Care and mobility considerations (Lower)
It is important to bear in mind that damage to specific parts or functions of the brain (which may be physically small) may cause disproportionate, and devastating disability. Some examples of this are dysphasia (difficulty with expressing and understanding language), hemianopia, and the inability to recognize faces. It is especially true of language loss, which may occur in isolation. A person with aphasia would not be able to speak, read, manage mathematical calculations etc.
Spinal cord strokes may well affect bowel and bladder control.
There may be other effects such as:
- Speech disorders, such as:
- Dysarthria (poorly articulated speech, caused by problems in muscle control)
- Aphasia (disorder of the language content of speech, a defect or loss of the ability to comprehend or express words)
- Anomia (inability to produce the correct word)
- Dysphonia (hoarse or whispered speech)
- Hemianopia (loss of half of the visual field)
- Cognitive function – effect on thinking, awareness of surroundings, attention, learning, judgement and memory)
- Hemianaesthesia (loss of sensation of the affected part)
- Perceptual problems (lack of awareness of the affected part of the body)
- Mood disturbances or depression
- Ataxia (problems with co-ordination, unsteadiness)
- Vertigo (balance disturbance)
- Problems controlling movements of the eyes
- Problems with swallowing
- Problems with bowel and bladder control
Vision guidance is available in addition where appropriate.
Lower limb condition – Mild Function restriction
| Category | Description |
|---|---|
| Disabling Effects | People with this level of functional restriction have normal or minimal loss of muscle power, and minimal or no spasticity of the affected lower limb. They are able to stand unaided or with the use of walking stick. |
| Mobility | People with such a restriction would normally be able to walk at over two hundred metres at a normal or near normal speed. They would normally have some restriction of lower limb function, causing a mild impairment of gait, such as a mild limp, but they would be unlikely to suffer from falls. |
| Care | People with this level of restriction would normally be able to safely manage all aspects of their personal care, as they would normally have reasonable lower limb muscle power. Such a person would normally be able to independently maintain personal hygiene and prepare and cook a meal. They would have little or no functional limitation on a day-to-day basis arising from any symptoms. |
Lower limb condition – Moderate Functional Restriction
| Category | Description |
|---|---|
| Disabling Effects | People with this level of functional restriction would normally be unable to stand unassisted, would have moderate loss of muscle power, and some difficulty in straightening the affected limb. |
| Mobility | People with this level of restriction would normally be unable to walk at normal speed. They would normally have an abnormal gait, may have problems with balance and would walk with a noticeable limp. They may need physical support, in order to walk. Such people may be able to walk 50 to 100 metres at a slow or very slow speed and they may suffer from falls. |
| Care | A person with this level of restriction may have difficulty coping with many activities of daily life. There may be spasticity of muscles (a state in which the normal tone of the muscle is increased leading to difficulty in movement). In other cases weakness of the muscles may be present. Spasticity and weakness of muscles may also co-exist. Any of these problems may cause difficulty with dressing, getting out of a normal chair, out of bed, rising from a toilet and getting out of a bath. There may be difficulty in climbing stairs, safely dealing with hot pans, and bending to the oven. People with such a condition may suffer from falls, and may have difficulty rising independently from a fall. |
Lower limb condition – Severe Function Restriction
| Category | Description |
|---|---|
| Disabling Effects | People with this level of functional restriction would normally be unable to stand unsupported, would have severe loss of muscle power, and significant spasticity of the affected lower limb. |
| Mobility | Walking would normally be significantly restricted in terms of speed, distance (unable to manage more than 50 metres) and gait. The person would normally be unable to walk without physical support, or the person may be unable to walk at all, or even stand unsupported. There is a significant risk of falls. |
| Care | People with this level of restriction would normally have significant difficulty coping with most activities of daily life. They may be unable to, or have significant difficulty in rising, leading to difficulty or inability to get out of a normal chair, out of bed, rise from the toilet or out of the bath. They would normally have significant difficulty or be unable to climb stairs safely. A risk of falls is likely, and due to muscle weakness or spasticity they would normally be unable to get up following a fall. |
Where there is upper limb and lower limb and cognitive involvement while each is considered separately when assessing functional restriction it must be borne in mind that the combined effects on a persons ability to self care and get around may be greater than the individual components.
