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Toni Talks about PT Today

What's Wrong With a Walker?

Published August 6, 2008 9:31 AM by Toni Patt

Why don't people want to use walkers? I've been asking myself this question a lot lately. I've had several patients who need to use a walker for safety but refuse to use one. Not only did they refuse to use one, but they told me they didn't need one and were offended that I mentioned it.

As a therapist, one of my first concerns is safety. When I do a gait assessment, I look at gait pattern, balance and foot placement. Not only do I assess what I will need to address in therapy, but how I can make them safe to walk today. Frequently this means use of an assistive device such as a walker. My intention is for the patient to use the walker now while working in therapy so it won't be needed later. Falls, particularly fractured hips resulting from falls, are among the top causes of disability and mortality in the elderly. A fall can lead to loss of independence and significant lifestyle changes. Naturally I want to prevent this. It seems clear to me. Patients, on the other hand, have trouble with this.

I worked with one woman who was referred to therapy for gait training. She'd fallen prior to admission so the physician was concerned. She insisted on walking unsupported. It was quickly obvious she was unsteady and a fall risk. I mentioned using a walker. She looked at me like I was speaking a foreign language. She told me she didn't use a walker before and wasn't going to use one now. Another patient told me she had a walker at home but didn't use it because she didn't need it. She did. A third told me not to worry. She walked better at home because she could hold on to the furniture. I don't run into this when I mention a cane.

Leaving a walker in the room doesn't help. The walker will be pushed out of the way so the patient can get up without it. When I try to work with these patients they refuse therapy because they don't need it right now. One woman, who was very unsafe, had a walker in her room. She used furniture to walk around her room as she explained to me she didn't need therapy. She then instructed me to take the walker with me because she didn't need it. I think it would be an interesting study to go over fall incident reports to see how many of the patients had walkers in the room they weren't using.

There must be a negative perception surrounding using a walker. No one seems to want to use one. For some reason it is more important to be getting around "by myself" than it is to be safe. Even those who acknowledge needing one tell me it will only be for a few days. I wonder how many walkers are sitting around gathering dust because the owner won't use it. I believe people must think less of themselves if they have to rely on the walker to get around. Maybe it makes them feel old. Some might see it as the final loss of independence. I understand how someone might feel that way. What I don't understand is why patients are resistant to being safe. The best I can do is stress that using a walker today doesn't mean it will be needed forever.

2 comments

I suffer from MS and am now using a walker as my right leg has become extremely stiff and weak. What I would like to know is how does one negotiate one step which is at the front entrance of the building we live in??  I am seeking help desperately. How to balance with the walker going down the step and similarly how to get up the step with the walker?

Regards

Beverley

beverley nick, - - -, - December 9, 2008 9:41 AM
Cape Town, South Africa

The difficulty with issuing walker to an elder population has many potential issues 1. Stigma - the use of a walker can confirm the aging process and another step in a loss of independence;  2. Dementia- I believe that many clinicans dealing with an elder population aren't aware of how many people have dementia despite not being diagnosed. If someone is refusing something that is obviousley going improve their safety and function reducing a potential for a fall. I would say that person has judgement and saftey issues and may need further investigation in their cognitive ability. It is often the PT that is first to recognize a pt's Dementia in the begining stages when a new event comes on and the person is unable to change to meet the new demand. 3. Difficulty - Try walking with a walker for a day it's not all that easy.

Josh Walbert, Rehab August 11, 2008 4:31 PM
Philadelphia PA

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