Q J Med 2004; 97: 463-475
QJM vol. 97 no. 8 © Association of Physicians 2004; all rights reserved.
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Quantification of walking mobility in neurological disorders
From the Department of Medicine (Section of Neurology and Ophthalmology), and 1Research Centre for Clinical Kinaesiology, Department of Physiotherapy Education, University of Wales College of Medicine, Cardiff, UK
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Introduction |
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Difficulty in walking is a major feature of neurological disease, and loss of mobility is the activity of daily living on which patients place the most value.1 Consequently, how to measure and assess this is of importance to any member of the inter-disciplinary team. In clinical practice, the World Health Organization international classification of functioning (ICF)2 is often adopted as the underlying framework for the assessment of mobility, which is an individual's ability to move about effectively in their environment.2 The ICF also introduces the constructs of performance (what an individual does in his environment) and capacity (ability to execute a task or action). This has a clear impact on the current methodology for the assessment of mobility.
Different pathologies and impairments culminate in abnormal or reduced walking. For instance, in multiple sclerosis (MS), impairments such as weakness and spasticity from pyramidal tract lesions, loss of proprioception and co-ordination from
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Current practice in mobility measurement |
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Quantitative or timed analysis |
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Timing of walking
Endurance tests (2 or 6 min)16
Quantitative movement analysis
Energy expenditure
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Functional scales |
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Specific mobility scales
Rivermead Mobility Index (RMI)28
Ambulation Index (AI)9
Impairment/disability scales
Kurtzke Expanded Disability Severity Scale (EDSS)31
UK (Guy's) Neurological Disability Scale (UKNDS)37
Global ability and participation measures
Patient-oriented measures
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Physical activity questionnaires |
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Ambulatory activity monitors |
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Accelerometers
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A new gold standard |
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Conclusion |
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Address correspondence to Dr O.R. Pearson, Section of Neurology, University of Wales College of Medicine, Cardiff CF14 4XN. e-mail: pearsonor@cardiff.ac.uk
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