Things You Should Know

For individuals with chronic lower body imbalance or weakness, current mobility-assistive devices (canes and four-legged walkers) provide support and stability at the extremes of mobility compromise and are the most widely used, simple-assistive devices (comprising 93% of units in use). The total population in the U.S. presently using canes and walkers is estimated to be 11.8 million persons, and this segment is growing in excess of 3% per year (U.S. Census Bureau, 2009). This rate of growth will result in an 11% increase in this segment of the population to over 13 million by 2015. Additionally, the 3.8 million wheelchair and scooter users often require a stable alternative device to assist in short distance mobility (e.g., from car to wheelchair).

Canes provide minimal support, and are adequate for the individual uncomfortable in walking without some assistance. As stability decreases, the individual loses confidence in the cane and must move to the only other level of assistance in walking currently available – the four-legged walker. Currently there are no devices intermediate to these extremes of mobility assistance.

Falls in the U.S.

Of the more than 40 million persons over 65 years of age in the U.S., in excess of 12 million fall each year (Centers for Disease Control; National Institute on Disability and Rehabilitation Research; Medicare Data 2000-2008). Most falls by cane and walker users occur with four-legged walkers (87%) compared to canes (12%). The results suggest that more research is needed to improve the design of walking aids. (Risk of falling of the Elderly in the US. CDC 2008; Journal of American Geriatrics Society, 2009; Medicare Data.)

The four-legged walker presents major adjustments and drawbacks. The cumbersome nature of the device is well known. The walker alone is larger than a typical dining chair. The “footprint” of the walker-assisted individual is three times that of a standing person which makes turning and negotiating around obstacles and furniture difficult, if not impossible.

Wheelchairs and scooters are used by individuals with a broad range of disabilities when other devices, such as canes and walkers, do not provide sufficient assistance to meet their normal mobility needs. Yet even wheelchair users need to move into and out of their wheelchairs (e.g., car to wheelchair, bathroom, bed, living area seating) for short distances. Other devices are often too unstable (cane) or too awkward to handle (walker) for such temporary needs.

Background reading

Research May Lead to Improved Mobility Device Designs
Older adult fall injuries associated with walking aids: 87.3% with walkers, 12.3% with canes (a 7 fold increase). Injuries and hospital admissions for falls associated with walking aids were frequent in this highly vulnerable population. The results suggest that more research is needed to improve the design of walking aids. http://www.ncbi.nlm.nih.gov/pubmed/19555423

Mobility Disabilities in Middle-Aged are Common
Mobility (walking) disabilities in the middle-aged are relatively common. The symptoms reported as causes in this age group differ little from those reported by older groups, and are dominated by lower limb pain and shortness of breath. More clinical attention paid to disabling symptoms may lead to disability reductions in later life. http://www.ncbi.nlm.nih.gov/pubmed/16970558

Stride and Gait Training
Gait training often incorporates the use of such assistive devices as parallel bars, walkers or canes to promote safe and proficient ambulation. In order to walk again without assistance, the patient will need mental attentiveness and adequate sensation, coordinated with adequate musculoskeletal functioning and motor control. http://www.enotes.com/gait-training-reference/gait-training

Falls Among Older Adults: An Overview
Each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable. http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

Tips for Choosing and Using Walkers
If you have difficulty balancing or you’re at risk of falling, a walker or cane can make it easier for you to get around — whether you use the walker temporarily or as a permanent aid. But how do you choose and use the correct walking device. http://www.mayoclinic.com/health/walker/HA00060

Tips for Choosing and Using Canes
If you need the cane only for balance, consider a standard cane with a single tip. If you need the cane to bear weight, you might choose an offset cane with four tips. http://www.mayoclinic.com/health/canes/HA0006

Mobility Problems Don’t Have to Stop You
It’s extremely important for seniors to see how to appropriately use a walker and have someone teach them appropriately.  http://www.lvrj.com/health/GO-Mobility-problems-dont-have-to-stop-you-87304962.htm

Tips to Prevent Falls
Physical changes and health conditions — and sometimes the medications used to treat those conditions — make falls more likely. In fact, falls are a leading cause of injury among older adults. http://www.mayoclinic.com/health/fall-prevention/HQ0065

Walkers and Canes Impede Lateral Stepping 
Assistive devices, such as walkers and canes, are often prescribed to aid in balance control. Recent studies have suggested that such devices may actually increase risk of falling. http://www.mendeley.com/research/walkers-canes-impede-lateral-compensatory-stepping-movements/