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

    [tab category='Neuropathy' header="Neuropathy - Nursing Assessment" tab1='Look' tab2='Listen' tab3='Recognize']

    Differential Diagnosis

    What do you suspect is the cause of difficulty walking?