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.

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.

New assistive walker improved local dynamic stability in young healthy adults.

In this study, we investigated the effect of walker type on gait pattern characteristics comparing normal gait (NG), gait with a regular walker (RW), and gait with a newly developed walker with vertical moveable handlebars, the Crosswalker (CW). Partial weight bearing (PWB) of the feet, peak joint angles and largest Lyapunov exponent (λmax) of the lower extremities (hip, knee, ankle) in the sagittal plane, and gait parameters (gait velocity, stride length, cadence, stride duration) were determined for 18 healthy young adults performing 10 walking trials for each walking condition. Assistive gait with the CW improved local dynamic stability in the lower extremities (hip, knee, ankle) compared with RW and was not significantly different from NG. However, peak joint angles and stride characteristics in CW were different from NG. The PWB on the feet was lower with the RW (70.3%) compared to NG (82.8%) and CW (80.9%). This improved stability may be beneficial for the elderly and patients with impaired gait. However, increased PWB is not beneficial for patients during the early stages of rehabilitation.

Evaluating the sit-to-stand transfer assistance from a smart walker in older adults with motor impairments.

AIM: To evaluate the effectiveness and user satisfaction with the sit-to-stand (STS) assistance system of a smart walker (SW), and to identify factors associated with them in potential users. METHODS: A total of 33 older adults (29 women, aged ≥65 years) with motor impairments (habitual rollator use) and no severe cognitive impairment (Mini-Mental State Examination ≥17 points) carried out a Five-Chair Stand Test without assistance and five STS transfers with the STS assistance system. Based on the number of successfully completed STS transfers, success rates were calculated for the Five-Chair Stand Test and the SW-assisted STS transfers, and compared using the Wilcoxon signed-rank test. User satisfaction was assessed using the Tele-healthcare Satisfaction Questionnaire-Wearable Technology (0-80 points, higher score = higher satisfaction). Bivariate correlations and multiple linear regression analyses were used to identify participant characteristics associated with the success rate and user satisfaction with the STS assistance system. RESULTS: The success rate for the SW-assisted STS transfers was significantly higher than for the Five-Chair Stand Test (93.3 ± 12.9% vs 54.5 ± 50.6%, P < 0.001). User satisfaction was high (Tele-healthcare Satisfaction Questionnaire-Wearable Technology 62.5 ± 11.2 points). The success rate with the STS assistance system was not significantly associated with any participant characteristics. Higher body mass index was a significant independent predictor of higher user satisfaction. CONCLUSIONS: The SW-integrated STS assistance system can provide effective STS support with high user satisfaction for a wide range of potential users. Our findings suggest the high potential of the STS assistance system for promoting mobility, independence and quality of life for older adults with motor impairments. Geriatr Gerontol Int 2020; 20: 312-316.

Differences in the Limits of Stability Between Older Rolling Walker Users and Older Single-Tip-Cane Users - A Preliminary Study.

PURPOSE: To identify the differences in the limits of stability (LOS) between older rolling walker and single-tip-cane users. DESIGN: This was a matched paired t-test design with repeated measure. METHODS: Eighteen older subjects were matched based on age, gender, and functional level. The subjects were assessed using the multidirectional reach test initially and 5-month later in four directions: forward, backward, leftward, and rightward. FINDINGS: Initially, there were no differences between cane users and rolling walker users in the LOS in all directions. However, 5-month later, the cane users who held their canes in their right hand had significantly better stability in forward and rightward reach than the walker users (p < .05). Further, the walker users demonstrated significantly decreased functional reach in forward reach (p < .05). CONCLUSION: Cane users might have better stability than walker users in the forward direction and in the direction toward the side holding the cane. This study may provide guide for clinicians including nurses for selecting appropriate rehabilitative interventions for older adults using walkers and canes.

Comparative Study of Assisted Ambulation and Perceived Exertion With the Wheeled Knee Walker and Axillary Crutches in Healthy Subjects.

BACKGROUND: Functional limitations after lower extremity surgery often require the use of an assistive device for ambulation during rehabilitation and recovery. There are no known objective data evaluating the wheeled knee walker as an assistive device for protected ambulation. The purpose of this study was to compare assisted ambulation and perceived exertion with the wheeled knee walker and the axillary crutches in healthy participants. METHODS: A prospective, randomized crossover study was performed using 24 healthy volunteers. Each participant performed a 6-minute walk test (6MWT) using each assistive device in a crossover manner. Preactivity and postactivity heart rates were recorded. The self-selected walking velocity (SSWV) was calculated and the participant's rating of perceived exertion was recorded using the OMNI Rating of Perceived Exertion (OMNI-RPE). Participant's preference for assistive device was identified. RESULTS: The 6MWT, SSWV, and the Omni-RPE were evaluated using paired t tests and determined to be statistically significant for the wheeled knee walker compared with axillary crutches. Evaluation of the preactivity and postactivity heart rates demonstrated a statistically significant difference for the wheeled knee walker compared with axillary crutches. The wheeled knee walker was preferred by 88% of participants. CONCLUSIONS: The wheeled knee walker provided increased assisted ambulation and had a lower rating of perceived exertion than axillary crutches on level surfaces in healthy participants. LEVEL OF EVIDENCE: Level III, comparative study.

A comparison of a two-wheeled walker and a three-wheeled walker in a geriatric population.

OBJECTIVE: There are few data on the effect of walkers on gait and mobility or on comparisons of different walker types. We compared a commonly used 4-legged, 2-wheeled walker and a newer 3-legged, 3-wheeled walker in measures of gait, mobility, and patient satisfaction. DESIGN: Cross-over controlled trial. SETTING: In the Physical Therapy Department of a Veterans Affairs hospital. PARTICIPANTS: Subjects were 15 male and female frail elderly veterans (mean age, 82 years), both inpatients and outpatients, consecutively enrolled from a sample of 35 patients referred to the Physical Therapy Department for mobility problems. Subjects met the following criteria: age 65 or over, ambulatory, no prior use of a wheeled walker, stable medical condition, and informed consent. INTERVENTION: Subjects were evaluated without either walker and with each of the two walkers on a 15-foot walkway and a 60-foot obstacle course. Subjects were asked which walker they preferred. OUTCOME MEASURE: Outcome measures were stride length on the walkway, time on an obstacle course, and walker preference. RESULTS: Stride length was 1.4 inches (3.6 cm) greater with the 3-wheeled walker than with the 2-wheeled walker (P = 0.016 by Wilcoxon signed-rank test). Time on the obstacle course was 16.0 seconds less with the 3-wheeled walker than the 2-wheeled walker (P = 0.002). The 3-wheeled walker was subjectively preferred. CONCLUSIONS: The 3-wheeled walker appears to have a greater positive impact on gait and mobility than the 2-wheeled walker.

The dual-task methodology and assessing the attentional demands of ambulation with walking devices.

The purposes of this article are (1) to provide a preliminary examination of the attentional demands of ambulating with two commonly prescribed walking aids (a standard walker and a rolling walker) and (2) to introduce the dual-task methodology to the physical therapy community. Five subjects familiar with the appropriate use of the walkers and five subjects uninformed as to the correct use of the walkers participated in the study. Each subject completed the three phases of the experiment: (1) performing the reaction time (RT) task only; (2) performing each of the walking tasks only; and (3) performing each of the walking tasks in conjunction with the RT task, which constituted the dual-task conditions. The findings indicated that walking aided by either the rolling walker or the standard walker was highly attention demanding. More importantly, it appears that greater attentional demand was required when ambulating with the standard walker. These results are discussed with respect to the gait modifications and accuracy demands required when using these walkers. The usefulness of the dual-task methodology as a research tool for addressing clinically oriented questions is emphasized, and some potential applications of this methodology for the therapist within the clinic are discussed.

The effect of walking with an assistive device and using a wheelchair on school performance in students with myelomeningocele.

An alternating-condition, single-subject research design was used to examine the effect of ambulation on three measures of school performance in three students with myelomeningocele. The subjects, aged 9, 10, and 15 years, had a physiological cost index greater than 1.00 beats per meter when walking with crutches or a walker. Subjects propelled a wheelchair at school for 5 days, ambulated with crutches or a walker for 5 days, and propelled a wheelchair for an additional 5 days. Performance in reading fluency, visuomotor accuracy, and manual dexterity was assessed at the end of each school day. Results were graphed and analyzed using the two-standard-deviation band method. All subjects had significantly lower visuomotor accuracy scores during the assistive-device ambulation phase than during the wheelchair phases. Performance in manual dexterity during the assistive-device ambulation and wheelchair phases varied among the subjects. Reading fluency was not affected by method of mobility. The results suggest that the high energy cost of walking may have a negative effect on certain aspects of the subjects' school performance. [Franks CA, Palisano RJ, Darbee JC. The effect of walking with an assistive device and using a wheelchair on school performance in students with myelomeningocele.

Comparison of anterior and posterior walkers with respect to gait parameters and energy expenditure of children with spastic diplegic cerebral palsy.

The purpose of this study was to compare gait pattern and energy consumption in children with spastic diplegic cerebral palsy, when using anterior and posterior walkers, and to determine which walker should be recommended as a walking aid for these children. Ten spastic diplegic cerebral palsied children, of average age 9 years, were enrolled in this study. Before assessment, they had all received a practice period of 1-month to familiarize themselves with both types of walker. Gait characteristics were evaluated by computer-based kinematic gait analysis using Vicon 370 Motion Analysis, and energy expenditure was determined by KBI-C while they were using the walkers. The oxygen consumption rate was significantly lower whilst using the posterior walker, as was the oxygen cost. Walking velocity and cadence on gait analysis showed no significant difference between the walker types. However, step length, single support time and double support time were significantly different for the two walkers. Flexion angles of the trunk, hip and knee were lower using a posterior walker. Gait analysis data and oxygen consumption measurements indicated that the posterior walker has more advantages in terms of upright positioning and energy conservation than the anterior walker.

Stability of walking frames.

Biomechanical tools were used to assess stability for 11 patients who, following the surgical amputation of one lower limb, required the assistance of a walking frame to ambulate. The Walker Tipping Index (WTI), as derived from the forces applied to the walking frame, was developed specifically for this study to examine the relationship between stability and walking frame height during ambulation. However, the WTI may be useful as a criterion of stability to assist clinicians in their evaluation of walker use in a variety of patient populations. Walker stability was examined as subjects, wearing their prostheses, completed 30-sec walking trials in each of the normal, high, and low walking frame height conditions. Adjusting the height of the walker to one setting (3 cm) above or below normal appears to redistribute the load of walking between the upper and lower extremities without adversely affecting stability.

Ambulation aid use during the rehabilitation of people with lower limb amputations.

Our objective was to describe the progression of ambulation aid use by people with lower limb amputations during their initial rehabilitation. We prospectively studied 37 people with recent lower limb amputations and a mean (SD) age of 68 (13) years. Subjects were evaluated each weekday during gait-training physiotherapy sessions, and the type and order of ambulation aids used during ambulation training were documented. The total number of gait-training sessions that we observed was 605, with a mean (SD) of 16.4 (7.7) sessions per participant and a range of 5-47. Of the 37 participants, 33 (89%) were discharged with prostheses. The mean (SD) number of aids per person was 2.9 (1.0). The percentage of participants who used each aid (presented in the mean order in which they were first used) were 76% parallel bars, 60% four-footed walkers, 81% two-wheeled walkers, 11% two crutches, 8% four-wheeled walkers, 46% two canes, and 14% one cane. People with lower limb amputations generally use a number of ambulation aids in a fairly consistent order as they progress through their initial rehabilitation. These findings have implications for the process of providing ambulation aids and provide a foundation for further study.

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.

Walker devices and microswitch technology to enhance assisted indoor ambulation by persons with multiple disabilities: three single-case studies.

These three single-case studies assessed the use of walker devices and microswitch technology for promoting ambulation behavior among persons with multiple disabilities. The walker devices were equipped with support and weight lifting features. The microswitch technology ensured that brief stimulation followed the participants' ambulation responses. The participants were two children (i.e., Study I and Study II) and one man (i.e., Study III) with poor ambulation performance. The ambulation efforts of the child in Study I involved regular steps, while those of the child in Study II involved pushing responses (i.e., he pushed himself forward with both feet while sitting on the walker's saddle). The man involved in Study III combined his poor ambulation performance with problem behavior, such as shouting or slapping his face. The results were positive for all three participants. The first two participants had a large increase in the number of steps/pushes performed during the ambulation events provided and in the percentages of those events that they completed independently. The third participant improved his ambulation performance as well as his general behavior (i.e., had a decline in problem behavior and an increase in indices of happiness). The wide-ranging implications of the results are discussed.