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Toni Talks about PT Today

Perceptions of Gait

Published November 3, 2010 11:24 AM by Toni Patt

Last Saturday I evaluated an acute stroke patient. She had a four-day history of episodic right-leg weakness so I was trying to determine her baseline. No matter what question I asked her, she responded that she had no trouble getting around at home. She denied weakness, leg instability or loss of balance. Then as an afterthought, she said, "Well, I've got my furniture to hold on to. I just go from piece to piece."

She didn't see any difference between walking independently and walking independently and holding on to furniture. In her mind, as long as she was doing it independently she didn't see a problem. She is not alone in that belief. For some reason I've yet to have a patient who saw anything wrong with furniture walking. When I point out the risk of falling, I'm told, "I just reach over from piece to piece."

It's almost laughable. I've had patients unable to walk with a RW and assist have no problem teetering across the hospital room holding on to whatever is close at hand. I've had patients and family members get mad at me because I wouldn't clear someone to furniture walk to the bathroom. After discharge one man sent his daughter back up to the unit to leave his RW because he wasn't going to use it at home. He said he didn't need it.

It amazes me. To many of my stroke patients, walking is only defined as without assist or assistive device. To them MI with a RW is not walking. Yet those same people see no problem with grabbing on to furniture to cross a room. They'll tell me with a straight face the two aren't similar at all. Family members do the same thing. I had a 93-year-old woman who was living almost independently and moved around her house by holding on to furniture. Both she and her family were vehemently opposed to a RW and didn't understand why I recommended a home-safety evaluation.

I wonder if there is any research looking at the fall rate of community-dwelling older adults who furniture walk. Actually I'd love to see research into the perceptions of gait without any device, with a RW and using furniture. I don't know how you could structure that study but I suspect the results would be fascinating.

I suppose there are situations where furniture walking is acceptable. If someone lived in a small house with too much furniture, there might not be enough room to fall. Or, maybe if someone paced it out and strategically placed furniture it might work. But under no circumstance is moving into max trunk excursion with acceleration to grab a piece of furniture safe. Clinging to the door knob of an open door while the door is swinging is even less safe. I've seen people use that method to enter/exit the BR.

Yes, this is one of those little things that drive me crazy. I know I can't fix it. I know there is very little I can do about it. But it bothers me nonetheless. It's right up there with people who insist on moving the cane and ipsilateral leg at the same time while hip-hiking the opposite one. I don't care how fast someone can do it. That's neither mechanically efficient nor safe.

1 comments

I am sure there are numerous falls due to this.  The person doesn't report them though if they are in their own home.  Assistive devices do seem taboo for some people and family.  We have had people wanting a four wheeled walker rather than a FWW because it looked better even though the person was not able to effective control it during walking. One place I worked began to spray paint the FWW different colors to make them more "hip".

Jason Marketti November 5, 2010 12:07 AM

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