It's still walk and roll to me

I suppose I still have Billy Joel on my mind (see the post about that here), but a recent conversation prompted this blog post on how to choose the right mobility aid for your needs. All too often, our therapists walk into a patient's home, and one corner of a room will be filled with various canes, walkers, and wheelchairs that have either been bought or given to them. Usually, none of this is being used, and the equipment is relegated to holding laundry or other items. Sound familiar? Equipment is expensive, and, more importantly, the wrong mobility aid can increase your chances for a fall or injury, so before you turn to Amazon for your next buy, here are some tips to help guide your decision.

The Cane

Trusty, inexpensive, and found in nearly every pharmacy or box store, a cane is often the first "go-to" for many people. Canes can help stabilize a person's gait by providing an extra point of contact with the ground, thereby increasing their base of support, and it is often a great choice for those who have joint pain. Canes support about 15-20% of a person's body weight and are intended to be used opposite a weak or painful leg to help reduce the force on the "bad" or weaker leg. There are some slight variations in cane design, each of which serves a different purpose:

Standard canes are helpful for patients who need just an additional point of contact with the floor for balance, have minor lower extremity weakness, or need a small amount of weight-bearing reduction (think knee pain!)

Offset canes provide slightly higher stability than a standard cane because of the bend that allows the handle to be placed directly over the main shaft of the cane, which creates a straight line of force through the cane to the tip.  Usually made of aluminum, they are easily adjusted.

Quad canes (as the name implies) have four tips and permit greater weight bearing, as well as an increased base of support for the user. Their self-supporting design can also make them easier to manage, especially for individuals with limited use of one hand or arm.

Hemi walkers provide a much broader base of support than even a quadruped cane and are intended for individuals who have lost function on one side of the body, typically after a stroke.

While it sounds like an easy choice, the truth is that there is much more to consider. Canes require that the user have both good balance and strength, as it will not help you if your leg gives out. It is also essential that the cane be set to the correct height. A cane that is too short or too long leads to poor posture, actually increases your risk for falls, and strains your back.

Walkers

Walkers come in all shapes and sizes and of varied quality. Different designs serve different purposes, but here is a general overview:

A Standard Walker (also known as a pick-up walker) does not have any wheels at all - just four rubber-tipped feet. Just as the name implies, you move this walker by "picking it up," putting it in front of you, and then taking your next step. Don't buy one. The only time this type of walker is generally used is when you can not bear any weight on a leg or after an amputation. It is heavy, produces an awkward gait pattern, and is difficult for most people to use. The need to pick up the walker at each step also requires significant endurance and strength, making it extremely cumbersome for long-distance walking.

Rolling Walkers are walkers with two wheels in the front and rubber tips in the back. The wheels mean that you do not have to pick up the walker at each step (a plus!). Still, it does limit your arm swing when walking, which takes away from a "normal" gait pattern. A rolling walker might be recommended for someone who has an unsteady or unstable gait pattern (how you walk) but does not need to bear substantial weight on the device.

The disadvantages of a rolling walker relative to a standard walker are that 1) it is less stable, 2) it requires more cognition, and 3) because the front wheels are fixed and cannot rotate, it requires a large turning arc. Because of this, many users will pick up the walker when turning, which can increase the risk of a fall. (Quick Tip - the correct way to turn with a rolling walker is to take multiple small turns.)

Rollators are a popular choice for individuals who may be limited by balance, endurance, cardiopulmonary impairments, or pain, yet still wish to be active in their communities. With 3- and 4-wheel options, rollators come equipped with hand brakes and seats, and offer additional features such as baskets or other add-ons. The addition of the seat opens up the possibility of travel in the community for many, as it allows you to stop and take a break when needed. They are generally much more maneuverable than rolling walkers (although heavier).

Which One is Right For Me?

While the above provides valuable information, there is much more to consider. Many people shy away from using a walker because it makes them feel self-conscious. A rollator may be the perfect choice in your home, but it may be too heavy to lift or may not fit into your car. Finally, if a person has a cognitive impairment such as dementia, there are other things to consider. It may not be possible to "learn" how to use the device, and it may be more of a hindrance than a help. When it's time to choose the right mobility device for you, ask for help. Physical therapists are mobility experts and can conduct a DME (Durable Medical Equipment) Evaluation to help you select the best device, size it to fit you, and teach you how to use it properly. It will save you time and money, and you can be confident that you have the best device for your needs. After that, all you have to do is choose your color! :-)