Walking speed is an important indicator of overall health that also helps guide therapists in how to address fall prevention for their clients.
by Kaila Morin, PT, DPT, CBIS
Did you know that there are not only five … but six vital signs?
Body temperature, blood pressure, heart rate, respiratory rate, and oxygen saturation are the most commonly known vital signs that can provide a good snapshot of a person’s overall health and status. Monitoring these indicators over time can identify subtle changes and irregularities that may be indicative of a more serious problem and may help inform future treatment plans.
But there’s a less commonly known sixth vital sign to be aware of: walking speed.
The Sixth Vital Sign
Also known as the functional vital sign, walking speed—or gait speed—is a valid and reliable measure that’s appropriate for assessing and monitoring functional status and overall health in a wide range of populations. Because walking speed correlates with functional ability and mobility, it has the potential to predict future health status and overall functional decline including hospitalization, institutionalization, discharge location, frailty, risk of falls, and mortality.
Walking speed is frequently used in rehabilitation because it aids in the prediction of falls and fear of falling. It can be measured with a test that is quick and easy to perform, and it is often utilized for a wide range of diagnoses. The most common walking tests utilized by rehabilitation professionals include the 10-meter walk test, 2-minute walk test, 6-minute walk test, and the Timed Up and Go (TUG). It should be noted that walking speed cannot stand alone as the sole predictor of functional ability, just as blood pressure is not the only sign of heart disease. To make use of this measure, you can compare a client’s walking speed against a number of different referenced norms available based on criteria such as age and gender, and even norms that identify the walking speed needed to cross a street safely (1.2 meters per second).1
If a person walks more slowly than their age-related norm, this indicates they are at an increased risk of both falling and future functional decline. Therefore, fall prevention and balance training are very important aspects of rehabilitation provided by physical therapists.
A typical course of rehabilitation includes gathering a client’s history, performing an evaluation, and establishing an individualized treatment plan to maximize the individual’s functional mobility and safety. Learning about a client’s specific therapy goals is key to tailoring their rehabilitation plan to their particular aims and interests.
It’s imperative that rehabilitation professionals specifically ask questions related to falls while taking a client history. They should ask clients if they have had any falls in the past six months or year and, if so, how many falls did they have. It’s also important to learn if their fall(s) resulted in any injury or hospitalization. A history of falls not only increases a person’s risk of having another fall, but also increases a person’s fear of falling. Asking these questions is not only crucial to obtaining a snapshot of a person’s fall history, but also is imperative to finding ways and methods of addressing a person’s fear of falling throughout their rehabilitation course.
One in three adults aged 65 or older living in the community experiences at least one fall a year. A client’s fall risk increases to 50% if he or she is over the age of 75. Falls often occur due to multiple factors. Older adults may fall due to balance or walking difficulties, poor vision, or cognitive impairments. Individuals with neurological disorders have a higher risk of falls compared to the general population. It’s also imperative to know what medications a client is taking. Some commonly used medications can increase a client’s risk of falls significantly. These include sleeping pills, medications for anxiety and pain relief, and medications to lower blood sugar or blood pressure.2
Fall Prevention Screening
A fall prevention screening performed by a physical therapist often includes a lower extremity strength and range of motion assessment, a balance assessment, and a general mobility assessment including stairs and walking.
Based on the findings from the assessment, the physical therapist will develop a treatment plan. This will most commonly include a combination of lower extremity and core strengthening exercises, balance exercises, and cardiovascular and endurance exercises.
Depending on the outcome of the range of motion assessment, the therapist may also incorporate lower extremity flexibility exercises into the treatment plan. During therapy sessions, home exercises to be completed outside of therapy—with or without the assistance of a family member or caregiver—should be provided to the client once they are deemed safe to perform without physical therapist supervision. As a course of physical therapy continues, the therapist should update or modify a client’s home exercise program to match the client’s progress and mobility level. It’s important that fall prevention efforts also include education for the client and their family members or caregivers.
Cognition a Vital Part of Fall Prevention
It’s also important to take a person’s cognitive status into consideration. For example, a person who has had a neurological event such as a stroke or traumatic brain injury or who has a neurodegenerative disease may experience cognitive challenges that negatively impact their safety. A client may lack insight and not be fully aware of their deficits and limitations, which therefore impacts their overall safety with mobility and places them at a fall risk.
Or a client may think their mobility is good enough to walk without their cane or walker and may leave it behind while in the house even though their doctor or physical therapist recommends the use of their assistive device. This will place a client at an increased fall risk and may result in injury or hospitalization after a fall. Therefore, safety education for clients and their support system is a very important part of fall prevention.
Home Safe Home
Fall prevention also often consists of recommended home modifications to decrease the risk of falls in the client’s residence such as removing any potential fall hazards, maintaining a brightly lit home, and continuing to use assistive devices as appropriate. There are many occupational therapists and other rehab professionals who are well-versed in performing full in-home safety assessments. The below information is by no means an exhaustive list, but an overview of some home modification recommendations.
First, it is important to identify home hazards and remove them to ensure clear and safe walking paths. Remove boxes, electrical cords, and other obstacles from walkways to reduce tripping hazards. Then, secure any loose rugs with double-sided tape or remove loose rugs entirely and repair any loose floorboards or carpeting right away. Store clothing, dishes, food, and other necessities within easy reach, and instruct clients and their caregivers to clean up any spills immediately.
In the bathroom—a high-fall-risk room—use nonslip mats in the bathtub or shower or a tub bench or shower chair, as this allows for safe bathing while the client is in a seated position. Also, ensure that the home is well lit to prevent tripping over objects that are difficult to see. Use night lights in the bedroom, bathroom, and hallways to reduce the risk of falls during nighttime hours. Create a clear path to light switches, and store flashlights in easy-to-find places in the event of a power outage.
Rehabilitation professionals may also recommend assistive devices such as a cane or a walker for safe mobility around the house. Other recommended assistive devices may include handrails installed on one or both sides of stairways, nonslip treads for wood steps, a raised toilet or a toilet with armrests, grab bars for the shower or tub, and a sturdy plastic seat for the shower or tub along with a hand-held shower nozzle for bathing.
How to Fall
Even though a physical therapist’s main goal for a person undergoing a fall prevention program is for them to avoid falls, falls or accidents still may happen. An important part of rehabilitation is to also teach clients how to fall safely and how to get up after falling. When falling, it is important that they avoid extending their arms to break the fall but instead raise an arm to protect their head. Also, clients should try to fall on their side or buttocks and roll over naturally.
When trying to get up from a fall it is recommended that the person crawl to the nearest couch or chair—if possible—to get up. If getting up is unsuccessful or if the person is injured in the fall, calling for help by using a medical alert device or cell phone would be the next step.
Further Investigation
Often, a course of rehabilitation along with recommendations for home modifications are sufficient to improve a client’s safety with mobility and reduce their risk of falling. However, occasionally, further investigation may be necessary to determine specifically why someone is falling.
An appointment with a client’s doctor may be warranted to review their medications and identify potential side effects or interactions that may increase a person’s risk of falling. A doctor may consider weaning a client off their medication that may make them drowsy or affect their thinking abilities, such as sedatives, antihistamines, muscle relaxers, and some types of antidepressants, in order to assist with fall prevention.
To conclude, walking speed is considered to be the sixth vital sign because, as a predictor of functional mobility and fall risk, it’s an extremely important measure of a person’s health. Armed with this vital information, physical therapists can decide if fall prevention screening is necessary and, if warranted, they can establish a treatment plan to reduce a client’s risk of falling and further injury or hospitalization. Clients determined to be at risk for falling can benefit from strength training, balance training, patient and caregiver education, home modification and assistive device recommendations, and education in a home exercise program. Physical therapists can also teach clients how to fall safely as well as how to recover from a fall if one occurs. And all of this can start with a simple test of walking speed. RM
Kaila Morin, PT, DPT, CBIS, is an outpatient physical therapist for Gaylord Specialty Healthcare in Wallingford, Conn. She received her doctorate degree in physical therapy at the University of Hartford. She specializes in neurological rehabilitation and has a passion for working with patients after stroke and traumatic brain injuries. For more information, contact [email protected].
References
- Middleton A, Fritz SL, Lusardi M. Walking speed: the functional vital sign. J Aging Phys Act. 2015;23(2):314-322. doi:10.1123/japa.2013-0236
- Fall prevention in the elderly. aapmr.org. https://www.aapmr.org/about-physiatry/conditions-treatments/medical-rehabilitation/fall-prevention-in-the-elderly. Accessed August 21, 2022.
CAPTION: Kaila Morin, PT, DPT, CBIS, of Gaylord Specialty Healthcare guides stroke patient LaSalle Blanks as he walks while wearing ankle weights to work on gait training and strengthening. Photo: Karen Ingham
