Different walk aids on gait parameters and kinematic analysis of the pelvis in patients with Adult Neuromuscular Disease.

OBJECTIVE: To investigate the effects of different walking aids (single cane, bilateral forearm crutch and walker) on gait parameters and kinematic analysis of pelvis in patients having adult neuromuscular diseases. METHODS: The study design was a self-controlled study. The study was conducted in the Department of Physiotherapy and Rehabilitation, Hacettepe University in Ankara, Turkey, between 2014-2015. The study included 18 adult patients with neuromuscular disease. The manual muscle test, the Rivermead mobility index, the motor function assessment scale, and the trunk control test were used as descriptive measurements. The 2-minute walking test, the modified Borg scale and the G-Walk gait analysis system (BTS Bioenginering S.p.A., Italy) were used as the outcome measures. The outcome measures were performed randomly during normal gait without walking aids (self control group), then during walking with single point cane, bilateral forearm crutch and walker. RESULTS: It was observed that the walking aids have decreased the walking speed, walking distance and cadence. When the pelvis kinematic was analyzed, there was only a significant difference in the extension of the pelvis between the groups (p<0.05). The most useful (61%), most comfortable (44.4%) and the most preferred (61%) walking aid was determined as single cane by patients and the safest (55%) one was determined as a walker. CONCLUSION: In the decision-making process for walking aids, the patient`s biomechanical, physiological and psychosocial needs, expectations, satisfactions and levels of independence should be considered before providing patients with aids for walking.

Designing instrumented walker to measure upper-extremity's efforts: A case study.

The high prevalence of shoulder pain in using walkers in patients who have spinal cord injury (SCI). Also, the limited options available to economically measure grip forces in walkers, which drove the need to create one. This article describes a method to obtain upper-extremities' forces and moments in a person with SCI by designing an appropriate instrumented walker. First, since the commercial multidirectional loadcells are too expensive, custom loadcells are fabricated. Ultimately, a complete gait analysis by means of VICON motion analysis and using inverse dynamic method has been held to measure upper-extremities' efforts. The results for a person with SCI using a two-wheel walker in low and high heights and a basic walker show that there are higher shoulder and elbow flexion-extension moments and also higher shoulder forces in superior-inferior direction and higher elbow and wrist forces in anterior-posterior directions. The results are not much different in using two different types of walker. By using the proposed method, upper-extremities' forces and moments were obtained and the results were compared to each other in using two different walkers.

Problems of older persons using a wheeled walker.

BACKGROUND: Wheeled walkers (WWs) are used to improve mobility and for fall prevention in older persons, but not all users are satisfied with the usability of WWs. Intelligent WWs are being developed to improve the usability. AIMS: The aim of this study was to support the development of intelligent WWs by investigating possible problems of using a WW. METHODS: This study investigated 22 geriatric in-patients (median age 82 years) with and without their WW while opening a door against the direction of walking and passing through. Other possible problems when using WWs were identified by interview. RESULTS: Walking through the door was faster without than with using the WW (8.71 versus 12.86 s, p < 0.001), while interference between door and WW was documented in 41 of 44 (93 %) cases. Backward walking performance was better when using a WW with regard to gait speed, step width and walk ratio (all p < 0.002). Most referred problems when using a WW were walking downhill (83 %) and uphill (77 %) and obstacle crossing in general (77 %). CONCLUSIONS: Problems with opening a door against the direction of walking and the optimization of downhill and uphill walking as well as obstacle crossing should be regarded when developing an intelligent WW.

Understanding the relationship between walking aids and falls in older adults: a prospective cohort study.

BACKGROUND: A substantial proportion of older adults living in residential aged care facilities are use wheelchairs or walk with aids. The relationship between using walking aids and falling is somewhat inconsistent and poorly understood. PURPOSE: To investigate the use of walking aids as a risk factor for future falls among older adults living in residential aged care facilities and to identify spatiotemporal gait parameters that mediate the potential relationship between walking aids and falling. METHODS: Forty-three older adults (22 using walking aids and 21 not using walking aids) living in residential aged care facilities were enrolled in this study. Fall history, fear of falling, and the use of psychotropic agents were registered. Spatiotemporal gait (GAITRite®), grip strength (Jamar®), and cognitive status (Mini-Mental State Examination and Clock Drawing Test) were assessed. Falls were prospectively recorded during a 12-month follow-up period using monthly calendars. RESULTS: Individuals using walking aids were older (P = .012), had a greater fear of falling (P = .017), and demonstrated a more conservative gait pattern compared with those not using walking aids. They walked slower (P < .001) and had a lower cadence (P < .001) and shorter step length (P = .018) and step time (P = .003). Twenty-two participants (15 using walking aids vs 7 not using walking aids) reported at least one fall ("fallers"). Univariate logistic regression identified using walking aids as a risk factor for future falls (odds ratio, 3.98; 95% confidence interval, 1.10-14.37; P = .035). A lower cadence, increased stance percentage, decreased swing percentage, increased age, and greater psychotropic drug intake were mediators that reduced the odds ratio of the relationship between using walking aids and faller status the most. CONCLUSIONS: Using walking aids is a risk factor for future falls among the older population living in residential settings. A substantial proportion of the relationship between walking aids and future falls could be explained by an altered spatiotemporal gait pattern, increased age, and psychotropic drug intake. This finding supports the aim of extensive training periods and appropriate instructions on the proper use of walking aids in terms of adequate and safe gait patterns.

Four-wheeled walker related injuries in older adults in the Netherlands.

BACKGROUND: With ageing populations worldwide, mobility devices are used more than ever. In the current literature there is no consensus whether the available mobility devices safely improve the mobility of their users. Also, evidence is lacking concerning the risks and types of injuries sustained while using a four-wheeled walker. OBJECTIVE: To assess injury risks and injury patterns in older adults (≥65 years) who presented at Emergency Departments (ED) in the Netherlands with an injury due to using a four-wheeled walker. DESIGN AND SETTING: In this study, the Dutch Injury Surveillance System was used to obtain a national representative sample of annual ED visits in the Netherlands in the adult population (≥65 years) sustaining an injury while using a four-wheeled walker. The numbers of four-wheeled walker users in the Netherlands were obtained from the national insurance board. The numbers of ED visits were divided by the numbers of four-wheeled walker users to calculate age- and sex-specific injury risks. RESULTS: Annually 1869 older adults visited an ED after sustaining an injury while using a four-wheeled walker. Falls were the main cause of injury (96%). The injury risk was 3.1 per 100 users of four-wheeled walkers. Women (3.5 per 100 users) had a higher risk than men (2.0 per 100 users). Injury risk was the highest in women aged 85 years and older (6.2 per 100 users). The majority of injuries were fractures (60%) with hip fracture (25%) being the most common injury. Nearly half of all four-wheeled walker related injuries required hospitalisation, mostly due to hip fractures. Healthcare costs per injury were approximately €12 000. CONCLUSIONS: This study presents evidence that older adults experiencing a fall while using a four-wheeled walker are at high risk to suffer severe injuries.

Ambulation and complications related to assistive devices after spinal cord injury.

OBJECTIVE: To evaluate long-term health outcomes including pain intensity, pain interference, and fatigue among ambulatory persons with spinal cord injury (SCI). DESIGN: Prospective cohort study. SETTING: Data were analyzed at a major medical university in the southeast USA. PARTICIPANTS: Participants included 783 ambulatory adults with SCI of traumatic origin, who were at least 1-year post-injury. Participants were identified through three sources of records at a large specialty hospital in the southeastern USA. INTERVENTIONS: Not applicable. OUTCOME MEASURES: Pain intensity and interference (Brief Pain Inventory) and fatigue (Modified Fatigue Impact Scale Abbreviated Version 5). RESULTS: Examining assistive devices used for ambulation, 66% of the population used at least one device. In the logistic model, wheelchair and cane usage were significantly related to the outcomes after controlling for age, gender, and race. Wheelchair usage 50% of the time or less was significantly related to pain intensity (odds ratio (OR) 2.05, 95% confidence interval (CI) = 1.39-3.03), pain interference (OR 2.11, 95% CI = 1.43-3.12), and fatigue (OR 1.99, 95% CI = 1.12-1.43). Additionally, unilateral cane use was significantly related to the outcomes; pain intensity (OR 1.86, 95% CI = 1.35-2.56), pain interference (OR 2.11, 95% CI = 1.52-2.93), and fatigue (OR 2.49, 95% CI = 1.52-4.08). CONCLUSIONS: Among ambulatory persons with SCI, increased pain intensity, pain interference, and fatigue are associated with minimal wheelchair usage (50% or less) and less supportive assistive device (unilateral cane) usage.

Vertical force and wrist deviation angle in a sample of elderly people using walkers.

Walkers are frequently used by elderly people with weak lower limbs and limited balance, but the ergonomic relationship between the use of a walker and stress on the upper limbs is relatively unstudied. The current study assessed wrist deviation and vertical force among elderly individuals using a walker for assistance in walking. 60 elderly volunteers (M age = 81.0 yr., SD = 8.8) participated, 30 of whom frequently used a walker, and 30 who had no such prior experience. Data were obtained from four load cells and a twin-axis wrist goniometer during assisted ambulation using the walker. No significant group difference was found in gait cycle. Significant wrist deviation occurred, with ulnar deviation/dorsiflexion of the right hand, which was greater than that of the left. Non-experienced participants had larger dorsiflexion than experienced participants. Experienced participants produced larger vertical force than non-experienced participants. The greaterthe wrist deviation, the greater was the vertical force. The horizontal handles of most marketed walkers cause wrist deviations. This is a concern for users, clinicians, and related industries. Improvements in walker design should be considered.

Mobility aid-related accidents in children.

During the period 1991-2008, more than 63 000 children were examined in US emergency rooms following an accident related to a mobility aid: 40% of the children were less than 10 years old; 60% of the accidents occurred at home; and 4.4% of the children were hospitalised. Wheelchairs were the devices most often involved (67%), followed by crutches and walkers. Most accidents involving children under 10 years old were linked to a walker or wheelchair, and mainly resulted in head injuries. Most of the accidents in older children involved crutches and caused lower-limb sprains. In practice, the correct use of mobility aids should be explained to parents and children, and information given about the circumstances most likely to lead to accidents. Children using these devices should be supervised if necessary.

Rollator use adversely impacts on assessment of gait and mobility during geriatric rehabilitation.

OBJECTIVE: To investigate the influence of the use of a rollator walking aid on assessment of gait and mobility. DESIGN: Prospective, longitudinal study. SUBJECTS: Geriatric patients during inpatient rehabilitation (n=109; mean age 83.1 years). METHODS: Assessment at the beginning and prior to discharge from rehabilitation using: gait-analysis (GAITRite®, speed, cadence, stride-time, stride-length, base-of-support, double-support), Performance-Oriented-Mobility-Assessment (POMA), and Timed-Up-and-Go (TUG). Differences between outcomes obtained without and with rollator use were calculated for baseline assessment and for changes over time for the total group and subgroups according to diagnosis (hip fracture vs. other). Responsiveness was calculated using standardized response means. RESULTS: Baseline performances were significantly (p ≤ 0.05) higher when assessed with vs. without rollator in the total group and in hip fracture (except cadence) and other (except cadence, stride-time, TUG) patients. Changes over time were significantly greater when assessed without vs. with rollator in the total group and hip fracture (except cadence, POMA) and other patients (except base-of-support, double-support). Tests without rollator showed superior responsiveness (except TUG). CONCLUSION: The use of rollator walking aids limits the detection of initial gait and mobility deficits, adversely affects the assessment of changes over time in gait and mobility performance, and reduces the responsiveness of tests. When full weight-bearing is permitted, assessment without a walking aid is recommended.

Research on patient safety: falls and medications.

Below you will find summaries of published research describing investigations into patient safety issues related to falls and medications. The first summary provides details on the incidence of falls associated with the use of walkers and canes. This is followed by a summary of a fall-prevention intervention study that evaluated the effectiveness of widespread dissemination of evidence-based strategies in a community in Connecticut. The third write up provides information on three classes of medications that are associated with a significant number of emergency room visits. The last summary describes a pharmacist-managed medication reconciliation intervention pilot program. For additional details about the study findings and interventions, we encourage readers to review the original articles.

Assessment of rolling walkers used by older adults in senior-living communities.

AIM: Rolling walkers (RW) are among the most common ambulatory devices used in senior-living communities. However, many observational studies have associated RW use with an increased risk of falling. Studies on how older RW users obtain and use their RW are lacking. Therefore, this study's purpose was to provide information about RW use that can aid clinical professionals in understanding how to educate RW users. METHODS: Data was gathered from 158 RW users (>or=65 years old) who had used their RW for an approximate mean of 24 months. Assessment utilized questionnaires, inspections and demonstrations. RESULTS: Almost 80% of all participants obtained an RW without consultation with a medical professional (61% through their own means; 19% through medical professionals without receiving instruction or demonstration). The most common misuse was incorrect RW height (55%). Maintenance problems were observed in approximately 17% of the RW. All users admitted that their walkers had not been rechecked by medical professionals since they had obtained them. Forward-leaning posture was apparent in participants during static standing (40%) and during ambulation (50%). Forward-leaning posture during ambulation seemed to be more problematic in causing falls. CONCLUSION: Lack to consult a medical professional when obtaining an RW, incorrect RW height, poor RW maintenance and forward-leaning posture were problems commonly identified. This knowledge could assist medical professionals in implementing strategies to address these problems.

Unintentional fall injuries associated with walkers and canes in older adults treated in U.S. emergency departments.

OBJECTIVES: To characterize nonfatal, unintentional, fall-related injuries associated with walkers and canes in older adults. DESIGN: Surveillance data of injuries treated in hospital emergency departments (EDs), January 1, 2001, to December 31, 2006. SETTING: The National Electronic Injury Surveillance System All Injury Program, which collects data from a nationally representative stratified probability sample of 66 U.S. hospital EDs. PARTICIPANTS: People aged 65 and older treated in EDs for 3,932 nonfatal unintentional fall injuries and whose records indicated that a cane or a walker was involved in the fall. MEASUREMENTS: Sex, age, whether the fall involved a cane or walker, primary diagnosis, part of the body injured, disposition, and location and circumstances of the fall. RESULTS: An estimated 47,312 older adult fall injuries associated with walking aids were treated annually in U.S. EDs: 87.3% with walkers, 12.3% with canes, and 0.4% with both. Walkers were associated with seven times as many injuries as canes. Women's injury rates exceeded those for men (rate ratios=2.6 for walkers, 1.4 for canes.) The most prevalent injuries were fractures and contusions or abrasions. Approximately one-third of subjects were hospitalized for their injuries. CONCLUSION: 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. More information also is needed about the circumstances preceding falls, both to better understand the contributing fall risk factors and to develop specific and effective fall prevention strategies.

[Paresis of nervus peroneus after immobilization with range of motion walker]. / Parese af nervus peroneus efter bandagering med range of motion walker.

It is well known that cast immobilization can cause pressure on the common peroneal nerve. In this case a 64-year-old female patient had a fracture of the distal fibula (SU2, according to Lauge Hansens classification of angle fractures). This avulsion was conservatively treated and immobilized in a flexible cast. Unfortunately, the cast was too high, the metal plates inside it caused pressure on the common peroneal nerve and the patient sustained a peroneal palsy.

Theoretical optimization of usage of four-wheeled walker and body posture of elderly users for comfortable steady walking.

Usage of a four-wheeled walker and body posture of elderly users is optimized by a two-dimensional statics model for comfortable steady walking. Analytical results suggest that fundamentals of body posture for comfortable walking should be as upright as possible. However, usage of the walker varies with exercise capabilities of elderly users. Users with high capabilities should use a higher handgrip for maintaining upright posture. Stooping users with low capabilities should use a lower handgrip, should maintain an erect trunk as much as possible, and should push the handgrip downward by leaning their upper body on the walker.

Assistive devices for balance and mobility: benefits, demands, and adverse consequences.

OBJECTIVES: To provide information on the advantages and possible disadvantages of using canes and walkers. DATA SOURCES: English-language articles were identified by searching MEDLINE and PubMed (1966-May 2003) for key words cane or walker , excluding articles unrelated to mobility aids. Bibliographies were reviewed and ISI Web of Science citation searches were run to identify additional references. Over 1000 articles were selected for further evaluation. STUDY SELECTION: We extracted all studies of single-tip canes or pickup walkers addressing: (1) functional, biomechanic, or neuromotor benefits; (2) biomechanic, attentional, neuromotor, metabolic, or physiologic demands; and (3) falls, injuries, or other problems. We included approximately 10% of the articles originally identified. DATA EXTRACTION: The methodology of each selected article, and findings relevant to the benefits, demands, or adverse effects of cane or walker use were summarized. DATA SYNTHESIS: Findings were synthesized by considering their relation to basic biomechanic principles. Some biomechanic findings appear to support the clinical view that canes and walkers can improve balance and mobility for older adults and people with other clinical conditions. However, a large proportion of users experience difficulties, and the use of such devices is associated with increased risk of falling. A small number of studies have characterized some of the specific demands and problems associated with using mobility aids. CONCLUSIONS: Clinical and biomechanic evaluations of canes and walkers confirm that these devices can improve balance and mobility. However, they can also interfere with ones ability to maintain balance in certain situations, and the strength and metabolic demands can be excessive. More research is needed to identify and solve specific problems. Such research may lead to improved designs and guidelines for safer use of canes and walkers.

Can use of walkers or canes impede lateral compensatory stepping movements?

Although 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. In this study, we investigated one possible mechanism: the potential for walkers or canes to interfere with, or constrain, lateral movement of the feet and thereby impede execution of compensatory stepping reactions during lateral loss of balance. Lateral stepping reactions were evoked, in 10 healthy young adults (ages 22-27 years), by means of sudden unpredictable medio-lateral support surface translation. Subjects were tested while holding and loading a standard pickup walker or single-tip cane or while using no assistive device (hands free or holding an object). Results supported the hypothesis that using a walker or cane can interfere with compensatory stepping. Collisions between the swing-foot and mobility aid were remarkably frequent when using the walker (60% of stepping reactions) and also occurred in cane trials (11% of stepping reactions). Furthermore, such collisions were associated with a significant reduction (26-37%) in lateral step length. It appeared that subjects were sometimes able to avoid collision by increasing the forward or backward displacement of the swing-foot or by moving the cane; however, attempts to lift the walker out of the way occurred rarely and were usually impeded due to collision between the contralateral walker post and stance foot. The fact that compensatory stepping behavior was altered significantly in such a healthy cohort clearly demonstrates some of the safety limitations inherent to these assistive devices, as currently designed.

Do baby walkers delay onset of walking in young children?

Baby walkers have been a source of considerable controversy. Some people suggest developmental benefit from their use while others focus on the potential harm that stems from accidents and even suggest developmental delay. This mini-review aimed to determine if use of a baby walker delays affects the onset of walking. The Cochrane library, Embase, CINAHL and Medline were searched for randomized controlled trials (RCTs) and cohort studies, which compared the onset of walking in infants who used baby walkers with a group who did not. Two RCTs and two cohort studies were identified and available for consideration. All of the studies examined the effect of infant walkers on the onset of walking. The results of the two RCTs did not demonstrate a significant effect on the onset of walking. The cohort studies suggest that the use of infant walkers delayed the onset of walking in young children and a pooled analysis of the four studies suggested a delay of between 11 and 26 days. Although the quality of the studies was relatively poor these studies lend no support to the argument that walkers aid the development of walking. The significance of a delay of this magnitude is however unclear. Further work is required to determine whether walkers are an independent causal factor in accidents.

Life-threatening subcutaneous hematoma caused by an axillary pad in an anticoagulated patient.

A large subcutaneous hematoma extending from the left axillary region to the left flank developed in a 70-year-old man receiving anticoagulant therapy. The cause was repeated microtrauma caused by the axillary pad on a walker. Physicians and physiotherapists should be aware that rehabilitation devices causing pressure on the skin increase hemorrhagic risk in patients taking anticoagulants. Accordingly, these patients should systematically be checked for hemorrhagic complications, and the use of such devices should be limited.