Selecting the Right Assistive Device

Kyle Tierney, DPT
Physical Therapist
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 an injury.

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
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
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
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!