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February 26, 1988, Vol 259, No. 8 >
ARTICLE | February 26, 1988

Identifying Mobility Dysfunctions in Elderly Patients: Title and subTitle BreakStandard Neuromuscular Examination or Direct Assessment? FREE

Mary E. Tinetti, MD; Sandra F. Ginter, RN
[+] Author Affiliations

Reprint requests to Department of Medicine, Yale University School of Medicine, Box 3333, 333 Cedar St, New Haven, CT06510-8056 (Dr Tinetti).


JAMA. 1988;259(8):1190-1193. doi:10.1001/jama.1988.03720080024022
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References

The need to assess functions such as mobility in elderly patients is increasingly recognized. Lacking other methods, clinicians may rely on the standard neuromuscular examination to evaluate mobility. Therefore, we checked the sensitivity of the neuromuscular examination for identifying mobility problems by comparing relevant neuromuscular findings with performance during four routine mobility maneuvers: (1) getting up from a chair, (2) sitting down, (3) turning while walking, and (4) raising the feet while walking. The subjects investigated were 336 elderly persons living in the community. Many subjects who performed poorly during mobility maneuvers did not have the corresponding neuromuscular abnormalities. For example, although hip and knee flexion are needed to sit down safely, abnormal hip flexion was found in only 15% and abnormal knee flexion in only 30% of the subjects who had difficulty sitting down. The relationship between neuromuscular findings and functional mobility was not predictable enough to rely on neuromuscular findings for identifying mobility problems. Therefore, a simple assessment that reproduces routine daily mobility maneuvers should be developed for use in the clinical care of elderly patients.

(JAMA 1988;259:1190-1193)

REFERENCES

1 +
The Public Health Aspects of the Aging of the Population . Copenhagen, World Health Organization, 1959;.
2 +
Canadian Task Force on the Periodic Health Examination:  The periodic health examination. Can Med Assoc J 1979;;121:1193-1254.
3 +
Katz S, Downs TD, Cash HR, et al:  Progress in the development of an index of ADL. Gerontologist 1970;;10:20-30.
4 +
Rosow I, Breslau H:  A Guttman Health Scale for the aged. J Gerontol 1966;;21:556-559.
5 +
Nagi SZ:  An epidemiology of disability among adults in the United States. Milbank Q 1976;;54:439-468.
6 +
Linn MW, Linn BS:  The rapid disability rating scale-2. J Am Geriatr Soc 1982;;30:378-382.
7 +
Mahoney FI, Barthel DW:  Functional evaluation: The Barthel Index. Md State Med J 1965;;14:61.
8 +
Imms FJ, Edholm OG:  The assessment of gait and mobility in the elderly. Age Ageing 1979;;8:261-267.
9 +
Finley FR, Cody KA, Finizie RV:  Locomotion patterns in elderly women. Arch Phys Med Rehabil 1969;;50:140-146.
10 +
Overstall PW, Exton-Smith AN, Imms FJ, et al:  Falls in the elderly related to postural imbalance. Br Med J 1977;;1:261-264.
11 +
Stanic V, Bajd T, Valencic V, et al:  Standardization of kinematic gait measurements and automatic pathological gait pattern diagnostics. Scand J Rehab Med 1977;;9:95-105.
12 +
Hoppenfeld S: Physical Examination of the Spine and Extremities . East Norwalk, Conn, Appleton-Century-Crofts, 1976;.
13 +
Berkman LF, Berkman CS, Kasl S, et al:  Depressive symptoms in relationship to physical health and functioning in the elderly. J Epidemiol 1986;;124:372-388.
14 +
American Medical Association, Committee on Rating of Mental and Physical Impairment, Council on Industrial Health: Estimation of loss of visual efficiency, in Physicians Desk Reference, Ophthalmology . Oradell, NJ, Medical Economics Books, 1979;, p31.
15 +
Blake RL, Ross AS, Valmassy RL:  Biomechanics gait evaluation. J Am Podiatr Med Assoc 1981;;71:341-343.
16 +
Mikulic MA, Griffith ER, Jebsen RH:  Clinical application of a standardized mobility test. Arch Phys Med Rehabil 1976;;57:143-146.
17 +
Guimaraes RM, Isaacs B:  Characteristics of the gait in old people who fall. Int Rehab Med 1980;;2:177-180.
18 +
Nelson AJ:  Functional Ambulation Profile. Phys Ther 1974;;54:1059-1065.
19 +
Imms FJ, Edholm OG:  Studies of gait and mobility in the elderly. Age Ageing 1981;;10:147-156.
20 +
Robinson JL, Smidt GL:  Quantitative gait evaluation in the clinic. Phys Ther 1981;;61:351-353.
21 +
Wolfson LI, Whipple R, Amerman P, et al:  Stressing the postural response. J Am Geriatr Soc 1986;;34:845-850.
22 +
Tinetti ME, Williams TF, Mayewski R:  Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 1986;;80:429-434.
23 +
Tinetti ME:  Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986;;34:119-126.
24 +
Jette AM, Branch LG:  The Framingham disability study: II. Physical disability among the aging. Am J Public Health 1981;;71:1211-1216.
25 +
Branch LG, Katz S, Kniepman K, et al:  A prospective study of functional status among community elders. Am J Public Health 1984;;74:266-268.
26 +
Kokemen E, Bossemeyer RW, Barney J, et al:  Neurological manifestations of aging. J Gerontol 1977;;32:411-419.
27 +
Klawans HL, Tufo HM, Ostfeld AM, et al:  Neurologic examination in an elderly population. Dis Nerv Syst 1971;;32:274-279.

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1 +
The Public Health Aspects of the Aging of the Population . Copenhagen, World Health Organization, 1959;.
2 +
Canadian Task Force on the Periodic Health Examination:  The periodic health examination. Can Med Assoc J 1979;;121:1193-1254.
3 +
Katz S, Downs TD, Cash HR, et al:  Progress in the development of an index of ADL. Gerontologist 1970;;10:20-30.
4 +
Rosow I, Breslau H:  A Guttman Health Scale for the aged. J Gerontol 1966;;21:556-559.
5 +
Nagi SZ:  An epidemiology of disability among adults in the United States. Milbank Q 1976;;54:439-468.
6 +
Linn MW, Linn BS:  The rapid disability rating scale-2. J Am Geriatr Soc 1982;;30:378-382.
7 +
Mahoney FI, Barthel DW:  Functional evaluation: The Barthel Index. Md State Med J 1965;;14:61.
8 +
Imms FJ, Edholm OG:  The assessment of gait and mobility in the elderly. Age Ageing 1979;;8:261-267.
9 +
Finley FR, Cody KA, Finizie RV:  Locomotion patterns in elderly women. Arch Phys Med Rehabil 1969;;50:140-146.
10 +
Overstall PW, Exton-Smith AN, Imms FJ, et al:  Falls in the elderly related to postural imbalance. Br Med J 1977;;1:261-264.
11 +
Stanic V, Bajd T, Valencic V, et al:  Standardization of kinematic gait measurements and automatic pathological gait pattern diagnostics. Scand J Rehab Med 1977;;9:95-105.
12 +
Hoppenfeld S: Physical Examination of the Spine and Extremities . East Norwalk, Conn, Appleton-Century-Crofts, 1976;.
13 +
Berkman LF, Berkman CS, Kasl S, et al:  Depressive symptoms in relationship to physical health and functioning in the elderly. J Epidemiol 1986;;124:372-388.
14 +
American Medical Association, Committee on Rating of Mental and Physical Impairment, Council on Industrial Health: Estimation of loss of visual efficiency, in Physicians Desk Reference, Ophthalmology . Oradell, NJ, Medical Economics Books, 1979;, p31.
15 +
Blake RL, Ross AS, Valmassy RL:  Biomechanics gait evaluation. J Am Podiatr Med Assoc 1981;;71:341-343.
16 +
Mikulic MA, Griffith ER, Jebsen RH:  Clinical application of a standardized mobility test. Arch Phys Med Rehabil 1976;;57:143-146.
17 +
Guimaraes RM, Isaacs B:  Characteristics of the gait in old people who fall. Int Rehab Med 1980;;2:177-180.
18 +
Nelson AJ:  Functional Ambulation Profile. Phys Ther 1974;;54:1059-1065.
19 +
Imms FJ, Edholm OG:  Studies of gait and mobility in the elderly. Age Ageing 1981;;10:147-156.
20 +
Robinson JL, Smidt GL:  Quantitative gait evaluation in the clinic. Phys Ther 1981;;61:351-353.
21 +
Wolfson LI, Whipple R, Amerman P, et al:  Stressing the postural response. J Am Geriatr Soc 1986;;34:845-850.
22 +
Tinetti ME, Williams TF, Mayewski R:  Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 1986;;80:429-434.
23 +
Tinetti ME:  Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986;;34:119-126.
24 +
Jette AM, Branch LG:  The Framingham disability study: II. Physical disability among the aging. Am J Public Health 1981;;71:1211-1216.
25 +
Branch LG, Katz S, Kniepman K, et al:  A prospective study of functional status among community elders. Am J Public Health 1984;;74:266-268.
26 +
Kokemen E, Bossemeyer RW, Barney J, et al:  Neurological manifestations of aging. J Gerontol 1977;;32:411-419.
27 +
Klawans HL, Tufo HM, Ostfeld AM, et al:  Neurologic examination in an elderly population. Dis Nerv Syst 1971;;32:274-279.

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