Jeanine is a 79 year old women living alone in a two-story home. For the past three years, she has been regularly using a single-point cane to get around the house and during her short walks with her dog. Due to arthritic knees, her balance has become increasingly unsteady even with the cane assist. Jeanine begins to wonder if a walker will be good enough to keep her safely walking (therefore maintaining walker mobility) or if she should just go ahead and invest in a wheelchair.
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There are a handful of diagnostic conditions that merit the immediate use of a wheelchair such as spinal cord injury, bilateral lower extremity amputations, traumatic brain injuries resulting in lower body paralysis, cerebral palsy, muscular dystrophy, etc.
Other conditions create a fuzzy line within this decision: Should I get a walker or a wheelchair?
First, let’s go through the progression of ambulation equipment from cane to power chair:
Single-Point Cane
Since there is only one, small point of contact with the floor, the single-point cane is appropriate for people who already have decent standing balance without an external support. The cane is NOT meant to take a full weight-bearing load, so users that find themselves leaning heavily into the cane in order to stay upright should consider alternative equipment. In order to have good balance in standing and while walking, the user will need the functional use of both legs and at least one good arm that exhibits enough shoulder, biceps, triceps, wrist, and grip strength for stabilization.
Quad-Cane
A quad cane increases support by having four points of contact with the floor. This type of cane is designed to assist people with more wobbly balance, but who can still stay standing relatively well without the use of a cane. Functional use of both legs and one arm is also required for safe use.
Crutches
Crutches, whether they are under-arm or fore-arm crutches, have two points of contact with the floor. However, because one crutch is used by each arm it further widens the base of support for the user. For safe use of crutches, the user needs full use of both arms and at least one leg in order to stay upright. Crutches are a popular go-to for people who succumb to a single, lower-limb fracture or who are fresh out of post-surgical operations on a hip or a knee. For individuals who are uncomfortable with using a cane while having full use of both arms can comfortably transfer to crutches if needs be.
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Walker
A walker has four points of contact with the floor, providing a wide rectangular base of support designed to hold the body upright in the event that standing balance is no longer an option using a cane. Although most walkers are used effectively with two functioning arms and at least one leg, forearm attachments can be used if the user has one or two bad shoulders. A standard walker will either come with four corked legs or two corks and two wheels, depending on what the user requires at the time. All configurations assist in improving walker mobility.
Rollator
This is just a fancy way of describing a walker with four wheels and a seat. The user requires the same bodily functions as needed for standard walker mobility, with the exception of decent grip strength to set/release the brakes. A person may opt for a rollator instead of a walker in the event that ambulating long distances is impossible without a few sitting rest breaks.
Note: Rollators are not a suitable replacement for manual wheelchairs. A normal rollator is not designed for persons to sit and propel the walker with their feet.
Manual Wheelchair
Using a manual wheelchair requires healthy strength and range of motion in both arms and cores strength to maintain an upright seated position. Manual wheelchairs can be easily customized for persons with physical abnormalities that prevent them from sitting in a typical position. Examples include seat cushions, tilt-in-space features, one-arm propulsion, push power assist systems, and contour back cushions. Wheelchairs (power or manual) or meant for people who experience severe immobility or who are at a high fall risk while walking (i.e. canes, crutches and walkers provide little to no ambulatory assist).
Power Chair/Mobility Scooter
Lastly, a person goes to a power chair or mobility scooter if none of the other ambulatory devices can safely support the user. Power chairs/mobility scooters are operated by joysticks, which is a great option for people who lack the upper body strength or range to self-propel a manual wheelchair.
If an individual is still ambulatory with some lower extremity weakness and a very low number of fall incidence, then there are ways to slow the progression of immobility that forces someone to get a wheelchair.
Consider the following tips:
Consult With Your Primary Physician On Walker Mobility
Seek out an assessment from your doctor. They will have the professional eye to tell you whether or not a certain device will be helpful for you. Furthermore, a doctor can write you a prescription for a piece of equipment for the sake of insurance purposes.
Consult With A Physical Therapist
A physical therapist will have extensive knowledge regarding all ambulatory devices listed above. With their highly-trained eye, a physical therapist can perform a full body assessment in order to fit you with the proper piece of equipment along with suggesting the right size, an accurate height adjustment, and recommended custom pieces if necessary.
Participate In Daily Exercise
In order to improve or maintain walker mobility, you must be actively using your body with the “use it or lose it” principle in mind. Consult with a physical therapist regarding what types of therapeutic exercises will fit your body’s needs and will keep you walking longer.
Incorporate Fall Prevention Techniques
Consult with a physical/occupational therapist or complete an internet search about fall prevention in your home. Remove all hazards and habits which could increase your chances of falling and injuring yourself.
Implement Energy Conservation Techniques
Use your body’s energy wisely throughout the day. If you have a condition that eats your energy (general weakness, multiple sclerosis, etc.), wisely incorporate rest breaks while performing the daily tasks that are necessary for you to complete. This is a basic but essential strategy for improving walker mobility.