There are many devices available to assist a person when ambulating (walking). Depending on an individual's diagnosis and past medical history, a physician or physical therapist may help you determine which device is appropriate. Ambulation aids help compensate for impaired balance, strength, coordination, and pain. They also help to increase independence and safety and, in some cases, help an individual maintain post-operative precautions regarding weightbearing after surgery.
Parallel Bars
Parallel Bars: Set of metal, adjustable, parallel bars which is bolted to the floor and found in most rehabilitative clinics. These bars are used to initiate standing, weightbearing and eventual walking with the assistance of a physical therapist. This device is used in the inpatient and outpatient settings for a variety of patients: orthopedic (i.e. post-surgical), neurologic (i.e. spinal cord injury, stroke), and, for the generally weak and deconditioned.
Walkers
Walkers: The pick up walker (PUW) and front wheeled walker (FWW) offer maximal stability and support. Both have 4 legs, the FWW having 2 front wheels. There are several variations of walkers such as the 3 wheeled walker and the walker with a built in chair. The FWW is used in lower level individuals whereas the PUW demands better endurance and upper body strength. Both walkers can be folded for storage. Disadvantages: Difficult or impossible to use on stairs and walker width may not be compatible with doorways and confined areas. Examples of individuals who may benefit: status post (s/p) orthopedic surgery (total hip/knee replacements, hip fracture requiring surgery); s/p stroke; for the elderly with history of falls/loss of balance; and, the generally deconditioned.
Hemiwalker
Hemiwalker: Four legged, metal, adjustable, "cane" used in individuals with moderate weakness on one side of the body. The hemiwalker is held in the strong, uninvolved upper extremity to decrease weighbearing through the weaker limb and to provide a larger base of support for better balalnce. An individual who is not independent enough to use a wide or narrow based quad cane may benefit from this device as provides a wider and more stable base of support. Example of individuals who may benefit: s/p stroke with hemiparesis (weakness of 1 side of the body).
Axillary Crutches
Axillary Crutches: May be wooden or metal with adjustable hand grips and height. Axillary crutches are less stable than the walkers, but allow for variation of walking patterns pending an individual's diagnosis. The individual must have good balance and upper body strength to utilize axillary crutches. Disadvantages include: axillary (armpit) nerve damage if used improperly; elderly or frail patients may feel insecure/unstable; not appropriate for individuals with upper extremity weakness. Example of individuals who may benefit: orthopedic (non-operative and post-operative) diagnoses which require partial weight bearing or non-weightbearing status of 1 limb (i.e. s/p ankle sprain, knee surgery, etc.). There are also crutches without axillary pads that suspend from the forearms (Loftstrand crutches) which are not illustrated here.
Canes
Canes: May be wooden or metal. 4 prong, wide or narrow based quad canes and single point canes are available. Canes are used mostly for balance although the narrow and wide based quad canes can be used for some weightbearing. The cane is used in the uninvolved, strong side to decrease weight through the painful or weaker limb and to increase base of support for better balance/stability. Canes can be used in narrow, confined spaces, up/down steps; and, can be easily stored/transported.
Attachments: If an individual is unable to weightbear through the upper extremity, a platform attachment can be placed on a walker, crutch or cane. Individuals who use platform attachments must have strong shoulder girdle strength as the patient will be less able to utilize the triceps muscle for weightbearing.
For insurance coverage of ambulation aids, most medical supply companies require a doctor's prescription. For proper fitting and training regarding sequencing of walking with a device, a doctor can also recommend a physical therapy consult.
