Are you (or your family member) using your Walking Aids correctly?

Walking aids like crutches, walking frames, walking sticks are a great way to improve an elderly person's confidence when walking, thus preventing or at least reducing the risks of falls.

However, there are many cases in which the elderly person is using the walking aid inappropriately, and hence, paradoxically increasing the risks of falls! This article is written to inform you or your family member of the basics of using a walking aid, thus hopefully, reducing the risks of falls.

First, let's talk about some of the pros and cons of using walking aids.

Pros:

1. Increase stability (for falls prevention)

Poor balance is a major risk factor for falls. A correct walking aid can help to increase a patient’s stability when mobilizing.

2. Improve mobility and function

By improving stability and balance, a patient can increase their daily mobility levels and thus increase their exercise tolerance, strength and balance.

3. Reduce pain and weight bearing on joints

Weight bearing through their upper limbs when using a mobility aid can help a patient to offload weight from a painful lower limb joint. For younger patients after any form of lower limb surgery, a walking aid may be helpful to reduce pain too.

4. Reduce caregiver burden when assisting the patient to walk

For a caregiver, a walking aid can be helpful for the patient when assisting a patient to walk long distances and even short transfers from bed to chair or commode. While often the main focus is often the patient, a caregiver must be helped to reduce the physical stress on their own body and back care is extremely important.

Cons:

1. Reduced walking reflexes specifically the ankle and hip righting reactions.

2. With reduced protective walking reflexes comes a reduced reaction speed to changes in ground slope, surface and external forces.

3. With prolonged unnecessary use of mobility aids, the patient's dependence on the mobility aid may increase and his/her lower limbs may become weaker as a result.

4. A patient often associates the mobility aid with safety, which helps to improve their confidence and reduce their fear of falling. However with this comfort comes increased dependency on the aid.

5. Inappropriate use of mobility aids is a risk factor for falls by itself. This often pertains to patients being given a walking aid that does not offer them enough support (e.g. a walking stick instead of a broad-based quadstick, or a patient with a cognitive impairment being given a walking aid they are unable to utilize properly).

So as you can see, there are many benefits to using walking aids, but there are also some potential pitfalls too!

The question now is what would be most suitable for the patient. You should visit your friendly neighborhood doctor, who has training in Geriatric Medicine, to have a good discussion on what is the most appropriate walking aid for you or your family member. But here is a quick run down of the various types of walking aids available.

Elbow Crutches

Walking Frame

Quad Stick (narrow base and broad base)

Rollator Frame

Walking Stick

Choosing the walking aid is tricky enough, but even more tricky is how to get the walking aid to fit you and learning how to use it appropriately. But here are some pointers on how to size the walking aid to you before you visit your doctor for a friendly discussion.

1. Hand grip of walking aid = level of wrist crease

2. Measure in standing if possible and check posture

3. Your doctor should observe for any abnormal posture when you are walking

4. At a standing position, your elbow should be bent at a 30 degree angle when holding the handgrip. The walking aid should be held on the opposite side of the affected leg. For example, if your left leg is the affected leg, the walking aid should be held on the right side.

How to walk with a walking aid?

Step 1: Bring forward the walking aid

Step 2: Step forward with your affected leg

Step 3: Follow by your good leg

How to walk up stairs?

Going up the stairs

Step 1: Good leg step up

Step 2: Place walking aid one step up

Step 3: Affected leg followed

Coming down from the stairs

Step 1: Place the walking aid one step down

Step 2: Step down with the affected leg

Step 3: Followed by good leg down

Checklist to ensure the walking aid is safe to use

• Rubber tip: intact and not worn-out

• Rubber handgrip: in good condition

• Stable, not shaky

• All parts are secured

• Correct height

So by now you can see that there are many considerations to think about when using walking aids. Even more so, you may need a practical session with a trained professional to go through with you the choice, sizing and use of the walking aid.

Visit your friendly neighbourhood geriatric medicine trained doctor for a further discussion as well as a practical session to learn the finer points of using walking aids appropriately!

By:

Dr Lee Joon Loong

MBBS (Australia)

Graduate Diploma in Geriatrics Medicine (Singapore)

Medical Director, Paddington Medical

References:

Department of Geriatrics, Department of Physiotherapy, Tan Tock Seng Hospital.