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Lisa I. Iezzoni, MD, MSc, Discussant

JAMA. 2000;284:2632-2639.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

DR DELBANCO: Mrs D is a 44-year-old woman with amyotrophic lateral sclerosis (ALS) who is having increasing difficulty ambulating. Married, with children and a grandchild, she lives outside Boston. Mrs D has commercial, managed care health insurance and is currently applying for Social Security Disability Insurance. She received primary care in a community-based practice, but for the past year, her principal physician has been Dr V, a neurologist at Beth Israel Deaconess Medical Center.

In fall 1998, Mrs D noted stiffening of her leg muscles on awakening, followed shortly thereafter by a feeling of "deadness" and resistance to motion. During active exercise as part of a weight control program, she began to trip while running and fell several times. She next developed morning leg spasms, without sensory symptoms, followed by twitching, initially involving the legs, but spreading subsequently to the trunk and facial muscles. . . . [Full Text of this Article]

MRS D: HER VIEWS

DR V: HER VIEWS

AT THE CROSSROADS: QUESTIONS FOR DR IEZZONI

Prevalence of Disability and Impaired Mobility in the United States

Psychosocial and Emotional Effects of Impaired Mobility

Role of Health Professionals in Addressing Mobility Impairments

Mobility Aids

Health Insurance and Financial Implications

Other Resources for People With Impaired Mobility

Recommendations for Mrs D

QUESTIONS AND DISCUSSION

Author Affiliation: Dr Iezzoni is Professor of Medicine, Harvard Medical School, Co-Director of Research, Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory, Boston, Mass.

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