Functional Considerations for
Gait Assistive Devices
Josh Kelley MSPT, PCC
Sutter VNA and Hospice
San Mateo Fall Task Force
9/16/10
Goals of this presentation
Audience will understand definition of gait
assistive devices
Types of devices will be covered from
most assistive to least
Functional pro/cons of assistive devices
will be covered
Clinical reasoning for proper gait device
Brief discussion of research article on
energy demands for gait devices
Gait Assistive Device
Definition: Assistive devices such as canes,
crutches, and walkers are commonly
recommended for problems of pain, fatigue,
equilibrium, joint instability, muscular
weakness, excessive skeletal loading, and
cosmesis.
Gait Assistive Device
A device that is selected by a medical
provider to enhance patients ability to
ambulate safely, functionally and
correctly to maximize mobility
This is a decision based on
“balancing” 3 concepts
Physical considerations (Strength,
Balance, Vision, Health history, Weight
bearing precautions)
Psychosocial considerations
(Compliance and attitudes toward use
of an assistive device)
Functional Needs (Stairs, Functional
mobility within home and community)
Merry Walker
Pros
Very stable with support
with ambulation
Provides place to sit if
fatigued
Cons
Unable to ambulate in
community effectively due
to width around person
Harness makes ADL’s
difficulty
Standard Walker
Pros
This walker is very stable and
allows patient to stand inside of
walker thus providing more
stability
Cons
Does not work on stairs a added
energy expense of lifting walker
up
Slower walking speed
Does not provide a place to rest if
fatigued
Difficulty for patient self
management in car
Requires more energy expense
than any other assistive device
Front Wheeled Walker
Pros
Allows patient to stand inside
of walker for added stability
Increased gait speed
Less energy expense than
standard walker
Cons
Doesn’t work on stairs
Decreased stability
Does not provide a place to
rest if fatigued
Difficulty for patient self
management in car
Four Wheeled Walker
Pros
Has a seat typically which
allows for place to rest
Requires less energy expense
than standard walker
Cons:
Does not work on stairs
Patient must be able to lock
brakes to use safely
Patient is situated behind
walker therefore increased
chance of loss of balance
4 wheels makes it more
unstable
Difficulty for patient self
management in car
Three Wheeled Walker
Pros
Smaller profile therefore
easier to maneuver
Cons
3 points of contact
unstable
Very unstable with wheels
Cannot be used on stairs
Does not provide a place
to rest if fatigued
Difficulty for patient self
management in car
Hemi-walker
Pros
Allows 4 points of contact with
ground and use of single arm
beneficial with certain medical
conditions
Ambulation up and down some
wider stairs are possible with this
AD
Easier to manage in car than any
other type of walker
Cons
4 points can catch a foot and
cause a fall
Does not provide a resting spot for
patient when fatigued
Does not work on all stairs
Single arm support on a single
side
Crutches
Pros
Allow for stairs
Increased speed of ambulation
Allow for partial weight bearing
Easy to manage in car and
does not require folding
Cons
Require coordination on
movement
Only 2 additional points of
contact
4 point cane
Pros
Promotes a more normal gait
pattern with a reciprocal arm
swing
Cane will stand up on its own
Easy to manage in car and
does not require folding
Slight increased base of
support over a standard cane
Can be used on most stairs
Cons:
Cane wobbles and patient
unsure of trusting cane for
stability
Can trip patient up and cause
a fall
Single Point Cane
Pros
Promotes a more normal gait pattern
with a reciprocal arm swing
Patients compliance improved with this
Assistive Device
Works well on stairs
Allows for increased ambulation speed
Easy to manage in car and does not
require folding
Cons
Single point of contact beyond patient
which increases fall risk
Oftentimes can lead to a false sense of
security and increased fall risk if
inappropriate for patient
Can be a fall risk to trip patient up
Clinical reasoning in Gait assistive
Device Selection
Device must be
selected by medical
provider individually
with patient based on
safety, compliance,
functional
considerations, and
physiologic
considerations
Functional Gait analysis
Timed Up and Go Test
Patient sitting then stands up and walks 10
feet and returns to chair using appropriate
assistive device
If less than 20 seconds tendency towards
independence and safety with device
If greater than 20 seconds consider more
stable assistive device or assistance with
all ambulation
Article Review
Effects of Assistive Devices on
Cardiorespiratory Demands in Older
Adults, Physical Therapy Volume 76
Number 12; (Foley et al)
Purpose to compare cardio-respiratory
demands of Un-assisted walking, standard
walker, wheeled walker and Single Point
Cane
Article Methods/Results
2 minute walking test of 10 subjects with all
assistive devices and unassisted
VO2 measured for energy expenditure
measured
Results 212% more energy required and 98%
higher heart rate with standard walker than with
unassisted walking
Standard walker requires 104% more energy
expenditure than wheeled walker as well
No significant difference in energy expenditure
between single point cane and unassisted
walking
Article Clinical Implications
The decision to
prescribe a wheeled
walker vs. a standard
walker may be
clinically important
with patients with
impaired Cardiorespiratory conditions
Conclusions/ Questions
The selection of an assistive device is a process
that should be performed with a medical
provider taking into account the following
Physiologic considerations (Strength,
Balance, Vision, Health history, Weight bearing
precautions)
Psycho-social considerations (Compliance
and attitudes toward use of an assistive device)
Functional considerations (Stairs, Functional
mobility within home and community)