Academic journal article International Journal of Child Health and Human Development

Foot Care and People with Intellectual Disability

Academic journal article International Journal of Child Health and Human Development

Foot Care and People with Intellectual Disability

Article excerpt

Introduction

The condition and capacity of a person's feet and legs is fundamental for their gait and mobility, which in turn underpin health, independence, and quality of life. This vast area of health care for people with intellectual and developmental disability (IDD) begins with appreciating the basics of gait and footwear, which need to be appended to the large impact issues of falls, diabetes, amputation, and the legality of informed consent.

Gait

The complexities of gait, and the impact of gait on an individual's health and quality of life, cannot be underestimated. Independent gait is physical autonomy, and entre to a breadth of work, sport, and life options, more preclusive to those who do not have such functioning. Even the least elegant of bipedal gaits affords an individual with the basic ability to transport themselves from A to B, and needs to be preserved at all costs - especially given the high prevalence of overweight and obesity in people with IDD.

Aids to gait come in different forms - intrinsic (e.g., strength, balance training) or extrinsic (orthoses, wheeled walker frames, walking sticks, glasses for vision).

Gait evaluation (see figure 1)

There are several validated and useful approaches to the assessment of gait and foot functional capacity for people of all ages and abilities. GALS (gait, arms, legs, spine) is a particularly helpful and standardized method of assessment. There is also a pediatric version of the GALS assessment format (p-GALS), making this a useful lifespan approach to assessment. The screening examination includes three questions, which can be incorporated into routine enquiry. These include:

· "Do you have any pain or stiffness in your muscles, joints or back?"

· "Can you dress yourself completely without any difficulty?"

· "Can you walk up and down the stairs without any difficulty?"

The patient's gait is assessed for symmetry and smoothness as well as the ability to turn quickly. With the patient standing there are many postural attitudes to consider. From behind, observe the patient for normal shoulder muscle bulk, straight spine, level iliac crests, gluteal bulk and symmetry, any popliteal swelling, calf muscle bulk and any rear-foot abnormalities.

From the side, look for normal cervical lordosis, thoracic kyphosis, lumbar lordosis and evidence of knee flexion or hyperextension. Ask the patient to touch their toes assesses both hip and lumbar flexion. Lumbar movement may be assessed by placing two or three fingers on the lumbar spine. Inspect for shoulder bulk, elbow extension, quadriceps bulk and symmetry, knee swelling and deformity, foot arches and any mid-foot or forefoot deformity.

Lateral flexion of the cervical spine is performed, followed by assessment of the temporomandibular joints. Full shoulder abduction and external rotation is performed by asking the patient to place their hands behind their head. Assess the hands: inspect for swelling and deformity of wrists and hands. Inspect the palms of the hands for muscle bulk and other visual abnormality. Power grip assesses wrist and hand function; squeezing the examiner's fingers assesses strength. Fine precision pinch tests hand joint movement, co-ordination and concentration. Gently squeezing the metatarsophalangeal joints screens for inflammatory joint disease.

With the patient on the examination couch, assess full knee flexion and internal rotation of the hip in flexion. A patellar tap should be performed to exclude knee effusions. The soles of the feet should be inspected for callus formation, and finally squeeze the metatarsophalangeal joints again to screen for inflammatory arthritis.

Regional examination of the musculoskeletal system (REMS) refers to a detailed examination that should be carried out once an abnormality has been detected either through the history or through the screening examination GALS. REMS has a simple look/feel/move/function approach. …

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