3 - Assessments, interventions, and outcome measures for walking

Summary

When walking fails

Difficulty walking is reported by 10% of Americans (Iezzoni, 2003). One-third report major difficulty. They are unable to walk or climb stairs or stand. The most rapid rates of increase occur after ages 54 and 74 years old. Musculoskeletal and joint diseases account for 24% of causes of major difficulty, back pain for 8%, stroke for 5%, and multiple sclerosis for 2%. Falls affect 41% of these people yearly. Eleven percent never leave their homes and only 32% get out of the home daily. By report, 25% receive some physical therapy during the year of major difficulty walking. At this level of difficulty, 48% with stroke use a cane, 28% use a walker, and 44% a wheelchair.

Six months after a traumatic spinal cord injury (SCI), 2% of subjects graded by the American Spinal Injury Association (ASIA) scale as ASIA A (sensorimotor complete) at 24 h after onset are able to walk at least 25 ft, 30% of those graded ASIA B (motor complete), and 94% graded ASIA C (Geisler et al., 2001). Six months after stroke, 85% of patients with a pure motor impairment, 75% with sensorimotor loss, and 35% with sensorimotor and hemianopsia deficits will recover the ability to walk at least 150 ft without physical assistance (Patel et al., 2000). These levels of gains do not necessarily lead to walking well enough to navigate outside of the home.