Mobility Aids, Orthotics, and Switches
What aid is best for me
Walking Cane
Can walk independently but one side is weaker, or mild balance issues. Need to navigate small spaces and rough terrain. Want to stay as active as possible.
Walkers
If you just need help with balance but have good upper and lower body strength. Good for walking over terrain that is flat but too rough for wheels, such as grass or stones.
Rollators (Wheeled Walkers)
If you need support with balance and cannot lift a walker. They are best suited to flat surfaces, like tiles and pavement. When getting a rollator, make sure it is adjusted so that you maintain good posture while walking.
Questions to considerate when choosing an aid
Is support required on one or both sides?
One side – walking stick
Two-sided support, consider a walker, rollator, wheelchair, or mobility scooter.
Do you still have the strength to walk?
It is important to try and stay as activate as long as you can so choose the aid that gives you the best support and if possible, the function to main mobility.
Consider your environment
Flat surfaces – rollator, wheelchair (all types), or basic mobility scooter. For uneven terrain – walking sticks, standard walkers, and all-terrain motorized wheelchairs and scooters.
How often will you use the aid?
Infrequent use – maybe a rental mobility aid.
Daily use – needs to be well fitted to your size and offers all of the comfort features you need.
Safety
When a walking aid is required, stairs and steps can be difficult and even dangerous to navigate alone. Depending on your chosen mobility aid(s), consider installing wheelchair ramps, stairlifts, and/or vertical platform lifts to stay safe and independent.
To make your home safer when using your mobility aid you can try the following:
Remove rugs, mats or other items that may cause you to trip
Make sure electrical cords are not in the way (Telephone)
Arrange furniture so that you have clear and sufficiently wide pathways between rooms.
Keep stairs clear
Have rooms well-lit
In the bathroom, use nonslip bath mats, grab bars, a raised toilet seat, and a shower tub seat.
Keep the items you need regular within easy reach and everything else out of the way.
Carry things hands-free by using a backpack, or an apron with pockets, some walkers also come with attached pouches.
Be mindful on unsteady or uneven surfaces (beach, gravel)
Be careful in areas like bathrooms and the kitchen
Walking Stick/cane
They only provide a bit of support; they help with balance. They can be easy to transport and you can get foldable ones. There are many different cane/stick handles,
Derby handle also know as the thumb stick handle – it is a slightly curved handle and it fits comfortably in the hand.
Fritz handle also known as a "crook" handle – it has a more dramatic curve handle that fits over the hand. This handle is easy to grip, and the handle is designed to be held securely in the hand.
Offset handle – angled slightly away from the shaft of the cane, which can help reduce pressure on the wrist and hand.
Palm Grip – it has a contoured handle and it fits comfortably in the hand, with a groove or channel to help align the fingers and reduce pressure on the palm.
T-handle – the handle is shaped like the letter "T," with a horizontal bar that is easy to locate and grip. It is a good choice for someone with limited hand strength or mobility.
There are many more unique and specialized cane handles available. Some cane handles are designed to be more comfortable to hold, with features such as soft-touch grips or padding.
It is important to note that when picking a cane take into consideration the handle size and shape and choose one which is easy to grip and comfortable to hold as hand fatigue may be caused.
When picking the height of your cane/stick place the tip of the walking cane about 15cm away from the outside of the foot while gripping the handle. If you can stand upright while maintaining a slight bend of the elbow (about 15 to 30 degrees), then that height should be good for you. Hold the cane in the hand opposite the side that needs support. To start walking put the cane about one small stride ahead of you and step off on your injured leg. Finish the step with your good leg.
Quad Sticks
A quad stick has a wide or narrow base and has four rubber-capped feet extending from the base to improve stability. Wide quad based sticks can be heavy and may be difficulty to move. Narrow base stick gives less support but are easier to move.
Walker Guidelines
When standing up straight, the top of the walker should reach to the crease in your wrist. Elbows should be slightly bent when holding the handgrips of the walker and back straight. Regularly check that the rubber tips on the walker's legs are in good shape.
When walking with the walker put it one step ahead, make sure the legs are on even ground. With both hands, grip the top of the walker for support and move weaker/injured leg into the middle area of the walker. Do not step all the way to the front. Push straight down on the handgrips of the walker as you bring stronger/good leg up so it is even with your injured leg. Always take small steps when you turn and move slowly.
Sitting when using the walker, back up until your legs touch the chair and use your hands to feel behind you for the seat of the chair. Slowly lower yourself into the chair.
Standing up when using the walker, using the strength of the arms push yourself up and grasp the walker's handgrips. Do not pull on or tilt the walker to help you stand up.
Some frames cannot be folded so this is something to consider
If grip is poor, a forearm walking frame or trough model is a good choice.
Need to consider the width of the frame for moving around the home and do not get to narrow a frame for the height of the person.
Walking Frames
Walking frames, aka Zimmer frames, have three or four legs and provide stability and balance. There are rubber ferrules attached at the bottom of each leg to give you some grip on the ground and hold the frame in place. To use a walking frame good upper body strength is required as 64% of the user’s weight is transferred through the arms. Not advised for walking long distances.
There are walking frames with wheels if moving one without wheels is too difficult. With a two-wheeled walking frame, the wheels are fitted to the front legs whilst the back two legs have the same rubber ferrules. The frame just needs to be tilted forward to lift the back to legs, so it takes less energy and effort to move.
Wheeled Walkers
Wheeled walkers have four wheels and are easy to move as well as give stability. However, due to wheels this may increase the risks or fall if the person has poor balance. Less arm strength is needed to use a wheeled walker, and they can partially support body weight and balance. They can also be used as a seat and possible have storage for shopping. Also works well on uneven terrain.
Rollators and wheeled walkers are the same thing. Rollator refers to a three wheeled or four wheeled walking aid. Rollators should not be used to support body weight, as they may slip from under the person if too much weight is unnecessarily put onto the frame. Always lock the brakes before sitting or standing. When going up or down slopes or stairs, it’s safer to walk unassisted than to navigate these terrains with a rollator.
Standard or Manual Wheelchair
Even with a walking aid, some people may still experience falls, rapid fatigue or pain when getting around. So, it may be good to consider using a wheelchair. To help with the emotional challenge of transitioning from walking to using a wheelchair, a walker or walking aid can be used for short distance or when save and wheelchair when needed.
A standard wheelchair (or manual wheelchair) is a mobility chair with large rear wheels and smaller front wheels. They can be pushed by a caregiver or pushed by the person themselves as they can reach the rear wheels. Standard wheelchairs are collapsible, transportable, and easy to use by both a wheelchair user or a caregiver.
Transport wheelchairs are narrow, smaller-wheeled chairs and they are pushed by a caregiver. They are light, compact, and easy to navigate. They are a good choice for travel and use outside of the home, or as a companion to a larger manual or electric wheelchair.
If you have a HSE (Health Service Executive) medical card or part of the HSE Long-Term Illness Scheme, Irish residents with either of these are entitled to a free wheelchair. If you have a medical card or are part of the Long-Term Illness Scheme, the HSE can provide you with other free equipment that is required to help ease daily life with a disability.
Electric Wheelchairs
Power wheelchairs feature a seat mounted on a power base containing a battery and motor and have a joystick on one armrest for steering. An electric wheelchair does not need any physical strength only the small movements of the joystick to steer the chair. An electric wheelchair can help maintain independence.
When choosing a wheelchair, make sure that the model has a sufficient weight capacity for your body mass as well as anything you might want to carry—such as shopping bags, oxygen tanks, or another mobility device like a cane. Also, choose a chair suited to your height. Make sure you know how to charge the wheelchair batteries correctly as correct charging can significantly extend your mileage and battery life.
Mobility Scooters
If you can walk but have difficulty with long distances, a mobility scooter could be used for long distances. A motorized scooter consists of a comfortable seat over a power base, a foot platform, and handlebars with a tiller for steering. For tight spaces or inside, a mobility scooter with three wheels can be a good choice. A four-wheel scooter offers more stability so a good choice for outside and for people with balance issues. All-terrain mobility scooters are available for driving over uneven surfaces like gravel, grass, and hills.
It can be a good solution for you if you tire after a day walking around an attraction or shopping all day. Mobility scooters can usually be fitted with a stick/cane holder, if your mobility changes and you require a stick/cane as well, you can then swap between walking and the mobility scooter, as your mobility challenges increase, you can still alternate scooting with walking to maintain your stamina and strength. If you plan to drive the scooter frequently and for long distances, it's worth investing in a top-tier, heavy-duty scooter.
Orthotic Devices (OD)
An orthotic device is a brace made to support weakened muscles. Braces can help keep the muscles flexible, which aids in slowing the progression of contractures, which occur when a muscle and its tendon shorten and reduce flexibility.
Braces can also be used to help with walking and making the movement to walk as it gives support in the correct places. This can be worn at day or night or both. Braces can be worn on feet and ankles to maintain gain, on the wrist to support and hold the hands in position while typing or writing helping people to stay independent at work/college/school and a shoulder sling can be used to support the arms and ligaments if the shoulders are weak and help lift objects. To help grasp small objects if the hands are weak, wrist and thumb splints can be used. The main types are ankle-foot orthoses and knee-ankle-foot orthoses. These devices can help improve quality of life.
Ankle Foot Orthosis (AFO)
Is used to support weak muscles and improve the walking pattern. This is done by the AFO reducing, preventing or limiting the movement in the lower leg and foot. This device can help prevent falls. AFOs are designed by first taking a cast of the leg. Then an AFO is made from this cast, then another appointment to test the AFO for comfort and function. Commonly used shoes or sneakers should be taken to the fitting appointment.
Knee-ankle-foot orthoses (KAFO)
They are similar to AFOs but also cover the knee joint. KAFOs help in preventing excessive joint motion so they lessen joint pain and help with joint alignment and stability. They are lightweight and made to suit each individual. They take more energy to walk with as the movement is restricted, they should be used in a safe environment indoors and given time to adapt to using it. To ease movement, electronic or electromagnetic controlled knee joints can be installed onto a KAFO.
Adaptive Switches
Adaptive switches can be used to operate computers and different devices independently by someone with a physical or cognitive impairment. Adaptive switches can be use with a light touch or by using a hand, foot or the head. They can be used instead of keyboards or mouses. They can be used to operate a wheelchair, play video games, for phone calls and texts.
There is a wide range of adaptive switches and they can be used in different ways to ensure everyone has access to technology. There are switches that connect directly to device they are operating and in some case an interface may be needed between the switch and computer.
Switch Devices:
Button switches, used by light touch.
Rocker switches, used by leavers moving back and forth.
Joystick switches, like rockers but the joystick can move in different directions.
Sip and Puff switches, used by sucking or blowing on a tube.
Head switches, used by head movements,
Foot switches, used by pressing down the foot.