Loss of transfer capacity

Specialty: Geriatrics.

• inability to get out of bed or chair
• postural transfer failure
• motor dependence for transfers
• standing lock

Why it occurs

• Severe proximal myopathy due to chronic disuse, severe malnutrition or advanced sarcopenia
• Ankylosing bilateral lumbosacral or coxofemoral osteoarthritis with severe and disabling pain at the beginning of passive mobilization
• Acute physical deconditioning syndrome established after a prolonged hospital stay or immobility at home
• Advanced Parkinson's disease with freezing and severe akinesia
• Multiple lacunar stroke affecting the extrapyramidal or pyramidal motor pathways

Initial workup

Physical functional evaluation using the SPPB battery, paying special attention to the test of getting up from the chair 5 consecutive times; anteroposterior radiograph of the pelvis, both hips and lumbosacral spine; arterial Doppler ultrasound of the lower extremities when suspected concomitant critical ischemia; blood work including electrolytes, serum levels of creatine kinase (CK), albumin, prealbumin and vitamin D; formal evaluation by a physical or occupational therapist of transfer patterns and the need for technical aids.

Standard management

• Paracetamol — 650 mg to 1 g orally three times a day administered on a scheduled basis, not on demand, to ensure a stable analgesic level that reduces the limiting pain of weight-bearing joints
• Tramadol — low doses of 25 mg to 50 mg orally every 8-12 hours, only if control with paracetamol is insufficient, monitoring the appearance of adverse effects such as constipation, sedation, nausea or delirium
• Calcitriol — 0.25 mcg orally per day in patients with associated severe renal failure to optimize bone remodeling and neuromuscular function
• Suspension of muscle relaxant drugs or benzodiazepines that depress muscle tone and alter postural reflexes.