How to select a walking aid!

In this article, I will attempt to simply explain about the great benefits of using walking aids. Walking aids or assistive devices help people with joint/movement problems to mobilise better. These devices also prevent falls and ease out joint pain by reducing the weight placed on leg joints.  

Walking, although simple, as it might seem, is a complex movement. The leg joints are moved in a rhythmic fashion to propel you forward and the swinging hands support this movement all throughout. The centre of gravity is the exact point through which the weight of the body falls through. The brain balances all movements, so that the centre of gravity doesn’t shift way too forward; which will make you fall on your face or shift backwards and make you fall on your back.   Have you ever seen an old person, struggling to take a few steps? They are in constant doubt whether they will fall or have joint pain. This  overcautious approach to walking creates problems.   Mammals are mostly four legged.

They are stable on four feet. Evolution made us two legged, but with these great powers came several disadvantages. But then again humans, having the ability to solve problems, came up with the idea of using walking aids. These have been in existence for thousands of years. They initially came as simple canes, something which is confirmed when you study the ancient Egyptian pyramid carvings.   

What does it do?

There are three things that walking aids (Assistive devices) do. They broaden the patients base of support, improve balance/stability and redistribute the weight so that the joint pain eases. There are a few goals that I target by prescribing walking aids. These are to improve confidence when walking, delay the decline in function of the elderly, reduce disability and also to reduce the burden on caregivers.  

There is research evidence in abundance  to show that walkers boost the confidence of patients. They make their users independent as well.  

Nevertheless, the assistive device can adversely affect one’s balance as well. The act of lifting and placing the device at a more forward position can itself cause the patient to fall. Also repetitively using the device can cause pain in arm joints and tendons and give rise to a condition called carpal tunnel syndrome. (A nerve gets trapped at the level of your wrist) Therefore, it should be carefully selected, ideally with the help of a joint specialist.   

How to use it
I will explain this in detail, but first of all I would like to highlight certain research findings on the improper use of canes. Studies have revealed that nearly 70 percent of cane/walking sticks in use are damaged, faulty or don’t have the propper height.   

Only one third of the patients in the west obtained their device through a medical professional. And out of that only 20 percent received knowledge on how to use them! More than one half of the canes had worn out rubber caps, were used on the wrong side or the height was excessive. And the sad side of the story is nearly 30 to 50 percent of patients stopped using the assistive device within weeks after purchase as they never received instructions regarding usage.   

So on which side should you keep the walking stick? It’s always on the good side. For example if you have a bad right knee and a relatively normal left knee, the walking stick should be used on the LEFT SIDE (Good side). And what is the ideal height? The handle of the walking stick should be at the level of the crease of your waist. When using the stick, the elbow should be bent in such a way that the angle between the arm and forearm is 150 to 165 degrees.  

The walking stick is moved together with the problematic leg. Eg-If the patient has a bad knee or hip on the left side, the walking stick is held on the right hand and moved together with the left leg. The intact or good leg moves independently. Even when climbing stairs, the painful leg moves together with the walking stick and the good leg moves independently. This is the correct way a cane should be used.  

Types of walking aids
There are many types of devices and you should select the one that helps you the most.   
Standard cane – Made of wood or aluminum. They are light in weight and popular as the aluminum ones are adjustable.  

Offset cane – This has a curvature along the upper part which distributes the weight to the lower part in a different manner. Suits people who depend more on the arms to mobilise and with knee osteoarthritis.  

Four legged cane – This is for greater weight bearing force as it provides a very stable base. All four legs should be in contact with the ground. Useful for patients who have suffered strokes with weaknesses in one side of the body   The handles of canes ideally should be flat and horizontal. The umbrella handles aren’t recommended as they can cause a condition called carpal tunnel syndrome.    Now let’s discuss about crutches. Crutches bear weight and two crutches can sometimes offload both legs of the entire body weight.   

Axillary crutches (Arm pit crutches) – The cheap traditional pair of crutches that can sometime apply pressure on nerves/blood vessels at the armpit. These are difficult to use.  

Forearm crutches – Have cuffs to fit around the forearms and hand grips to hold on to. Patients using them are less likely to fall because one can rely on the cuff while performing tasks using hands.  
Next we will discuss about walkers. Walkers are meant for patients who have great difficulty in walking. They improve mobility by increasing the base of support. They might prohibit the patient from moving fast and are clumsy to use when climbing stairs.  

Standard walker – Has four legs and no wheels. The patient has to always lift and place the walker in front to move forward. Not suitable for patients with Parkinson’s disease.  

Front wheeled walker – This has two wheels on the front. The hind legs have rubber caps. It is good for patients with diseases like Parkinson’s where lifting the walker off the ground is difficult. Stability with this type of walker is less as it can slide forward on certain instances.  

Four wheeled walker with handbrakes – Also called Rollators,these are very popular in western countries, but not so popular in Sri Lanka, a land of rough terrain! It’s very easy to propel! But it can be slid forwards and become unstable at times. Brakes are designed, so that one can fully lock the wheels. There is a built in miniature seat as well. It’s very useful for patients with heart or lung disease, who need an occasional rest. It’s not good in terms of bearing weight.  

Always consult your specialist before purchasing the appropriate walking aid/ assistive device. Ideally proper training sessions in walking should be provided to the patient by the doctor prior to the walking aid being put to use. Assistive devices in correct hands provide patients a whole new set of exploring possibilities!