Walkers

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Introduction

Modern style Rollator

A walker is a walking aid that has four points of contact with the ground. It usually has three sides with the side closest to the patient being open. It provides a wider base of support than a walking stick, so it is used more to stabilise patients with poor balance and mobility or lower extremity impairment. Having a caregiver and being unable to walk more than one metre per second has been significantly associated with walking frame use. Paradoxically, walker or frame 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, minimise their falls risk and optimise 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.

4 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 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 Parkinson's

• 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

• Pulpit frames - 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

• 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 their own mobility aids at a realistic price.
• 4 wheeled walker and transport chair all in one

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) centre 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 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.

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.

Zimmer Frame

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. The user should:

• Pick it up
• Move it forwards
• Place it in front of them
• Lean on the frame, taking weight through the upper limbs
• Walk into it (the patient should be encouraged to take two small, even steps to avoid a disordered gait pattern)

4 Wheeled Walker

• 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