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As people grow older, important daily activities, like walking, dressing, bathing, and eating, may become increasingly difficult to manage alone. Many older persons depend on helpful products or devices to help carry out these activities.
Millions of Americans rely on devices to help them walk and move around. The most common devices used for walking are canes and walkers, which provide support and balance. This booklet describes several types of canes and walkers and general instructions for their use.
For help in selecting and using canes and walkers, always consult a professional, such as your doctor or a physical therapist. Canes and walkers are reimbursable under Medicare and many other third party payers.
The cane is the most widely used assistive device. In the United States alone, over 4 million people use canes. People who have difficulty walking use canes for support and balance. Canes support up to 25% of a person’s weight and may prevent many falls.
Canes are found in many stores for fairly inexpensive prices, ranging from $5 to $100. Because of their availability, people often acquire canes without the help of a qualified professional. This may result in an improper choice of a cane. For example, the cane may be too short or too long for the user. To guarantee a proper fit and good performance, a health professional, such as a physical therapist should help select the cane.
Important Considerations for Effective Cane Use
Do not use canes on stairs without using a handrail or the support of another person on the opposite side. Most quad canes and other wide base canes are not safe for use on stairs.
Canes consist of four components: the handle (a), the shaft (b), the base (c), and the tip (d).
The handle of the cane should be as high as the wrist of the hand opposite the weak side. While standing and holding the handle of the cane, the elbow should be at a 20 to 30 degree angle, as pictured on the next page (figure e).
There are many different types of cane handles. Choose the style that makes you feel most secure.
Types of cane handles include the crooked handle (a), the ball-topped handle (b), the straight (or offset) handle (c), and the shovel handle (d). For a person with weak grasp, a pistol handle (e), which contours to the hand, may be more comfortable. To increase comfort and improve grasp, foam (f) or other materials can be added to the cane handle.
Different materials used in the shaft change the weight and feel of canes. Traditional wood (a) is relatively heavy. Aluminum (b) is very common and lighter than wood. Newer, lightweight materials, like carbon fiber, are beginning to be used in the cane designs. Height adjustment buttons on metal canes raise and lower the height of the cane, to guarantee a perfect fit for each user.
Some companies sell “designer” canes (c) with painted or decorated shafts. Many people prefer using canes that look “special”.
In a single shaft design, the base is simply the end of the shaft. Greater support can be achieved by adding more legs, and making the base of the cane higher and wider. However, as legs are added and bases are widened, canes become heavier. They may become too heavy for people with decreased strength. Furthermore, multi-legged canes may be too wide for use on stairs.
Multi-legged canes include the quad high profile cane (a) and the quad narrow cane (b). A quad wide base cane is also available.
Tips on the end of cane legs provide traction and absorb shock, thereby cushioning the hand. A suction tip (a) grips the floor for extra protection against falling. Stabilizers (b) can be added to a cane to help the user maintain balance and equilibrium while walking. Because they slip easily, do not, in general, use canes on snowy or icy surfaces. However, metal or rubber tips (c & d) that grip the ice may give more protection against slipping and falling.
Many special features are available for canes. Some canes fold down to form a convenient tripod seat (a). Cane holders (b) keep the cane upright when leaned against a counter or table. Wrist straps (c) allow the hand to be free without having to set down the cane. They also prevent a person from dropping the cane. Forearm cuffs and platforms (d & e) help people with limited hand or wrist strength because they shift weight to the forearm or upper arm. The reacher accessory (f) is useful for picking up items off the floor.
Walkers rank second behind canes in amount of users, numbering almost two million people in the United States. Since their introduction over 200 years ago, walkers have changed greatly. Originally designed as a temporary rehabilitation device, walkers have been modified for use in the home, adding features like wheels, brakes, and accessories.
Able to support up to 50% of a person’s weight, walkers are more stable than canes. Walkers are helpful for people with arthritis, weak knees or ankles, or balance problems. Prices range from $30 for a basic rigid walker, to $600 for a wheeled walker with accessories.
Important Considerations for Effective Walker Use
A professional, such as a physician or physical therapist, should help choose or prescribe the walker. The physician or physical therapist should demonstrate how to walk correctly with the walker on different types of surfaces.
Walker height is best when the users’ shoulders are level, and the arm bends at the elbow in a 20 to 30 degree angle.
Many people use walkers for several years. Extended walker use may cause side effects such as a stooped posture.
To prevent tripping or falling, always look ahead, not at the feet, when walking and use walkers only in well-lit areas. Beware of crowded, cluttered areas. Avoid throw rugs and wires running across the floor, which may catch the wheels of the walker. Footwear is also important when using a walker. Properly fitting shoes with rubber soles are best. Do not wear loose fitting footwear such as slippers, high heels, or slippery soled shoes.
When coming to a standing position from sitting, use the arms of the chair, not the walker, to help in lifting. Once up, be sure there is no dizziness before beginning to walk. When sitting, reach back to the arms of the chair to provide a safe descent to the seat.
Avoid using the walker on stairs. In two or three story homes, it may be necessary to have a walker at each level. Small rooms, like bathrooms, may prevent proper use of the walker. A solution is to install appropriately placed grab bars.
The most basic walker design, the rigid walker (a) is the type most often used in therapy. The frame of the rigid walker is typically made of aluminum. The width can sometimes be adjusted. Other components of the rigid walker include crutch or cane tip legs, and handles. Handles come in a variety of styles, and can be modified for comfort with materials such as sheepskin (b).
To operate, a person lifts the walker, moves it forward, and puts it back down with each step. Because they require lifting, extended use may cause strain on the wrists, shoulders, and arms. It is important to have a therapist determine if this is the best type of walker for you.
The side walker (a) is a variation of the rigid walker design. Often, it has two grasp bars at different heights. Grab the lower bar when rising from a seated position. Use the upper bar for walking.
The folding walker (b) has the same components and is used in the same manner as the rigid walker. However, it folds into a flat object so that it can be carried or transported easily when not in use.
Unlike the rigid walker, the user merely pushes the two-wheeled walker (a) forward. No lifting is necessary, so the walking style is more natural. Two-wheeled walkers have automatic brakes that work when you push down on the walker. Some have auto-glide features (a) that allow the rear legs to skim the surface.
Three or four wheeled walkers (b) & (c) require less energy and strength to use. Gliding over carpets and thresholds is easier, and they may provide better performance in turning. Three and four wheeled walkers often have hand brakes (c).
Wheel size and walker weight vary greatly in different models of wheeled walkers. All are heavier than rigid or folding walkers. Because many wheeled walkers do not fold, they may be more difficult to transport.
Convenient accessories are available, such as detachable baskets (a), and seats (a) and trays (b). Walker bags (c) allow you to carry small items while keeping your hands free to hold the walker. Clips can attach other accessories to rigid walkers, such as a platform arm support (d).
ABLEDATA is a database that lists information on thousands of assistive devices. It currently includes over 150 canes and over 200 walkers. To access the ABLEDATA database, call or write to the address below. Information specialists are available to help with database searches.
8455 Colesville Road, Suite 935
Silver Spring, MD 20910-3319
1-800-227-0216 or 301/588-9284 (V/TT)
The American Association of Retired Persons (AARP) published two consumer reports on canes and walkers which include product comparisons. For a free copy of these reports, (specify Product Report: Canes or Product Report: Walkers) write to:
601 E Street NW
Washington, DC 20049
Project LINK is a free, national information service that mails catalogs and other product literature from companies that make or sell helpful products. Since no names or addresses are released to companies, the confidentiality of the consumer is protected. To join Project LINK, write to:
University at Florida
Department of Occupational Therapy
Gainesville, FL 32610-0164
State Assistive Technology Information, provide a variety of assistive technology services. RESNA is a national association which provides information and technical assistance to these programs. For information on your state’s Assistive Technology Program, write to:
RESNA – Technical Assistance Project
1101 Connecticut Ave. NW, Suite 700
Washington, DC 20036
Voice: (202) 857-1199 • TTY: 703-524-6639