As rehabilitation professionals and as compassionate human beings, we are dedicated to improving the quality of life of those with whom we interact, especially elderly clients. Most would agree that preservation of independent, safe walking is a prime element in a satisfying, fulfilling life. Being able to go where one wants in an independent, dignified manner, is a hallmark of a happy old age. A casual glance at a chamber music audience or a college reunion confirms that aging is highly variable. Some will walk at a sprightly pace, others will proceed cautiously, leaning on a cane or walker, and a few will use a wheelchair for community mobility. Of even greater concern are those who deny themselves the pleasure of hearing great music performed live or renewing longtime campus friendships because they judge that the social and esthetic reward is not worth the risk of injury. Days degraded by the fear or the actuality of falling are bitter, as the elderly person limits community activities and ultimately, constricts personal relations.
Mobility has many facets of professional interest, both as to the populations we serve and the pathologies that diminish function. Physical therapists and occupational therapists are responsible for creating interventions that improve, restore, or maintain mobility. A given treatment plan should reflect the physical, social, emotional, and cognitive status of each older client.
The authors who contributed to this issue of Topics in Geriatric Rehabilitation draw from a broad range of professional experience. They are truly an interdisciplinary group, in which occupational therapists and physical therapists join forces with experts in public health and falls prevention. Their combined years of experience is truly awesome; their practice settings range from rural home care to urban day centers, and from virtually every corner of the United States.
Ideally, functional mobility is enhanced by therapeutic exercise, which becomes a lifelong passion for the older person. Bill Gallagher integrates his physical therapy prowess with his considerable experience with Chinese martial arts to show in Western scientific terms how Tai Chi Chuan and Qigong specifically benefit older people, reducing their number of falls and increasing their resistance to frailty.
Illustrating how veteran therapists approach a given mobility challenge from somewhat different perspectives, Bella J. May and Elizabeth Smith Cole offer two approaches focused on enhancing mobility of older adults with amputations. Cole taps her substantial familiarity with several prosthetics facilities to present Medicare-designated codes, which have a profound effect on the mobility potential of those with amputations. She provides a week-by-week program designed to enable the new prosthesis wearer to achieve maximum function. May's program reflects her years of practice in academic medical centers and in rural homes. She bases her intervention in motor control and motor learning theories.
Addressing a poorly understood factor in falls prevention, Patricia A. Miller and Ernestine S. Pantel report a pilot study aimed at exploring emotions that may predispose the older person to falling. The interrelationships among anxiety, depression, worry about falling, and falls self-efficacy contribute to falls. Miller reflects her years of academic and clinical occupational therapy experience with community-dwelling elders in formulating a hypothesis that depressive syndromes and anxiety disorders play important roles in determining whether or not a person will fall. Pantel contributed immensely to the research with her extensive public health knowledge.
In another collaboration, occupational therapist E. Adel Herge and physical therapist Jan Bruckner shine the spotlight on a neglected population, namely, older adults with mental retardation and developmental disabilities. Although they were unable to distinguish fallers from nonfallers by a modification of the Timed-Up-and-Go Test, they make the cogent observation that those with cognitive deficit are less familiar with conventional ambulatory aids, such as rolling walkers, and thus walk even slower with them than when unassisted. They also offer guidance on obtaining informed consent from a vulnerable population.
The reality of contemporary rehabilitation is that therapists will not be reimbursed for services designed to improve mobility unless treatment is documented properly. Anne Coffman, manager of a national contract therapy company, warns that ambulation is not synonymous with gait training. She leads therapists through the criteria now necessary under Medicare regulations. Coffman makes it possible for clinicians to implement the programming described by the other distinguished contributors to this issue.
It has been my great pleasure and privilege to work with such truly wonderful colleagues, many of whom I value as friends of long duration, and a few whom I have come to know through this editorial process. They present a treasure trove of insights into many aspects of mobility that can have an immediate impact on clinical practice. I trust that I reflect the heartfelt wish of all of us by proclaiming that functional mobility is a bedrock right of all people, most especially the elderly.