Books


Mobility Problems

Introduction

  • activity intolerance is common among cancer patients and it is often difficult to determine the cause
  • some common causes include:
    • tumors of the nervous system
    • secondary effects of treatment or medication
    • unrelated chronic illness
    • CNS infections
    • sensory or motor neuropathies
    • metabolic disturbances
  • early identification of the signs and symptoms of neurological deficits is necessary to stop progression to permanent disability
  • some signs and symptoms include paresthesias, loss of motor strength, weakness, spasticity, loss of bowel and bladder control, pain, loss of proprioception, decrease or loss of sensation
  • quality of life is decreased by physical disability
  • the effects of immobility include:
    • decreased range of motion and contractures
    • thrombus formation
    • decubitus ulcers
    • constipation
    • indigestion
    • depression

Assessment

  • assessment of functional status should be done at the time of diagnosis and throughout the course of the disease
  • the ECOG and Karnofsky scales (see below) have proven reliable, valid and easy to use measures to assess the patients ability to perform normal activities of daily living or the degree of dependency on others for assistance
  • a complete medical history should be obtained
  • the physical exam provides objective information to verify absence or presence of reported abnormalities include neuro, musculoskeletal and skin exams

Intervention

  • identify and discuss limitations and strengths with the patient and care giver
  • promote energy conservation, include rest periods with activities
  • coordinate referrals to appropriate sources, including:
    • physical therapy
    • occupational therapy
    • rehab
    • social work
  • review appropriate positioning, alignment, range of motion with care givers
  • preserve skin integrity to prevent decubitus ulcers
  • promote safe environment, teach safety measures
  • encourage patient involvement in ADLs as much as possible

References

Dufault, K. and Birenbaum, LK (1996) "Immobility" in McCorkle, R., Grant, M., Frank-Stromborg, M., Baird, S. Cancer Nursing: A Comprehensive Textbook, 2nd ed. Philadelphia: WB Saunders Company, p. 1120-1144.

Meehan, JL (1994) "Mobility and Neurologic Function" in Gross, J. and Johnson, BL (eds) Handbook of Oncology Nursing, 2nd ed., Boston: Jones and Bartlett, p. 465-496.


Mobility Problems Assessment
Karnofsky and ECOG Performance Scales

Description Karnofsky Scale

Karnofsky Scale

ECOG Scale

Description ECOG Scale

No complaints, no evidence of disease 1000Normal Activity
Able to carry on normal activity, minor signs or symptoms of disease 900Normal Activity
Some signs or symptoms of disease 801Symptoms of disease, but ambulatory and able to carry out activities of daily living
Cares for self with effort, unable to carry on normal activity or to do active work701Symptoms of disease, but ambulatory and able to carry out activities of daily living
Requires occasional assistance but is able to care for most personal needs602Out of bed more then 50% of the time; occasionally needs assistance
Requires considerable assistance and frequent medical care50 2Out of bed more than 50% of the time; occasionally needs assistance
Disabled: Requires special care and assistance403In bed more than 50% of time; needs nursing care
Severly disabled: Hospitalized indicated, although death not imminent 303In bed more than 50% of the time; needs nursing care
Very sick, hospitalization necessary, requires active supportive treatment204Bedridden, may need hospitalization
Moribund, fatal processes processing rapidly

Dead

104Bedridden, may need hospitalization
NOTE: ECOG = Eastern Cooperative Oncology Group




News
Early Palliative Care in Lung CA Focuses on Coping, Symptoms

Jan 31, 2013 - Early palliative care clinic visits, integrated with standard oncologic care for patients with metastatic lung cancer, emphasize symptom management, coping, and psychosocial aspects of illness, according to research published online Jan. 28 in JAMA Internal Medicine.



I Wish You Knew

Healthcare Affordability Act

View More



Blogs and Web Chats

OncoLink Blogs give our readers a chance to react to and comment on key cancer news topics and provides a forum for OncoLink Experts and readers to share opinions and learn from each other.




OncoLink OncoPilot

Facing a new cancer diagnosis or changing the course of your current treatment? Let our cancer nurses help you through!

Learn More