A walker provides a movable stable platform that increases the base of support anteriorly and laterally, greater than that provided by a cane. Walkers are indicated for poor balance in general, as well as for bilateral leg problems (where one would otherwise have difficulty deciding in which hand to carry a cane), to achieve non-weight bearing status for one leg, for those afflicted with Parkinson’s disease, and to transmit weight through the arms rather than through a painful spine. Walkers are made of aluminum and are adjustable in height. Many can be easily folded up when not in use. There are three main types of walkers: standard, front-wheeled, and four-wheeled. Patients whose grip is impaired from weakness or arthritis, can lean on a forearm-support walker with their forearms.
Standard walkers. A standard or pick-up walker is a metal, four-legged frame with rubber tips, which must be lifted and moved forward with each step or two. This type of walker is used when maximum assistance with balance is required or when restrictions on weight bearing are present. While easier to use than a cane, this style of walker does require some degree of upper body strength and cognitive ability to use safely, and results in a fairly abnormal gait.
Front-wheeled walkers. For people who have weak arms or a tendency to fall backward, a walker with wheels on the front two posts can be used. This type of walker promotes a forward displacement of the center of gravity and allows a more normal gait, as the person can continue walking without stopping to lift the walker. The front-wheeled walker is particularly useful in patients with Parkinson’s disease, as it reduces the risk of falling backwards. In addition, it is less likely to allow the patient to pick up speed as he goes along, relative to the four-wheeled walker.
Four-wheeled walkers. The most normal gait is seen when using a four-wheeled walker. While easiest to use of the three types, they also provide the least stability. Wheeled walkers for use in the community can be equipped with hand brakes, baskets for shopping, and a seat that allows the person to stop and rest. However, the user must be capable of learning to apply the brakes in order to use them safely.
Unlike canes, which must be moved in correct sequence relative to the legs, walkers generally require less instruction to use effectively, and can be ideal in older adults with mild to moderate cognitive impairment and balance or strength problems. Some instruction is necessary so that the walker is not used in an attempt to get up out of a chair. Advanced cognitive impairment can make the proper use of a walker impossible, and may be best managed by human assistance for ambulation. Disadvantages of walkers are that they require more space in which to maneuver than a cane, they may not roll well on carpeting, they make crossing thresholds difficult, and they can not be used on stairs. The use of any walking aid, in particular walkers, results in a slower gait speed and requires considerably more energy and cardiovascular fitness than walking unassisted.
AXTEL, L. A., and YASUDA, Y. L. ‘‘Assistive Devices and Home Modifications in Geriatric Rehabilitation.’’ In Clinics in Geriatric Medicine: Geriatric Rehabilitation, vol. 9, no. 4. Edited by K. Brummel-Smith. Philadelphia: W.B. Saunders, 1993. Pages 803–821.
BOHANNON, R. W. ‘‘Gait Performance with Wheeled and Standard Walkers.’’ Perceptual and Motor Skills 85 (1997): 1185–1186.
FISHBURN, M. J., and DE LATEUR, B. J. ‘‘Rehabilitation.’’ In Geriatrics Review Syllabus, 3d ed. Edited by D. B. Reuben, T. T. Yoshikawa, and R. W. Besdine. Dubuque, Iowa: Kendall/Hunt Pub. Co., 1996. Pages 93–103.
KUMAR, R.; ROE, M. C.; and SCREMIN, O. U. ‘‘Methods for Estimating the Proper Length of a Cane.’’ Archives of Physical Medicine and Rehabilitation 76, no. 12 (1995): 1173–1175.
MULLEY, G. ‘‘Walking Frames.’’ Biomedical Journal 300 (1990): 925–927.
RUSH, K. L., and OUELLET, L. L. ‘‘Mobility Aids and the Elderly Client.’’ Journal of Gerontological Nursing 23, no. 1 (1997): 7–15.