Selecting the Right Assistive Device
Kyle Tierney, DPT
Marcus Daly Rehabilitation Center
A service of Marcus Daly Memorial Hospital
Selecting the Right Assistive Device
According to the Centers for Disease Control and Prevention, greater than
one out of four individuals 65 years or older fall at least once a year.
These falls lead to 2.8 million emergency room visits and a total of $31
billion spent annually on direct medical costs associated with the falls.
With the number of community-dwelling older adults suffering from chronic
conditions increasing, disability and associated mobility problems are
expected to rise significantly. As a result, the medical community is
dedicated to reducing immobility within the population, and the direct
medical costs associated with it. One way of doing so is by prescribing
the use of assistive devices and correctly educating individuals on their use.
The National Institute on Disability and Rehabilitation Research estimates
that 4.1 million community-dwelling adults aged 65 or older use mobility
devices, which includes walkers, canes, and crutches. These devices are
prescribed to increase a patient's base of support in an effort to
improve balance and stability, or redistribute weight from the lower limbs
to help alleviate joint pain or compensate for gait deviations following
Following the correct prescription, and education on use, individuals
should note a feeling of improved safety which can result in increased
activity levels and independence.
With that being said, research has shown that most individuals obtain
their assistive device on their own, or through recommendations of family
and friends. This means that most individuals have not been properly educated
on their use and it has resulted in up to 70 percent of assistive devices
being faulty, damaged, or the wrong height. When assistive devices are
not fit, or operated correctly, individuals have a greater risk of falling
and may be placing unnecessary repetitive stress on joints. This leads
to 30 to 50 percent of individuals discontinuing the use of their assistive
device soon after receiving it because it is not meeting their expectations.
In an effort to decrease the incorrect use of assistive devices and maximize
safety, the remainder of this article will provide information on how
to correctly fit and use the most common forms of assistive devices.
Canes are prescribed to help redistribute weight from a weak or painful
lower extremity, or to improve stability and balance by increasing an
individual's base of support. There are multiple types of canes seen
within the community, but they can all be classified as single point or
quadripod (quad) canes. Single point canes can have various types of handles
and are typically made of wood or aluminum. Aluminum canes are beneficial
when compared to wood because they are adjustable in height, light-weight,
and inexpensive. They are most commonly prescribed to help alleviate arthritic
joint pain within the lower extremities. A quad cane has a larger base
with four points on the bottom which makes it more stable when compared
to a single point cane. Due to this increased stability, quad canes are
heavier and slightly more difficult to manage. They are most commonly
used with individuals suffering from hemiplegia, which is paralysis within
one half of the body.
The correct height of a cane is when the handle reaches the level of the
individual's wrist crease. This should be measured with the individual
standing upright with their arms relaxed at their sides. When holding
the cane at this height, the individual's elbow should bend to a 15-to-30
degree angle. In order to walk correctly with a cane, the cane should
be held in the hand opposite of the weak or painful lower extremity and
advanced simultaneously with the weak or injured leg. This means that
every time the impaired leg lands on the ground, the cane should land with it.
Walkers are prescribed to individuals who have poor balance or need a
greater amount of stability than can be given by a cane. When using a
walker an individual is able to use both upper extremities for support
on the wide frame which naturally increases stability. With this being
said, walkers are more cumbersome than canes, are difficult to navigate
stairs with, and can lead to poor back posture if not fit and used correctly.
As with canes, there are multiple types of walkers and choosing the correct
type should not be taken lightly.
Standard walkers are the most stable model, as they do not have any wheels,
but they result in slower walking speeds and require good upper extremity
strength to lift with each step. Front-wheeled walkers, also called two-wheeled
walkers, are less stable than standard walkers, but allow for more of
a normal walking pattern as they glide across the floor. Four-wheeled
walkers, often referred to as rollators, are useful for highly mobile
individuals who need increased stability, but do not need to bear weight
through their arms. These walkers are popular because they propel easily
and have baskets and seats. They are great for individuals with respiratory
or cardiovascular impairments because they can be used to sit and rest on.
They should not be used with individuals with cognitive impairments because
they require management of the brakes.
The correct height of a walker is the same as a cane. The hand grips should
be at the level of the individual's wrist crease while the individual
is standing upright with their arms relaxed at their sides. When using
a walker, both feet should stay between the posterior legs or wheels and
the individual should maintain an upright posture without a forward lean.
When turning, the individual should remain between the posterior legs
or wheels and the walker should not be lifted off of the ground. When
attempting to sit on a four-wheeled walker, the brakes should always be
locked and it should be placed against a wall or other solid object.
Crutches are helpful for highly mobile individuals who need to use their
arms for weight bearing and propulsion. There are various types of crutches,
but the most common is referred to as the axillary crutch. Correct use
leads to significant energy expenditure and requires a substantial amount
of arm and shoulder strength. For this reason they are generally not prescribed
for the older population. The correct height of an axillary crutch is
when there is approximately two finger widths between the individual's
axilla (armpit) and the top pad of the crutch while the individual is
a standing position. The handle position should be adjusted so that the
elbow is bent at a 30 degree angle. If the crutch is fit incorrectly it
can cause nerve or artery compression.
The implementation of the use of an assistive device is intended to maximize
an individual's independence and promote increased activity levels.
Individuals who feel as if they are not using an assistive device correctly,
or feel that they may benefit from the use of an assistive device should
contact a medical professional.
Questions and or comments regarding this week's health column please
contact, Kyle Tierney, DPT at Marcus Daly Rehabilitation Center and Services,
a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton,
MT 59840. Working together to build a healthier community!