Walking Aids

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Introduction

Walking aids are sometimes also referred to as ambulatory assistive devices. A walking aid is one of several devices a patient may be issued in order to improve their walking pattern, balance or safety while mobilising independently. They can also be a means of transferring weight from the upper limb to the ground, in cases where reducing weight bearing through the lower limb is desired.

Walking aids fall into multiple categories and include the following:

• Canes or walking sticks (note - The distal tip of canes and crutches should have a rubber ferrule to prevent the walking aid from slipping, with some ferrules being depressed to form a vacuum when it comes into contact with the ground. The ferrule should not be worn or cracked and should fit well onto the point of the walking aid).
• Crutches
• Walkers
• Standing Aids: to assist with manual handling often used with in rehabilitation.

The video below gives a good introduction to the categories

Prescription

Although often a solution to mobility issues, walking aids do come with their own mix of benefits and challenges to the individual using them. A 2005 study reported that these devices can improve balance and mobility but also can interfere with balance in certain situations, and the strength and metabolic demands can be excessive. They hoped for improved designs and guidelines for safer use of canes and walkers.

Prescription of walking aids should ideally be done by a physiotherapist or occupational therapist after a thorough assessment of gait, balance, cognition and the cardiovascular, musculoskeletal and neurological systems. Assessment should also take into account any clinically significant co-morbidities and the individual's day to day mobility requirements for example. thresholds in their home, community ambulation, navigating steps or public transport. Thought needs to be given to whether the walking aid is a temporary requirement for example post fracture or a more long-term option for example a walking frame for an elderly adult with reduced mobility post stroke.

Therapists should also be aware of the perceptions of walking aids can be negative at times as individuals may feel like they are giving up their independence or fear they will look frail. In such instances, the Therapists needs to balance the individual's concerns with safety, encouraging the individual to consider the walking aid as keeping them mobile and able to participate in their activities of daily activities.

Follow up is also needed after an initial assessment and prescription in order to adjust the walking aid as needed. Although beneficial for stability and balance, walking aids can be difficult to use which is associated with falls. See the canes, crutches and walkers pages for further detail.

Descriptors of Weight Bearing Status

Prescription of an appropriate walking aids requires knowledge of weight bearing prescribed to the patient or being allowed by the problem

present. Weight bearing status can be described using the following:

• Full weight bearing (FWB): There are no restrictions and client can bear 100% body weight on the lower extremities (LE).
• Non-weight bearing (NWB): No weight is borne on the involved limb
• Partial weight bearing (PWB): Client is allowed to bear only a portion of body weight on lower extremities. It is sometimes expressed as a percentage of body weight (example 20% to 70%)
• Toe touch weight bearing (TTWB): Only the toes of the affected extremity contact the floor to improve balance

Weight bearing as tolerated (WBAT): Weight bearing is limited by patient tolerance of weight borne on extremity.

Effectiveness

A 2017 study into "Do Canes or Walkers Make Any Difference? NonUse and Fall Injuries"

Reported that of the people who fell at home, most did not have an assistive device with them when they fell. Nonusers who fall sustain more severe injuries. The concluding thoughts were that providers must place increased emphasis on the importance of cane/walker use for injury prevention via patient education, promoting personal relevance, proper fitting, and training. Also new strategies are needed to improve device acceptability and accessibility.

Limitations

• Rollators: Studies have shown a reduction in the use of the quadriceps during the stance phase due to a reduction in knee extensor movement. There is also an increase in hip flexion throughout the stance phase due to the increased forward trunk flexion. "The reduced knee flexion during rollator-walking could possibly explain the reduced dorsiflexion of the ankle joint observed in this situation."
• Quad Stick/Cane: heavier than a standard stick/cane. Require a slower walking pattern (gait).

• Reduced stability: Up to 30% of the time people were using their 2 wheel or non-wheel zimmer frames/ walker incorrectly by not putting the appropriate amount of weight through the frame when stepping.