II. Background
- Walkers provide broadest base of support of the Ambulatory Devices (compared with Crutches, canes)
- Decreased maneuverability compared with other Ambulatory Devices
- Requires upper body strength and partial weight bearing
III. Indication
- Gait disturbance (full weight bearing)
- Difficult balance
- Bilateral lower extremity weakness
IV. Types (in order of most stable to most mobile)
- Standard Walker
- Four 4 Rubber-tipped legs and no wheels
- For Ataxia (offers full weight bearing support)
- Advantages
- Most stable device of the Walkers
- Disadvantages
- Need strength and balance to fully lift walker with each step
- Requires slow deliberate gait pattern
- Needs most attention of any Ambulatory Device
- Front-Wheeled Walker or Two Wheeled Walker
- Two Rubber tipped back legs and two front wheels
- Rubber tipped back legs help prevent the walker from sliding away from patient
- For Movement Disorder (e.g. Parkinson's) or Ataxia
- Allows those with poor upper body strength to move walker without lifting
- Allows for normal gait and faster pace than Standard Walker
- Less stable for weight bearing than Standard Walker
- Four-Wheeled Walker (Rollator)
- Four wheeled freely mobile device
- Least stable of the Walkers, with risk of sliding out from under the patient
- May come equipped with hand brake to prevent unwanted movement
- Advanced models include a seat and basket allowing for rest breaks
- Consider in patients with cardiopulmonary disease with limited walk distance
- For mild Movement Disorder or Ataxia
- Intended for relatively high functioning patients who do not need support of weight bearing
- Do not use for weight bearing support (Fall Risk)
V. Fitting
- Keep elbow flexed at side to 15 to 30 degrees
- Cane length: greater trochanter to floor (with shoes)
- Technique is important
- Do not lean over the walker (poor spine mechanics)