by Barbara Purdy, Reg. OT, Reg. PT
Most people using walkers are over 65 years old and have problems that are musculo-skeletal (muscle/bone) or neurological. They most commonly have arthritis, mainly in their knees and hips, or they have fractured a bone, are post surgical, or are recovering from a debilitating illness. Conditions which lead to walker use include Osteoporosis, Multiple Sclerosis, Parkinson’s Disease, or hemiplegia (when half of a person’s body is paralyzed, often due to a stroke).
As with most medical devices, choosing a walker should be done with care. For people with complicated conditions especially, choosing a walker should be under the guidance of an occupational or physiotherapist because their needs vary so greatly.
Reasons for using a walker:
The main reason for someone to use a walker is to help increase their ability to walk independently and safely, increase the amount and distance they can walk, and to decrease pain and discomfort while walking. The result of using a walker can be increased independence, self confidence, and life satisfaction.
To determine the correct walker to use, consider the following:1) Balance: As people age, they may have increasing difficulty to remain upright and balanced. “Postural Sway,” is their unconscious attempt to remain stable by constantly correcting their muscles. The person often walks with their feet wide apart to try to control this “sway” and stay balanced. They are at risk of falling. A walker gives them a wider base of support when walking, helping to overcome this “postural sway” and keep them from falling.
2) Weight Bearing: Some people are not able to tolerate the body’s full weight through their legs due to pain or weakness. A walker allows the arms to assist by pushing down on the frame, allowing the walker to take on some of this weight. This helps to correct posture and gait.
3) Endurance: A walker can be used as an energy saver if a person has heart disease, breathing restrictions, or fatigues quickly.
4.) Build muscle strength and agility: Following a stroke, hospitalization, or other illness, or simply from lack of activity, muscle strength and agility may decline. Walkers help people re-build their muscles and regain optimal mobility.
Types of walkers:
Although price is, of course an important consideration, it should not be the only factor which determines your choice of walker. Cheaper versions may be just that – cheap. Some of the features in a more expensive walker are worth the extra expense.
1) Basic Frame with rubber tips – no wheels
This walker provides the most support and stability. By being “steady” and not moving much, it helps you control your own body and learn to be upright. More of your weight can be supported through your arms with less weight on your legs. Because it gives more support, it must be picked up and moved before every step. The resulting gait or walking rhythm is not smooth, but for some individuals it is more important to have stability. Advantage: Good for moving very short distances and transferring from one chair to another. Attachable trays are available for carrying small items. Disadvantage: Not recommended for walking greater distances.
2) Basic Frame with two 5″ wheels at front and 2 glides at back.
This walker assumes you have more mobility and can take more of your body weight through your legs. It is easier on your arms and the resulting walking steps are more natural. The walker still gives a lot of support as you can stand within the frame, but instead of “lifting” the walker, you just “push” it forward. It slides as you walk, rolling easily on the front wheels while the back glides slow the movement and controls the speed. This walker allows a more normal gait pattern and is the most common walker used for indoors. Advantage: Takes up less space when maneuvering in the house and folds for storage. Good on carpets. Attachable trays are available for carrying small items. Disadvantage: Not good for outdoor use as small wheels can get stuck causing tripping on the rougher terrain.
3) Walker with 4 wheels, seat, and braking system.
- There are some lighter versions with wheels available for indoor use that can be taken outdoors. Generally, the users of these walkers are more independent and need the walker for balance or weakened bones (osteoporosis) and the weight of a normal walker would be too heavy. (Lightweight walkers are under 15 lbs). A 3-wheeled walker is not recommended as it can tip. Advantage: these walkers are lighter and easier to fit into the back of a car. Disadvantage: Because the walker is light, if a lot of force is needed to sit down on it, the walker may slip backwards.
- A (“Rollator”) regular weight walker is generally around 20 lbs. and there are many to choose from. Look for well-constructed frames with large 8″ wheels, comfortable, adjustable handgrips with easy to manage hand breaks, adjustable back supports, seats available in different heights and a carry basket. Some of the better walkers have a seat that folds up when in use so you can move into the frame. Others have the wheels wider at one end so the user does not trip on the frame if they walk with their feet far apart. Slow down brakes attached to the wheels are also helpful if hand strength alone does not fully operate the brake. Extras include oxygen tank holders, trays etc. Advantages: As the walker has a seat, the user can walk a longer distance and sit down when tired. Also these walkers can be used as an exerciser by increasing the distance and speed walked daily and thus improving endurance and strength. Disadvantage: Can be very bulky for indoor use.
Barbara Purdy is Diamond Geriatrics’ Physiotherapist/ Occupational Therapist. She is also the owner of Free to Be/Rehabilitation Consulting Inc. (www.freetobe.ca)
Measuring for Walkers
by Barbara Purdy, Reg. OT, Reg. PT
A walker is most helpful when correctly measured for the individual who will be using it. A properly fitted walker is especially important when it is needed by someone who is quite fragile or at great risk for falls.If someone is being discharged from hospital and may need a walker, request an assessment by a therapist in hospital before discharge.
Both Occupational Therapists and Physiotherapists are trained in measuring and assessing the correct walker for an individual. If you purchase a walker from a Home Health agency or a Health Equipment provider their personnel may have some training in measuring for walkers, as well as wheelchairs and other equipment. When shopping for a walker, ask about the training is of the person who is selling it.
To measure for a correct walker, first make sure the person is wearing the shoes they will have on when using the walker. Ideally these are good, supportive shoes.
A basic frame walker, with or without wheels, allows the person to move into the walker and be more upright when they walk. So a quick measure is to have them stand within the frame with their arm at their side. The handgrip should just come to their wrist crease. When the arm is then positioned on the handgrip, the elbows will be roughly at 15 degrees. The arm is strongest in this position for pushing down. If shoulders are elevated the walker is too high. Often people using a frame walker push it too far ahead of them and thus walk bent over.
A rollator walker will not allow as much weight to be taken through the arms, so the wrist crease method is just a guideline. Look more at the persons’ posture. Are they erect or bent over? Sometimes the walker must be raised to support their upper body. Are their feet hitting the walker frame when they walk? The walker frame may be too narrow for them. The height of the seat is important as it is easier to get up from a higher seat, but it is also important to have the feet touching on the ground. Often public benches are too low for people to use so the correct seat height of the walker is important.
Once someone has a properly fitted and measured walker, they have themselves a wonderful tool to help prevent falls, increase strength, well being, and independence.
