Life Begins At.....
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O ccupational therapists and physiotherapists can assist individuals in selecting the most appropriate mobility device. It is important that all equipment is considered in context of the individual user, the distinctive features of the equipment and the environment where the mobility aid is to be used. Walking aids When use correctly, walking aids can assist with balance, reduce strain on joints, diminish fatigue and pain and facilitate a safe gait. Walking sticks, quad sticks and tripods Walking sticks provide a basic level of support and are designed to assist with balance and/or decrease weight on an affected leg. Sticks can be made from wood, steel or aluminium and may be available in a fixed or adjustable length. There are folding aluminium sticks that can fit into large handbags. Wooden walking sticks need to be cut to the correct height and should not be stored in direct sunlight or in a damp environment to avoid swelling and cracking. A range of handle styles are available. A T-handle is at right angles to the stick and is easy to grip, providing good control. Crook handles are generally less comfortable to hold than T-handles, but they can be hooked over the arm when performing two-handed activities. Swan neck handles are offset above the stick which spreads the user's weight more centrally over the base, improving stability. Contoured handles (sometimes termed arthritic handles) are contoured to the shape of the hand to spread the pressure over a wider area of the palm. Three and four point sticks (also known as tripods and quad sticks) usually have a swan neck handle that is offset above the stick and three or four points at the base which provide a wider base of support than the usual walking stick. The straight side of the base should be positioned nearest to the foot. If the user's foot angles towards the walking stick it may get caught in the three/four-point base. A lower-profile base decreases this likelihood. All points of the stick should contact the ground when the stick is placed down. An advantage of a three- or four-point stick is that it is able to stand unaided. The Unifoot Walking Stick aid is a small plastic platform that fits onto the end of a walking stick and has four points that contact the ground. The base stays in contact with the ground regardless of the angle of the walking stick. Sure Step and Sure Foot Canes have a large base pad that stays flat on the ground when walking, due to a moveable joint and two springs attaching the cane to the base. It is self righting. If the stick cannot stand unaided, options include a leather wrist strap attached below the stick handle or a "Frog Walking Stick Holder" that is clipped onto the stick below the handle and enables the stick to balance on a flat surface. Alternatively the Atlas Fall Free Cane has an in-built spring-loaded mechanism to attach the stick to a table edge. The U-step Laser Cane may assist some people with Parkinson's Disease. When activated, it projects a red laser 88 www.theretiree.com.au beam across the user's path that provides an obstacle- free visual cue designed to break a 'freezing' episode. The Path Lighter Walking Stick has an in-built Xenon light that illuminates the user's path and surroundings. Three- or four-wheeled walkers Three- or four-wheeled walkers provide more support than walking sticks and encourage a more symmetrical gait. Three-wheeled walkers are less stable than four wheeled models, which have a larger base of support. Wheeled walking frames are generally designed for both indoor and outdoor use and feature either bicycle style hand brakes or push-down brakes. Bicycle style hand brakes have levers that can be squeezed upwards to slow down descent, or pushed down to lock into place. This style requires the person to remember how to apply the brakes and have sufficient hand skills to operate them. They are suitable for more active community users who can walk short distances unaided but require support for longer distances. Push-down brakes work via pressure through the handles which pushes a spring-loaded rubber stopper onto the ground, between twin rear castors. When pressure is removed from the handles the brakes will cease. These are more suitable for people with hand weakness and cognitive impairment that find operating bicycle style brakes difficult and for people who cannot walk unsupported. This often includes frail elderly in aged care facilities. It is recommended users are supervised when walking with this frame. If they apply insufficient pressure through the handles when attempting to sit the walker could move. If they press heavily on the handles it will apply the brakes and they cannot move forwards. In this case a rollator frame should be considered. If a walking frame is too low it will encourage the user to stoop. If it is too high, the user cannot straighten their elbows adequately to take sufficient body weight through their arms. The hand grip height of all walking frames should be at wrist level when the elbow is slightly bent (between 15-30 degrees flexion). This also applies for walking sticks, quad sticks and tripods. Gutter frames are available for users needing forearm support. Generally the seat height of four-wheeled walkers is fixed. However there are walkers with adjustable seat heights. There are models designed to suit a range of body shapes, weights and heights. In-step Mobility U-Step Walking Stabilisers are especially designed for people with Parkinson's Disease who are affected by 'freezing' episodes or festination. Heavier walkers may assist some people with an unsteady gait but they are heavier to lift into car boots. Many walkers have optional accessories such as baskets or bags, trays and oxygen bottle holders. It is important not to overload a walking frame with too much additional weight because this may affect its balance. As with all equipment, it is also important that the user's weight does not exceed the load capacity of the walking frame. Most styles of walkers fold for storage or transportation.