Ambulation – Just one form of mobility

Learning to walk is a big deal. For parents, watching their child take her/his first steps is a major milestone. After those first few tottering months of early ambulation, walking becomes a smooth, generally routine activity. Despite the lack of conscious thought we put into each step, the ability to walk safely and efficiently is actually a very complex sequence of events requiring significant neuromuscular control. Our ability to walk is really about controlling instability. We learn to step forward with one leg, to prevent us from falling down after our bodies lean forward past our balance point.

If there is impairment in any one of a variety of body systems – neurological, muscular, vestibular and balance -- the result is often a loss of the functional ability to ambulate safely and effectively. For many who lose the ability to walk, even temporarily, the impact can be profound. Regaining the ability to ambulate becomes the primary focus of medical intervention.

When evaluating a person’s ambulation skills, we really want to keep the specifics of function in mind. Does the person have the coordination, balance and walking speed to, let’s say, get through a grocery store. Would the introduction of (and training on safe use of) an ambulation aid improve the person’s safety and efficiency? Would a cane (or 2), a pair of crutches or a walker provide the support needed to prevent falls? … or increase speed of walking?

In evaluating an individual’s candidacy for an ambulation aide, it is critical to assess the person’s walking skills in multiple environments -- both indoors and out of doors. A person with poor balance may find it impossible to bring a rolling walker up and down stairs. Are stairs a frequently encountered obstacle in this person’s life? Would a small ramp make access into and out of the home more feasible?

Many people will cling to the ability to walk as a symbol of independence, youth and well-being, even when fatigue and potential injury from falls is highly predictable. Especially during the Polio-era of the 1940s and 50s, patients were frequently counseled by the healthcare community to “use it or lose it.” Many polio survivors relished the ability to be upright – using a wide range of braces and crutches to be able to walk. Regardless of the energy used while walking, many polio survivors continued to walk for 30-40 years, until the signs of post-polio syndrome caused overwhelming fatigue and loss of function.

Taking a cue from Polio findings, research on the effects of aging on other disabilities – including Spinal Cord Injury and Cerebral Palsy -- have found acceleration of the aging process. (http://www.agingwithdisability.org, http://www.jik.com/hwawd.html). This evidence of accelerated aging has caused some in the health care community to shift from a “use-it-or-lose-it” attitude to “conserve to preserve”.

If long distance ambulation is not truly functional, what are some mobility alternatives?