assessment tool that can be easily administered in a clinical setting. According to the study by 1, the TUG test is a reliable and effective way to assess mobility and fall risk in older adults.
Consideration of Fall Risk
Fall risk is a critical consideration when assessing difficulty walking, particularly in older adults. The Berg Balance Scale or Tinetti Assessment Tool can be used to evaluate fall risk and identify individuals who may require additional support or interventions to prevent falls. As noted in the study by 1, a TUG score greater than 12 seconds is associated with increased fall risk, highlighting the importance of using this test in clinical practice.
Clinical Decision-Making
When interpreting the results of the TUG test and other assessments, clinicians should consider the individual's overall health status, medical history, and functional abilities. This information can be used to develop a personalized treatment plan that addresses the underlying causes of walking difficulty and reduces the risk of falls. As recommended by the study by 1, a multipronged approach that includes exercise, physical therapy, and counseling can be effective in maintaining mobility and preventing falls.
From the Research
Assessing Difficulty Walking
To assess difficulty walking, several factors should be considered, including:
- Posture, walking aids, and footwear 2
- The gait cycle, which can be broadly divided into the stance and swing phases 2
- Spatiotemporal gait parameters, which can be measured using validated clinical outcome measures 3
- Walking speed, which can be assessed using short walking capacity tests such as the timed 25-foot walk (T25FW) or the 10-m walk test (10 MWT) 3
- Walking distance, which can be assessed using middle distance tests such as the 2-min walk test (2MWT) and the 6-min walk test (6MWT) 3
Common Causes of Difficulty Walking
Difficulty walking can be caused by a variety of factors, including:
- Neurological causes such as sensory ataxia due to polyneuropathy, parkinsonism, and frontal gait disorders 4
- Non-neurological causes such as hip and knee osteoarthritis 4
- Medications with anticholinergic and sedative effects, which can increase the risk of difficulty walking 5
- Systemic diseases or adverse effects of medication, particularly polypharmacy including sedatives 4
Clinical Assessment and Management
A thorough clinical observation of gait, taking a focused patient history, and physical, neurological, and orthopedic examinations are basic steps in the categorization of gait disorders and serve as a guide for ancillary investigations and therapeutic interventions 4. Additionally, strategies such as pharmacological symptomatic treatment and non-pharmacological rehabilitation approaches, including exercise and task-specific training, can help restore walking function 3.