Airport: The Ultimate Mobility Test

What the Airport Taught Me About “FuNcTiOnAl MoBiLiTy”

Airports are fascinating places. They are also some of the most demanding environments for functional mobility. While waiting for my own flight, I noticed how traveling challenges balance, strength, coordination, and endurance in ways we often overlook. Below are a few observations, written through the lens of what people were struggling with, why those struggles occur, and how we can bring those lessons back into the clinic.

Observation 1: Constant Awareness in a Busy Environment

Walking through an airport is like walking through a living obstacle course. People dart in every direction, stop abruptly, pivot without warning, and drift into your path while staring at their phones or wearing headphones. The environment is visually and overwhelming with constant announcements, rolling suitcases, and flashing signs.

Primary Function Challenged:

• Dynamic balance, anticipatory and reactive postural control, dual-tasking (visual + auditory + motor integration).

Difficulties Presented:

• Navigating through crowds with abrupt starts, stops, and pivots.

• Sensory overload in busy, noisy settings (visual clutter, auditory noise, distractions like headphones).

Safety Risk:

• Collisions, trips, or falls when unable to adapt quickly.

• Increased risk for individuals with slowed motor responses or impaired sensory integration.

Clinical Takeaways:

• Emphasize dynamic balance and gait training in variable environments (obstacle courses, sudden stop/start cues, walking with head turns).

• Practice dual-task training (walking while responding to auditory/visual cues).

• Populations at higher risk include individuals with Parkinson’s disease (freezing episodes, initiation difficulty) and those with vestibular impairments/VOR deficits, where gaze stabilization is compromised.

Observation 2: Managing Luggage

Watching people navigate the airport with luggage is a lesson in multitasking. Some glide effortlessly with rolling bags, weaving through coffee stands and crowds, but many struggle. A small shift in a suitcase’s wheels can pull them off balance, and weaving around obstacles requires coordination that does not come naturally to everyone. Then there is the dreaded overhead bin. People lift heavy carry-ons above their heads in cramped aisles, often while trying not to bump into fellow passengers already seated.

Primary Function Challenged:

• Upper/lower body coordination, fine motor skills, strength, and balance.

Difficulties Presented:

• Steering rolling luggage through obstacles.

• Lifting carry-ons overhead in tight, crowded aisles.

• Limited ability to use protective reactions if balance is lost.

Safety Risk:

• Shoulder strain or injury from awkward lifting mechanics.

• Loss of balance while one hand is occupied with luggage.

Clinical Takeaways:

• Train functional strength for lifting tasks (simulated overhead bin lifts, loaded carries).

• Incorporate coordination training, navigating with resistance or weighted carts.

• Teach safe body mechanics and lifting strategies.

• Neurologic populations (stroke, hemiplegia, MS) may especially struggle with the dual demand of carrying + navigating.

Observation 3: Walking On/Off Moving Walkways

The moving walkway is one of the trickiest parts of the airport. People step onto a surface that suddenly carries them forward at a faster speed than they were walking. A few minutes later they must step off and instantly adjust their gait to slower ground. This abrupt change in speed demands quick anticipatory and reactive balance.

It was easy to see how people miscalculated their steps when exiting, often stumbling forward or overcorrecting as the ground no longer moved beneath them. Add a suitcase in each hand and the ability to catch yourself with an arm swing is gone.

Primary Function Challenged:

• Gait adaptability, vestibular recalibration, anticipatory and reactive balance.

Difficulties Presented:

• Sudden change in velocity requires immediate gait adjustment.

• Hands often occupied with luggage, reducing protective reactions.

Safety Risk:

• High fall risk at entry/exit points, particularly if distracted or fatigued.

• Overcorrection and loss of balance when stepping off.

Clinical Takeaways:

• Practice variable speed gait training (treadmill transitions, perturbation training).

• Incorporate dual-task balance challenges to mimic divided attention scenarios.

• Focus on anticipatory postural adjustments in populations like Parkinson’s, where speed transitions are particularly impaired.

Observation 4: TSA Security Check

TSA security is its own form of functional mobility test. People shuffle through the line until it is their turn to quickly unload bags, remove belts and jewelry, and reorganize belongings into bins. I saw how those with coordination or fine motor difficulties immediately fell behind, struggling to unzip luggage, pull out electronics, or take off accessories while dozens of impatient travelers watched. The pressure of the line only added to the anxiety and slowed them down even more.

Primary Function Challenged:

• Fine motor control, executive function, and task sequencing.

Difficulties Presented:

• Quickly unloading/opening luggage, removing belts/jewelry, reorganizing belongings.

• Pressure from line pace can increase stress and decrease efficiency.

Safety Risk:

• Panic or rushing leads to missteps, dropped items, or falls.

• Older adults or those with neurologic conditions (Parkinson’s, MS, cerebellar damage, tremor disorders) may experience heightened frustration and physical difficulty.

Clinical Takeaways:

• Simulate functional tasks under mild time constraints in therapy (packing/unpacking, buttoning/unbuttoning).

• Practice task sequencing and dual-tasking to support executive function under stress.

• Train fine motor skills alongside gross mobility.

Observation 5: Sleeping with Neck Pillows

This observation is a little less serious, but hard to miss when walking around any airport. I believe there is an illusion of comfort created by neck pillows. I saw dozens of travelers contorting themselves into odd positions, pressing their heads into the side of the chair or curling forward in ways the pillow was never meant to support. While it allowed them to catch some sleep, I imagine many woke up with stiff or painful necks. Just because you own a neck pillow shouldn’t mean anything goes.

Parting Words

Airports are not just travel hubs. They are full-scale mobility challenges that demand awareness, adaptability, and resilience. By paying attention to these real-world struggles, we as clinicians can better prepare patients for them. Education and targeted training can help prevent falls, reduce anxiety, and make what should be an exciting trip less of a physical and mental burden.

Most importantly, therapy must be task specific. It is not enough to prepare patients only for generic daily activities. We need to understand what is meaningful to each person, whether that is traveling, gardening, playing with grandchildren, or returning to a favorite hobby. When we design therapy that reflects their goals and life interests, we are not just preventing falls, we are helping people participate fully and live meaningful lives.

Disclaimer

I am a current Doctor of Physical Therapy (DPT) student sharing information based on my formal education and independent studies. The content presented in this newsletter is intended for informational and educational purposes only and should not be considered professional medical advice. While I strive to provide accurate and up-to-date information, my knowledge is based on my current academic and clinical rotations and ongoing learning, not extensive clinical practice.