Walkers

Original Editor - The Open Physio Project.

Top Contributors - Lucinda hampton, Lauren Lopez, Admin, Jess Bell, Kim Jackson, Rachael Lowe, Jeremy Bryan, Larisa Hoffman, Abbey Wright, Ammar Suhail, WikiSysop, Redisha Jakibanjar, Robin Tacchetti and Naomi O'Reilly

Introduction

Modern style Rollator

A walker is a walking aid that provides a wider base of support than a walking stick. It usually has three sides with the side closest to the patient being open. While walkers are often used to help stabilise patients with poor balance and mobility or lower extremity impairment, their use has been associated with an increased risk of falls in both community-dwellers and those who live in residential care. Despite the positive correlation between device use and falls, caregivers report mobility aids promote independent mobility in people with disability, and users report that mobility aids increase opportunities for social interactions. Using a walker can also increase metabolic and musculoskeletal demands, so prescription and education are key to helping the user maintain their balance, minimize their falls risk and optimize their activity levels.

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

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

A study in the USA, found that 11.6% of those aged over 65 used walking frames. It was also found that the use of walking aids had jumped up by 50% in the 10 years prior to 2015.

In a Canadian study which used data from 2012, 4.1% of the population aged 15 years and older used a walking frame, stick or crutch. Approximately 50% of these used a walker. Since 2004, there was a 2% increase in walking aid use in the community.

Types of Walkers 

Many walkers exist on the market, but physiotherapists are well placed to help select the correct walker based on the differing needs of users.

Four Wheeled Walker

• Wheel size: large wheels for outdoors, small wheels for indoors.
• Push down brakes or grip on brakes.
• Ability to be folded.
• Made of lightweight material such as carbon fiber or aluminum, which makes. traveling 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 Parkinson's

• 4 wheeled walker and transport chair all in one

Gutter Frame Walkers/Platform Walkers/Podium Walkers/Pulpit Frame Walkers/Upright Walkers

• Going by several different names and with several different styles, these four wheeled walkers are for users who need more support. The user weight bears through their forearms on supports, with the elbows flexed to approximately 90 degrees

Two Wheeled Walkers

• Two front legs have wheels, no wheels on the two rear legs
• Made of aluminum
• Usually fold flat for transport and storage
• No brakes

Standard Walker/Four Point Walker/Zimmer Frame

• Four legs, no wheels

Innovative Mobility Device Model

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 their own mobility aids at a realistic price.

Prescription

There is no one walker that is more desirable than another.

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 to suggest that the stability of a user and their walker can be measured "as one". The methodology considered a combined (user plus walker) center of pressure and combined base of support (again created by user and walker, not two separate bases of support). 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 the same way as one would measure for a walking stick. Shoes should be taken into account during prescription as shoe height can significantly affect walker use.

Factors to take into account when prescribing a walking frame:

• Height of the frame
• Weight of the frame when user propels and maneuvers it
• Base area
• Maneuverability 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.

Walkers can result in decreased arm swing and poor back balance.

Usage

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.

Four Point Walker / Zimmer Frame

Zimmer frame

The user should:

• Pick up walker
• Move walker one step length forward
• Place the walker on the floor in a manner that all four legs touch the floor at the same time
• If needed, lean on the frame, while performing shoulder depression and elbow extension in order to bear some of body weight through arms and walker
• Step into walker

Two Wheeled Walker

• Similar to four point walker/zimmer frame use, except that instead of picking up the walker, the walker is slid forward.
• With continuous ambulation, the walker should be slid forward as a constant rate, matching gait speed.

4 Wheeled Walker

The user should:

• Make sure walker is completely opened and that the hinges are 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 the brakes are locked before sitting on the seat of frame, with frame on level ground, preferably with wall or fence behind.

Maintenance

• 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.
• 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