Fitting, Choosing, and Walking with a Walker: Simple 3-step guide
Let us begin by casting the caricature aside – not everyone walking with a walker is frail or crippled. Nursing and physical therapy professionals will attest to this. Sure, walkers are very commonly used in geriatric populations because they offer a significant amount of support and stability. This doesn’t mean that an older person walking with a walker is destined for the wheelchair, however. Nor does it mean that post-op/younger population don’t use them. If you fall into any of the above categories and/or have been recommended by a healthcare professional to begin walking with a walker, this guide will show you which kind to use, how to fit it, and of course, how to use it properly.
Choosing a Walker
Whatever challenges your condition or injury create, there is a walker that can help. The question is, which kind? There are hemi walkers for use with one hand, walkers meant specifically for Parkinson’s, and even posterior walkers that follow behind, not in front of the user. Following is a quick and easy guide to help you narrow down the best options for your scenario.
|Walker Type||Pros||Cons||Ideal For|
|Standard (no wheels)||--Highest stability.|
--Foldable and compact.
|--Slowest of walkers.|
--Wide base when in use.
|Populations with decreased strength, endurance, and balance requiring significant support. Parkinson's disease, hip fracture/replacement patients, generalized weakness, etc.|
|Front Wheeled||--High stability.|
--Faster than standard.
--Foldable and compact.
|--Minor fall risk increase compared to standard.|
--Wide base when in use.
|Populations with above criteria, but slightly more independent and functional. Can be transitioned to (from standard) as strength and balance improve.|
|Rollator||--Fastest walker type.|
--Narrower base than standard and front-wheeled.
--Includes a fold-out seat.
|--Higher fall risk than standard and front-wheeled.|
--Heavier and most are not foldable.
|Populations with generalized deconditioning > acute injuries who need to be walking with a walker but only require mild to moderate support. Ideal for long-term use in this fashion.|
|Hemi Walker||--Usable with one hand.|
--More stable than standard canes.
|--Less supportive than other walkers.||The hemi walker is used almost exclusively by post-stroke patients who need moderate support and have one arm available for an assistive device. Can be used to transition from a walker to a single-point cane.|
|Knee Walker||--Accomodates most weight-bearing restrictions.|
--Faster than crutches.
|--Most difficult to learn.|
--Most awkward for curbs, stairs, etc.
--Increased stress on knee of affected leg.
|The knee walker is ideal for people with acute ankle or foot injuries who are otherwise highly functional. May be used as an alternative for axillary crutches if they cause armpit, shoulder, or am issues.|
Fitting Your Walker
Hopefully you have a much clearer picture of the different kinds of walkers and who they are intended for. Before you can begin walking with a walker, though, you need to know how to properly fit one. No need to enlist a friend or family member, excavate the tape measure, and awkwardly measure from your hand to the ground while trying not to fall over. Simply complete the following: unfold your walker (if it is the folding type), adjust the height to your best guess, and set it in front of you. When you are ready, stand up as straight as you can within your walker base. With hands at your sides and the most upright posture you can manage, the hand grips should align with the crease of your wrists. If not, adjust accordingly. Done!
Walking with a Walker
Once you have the right equipment, actually learning to walk with a walker is very straightforward, no pun intended. With a standard walker, the sequence is as follows:
- Advance the walker
- Advance your weaker/injured leg.
- Advance the good leg.
Make sure that you advance the walker by extending your arms and not bending forward at the waist. Another consideration at step two is to make sure your weaker foot gets all the way in the walker base. Okay, that’s more than easy enough, but there are other kinds of walkers out there. Following are gait pattern summaries of the most popular alternatives to the standard:
Front-Wheeled Walker Pattern: With a front-wheeled walker or rollator, which obviously function without needing to be picked up and set down, you simply advance the walker, then your weaker leg, then your stronger leg. Make sure to maintain upright posture and stay within the walker base to the best of your ability.
Hemi Walker Pattern: A hemi walker is basically a cane with a massive base designed for people who are a little to independent to be walking with a walker in the traditional sense. It is used in the same fashion as a single point cane. If you have mild deficits in strength and balance, then advance the affected leg and the hemi walker at the same time before advancing the unaffected leg. If your deficits are moderate to severe, advance the hemi walker first, THEN your affected leg before proceeding with the unaffected leg.
Knee Walker Pattern: Learning to actually maneuver a knee walker is simple. First, rest your affected leg with knee at a 90 degree angle on the pad. Next, use your unaffected leg to push forward or backward like a scooter or skateboard. Your typical knee walker will feature steerable handles and a brake. The handles should align with your waistline. Safely using your knee walker in the community can be daunting. Of all the assistive devices, it is arguably most imperative to start slow with a knee walkers especially if you’ve never used one. Test the brake and the steering, kick a tire or two, and make sure you get regular oil changes (couldn’t help it).
Find yourself leaning forward? By far, the most common gait deviation demonstrated by those walking with a walker would be forward flexed posture. This is caused by leaning on the walker too much and not remaining within the base, i.e. leading it too far in front of you. If you desire NOT to be hunched over, stand up straight and stay within the walker base (the two are mutually inclusive). Stand up straight and stay within the walker base. I repeat once more – stand up straight and stay within the walker base!
Falling backwards when standing up from chair to walker? Ensure you do not adopt the habit of pulling on your walker to assist when standing from a chair, bench, etc. You weigh more than the walker. It will fall, and so will you! Push from the surface you are on if you need an extra boost, and THEN reach for the walker. This goes for the hemi walker and knee walker populations as well.
Unsure whether you need raising or lowering? If you must lock your elbows to reach the handgrips when walking with a walker, it needs to be raised. If you are wearing your shoulders as earrings, the walker needs to be lowered (see above fitting guidelines for both). Congratulations and good luck! Remember to start slowly, be patient, and always be aware of your environment.
To help you or your patients remember the above steps, we slapped together a simple infographic. Print it, post it, do your thing. Enjoy!