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A walker is an assistive device used to provide stability and relieve full or partial weight bearing on a lower extremity. Of the possible assistive devices available (crutches, canes, or walkers), walkers provide the greatest anterior and posterior stability and base of support.1 Walkers are typically made of lightweight aluminum and are easily adjusted using pushpins on the legs. Standard walkers have molded handgrips and rubber tips on all four legs. They come in a variety of sizes, including tall, adult, youth, child, and bariatric. There are a variety of different features available, including folding, reciprocal, stair climbing, and two- and four-wheeled walkers (also known as rollators).1 Selection of the walker type and features depends on the patient's needs (Table 1). Use of a walker does not negatively impact rehabilitation or functional outcomes and may boost confidence needed to attain maximum mobility.2
To adjust the height of the walker, the patient should stand upright inside the walker with arms straight at his or her sides. The handgrip should be level with the patient's wrist crease, ulnar styloid process, or greater trochanter of the hip. Adjusting the walker to this height allows sufficient elbow flexion (20 to 25 degrees1) to enable the patient to lift his or her body weight off the floor (Figure 1).
Gait pattern is determined by the required weight-bearing status. When using a standard walker and full weight-bearing status, the patient lifts the walker and moves it forward. Then he or she takes a step forward with one foot and then the other while taking as much support as needed on the walker, and the cycle is repeated.1 Use of a wheeled walker allows for a more natural, reciprocal gait pattern, providing a smoother forward progression. With any walker, but especially a rolling walker, the patient may let the walker get too far forward. This could cause the patient to fall forward. To teach the patient the appropriate forward placement of the walker, the therapist should place a folded towel under each of the patient's arms. The towels should be held in place while using the walker.
When using a walker with a partial weight-bearing status, the patient lifts and advances the walker a comfortable distance. The involved lower extremity is placed on the floor bearing the appropriate amount of weight. Weight is shifted to the arms, and the patient steps forward with the uninvolved lower extremity.
When using a walker with a non–weight-bearing gait, a three-point gait pattern is used where the patient stands on the uninvolved lower extremity and uses both hands to lift and advance the walker. The patient then hops or steps to the walker on the uninvolved lower extremity. If the involved lower extremity is casted or held in knee extension, the involved extremity is lifted off the ground and held slightly in front of the uninvolved lower extremity during gait. If the involved lower extremity is not casted or held in knee extension, patients will typically flex the knee and hold the involved lower extremity in that position during forward progression.
When guarding a patient who is using a walker, the therapist stands on the involved side and slightly behind the patient, with one hand on the transfer belt. When guarding a patient on the stairs, the therapist stands behind him or her when ascending stairs and in front or behind him or her when descending stairs (Figure 2).1
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Foley, M., Bowen, B. (2014). Comparison of metabolic cost and cardiovascular response to stair ascending and descending with walkers and canes in older persons. Archives of Physical Medicine and Rehabilitation, 95(9), 1742-1749. doi:10.1016/j.apmr.2014.03.032 (classic reference)* (Level V)
*In these skills, a "classic" reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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