Impaired Mobility

 

Instructions: Fill out this form, print it, and hand it in with your assessment to your instructor. When you click on Next at the bottom of the page, you see the data you submitted. Please follow the instructions on how to save the data on the next page.

AOL users: Read this instruction.

Definition: limitation of purposeful, independent movement of body or extremity

1. Your initials (required): 

2. Defining Characteristics- check those that apply to your client:

None- high risk diagnosis limited gross motor skills  limited fine motor skills 
changes in gait  limited range of motion  decreased strength  impaired coordination   postural instability 
3. Related Factors- check those that apply to your client:

pathophysiologic disorders (musculoskeletal, neuromuscular, pain, malnutrition)  depressive mood or anxiety  medications  sedentary lifestyle or disuse  sensoriperceptual impairments  trauma  surgery (amputation, joint replacement for example)


4. Goal (ultimate, long term) 

5. Outcome Criteria (short term) 

6. Evaluation: Was the outcome criteria met? 

Yes- Give Evidence: 

No- Explain how you would change the plan: 

7A. Interventions 

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7B. Rationale for each intervention

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