Walkers: Difference between revisions

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== Introduction  ==
== Introduction  ==
[[File:Modern Rollator.jpg|thumb|Modern style Rollator]]A walker'''&nbsp;'''is a [[Walking Aids|walking aid]] that has four points of contact with the ground and usually has three sides with the side closest to the patient being open. It provides a wider [[Base of Support|base of support]] than a [[Canes|walking stick]] and so is used more to stabilise patients with poor [[balance]] and mobility.   
[[File:Modern Rollator.jpg|thumb|Modern style Rollator]]A walker'''&nbsp;'''is a [[Walking Aids|walking aid]] that has four points of contact with the ground and usually has three sides with the side closest to the patient being open. It provides a wider [[Base of Support|base of support]] than a [[Canes|walking stick]] and so is used more to stabilise patients with poor [[balance]] and mobility.<ref>Arefin P, Habib MS, Arefin A, Arefin MS. [https://www.researchgate.net/publication/341463954_A_comparison_of_mobility_assistive_devices_for_elderly_and_patients_with_lower_limb_injury_Narrative_Review A comparison of mobility assistive devices for elderly and patients with lower limb injury: Narrative Review]. Int J Aging Health Mov. 2020 May 17;2(1):13-7.</ref><ref name=":1">Prajapati G, Sharmila K. [http://gerontologyindia.com/pdf/vol34-3.pdf#page=118 Role of assistive devices in wellbeing of elderly: A review]. Indian journal of Gerontology. 2020;34(3):394-402.</ref>    


Having a caregiver and being unable to walk more than one metre per second has been significantly associated with walking frame use<ref>Suwannarat P, Thaweewannakij T, Kaewsanmung S, Mato L, Amatachaya S. [https://www.sciencedirect.com/science/article/pii/S1013702514000463 Walking devices used by community-dwelling elderly: Proportion, types, and associated factors.] Hong Kong physiotherapy journal. 2015 Jun 1;33(1):34-41.</ref>. Paradoxically, walker or frame use has been associated with an increased risk of falls in both the community-dwellers and those who live in residential care<ref>Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. [https://pubmed.ncbi.nlm.nih.gov/20585256/ Risk factors for falls in community-dwelling older people:" a systematic review and meta-analysis"]. Epidemiology. 2010 Sep 1:658-68.</ref><ref>Deandrea S, Bravi F, Turati F, Lucenteforte E, La Vecchia C, Negri E. [https://pubmed.ncbi.nlm.nih.gov/23294998/ Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis.] Archives of gerontology and geriatrics. 2013 May 1;56(3):407-15.</ref>.  Despite the positive correlation between device use and falls, caregivers report mobility aids promote independently mobility in people with disability,<ref>Hunter SW, Meyer C, Divine A, Hill KD, Johnson A, Wittich W, Holmes J. [https://pubmed.ncbi.nlm.nih.gov/32233813/ The experiences of people with Alzheimer's dementia and their caregivers in acquiring and using a mobility aid: a qualitative study]. Disabil Rehabil. 2021 Nov;43(23):3331-3338.</ref> and users report that mobility aids increase opportunities for social interactions<ref>Bertrand, K ''et al.'' [https://journals.lww.com/ajpmr/FullText/2017/12000/Walking_Aids_for_Enabling_Activity_and.8.aspx?casa_token=tPoMPGYTVV8AAAAA:0IxjU6ni0PxuSkvs41ACHSt6z-avgAJ6BU0Aq3jC9nVVv3mTyVKqbNuejeQO8mvYCLAZlcQ2PCv7PQ4W0mXF Walking Aids for Enabling Activity and Participation], American Journal of Physical Medicine & Rehabilitation: December 2017 - Volume 96 - Issue 12 - p 894-903</ref>. Using a walker can also increase metabolic and musculoskeletal demands so prescription and education is key to helping the user maintain their balance, minimise their [[falls]] risk and optimise their activity levels<ref>Bateni H, Maki BE. [https://www.archives-pmr.org/article/S0003-9993(04)00474-5/fulltext Assistive devices for balance and mobility: benefits, demands, and adverse consequences.] Archives of physical medicine and rehabilitation. 2005 Jan 1;86(1):134-45. </ref>.   
Having a caregiver and being unable to walk more than one metre per second has been significantly associated with walking frame use<ref>Suwannarat P, Thaweewannakij T, Kaewsanmung S, Mato L, Amatachaya S. [https://www.sciencedirect.com/science/article/pii/S1013702514000463 Walking devices used by community-dwelling elderly: Proportion, types, and associated factors.] Hong Kong physiotherapy journal. 2015 Jun 1;33(1):34-41.</ref>. Paradoxically, walker or frame use has been associated with an increased risk of falls in both the community-dwellers and those who live in residential care<ref>Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. [https://pubmed.ncbi.nlm.nih.gov/20585256/ Risk factors for falls in community-dwelling older people:" a systematic review and meta-analysis"]. Epidemiology. 2010 Sep 1:658-68.</ref><ref>Deandrea S, Bravi F, Turati F, Lucenteforte E, La Vecchia C, Negri E. [https://pubmed.ncbi.nlm.nih.gov/23294998/ Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis.] Archives of gerontology and geriatrics. 2013 May 1;56(3):407-15.</ref>.  Despite the positive correlation between device use and falls, caregivers report mobility aids promote independently mobility in people with disability,<ref>Hunter SW, Meyer C, Divine A, Hill KD, Johnson A, Wittich W, Holmes J. [https://pubmed.ncbi.nlm.nih.gov/32233813/ The experiences of people with Alzheimer's dementia and their caregivers in acquiring and using a mobility aid: a qualitative study]. Disabil Rehabil. 2021 Nov;43(23):3331-3338.</ref> and users report that mobility aids increase opportunities for social interactions<ref>Bertrand, K ''et al.'' [https://journals.lww.com/ajpmr/FullText/2017/12000/Walking_Aids_for_Enabling_Activity_and.8.aspx?casa_token=tPoMPGYTVV8AAAAA:0IxjU6ni0PxuSkvs41ACHSt6z-avgAJ6BU0Aq3jC9nVVv3mTyVKqbNuejeQO8mvYCLAZlcQ2PCv7PQ4W0mXF Walking Aids for Enabling Activity and Participation], American Journal of Physical Medicine & Rehabilitation: December 2017 - Volume 96 - Issue 12 - p 894-903</ref>. Using a walker can also increase metabolic and musculoskeletal demands so prescription and education is key to helping the user maintain their balance, minimise their [[falls]] risk and optimise their activity levels<ref name=":1" /><ref>Bateni H, Maki BE. [https://www.archives-pmr.org/article/S0003-9993(04)00474-5/fulltext Assistive devices for balance and mobility: benefits, demands, and adverse consequences.] Archives of physical medicine and rehabilitation. 2005 Jan 1;86(1):134-45. </ref>.   


People may be resistant to use walkers due to social stigma and peer pressure, particularly in minority groups. By having positive peers models, greater physician input, more visually pleasing walkers, lower cost walkers and user-friendly walkers would aid in greater acceptance.<ref>Resnik L, Allen S, Isenstadt D, Wasserman M, Iezzoni L. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768139/ Perspectives on use of mobility aids in a diverse population of seniors: Implications for intervention]. Disability and health journal. 2009 Apr 1;2(2):77-85.</ref>
People may be resistant to use walkers due to social stigma and peer pressure, particularly in minority groups<ref>Borade N, Ingle A, Nagarkar A. [https://www.tandfonline.com/doi/pdf/10.1080/17483107.2019.1701105?casa_token=s7Z8lSHDhxMAAAAA:BzInsi1V8mjKUnhoNioc-0974ldLqdk5lWu38ga7_wYU7BYHD3jUbdOdQSzJPeHmHLxjDlgAtA Lived experiences of people with mobility-related disability using assistive devices]. Disability and Rehabilitation: Assistive Technology. 2021 Oct 3;16(7):730-4.</ref>. By having positive peers models, greater physician input, more visually pleasing walkers, lower cost walkers and user-friendly walkers would aid in greater acceptance.<ref>Resnik L, Allen S, Isenstadt D, Wasserman M, Iezzoni L. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768139/ Perspectives on use of mobility aids in a diverse population of seniors: Implications for intervention]. Disability and health journal. 2009 Apr 1;2(2):77-85.</ref>


In 2009 in Australia the percentage of people with disabilities using aids was 15% [ 6.6% using walking frames, 6.7% walking sticks].<ref>Australian Bureau of statistics [ 4446.0] Disability, Australia,2009. Available from: http://www.abs.gov.au/ausstats/[email protected]/Lookup/4446.0main+features82009 [accessed 19.2.2019].</ref>
In 2009 in Australia the percentage of people with disabilities using aids was 15% [ 6.6% using walking frames, 6.7% walking sticks].<ref>Australian Bureau of statistics [ 4446.0] Disability, Australia,2009. Available from: http://www.abs.gov.au/ausstats/[email protected]/Lookup/4446.0main+features82009 [accessed 19.2.2019].</ref>

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Introduction[edit | edit source]

Modern style Rollator
A walker is a walking aid that has four points of contact with the ground and usually has three sides with the side closest to the patient being open. It provides a wider base of support than a walking stick and so is used more to stabilise patients with poor balance and mobility.[1][2]

Having a caregiver and being unable to walk more than one metre per second has been significantly associated with walking frame use[3]. Paradoxically, walker or frame use has been associated with an increased risk of falls in both the community-dwellers and those who live in residential care[4][5]. Despite the positive correlation between device use and falls, caregivers report mobility aids promote independently mobility in people with disability,[6] and users report that mobility aids increase opportunities for social interactions[7]. Using a walker can also increase metabolic and musculoskeletal demands so prescription and education is key to helping the user maintain their balance, minimise their falls risk and optimise their activity levels[2][8].

People may be resistant to use walkers due to social stigma and peer pressure, particularly in minority groups[9]. By having positive peers models, greater physician input, more visually pleasing walkers, lower cost walkers and user-friendly walkers would aid in greater acceptance.[10]

In 2009 in Australia the percentage of people with disabilities using aids was 15% [ 6.6% using walking frames, 6.7% walking sticks].[11]

A study in the USA, reported on on 2015, found that 11.6% of those over 65 used walking frames. The use of walking aids it also reported had jumped up by 50% in the last 10 years.[12]

In a Canadian study using 2012 data 4.1% of the population, 15 years and older, used a walking frame, stick or crutch. Approximately 50% of these used a walker. Since 2004 there has been a 2% increase of walking aid use in the community.[13]

Types of Walkers [edit | edit source]

Many walkers exists on the market and a physiotherapist is well placed to be instrumental in choosing the correct walker for the differing needs of users.

[14]

4 Wheeled Walker[edit | edit source]

  • Wheel size: large wheels for outdoors, small wheels for indoors
  • Push down brakes or grip on brakes
  • Ability to be folded and lightweight material such as carbon fibre, which makes travelling with the frame easier
  • Trays, seats and baskets may be attached
  • Other modifications such as a light that projects a red line on the ground in order to guide step length in individuals with Parkinsons
[15]
  • High or gutter frames for users who need more support. The user weight bears through their forearms on gutter-shaped supports, with the elbows flexed to approximately 90 degrees.
[16]
  • Pulpit frames where the user also weight bears through their forearms and hands on a padded U-shaped support, similar to leaning on a pulpit.

Variations on 4 Wheel Walkers[edit | edit source]

  • Two front legs with two rear casters
  • Two front legs and two rear wheels
  • "Square" wheels
  • A modular kit with interchangeable parts to make frames and other mobility devices. This is a great innovation made by a final year engineering student aimed at the worlds poorest communities. Such a kit helps these communities make there own mobility aids at a realist price.[17]
  • 4 wheeled walker and transport chair all in one
[18]

Prescription[edit | edit source]

There is no one walker that is more desirable than another[19].

Walker choice is dependent on:

  • what activities the user will use it for
  • where the walker will be used
  • how much support the user requires
  • the user's confidence with a walker
  • funding source for the walker - if the walker can be sourced through government funding there may be an established range to choose from


There is recent, preliminary evidence that suggests that the stability of a user and their walker can be measured "as one". The methodology considered a combined (user plus walker) centre of pressure and combined base of support (again created by user and walker, not two separate bases of support)[20]. This may not be so practical for physiotherapists, particularly those assessing users in their homes, but the physics behind the methodology is useful to consider.

Walkers should be adjustable in height, which is measured in the same way as one would measure for a walking stick[19]. Shoes should be taken into account during prescription as shoe height can significantly affect walker use[19].

Factors to take into account when prescribing a walking frame[19]:

  • Height of the frame
  • Weight of the frame when user propels and manoeuvres it
  • Base area
  • Manoeuvrability including wheel design e.g. fixed versus swivel
  • Wheel placement
  • Hand grip design
  • Arm support design
  • Folding versus unfolding
  • Attachments e.g. trays and seats

Assessing the user with a walking aid should be done using an appropriate outcome measure such as the 10 Metre Walk Test or Timed Up and Go.

Usage[edit | edit source]

Users should have a smooth gait pattern that is unimpeded by the frame. There should be adequate space for step placement. Users should never attempt to use a frame, by pulling on it, to help them sit or stand.

Zimmer Frame[edit | edit source]

Zimmer frame
A zimmer frame is a frame with four legs and a wide base. It is used in the following way if weight-bearing on both legs.
  • Picks it up
  • Moves it forwards
  • Places it in front of them
  • Leans on the frame, taking weight through the upper limbs
  • Walks into it (the patient should be encouraged to take two small, even steps to avoid a disordered gait pattern)

4 wheeled walker[edit | edit source]

  • Make sure walker is completely opened and hinges locked
  • Keep close to the frame at all times, near the back wheels
  • For downhill ramp use gently squeeze on brakes at all times
  • Ensure that brakes are locked before sitting on the seat of frame, with frame on level ground, preferably with wall or fence behind.[21]

Maintenance[edit | edit source]

  • Brakes - checked regularly to ensure they are working correctly.
  • Wheels - checked regularly and when the user reports tracking issues, e.g. frame pulling to one side. Wheels should also be checked as sometimes hard and repeated braking can distort the shape of the wheel making it lose its roundness.
  • Ferrules - checked regularly and replaced if worn. Wear may occur more quickly if the walker is used outdoors[19].
  • Height of the frame - checked periodically to ensure it is the optimal height for the user's posture. This is especially important if the user is undergoing rehabilitation and changes in their balance, strength and posture are expected or observed on assessment.

References[edit | edit source]

  1. ↑ Arefin P, Habib MS, Arefin A, Arefin MS. A comparison of mobility assistive devices for elderly and patients with lower limb injury: Narrative Review. Int J Aging Health Mov. 2020 May 17;2(1):13-7.
  2. ↑ 2.0 2.1 Prajapati G, Sharmila K. Role of assistive devices in wellbeing of elderly: A review. Indian journal of Gerontology. 2020;34(3):394-402.
  3. ↑ Suwannarat P, Thaweewannakij T, Kaewsanmung S, Mato L, Amatachaya S. Walking devices used by community-dwelling elderly: Proportion, types, and associated factors. Hong Kong physiotherapy journal. 2015 Jun 1;33(1):34-41.
  4. ↑ Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. Risk factors for falls in community-dwelling older people:" a systematic review and meta-analysis". Epidemiology. 2010 Sep 1:658-68.
  5. ↑ Deandrea S, Bravi F, Turati F, Lucenteforte E, La Vecchia C, Negri E. Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis. Archives of gerontology and geriatrics. 2013 May 1;56(3):407-15.
  6. ↑ Hunter SW, Meyer C, Divine A, Hill KD, Johnson A, Wittich W, Holmes J. The experiences of people with Alzheimer's dementia and their caregivers in acquiring and using a mobility aid: a qualitative study. Disabil Rehabil. 2021 Nov;43(23):3331-3338.
  7. ↑ Bertrand, K et al. Walking Aids for Enabling Activity and Participation, American Journal of Physical Medicine & Rehabilitation: December 2017 - Volume 96 - Issue 12 - p 894-903
  8. ↑ Bateni H, Maki BE. Assistive devices for balance and mobility: benefits, demands, and adverse consequences. Archives of physical medicine and rehabilitation. 2005 Jan 1;86(1):134-45.
  9. ↑ Borade N, Ingle A, Nagarkar A. Lived experiences of people with mobility-related disability using assistive devices. Disability and Rehabilitation: Assistive Technology. 2021 Oct 3;16(7):730-4.
  10. ↑ Resnik L, Allen S, Isenstadt D, Wasserman M, Iezzoni L. Perspectives on use of mobility aids in a diverse population of seniors: Implications for intervention. Disability and health journal. 2009 Apr 1;2(2):77-85.
  11. ↑ Australian Bureau of statistics [ 4446.0] Disability, Australia,2009. Available from: http://www.abs.gov.au/ausstats/[email protected]/Lookup/4446.0main+features82009 [accessed 19.2.2019].
  12. ↑ Tech times. Use of walking aids going up for elder. Available from:  https://www.techtimes.com/articles/51335/20150507/use-of-walking-aids-going-up-for-elder-americans.htm(accessed 20.2.2019)
  13. ↑ Charette C, Best KL, Smith EM, Miller WC, Routhier F. Walking aid use in Canada: prevalence and demographic characteristics among community-dwelling users. Physical therapy. 2018 Jul 1;98(7):571-7.
  14. ↑ Reviews vid. Best walkers 2018-best rollator walkers with a seat. Available from: https://www.youtube.com/watch?v=azig88E770k&feature=youtu.be [last accessed 24/6/2018]
  15. ↑ AccessibleDesign. U step Parkinsons walker with Laser. Available from: https://www.youtube.com/watch?v=J6g-OjBJ5c0 [last accessed 18/2/2019]
  16. ↑ CEC. Falls prevention-safe use of mobility aides -forearm support frame . Available from: https://www.youtube.com/watch?v=ZV01-lwNwng [last accessed 17/6/2016]
  17. ↑ Science News. Brunel University. Modular disability aids for world's poorest May 2015. Available from: https://www.sciencedaily.com/releases/2015/01/150127104921.htm (accessed 19/2/2019)
  18. ↑ Physical Therapy Video. Genius! a 4 WW and transport chair in one. Available from: https://www.youtube.com/watch?v=EP_0w20Kb9M&t=258s [last accessed 6.2.2016]
  19. ↑ 19.0 19.1 19.2 19.3 19.4 Hall J, Clarke AK, Harrison R. Guide lines for prescription of walking frames. Physiotherapy. 1990 Feb 10;76(2):118-20.
  20. ↑ Costamagna E, Thies SB, Kenney LPJ, Howard D, Liu A, Ogden D. A generalisable methodology for stability assessment of walking aid users. Med Eng Phys. 2017. 47:167–175.
  21. ↑ Government of South Australia. Department for communities and social services. January 2013. Available from https://www.des.sa.gov.au/_data/assets/word_doc/0011/19595/4-wheeled-walkers-fact-sheet.doc Last accessed 17/2/2019
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