Symptom: Walking, Difficulty

Initial Grading Reminder

CTCAE Grading of Walking Difficulty:

Grade 1: Mild change in gait (e.g., wide-based, limping, or hobbling)
Grade 2: Moderate change in gait (e.g., wide-based, limping, or hobbling); assistive device indicated; limiting instrumental ADLs
Grade 3: Disabling; limiting self-care ADLs

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had any issue with walking in the past? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

How difficult do you find it to walk? Are you able to walk unaided or do you need a cane/walker? Are you able to do the things you want to do and take care of yourself?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you have any difficulty breathing? Have you fallen?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Patients with new onset moderate or worse (or worsening) walking difficulty need to be seen.

    Patients with any of the red-flag symptoms should be seen immediately.

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    Nursing Assessment of Potential Causes

    Neuropathy - Nursing Assessment

    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Does the patient appear weak?
    • Does the patient appear uncomfortable?
    • Altered ambulation or general movement?
    • If muscular weakness is present, any respiratory difficulties apparent?
    • Does the patient report weakness (unilateral or bilateral)?
    • Does the patient report new or worsened pain, numbness, or tingling?
    • Does the patient report difficulty walking or holding items?
    • Motor deficits
    • Sensory deficits
    • Mental status changes
    • Paresthesias
    • Laboratory values
    • Does the patient have diabetes mellitus?
    • Are there neurologic signs and symptoms?
    • Results of prior imaging
      • Metastases to spinal cord
      • Other metastases that may cause symptoms

    Differential Diagnosis

    What do you suspect is the cause of difficulty walking?