Introduction

Human body is made to move. Mobility is vital part of our daily lives. Moving improves ability to perform daily activities and thus improves quality of life. Walking can become a problem as people aged by means of disabilities preventing the person from using the limbs, reduced endurance, deficits in motor coordination, flexibility and strength. Movements are compromised and may make activities that require combination of mobility and stability. The chance of falling also increases with age. A walking aid is use to:

• Decrease the effort and energy required to walk
• Compensate for lack of balance and reduce the risk of falls
• Decrease the weight on weak or injured leg
• Decrease pain
• Help ambulation in absence of a lower extremity

Types of Walking Aid

There are varieties of walking aids available for the older person or for those with walking difficulties. Among the commonly used walking aids are:

• Walking frame ( standard / reciprocal)
• Rollator
• Tripod  / Quadruped (quad stick)
• Walking stick / cane
• Crutches (axilla / forearm / elbow crutches)

Walking aid supports part of body weight through the arm or arms during gait. They provide sensory cues for balance and enhance stability by increasing the size of base of support.

Wheelchair is recommended only for those who cannot safely use or unable to ambulate with a walking aid.

Choosing a Walking Aid

It is important for individual assessment to be carried out for selection, measurement, fitting and use of appropriate assistive devise either for temporary / long-term purpose. Factors considered when choosing an appropriate walking aid for the loved ones /users are as below:

• Health status
• Age
• Size
• Comfort level
• Ease of use
• Stability
• Safety

Once a suitable walking aid is chosen, it is important to ensure safety and good posture by correctly adjusting it to the user and by using proper footwear.
Avoid use of slippers, loose fitting footwear or high heels as it may increase the risk of falling or tripping. Also avoid long clothes (below ankle level) which may trip the user.

1. Walking stick / cane:

• Supports only 15-20% of body weight
• Single point
• Used for user with minor balance problems or those with painful hip or knee
• Used on contra-lateral side to reduce loading on the painful joint
• Cane is advanced during the swing phase of the leg that it is protecting

2. Tripod / Quadruped:

• Functions are the same but provide greater stability than walking stick by having broader base of support (3 / 4 point)

3. Crutches:

• Axilla Crutches
  • Support full body weight but seldom used by elderly person because it needs arm strength. It may increase risk of nerve injury (Brachial plexus)
  • Able to transmit forces in a horizontal plane (2 points of attachment exists-hand & higher on the arm)
  • User cautioned not to lean on the crutches at the armpit (may cause damage to blood vessels or nerves)
  • Used when one leg has restricted weight bearing capacity / both legs are straight & have limited or no weight-bearing capacity
  • Suitable for short term use (such as fracture of leg)

• Forearm / Elbow Crutches:
  • Able to transmit forces in a horizontal plane (points of contact- hand & forearm)
  • Lever arms are shorter than axillary crutches (forearm platforms for clients who unable to bear weight through their hands or wrists (such as arthritis)
  • Lighter
  • Used for active people with severe leg weakness (All crutches require good upper body strength)

4. Walking frame:

• Can completely support one lower extremity but can’t support full body weight.
• More stable than canes or crutches (requires use of both arms but do not require as much upper body strength or balance as crutches).
• Variations:-
  • Reciprocal walking frame does not require much use of upper limb strength of the user to lift-up
  • ‘Pick-up’ style walker (takes short step with each foot & then moves the walker again- can be slow)
  • ‘Front-Wheeled’ Walker (lighter & easier to advance)
  • ‘Four wheels with a breaking system’
  • ‘Walker with seat’ (client can rest when becomes fatigue)

Adjusting the Walking Aid

Steps for correct adjustment measure for walking aids are as below:

• Wear appropriate shoes
• Stand tall and place the walking aid by the side of user
• Adjust the walking aid’s  grip handle until it is aligned to the users wrist level

(For axilla crutches- adjust the height of the crutches to about 2-3 fingers spacing between the arm pit of the user and the top of the crutch)

Training

Proper training on ergonomics should be conducted for safe and comfortable mobility before the user starts walking independently.

Reference

1. Hasselkus, B. (1974). Aging and the human nervous system. American Journal of Occupational Therapy, 28,16-18
2. Christianson, M. (1990).Aging in the designed environment Physical & Occupational Therapy in Geriatrics 8, 1.
3. Zoltan B. (1990) Occupational Therapy Practice skills for Physical Dysfunction.Mosby Company.
4. Trombly, A.N, Occupational Therapy for Physical Dysfunction (2nd Edition), Williams & Wilkins, Baltimore, London.