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When Walking Fails

When Walking Fails: Mobility Problems of Adults with Chronic Conditions

Copyright Date: 2003
Edition: 1
Pages: 366
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  • Book Info
    When Walking Fails
    Book Description:

    Roughly one in ten adult Americans find their walking slowed by progressive chronic conditions like arthritis, back problems, heart and lung diseases, and diabetes. In this passionate and deeply informed book, Lisa I. Iezzoni describes the personal experiences of and societal responses to adults whose mobility makes it difficult for them to live as they wish—partly because of physical and emotional conditions and partly because of persisting societal and environmental barriers. Basing her conclusions on personal experience, a wealth of survey data, and extensive interviews with dozens of people from a wide social spectrum, Iezzoni explains who has mobility problems and why; how mobility difficulties affect people's physical comfort, attitudes, daily activities, and relationships with family and friends throughout their communities; strategies for improving mobility; and how the health care system addresses mobility difficulties, providing and financing services and assistive technologies. Iezzoni claims that, although strategies exist to improve mobility, many people do not know where to turn for advice. She addresses the need to inform policymakers about areas where changes will better accommodate people with difficulty walking. This straightforward and engaging narrative clearly demonstrates that improving people's ability to move freely and independently will enhance overall health and quality of life, not only for these persons, but also for society as a whole.

    eISBN: 978-0-520-93712-3
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. List of Illustrations and Tables
    (pp. ix-x)
  4. Foreword
    (pp. xi-xii)
    Daniel M. Fox and Samuel L. Milbank

    The Milbank Memorial Fund is an endowed national foundation that engages in nonpartisan analysis, study, research, and communication on significant issues in health policy. The Fund makes available the results of its work in meetings with decision makers, reports, articles, and books.

    When Walking Failsis the eighth of the California/Milbank Books on Health and the Public. The publishing partnership between the Fund and the Press seeks to encourage the synthesis and communication of findings from research that could contribute to more effective health policy.

    This book is about statistics, health services, policy, and the experience of people whose mobility...

  5. Acknowledgments
    (pp. xiii-xiv)
  6. Preface
    (pp. xv-xxii)
  7. 1 Mobility Limits
    (pp. 1-9)

    One Christmas my husband and I went to an exclusive shop downtown to buy my father a tie. It is one of those stores where you feel scrutinized by security cameras even if you do not roll in on a battered old scooter held together by bright red airline baggage tape. The saleslady eyed us with barely veiled suspicion as we sorted through the tie rack. When we finally selected a tie and pulled out our credit card, she brightened up and began talking about her mother.

    Her mother had had a stroke. She had largely recovered but was terrified...

  8. 2 Who Has Mobility Difficulties
    (pp. 10-22)

    How many people have trouble walking? It′s hard to tell from simply looking around. Even just three decades ago, many people with difficulty walking were ″somehow made invisible and kept isolated from the rest of the world″ (Zola 1982, 95). Nowadays, high-profile celebrities roll in their wheelchairs before the public eye: Christopher Reeve, once a comic book superhero, now an effective albeit controversial advocate of medical research; John Hockenberry, a broadcast journalist, reporting from around the world; Stephen Hawking, an astrophysicist, spinning theories of the universe; and Barbara Jordan, the late congresswoman from Texas, who some said had the voice...

  9. 3 Sensations of Walking
    (pp. 23-46)

    Most people walk without giving it a thought. Their legs automatically and painlessly obey the myriad impulses zipping to and from their brains, moving them effortlessly at will. These complex commands and compliant responses do not penetrate consciousness until something goes wrong. Reynolds Price, the novelist and radio commentator, described warning signals sent by his still-hidden spinal tumor as he rushed one afternoon, late for an appointment: ″I should hurry along. I know I thoughtRun, a conscious signal, but I couldn′t run. The command had got no further than my brain. Some bridge was out. I stalled … inexplicably...

  10. 4 Society′s Views of Walking
    (pp. 47-65)

    ″Lena Walks!″ my sister announced excitedly on the subject line of her e-mail message. Her little daughter had astonished parents and daycare workers alike by taking her first independent steps at eight months. After initial forays, she retrenched and resumed crawling, but that was too slow. Lena soon walked again, then started running lickety split. Two months later we observed this phenomenon firsthand. Lena ran everywhere, joyously climbing stairs, jumping delightedly, and laughingly being swept from the precipice of disaster by vigilant parents. After two days, merely watching made me weary. ″Don′t you wish Lena had walked a little later?″...

  11. 5 How People Feel about Their Difficulty Walking
    (pp. 66-82)

    Many years ago, when I still walked with one cane, a close friend took Reed and me to her new boyfriend′s house for dinner. We′d heard good reports about this fellow and wanted to like him. Such meetings are often awkward, and after several forays, conversation finally focused on travel. The new boyfriend recounted well-researched ventures to distant, exotic destinations. In concluding, he asserted that he wanted to travel while he still could, before he got too old and slow. ″Frankly,″ he said, turning to me, ″I wouldn′t want to live like you.″

    In deference to our friend, we let...

  12. 6 At Home—with Family and Friends
    (pp. 83-104)

    One night several years ago, a familiar driver picked me up in his wheelchair-accessible taxi at Boston′s Logan Airport. He had immigrated from Afghanistan and wore traditional garb—colorful crocheted cap and multilayered thigh-length cotton shirting—despite the biting December cold. The first time he had driven me, he had asked immediately if I was married, then said how happy he was to bring me home to my husband. He had driven me several times since, always asking the same question: ″How is your husband?″

    ″He′s fine.″

    ″I remember you. I think about you. I talk about you to my...

  13. 7 Outside Home—at Work and in Communities
    (pp. 105-126)

    The possibility of experiencing discrimination had never occurred to me—of course not, given my demographics. I am white, upper middle class, well educated, from a family of girls taught we could achieve whatever we wanted if we worked hard enough. I therefore didn′t recognize the warning signs until they almost literally knocked me over.

    As I noted in the preface, the uncertainty and physical consequences of MS consumed most of my psychic energy during my years at Harvard Medical School. And people′s reactions to the ″me″ they equated with MS were equally daunting. Though the medical school made necessary...

  14. 8 People Talking to Their Physicians
    (pp. 127-141)

    ″Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick,″ wrote Susan Sontag (1990, 3). ″Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.″ Sontag argues that, when ill, we should remain unencumbered by ″punitive or sentimental fantasies concocted″ about living with illness. Her advice certainly applies when walking fails. Preconceptions about using wheelchairs, for example, typically convey dismal dependence and limited lives. Actual experiences often differ...

  15. 9 Physicians Talking to Their Patients
    (pp. 142-162)

    Medicine is not monolithic. As in other professions, some physicians, generalists and specialists alike, are more knowledgeable, technically skilled, and interested than others. I interviewed wonderful physicians who seemingly do the ″right″ things for people with mobility problems. Nevertheless, as mentioned repeatedly by physician interviewees, especially those in primary care: physicians receive little training about addressing mobility; they wonder if it′s really their job; and general medical publications provide little information about assessing mobility or physical functioning, in general. No wonder people sometimes question the utility of talking to physicians about walking problems.

    Ironically, however, physicians are the anointed arbiters...

  16. 10 Physical and Occupational Therapy and Other Approaches
    (pp. 163-180)

    Dr. Alan Magaziner feels stymied. He hits that ″borderline between what′s medical and what′s social″ and can′t make the leap. Firmly rooted on the medical side, he recognizes that walking difficulties raise complex issues—physical, psychological, social, environmental—that he is poorly equipped to address. Unsure exactly what they do, Dr. Magaziner nonetheless calls on physical or occupational therapists (PTs or OTs).

    These two health professions have roots not only in medicine but also in social perspectives, including the effect of environmental factors on people′s daily functioning. Their approach thus ″melds two significantly different models of health, illness, and medical...

  17. 11 Ambulation Aids
    (pp. 181-196)

    I had no choice about using a cane. One day during my surgical rotation in medical school, my right leg suddenly collapsed, and the fall broke a small bone in my foot—the fifth metatarsal. The fracture was minor, the pain abating within a week. The cane aided bone healing by off-loading weight from the foot. Afterward the cane steadied my veering, unbalanced gait.

    Despite its utility, the cane embarrassed me—I′m not sure exactly why. It precipitated a barrage of eerily identical questions: ″Did you have a skiing accident?″ I had never skied in my life, unless you count...

  18. 12 Wheeled Mobility
    (pp. 197-222)

    Several years elapsed before I acceded to the guard′s prediction—that I would need a wheelchair sooner or later—and purchased my scooter-wheelchair. I raised all the usual objections: using a scooter conceded failure; I would never walk again; my remaining muscle strength would wither; riding was embarrassing; and I didn′t want to be seen that way. Having left an awkward girlhood, I relished being tall. And in a wheelchair, I would constantly gaze up at the world rather than look it straight in the eye. But the countervailing arguments won. My legs carried me shorter and shorter distances, more...

  19. 13 Who Will Pay?
    (pp. 223-238)

    When I bought my first scooter over a dozen years ago, I had a gold-plated indemnity insurance policy, now virtually extinct, from Blue Cross–Blue Shield. The benefits package clearly included wheelchairs, but Blue Cross rejected my claim, arguing that a scooter-type electric wheelchair is a ″recreational vehicle″ analogous to a ″golf cart″—a convenience item. Two neurologist friends intervened with letters and telephone calls, but Blue Cross stood firm. The insurer did offer to pay for a four-wheeled power wheelchair (then about $4,500), but not a scooter-type wheelchair (roughly $2,300), never mind that the scooter better suited my mobility...

  20. 14 What Will Be Paid For?
    (pp. 239-259)

    A colleague who lives in a small mountain town described his neighbor. ″Mary Jo is her name. She lives three blocks from us. She′s thirty-nine or forty, and she has diabetes. She′s had one leg amputated, and the other leg is constantly in danger. She lives in a low-income apartment, one of those little places like a motel room. Some friends raised the money and gave her an electric wheelchair—a real cheap one, but it allowed her to get out the door and up to a small park. On a nice spring day, she can go out and sit...

  21. 15 Final Thoughts
    (pp. 260-272)

    A father called me recently to ask advice about his daughter Julie. The father is a physician, retired from practice but still well connected and vigorous. Julie, in her mid forties, had quit working several years ago because of MS. Her disease exhausts her, leaving her virtually bedridden on bad days. Without respite, it waxes and wanes, bringing disheartening new symptoms and giving her little peace. Julie′s walking, however, had been reasonably good until now.

    Julie′s father didn′t ask about cures for MS or techniques to improve her walking. Through his medical connections, she has seen the best neurologists and...

  22. APPENDIX 1. Familiar Interviewees
    (pp. 273-280)
  23. APPENDIX 2. Selected Resources
    (pp. 281-296)
  24. Notes
    (pp. 297-318)
  25. References
    (pp. 319-334)
  26. Index
    (pp. 335-355)
  27. Back Matter
    (pp. 356-356)
  28. [Illustrations]
    (pp. 357-362)