Walking Equipment:

If you feel insecure when you walk, experience weakness or pain, or have had a fall, then you may be considering getting a walking aid. The aim of this information sheet is to provide information on the types of equipment available for positioning, standing and walking and details about the useful features of some of the more standard pieces of equipment.

The information contained in this document is strictly for information purposes only. There are hazards with all equipment and the suitability of any solution is totally dependent on the individual. It is strongly recommended to seek professional advice and assistance before you consider buying any type of equipment mentioned in this Information Sheet.

Provision of equipment

Medical Card Holders

Equipment for people with disabilities, sometimes referred to as aids and appliances, is usually supplied free of charge to medical card holders. The card holder must first be assessed by the relevant therapist who can recommend and prescribe the most suitable equipment.

Long-Term Illness Card Holders

People who have one of the conditions listed as qualifying under the Department of Health’s Long Term Illness Scheme may be eligible to receive items of equipment, essential for the primary condition, free of charge. Assessment by the relevant professional is required.

Hospital Treatment

People in hospital may have aids and appliances provided free of charge when they are prescribed as part of in-hospital treatment in a public hospital.

Health Insurance Schemes

The main companies offering private health insurance in Ireland. These are:

• Voluntary Health Insurance (VHI)
• Irish Life Health
• Laya Healthcare
• GloHealth

Some policies provide members with cover for a limited number of aids and appliances under their out-patient schemes. A list of approved appliances is available on request. A claim for the reimbursement (part or full) will be subject to a member’s out-patient excess. Medical certification is usually necessary. Contact your health insurance company’s Customer Services to check if a particular appliance is covered by your policy.

Some employers have their own special health insurance schemes which provide cover for their employees. The employee’s family is also often covered. Check with the employer to see what, if any, equipment is covered under the scheme.

Private Purchase of Equipment

Private purchase may be necessary if the user is not eligible to obtain the necessary equipment from the local area health services. Some people may also choose to buy privately because they want the wider choice of equipment available on the private market.

The purchaser has the option of:

• personally funding the cost of the equipment
• applying to charities/benevolent funds etc for funding
• buying second-hand
• checking with your health insurance company, if a member, to see if, or what, reimbursement is available.

Private Purchase – Applying for a VAT Refund

VAT paid on certain equipment which is privately purchased for use by a person with a disability can be reclaimed from Revenue. The relief applies to VAT on the purchase of goods which are aids and appliances designed to assist a disabled person to overcome a disability in the performance of their daily functions. Most aids to daily living and communication aids are included. Goods designed for leisure purposes are not. An invoice clearly stating the VAT content of the total amount paid must be included with the application. Contact Revenue’s Central Repayments Office to request Form VAT 61a (see Useful addresses), or you can apply online for a VAT refund using eRepayments in Revenue’s myAccount service.

Assessment

Depending on the type of equipment required, a qualified therapist will assess the individual and make a recommendation to the body responsible for the provision of the equipment or to the person or agency who has requested the assessment. Generally the following applies, but the assessment process and provision may vary in different parts of the country.

• Occupational therapists will assess for aids to daily living – these include wheelchairs, mobility aids, specialised chairs, bath, shower and toilet aids, stairlifts, hoists etc
• Physiotherapists will assess for movement, strength and balance training equipment, walking aids and exercise devices
• Speech and language therapists will assess for communication, speech therapy, and training aids
• Other relevant therapists and specialists may also be involved in carrying out assessments, depending on the equipment or appliance required.

All the different therapists described above are based in hospitals, community care areas, and with various voluntary agencies. For more information, contact the Community Care section of your Health Services Executive area or the relevant hospital department as appropriate.

Private Occupational Therapists

Occupational therapists in private practice can carry out assessments in the home or workplace, and if modifications are being considered, provide a report detailing the recommendations. It is important to ensure the therapist is experienced in relation to your particular needs. Make sure to discuss fees before engaging anyone’s services, and also check what the assessment fee includes (or does not include). The profession’s representative body, the Association of Occupational Therapists in Ireland (AOTI), keeps a list of contact details of member occupational therapists working in private practice in Ireland. This list is available from the AOTI (see Useful addresses) and is also on the AOTI website www.aoti.ie.

Private Physiotherapists

Physiotherapists can assess for movement, strength and balance training equipment, walking aids and exercise devices and recommend accordingly. If you wish to consult a physiotherapist you can go directly to your local chartered physiotherapist or ask your GP to refer you. It is important to ensure the therapist you consult is experienced in relation to your particular needs. Chartered physiotherapists work in hospitals and in the community where treatment is covered under the public health service. They also work in private practice and can be contacted through the profession’s representative body, the Irish Society of Chartered Physiotherapists (see Useful addresses). The contact details of chartered physiotherapists are also on the www.iscp.ie website.

If you decide to buy equipment privately it is strongly recommended to seek the advice of an appropriate therapist on the suitability of that equipment to your condition or situation. It is also recommended that you try out the equipment, if possible, before purchase.

Purpose of walking equipment

Walking equipment is used for two purposes: as part of a rehabilitation programme when the user is recovering from an injury or operation; and as a long-term aid to mobility when the user has a permanent difficulty with walking.

The rehabilitation process is a gradual progression towards independent and unassisted walking and may commence with the use of a walking frame to give the user confidence before progressing to another walking aid. The ultimate aim of a rehabilitation programme is for you to regain as much independence and safety as possible in your walking, preferably without walking equipment.

However, walking frames are often not practical for long-term use because they are difficult to manoeuvre in tight spaces and cannot be used on a flight of stairs. Crutches give a higher level of mobility – they allow for a quicker gait and can be used safely on stairs if the correct technique is used. As the user increases in confidence and is allowed to put more weight through their affected leg, they will progress onto one or two sticks. The ultimate aim of a mobility rehabilitation programme is for the user to be walking independently, without walking equipment.

Sometimes, complete recovery is not possible or users have an illness or disability that permanently affects their legs, their balance or their coordination. In these situations, mobility equipment may be required for long-term use, and to ensure that the appropriate device is selected, the user’s lifestyle and home environment should be reviewed, as well as assessing his/her personal physical abilities.

Walking equipment may perform one or more functions including:

• To ensure that the appropriate device is selected, your needs, your lifestyle and your home environment should be assessed
• Offer greater stability and balance by providing a wider support base.
• Facilitating the walking pattern of the user in terms of speed and evenness of stride. The equipment may also help maintain an upright body posture.
• Increasing the confidence of the user in his/her walking ability.
• Weight redistribution – some of the weight carried through the legs when walking is transferred through the arms of the frame or stick as it is leant on for support. This may help reduce pain in the joints, muscles and ligaments in the lower limbs.

Safe use of walking equipment

The correct use of a walking aid is not always as straightforward as it seems. The ‘usual’ way of using an aid may need to be adapted to suit you and your particular condition or circumstances. If you, or the person you care for, have reduced cognitive functioning, it may also be more difficult  to learn, or remember how to use a walking aid. Walking equipment should improve mobility but, if an inappropriate walking device is used, if incorrect techniques are adopted, or if the device is not suitable for a particular environment, the independence and safety of the user will be jeopardised.

A physiotherapist or occupational therapist should be able to give you appropriate teaching and advice when you are assessed. Other factors that should be looked at to minimise the risk of falling whilst using a walking aid include:Home environment Remove all loose rugs, trailing flexes and clutter from the floor. Keep your access routes around the house clear at all timesStairs If you have stairs in your house and use a walking aid, obtain a second one and keep one upstairs and one downstairs. Do NOT attempt to take a walking frame up and down stairsStanding from a chair Do not attempt to use a walking frame or stick to rise from a chair. They are not stable enough. You should push up with your hands on the arms of the chair and only take hold of the frame or stick once standing. If necessary ask to practise this with a healthcare professional. Further information about getting in and out of a chair is available in our information sheet on Chairs and chair accessories.Wet floors Walking equipment should not be used in wet floor areas. If you need to access a wet room or shower area, ask the advice of an occupational therapist. You may be able to install grab rails.Footwear Footwear should be well fitted, secure on your feet and supportive as you walk.

Maintenance of walking equipment

All walking equipment should be checked regularly for signs of wear and tear. Particularly vulnerable parts include the ferrules, which must be replaced if the slip-resistant rings or bobbles on their underside lose their definition, or if the rubber shows signs of cracking. Equipment that is height-adjustable can show signs of stress at the height setting after prolonged use. Handgrips and underarm pads can also become worn.

If you feel that your working device is structurally no longer safe to use, inform the issuing health service which may provide you with a replacement. Replacement ferrules are usually available from the supplier of the walking aid. If you have bought your walking device privately, then you are responsible for maintenance and upkeep. Replacement parts are usually available from the commercial outlet from which you bought the equipment.

Things to consider when choosing walking equipment

Below are listed some aspects which need to be considered when choosing walking equipment.

Height

Walking frames

It is very important to have the frame at the correct height for use.

• If the frame is too high, the person will find it difficult to straighten out his/her elbows sufficiently and will not take enough body weight through the arms.
• If the frame is too low, it will encourage the person to be bent over in a poor posture. However, a physiotherapist may deliberately set up a frame at a low height for people who tend to fall backwards – this will encourage them to lean forwards.
• Always be measured for the height of your walking frame wearing appropriate and supportive footwear.

To use the frame correctly, people should lift and move it slightly in front of them. They can then lean on the frame, taking their weight through the handgrips, and take two equal length steps into the centre of the frame.

To ensure that the arms are in the best position for weight bearing, the height of the handgrips should be at the level of the wrist bone, when the user’s elbows are very slightly bent (at an angle of about 15° flexion).

Some models are available in a number of fixed heights – the nearest suitable height should be chosen. Others have telescopic legs so that their height can be more finely adjusted using spring loaded catches.

Crutches

Crutches must be at the correct height for use. Both axilla and elbow crutches usually have two adjustment points.

The overall height of axilla crutches can be adjusted. This should be measured by standing upright in appropriate and supportive footwear. The underarm pad should fit under the armpit with two finger widths of space above to ensure no pressure is applied through the armpit when the crutches are being used. The handgrip adjusts along the upright(s) of the crutches and should be set at a height level with the protruding bone at the side of the wrist.

The overall height of elbow crutches can be adjusted. This is measured by lining up the handgrips with the wrist bone. Some elbow crutches also have an adjustment for the elbow cuff, which should cradle the forearm just below the elbow joint so that movement of the elbow is not impeded.

Walking sticks

It is very important to have the walking stick at the correct height for use. If the height is incorrect then the support will not be adequate. The most effective method of ensuring this is to have people standing in their regular footwear with their hands by their sides. The measurement to take is the distance between the wrist bone and the ground.

Some walking sticks are made of wood, which must be measured and cut with a saw to the correct height. In practice, when therapists are measuring wooden sticks, they turn the stick upside down and mark the point where the stick should be cut; keeping in mind the small addition to the overall height once a ferrule is attached.

Metal sticks are available in a variety of fixed heights – the nearest suitable height should be chosen – or they have a telescopic mechanism. This can be finely adjusted using spring loaded catches.

Tripods and quadrupods

It is very important to have the tripod or quadrupod at the correct height for use. The most effective method of ensuring this is to have people standing in their regular footwear with their hands by their sides. The measurement to take is the distance between the wrist bone and the ground.

All tripods and quadrupods are made of metal, usually aluminium or steel, and have a telescopic mechanism for adjusting using spring/loaded catches.

Crutch/Handgrips

Some crutches can have contoured handles shaped to follow the contours of the hand, spreading the pressure over a wider area of the palm for more comfortable use. A gel handgrip can also help to improve comfort. Elbow crutches can be supplied with gutter armrests. These allow people to bear weight through their forearms rather than through their hands. They have padded, vinyl-covered, trough-shaped supports with vertical handgrips. The length and angle of some handgrips can be adjusted to achieve the most comfortable position.

Walking stick/handles

A variety of different shaped handles are available including:

Crook handles

These may be less comfortable to hold than a right-angled handle, but can easily be hooked over the arm when not in use.

Right-angled handles

These are often more comfortable to use than a crook handle. The addition of a wrist strap may be useful to secure the stick when it is not in use.

Swan neck handles

Handles with swan-necked shafts are offset above the stick, and spread the person’s weight centrally over the base, which may be helpful for people who require more stability.

Contoured handles

These are anatomically shaped handles, which spread the pressure over a wider area of the palm to improve comfort for permanent users or those with painful hands.

Base type

The more points of contact a walking device has with the ground, the more stable it will be. Also the wider the base of support, the more stable the frame will be.

All walking equipment without wheels should be fitted with rubber ferrules to maximise grip.

Types of walking frames

As walking frames have more points of contact with the floor they tend to be used by those with greater balance problems and/or weak legs. A walking stick can off-load 25% of the user’s weight compared to a frame which can transfer 64% of the user’s weight through the arms (Youdas, Kotajarvi, Padgett et al. 2005). This weight re-distribution from legs to arms can also help reduce leg pain.

Non-wheeled frames

Standard pulpit frames (zimmer frames)

Standard walking or pulpit frames are commonly known as zimmer frames and are mostly used indoors. They include the following features:

• Metal frames made from aluminium or steel.
• Rubber ferrules on the bottom of their four legs which aim to prevent the frame from slipping.
• Moulded plastic or foam rubber handgrips. It is possible to get models with contoured handgrips, which enable the pressure exerted through the hands to be spread evenly over the palm.

The height of some models is fixed, on others it can be adjusted. Consider the size of the base if it is going to be used in a domestic setting, some may be too wide to go through small doorways. Alternatively, narrow frames are available but they may not offer sufficient stability.

Although walking frames are useful because they provide a large area of support, they do not allow the user to walk using a flowing walking pattern. The user has to keep stopping and starting as the frame is picked up, moved forwards and stepped into. They are therefore used as a rehabilitation aid but, where possible, other types of equipment are recommended for long-term use.

Folding pulpit frames

A folding frame can easily be stored within the home if it does not need to be used all the time. It also makes it easier to transport in a car boot. Some pulpit-shaped frames have hinged sides, which can be folded flat against the front of the frame when the catches are released.

Folding pulprit frames

There are a variety of catch mechanisms available to allow the frame to fold. You are advised to make sure you can operate the catch easily before you buy. It is suggested that some users often find it difficult to fold frames with press-button releases or levers (Hall et al. 1990).

Some pulpit shaped frames have a different folding mechanism. The frame is folded by pulling up a wooden ball, suspended between the top and bottom horizontal bars at the front of the frame, lifting the bottom bar upwards and closing the frame as it pivots at the point where the bottom bar meets the rear legs of the frame.

These pulpit-shaped frames have hinges between the front leg section and the rest of the frame. The frame is folded by pulling up a wooden ball on a drawstring attached to a movable bar on the front of the frame. This is an easy mechanism to operate but these frames are not as compact when folded as those with other folding mechanisms.

High or forearm walkers

These are also called “gutter frames” and have forearm troughs or gutters which allow users to bear weight through their forearms rather than their hands. Adjustable troughs and handgrips enable users to achieve the most comfortable position. Thus gutter frames may be considered if you have arthritis in your hands or have broken your hand or wrist (Ainslie 2012).

The troughs and handgrips can be adjusted to find the most suitable and comfortable position. Alternatively, some walkers have a platform rather than individual gutter rests on which to rest the forearms and a vertical handgrip. High or forearm walkers may be wheeled or non-wheeled.

Reciprocal frames

These frames are hinged so that the sides can be alternately placed forwards with each step. They will go through tighter spaces than standard frames. The advice of a physiotherapist should be sought when considering this equipment. Users often have difficulty learning to use reciprocal frames which makes them unpopular.

Wheeled walking frames and rollators

Frames with two wheels can be used in two ways:

• the frame is pushed with the rear ferrules lifted fractionally off the ground or they are allowed to glide across the floor surface, allowing the person to adopt a more fluent walking pattern
• alternatively, it is used like a non-mobile pulpit frame, except that the frame does not have to be lifted up to move it forwards – the person pushes it instead. This frame is held stationary while the user steps forwards.

Wheeled pulpit frames

These frames are basically the same as standard pulpit frames but instead of ferrules they have small wheels on the front legs. It may be possible to exchange the ferrules on a standard, non-mobile frame for wheeled extensions. The small wheels make them more suitable for indoor use but, as the wheels do not swivel, they can be difficult to manoeuvre.

Wheeled frames are useful for people who find it difficult to use a traditional frame as they make a more continuous walking pattern possible, and do not need to be lifted clear off the ground to move forwards. These frames should not be used for people who put significant weight through the frame, as the frame can unintentionally move forward with a pushing down/forward movement. They can also be hazardous to individuals with a Parkinsonian gait (characterised by small shuffling steps which accelerate) so consult with your healthcare professional (Elmamoun and Mulley 2007).The wheels on these frames do not pivot around a corner, so the frame needs to be lifted when turning.

Three-wheeled rollators (Delta frames)

Triangular frames are sometimes called ‘Delta’ or ‘tri-wheeler frames’. They have a single front swivel castor and two uni-directional rear wheels. The larger wheels make them suitable for use outdoors. You may find them more manoeuvrable than four wheeled walkers, although not as stable. As they are so manoeuvrable, the use of the brakes when the person stops walking is important for safety. Like two wheeled rollators they may allow you to adopt a more flowing walking pattern than a non-wheeled walking frame. The height of the pushing handles can be adjusted.

As with all mobility equipment, it is essential that triangular walkers are inspected regularly with particular attention paid to the locking mechanism (usually consisting of a cross brace), which maintains the rollator in an open position. If the folding mechanism is not properly locked the frame may fold unexpectedly (Ainslie, 2012).

Four-wheeled rollators

Four wheeled walkers, when used appropriately, will allow the person to adopt a more fluent walking pattern. Large wheels and/or large swivelling castors facilitate travel. However, they may be too mobile for people who need to lean or push against the frame for support – the frame may run away from them. The size of these walkers make them more suitable for outside use, but with adequate space, can be used inside.

Although many find their rollators very useful, some find them difficult to handle especially when out in the community, for example getting them on or off buses (Brandt, Iwarsson and Stahl 2003). Studies have suggested that users of rollators can walk faster and use less energy than users of zimmer frames (Cetin et al, 2010).

The correct height for walking frames

It is very important to have the frame at the correct height for use.

• If the frame is too high, you may find it difficult to straighten your elbows sufficiently and may not take enough body weight through your arms
• If the frame is too low, it will encourage you to be bent over in a poor posture. However, a physiotherapist may deliberately set up a frame at a low height for people who tend to fall backwards – this will encourage them to lean forwards (Elmamoun and Mulley 2007)
• When being measured for the height of your walking frame wear appropriate and supportive footwear.

Generally, to ensure that the pushing handles are in the best position for weight bearing, the height of the handgrips should be at the level of the wrist bone when the user’s elbows are very slightly bent (at an angle of about 15 degree flexion) (Hall et al. 1990). Some models are available in a number of fixed heights – the nearest suitable height should be chosen. Others have telescopic handles, with spring-loaded catches, so that their height can be more finely adjusted.

Features to consider when choosing a walking frame or rollator

Brakes on rollators
It is very important to ensure that a fully mobile frame has brakes and that they can be operated quickly and easily by the user, so that he/she always feels in control. These are the most common types:

• Pressure brakes These are operated by downward pressure on a spring-loaded frame. This causes the motion of the rear wheels to be interrupted when the user is leaning on the frame. However, they may not be suitable for users who cannot push down heavily enough on the frame or for heavier users who may apply the brakes permanently
• Cable brakesThese are similar to bicycle brakes and require a squeeze action to apply them so they may not be suitable if you have weak or painful hands. Care should be taken when using the brakes as they instantly stop the frame. Users in some studies have found the brakes too stiff to operate or that they required too big a hand grip (Hall et al. 1990). Simultaneous use of both hands on each side of the frame is necessary. Cable brakes must be periodically checked and adjusted
• Locking brakes Many brake lever handles can be pushed down to lock the brakes in the on position so that the grip does not have to be continuously maintained. This safety feature is important when using a frame with a built-in seat
• Handgrips Most standard walking frames have either moulded plastic or foam rubber handgrips. However, someone with weak or painful hands or wrists will find it uncomfortable to push down on these. Alternatives are available. A few mobile frames are available with contoured, anatomically shaped handgrips which are designed to spread the weight over a wider area of the palm.

Weight
Heavy frames tend to be more stable, but may be difficult for some people to lift. Heavy frames can also cause shoulder and neck discomfort (Hall et al. 1990). Walking equipment designed for heavy duty use may be steel reinforced, adding to its weight.

Material
The majority of walking frames are made of aluminium. Some are made of steel which may be stronger for heavy duty use, but will weigh more. Some suppliers will offer a range of colours.

Wheels
Small solid wheels or castors are really only suitable for use indoors and may require more effort to push over deep pile carpet or carpet bars than larger wheels (Hall et al, 1990).

Pneumatic wheels will require pumping up from time to time, but provide more suspension than solid rubber tyres. If you have painful hands that may be aggravated by jarring you may find this an advantage.

Swivel vs fixed wheels or castors
Frames with castors that swivel may be more manoeuvrable, but fixed wheels can help to make it easier to walk in a straight line. Larger wheels are more suitable for uneven/outdoor terrain (Elmamoun and Mulley, 2007; Choi et al, 2009). Some studies have suggested that four wheeled walkers are more stable than three wheeled (Waara-Conway, 2001).

Additional features

Additional features, which may contribute to the user’s independence, include:

Seats

These enable the person to take a rest if he/she becomes tired whilst walking. Some have a small backrest and armrests to help when sitting/standing.

• Check on the size and the height of the seat; some are very narrow, others are very low. It is advisable to have brakes, which will lock on, to ensure that the frame remains steady when standing up.

Trays

These can be fixed onto the frame and fold down or are removed when not required. They are especially useful for carrying items such as cups from room to room.

Shopping baskets or bags

The size and position of these will vary from model to model. Baskets that are positioned low down on the frame may be difficult to reach. However, carrying weight high up on the frame is more likely to disrupt the stability of the frame.

Walking stick holders

These enable the person to have his stick on hand to use when it is not convenient to use the frame, for example in a tight space.

Trainer walkers

This style of walking equipment offers the user additional postural support for gait training and rehabilitation. Advice should be sought from a therapist about the use of this equipment.

Mobile frames for one-handed use

These frames have a central handgrip that enables the frame to be held in one hand. Care should be taken if using a one-handed frame as it does not offer as much support as gripping the frame with both hands. Advice should be sought from a physiotherapist or occupational therapist as using this sort of frame may have an adverse effect on some rehabilitation treatments or grogrammes.

Reverse mobile walkers

These are wheeled walkers in which you stand and face outwards. The cross rails of the walker are therefore behind you as you moves forwards.

Types of crutches

There are basically two styles of crutches: axilla (or underarm crutches) and elbow crutches. As a general rule, underarm crutches are used by people who must not weight bear through their bad leg and elbow crutches by those who can partially weight bear. Both styles of crutches are standard issue from your local hospital and tuition in their use should be available. Some simple guidelines for use are:

Crutches are designed to be used in pairs. Occasionally one crutch is used on its own but this should only be done under the guidance of a physiotherapist.

The affected leg stays with the crutches so you should move the bad leg forwards with the crutches then swing through with the good leg.

When going up steps or stairs remember to step up with the good leg first, following on with the bad leg and crutches; when going down stairs, the bad leg and crutches lead. Tuition may be required in techniques used to ascend or descend stairs.

Elbow crutches

Both floor-to-handgrip height and the distance between the cuff and the handgrip are adjustable on double adjustable elbow crutches. Single adjustable elbow crutches only allow floor to handgrip height adjustment. Standard and anatomically-moulded handgrips are available.

Elbow crutches are available with two styles of cuff: open or closed. An open cuff is semi-circular in shape and provides a support to brace the forearm against in the step-through phase of walking. A closed cuff is an incomplete ring which prevents the forearm from slipping out of place. It also holds the crutch on the arm if, for example, the user needs to take his/her hand off the crutch to open a door.

Axilla crutches

These have a single or double shaft. The height and the distance between the handgrip and the axilla pad are adjustable.

If you are using axilla crutches do not lean on the underarm pad as this may interrupt the blood flow and put pressure on important nerves that run through the armpit. The handgrips should be positioned so that the elbows are slightly flexed.

Forearm crutches with gutter armrests

These are designed for people who need to weight bear through the length of their forearm rather than their hand and wrist, for example those who experience pain in their hands. The height of these crutches can be adjusted and they have trough or gutter armrests that support and spread the user’s weight onto his/her forearms. The length and angle of the handgrip can be adjusted.Handgrip

Some crutches can have contoured handles, shaped to follow the contours of the hand and spreading the pressure over a wider area of the palm, for more comfortable use. A gel handgrip can also help to improve comfort.

Elbow crutches can be supplied with gutter armrests. These allow people to bear weight through their forearms rather than through their hands. They have padded, vinyl covered, trough-shaped supports with vertical handgrips. The length and angle of some handgrips can be adjusted to achieve the most comfortable position.

Material

Most crutches are made of metal, either aluminium or steel-reinforced aluminium for heavy-duty use. You may find some underarm crutches are still made of wood. Some metal crutches can have a coloured paint finish. All crutches must be fitted with an appropriate ferrule. The ferrules of metal crutches must incorporate a metal ring to prevent the base of the crutch cutting into the rubber of the ferrule.

The correct height for crutches

Crutches must be at the correct height for use. Both axilla and elbow crutches usually have two adjustment points.

The overall height of axilla crutches can be adjusted. This should be measured by standing upright in appropriate and supportive footwear. The underarm pad should fit under the armpit with two finger widths of space above to ensure no pressure is applied through the armpit when the crutches are being used.

The handgrip adjusts along the upright side of the crutches and should be set at a height level with the protruding bone at the side of the wrist.

The overall height of elbow crutches can be adjusted. This is measured by lining up the handgrips with the wrist bone. Some elbow crutches also have an adjustment for the elbow cuff, which should cradle the forearm just below the elbow joint so that movement of the elbow is not impeded.

Types of walking sticks

When using only one stick it should be held in the opposite hand to the affected leg so that a natural walking pattern and an upright posture can be maintained. The stick and the affected leg should be moved forwards together. If using more than one stick, professional advice should be sought for guidance on the most suitable pattern of use.

Wooden walking sticks

These usually have a crook or similar shaped handle so that they can be hooked over the forearm. Various diameters are available and they should be cut to the correct height. They are available in various diameters and strengths which are designed to take different loads. They are not as adaptable as metal sticks.

Metal walking sticks

These metal sticks tend to be stronger than wooden walking sticks. The height of some is fixed but the majority are height adjustable. Metal sticks are available with right-angled handles, crook-shaped handles and anatomically-shaped handgrips. The ferrules of metal sticks must incorporate a metal disc to prevent the end of the stick cutting into the rubber of the ferrule.

Folding walking sticks

These are lightweight metal sticks with sectioned shafts that enable them to be folded up for storage, for example in a handbag.

Strong elastic runs inside the shaft to ensure that in its open position the stick remains stable. Fixed height or adjustable height versions are available. Some are provided with a plastic, storage wallet.

Walking sticks with a contoured handgrip (Fischer sticks)

These spread the weight of the user over a wider area of the hand and may be more comfortable for permanent users or those with painful hands, perhaps due to arthritis.

Walking sticks with a swan neck

A swan neck is offset so that the weight of the user is transferred centrally over the base of the stick. This may be helpful for those who require more stability.

Walking sticks with a seat attached

These are particularly useful for people who need to rest periodically, for example for those with breathing difficulties or a heart condition. However, they are not recommended for people who need to take a lot of weight through the stick as the addition of a seat alters the balance of the stick.

The weight of stick seats and the amount of strength needed to open and close the seat varies.

The height of many of these sticks cannot be adjusted and it is important to ensure that the overall height is appropriate for the individual user so he/she gains walking support from it.

The seat size is often small and seat height varies between the models; the lower the seat the more difficult it is to stand up from. Most do not provide back support or armrests to push up from.

Those with three or four legs provide a broader base of support and are therefore more stable to sit on than the shooting stick type, which have only one leg. Seat sticks with a single point base must have a rubber ferrule. Traditional style shooting sticks with a single point and plate base instead of a ferrule do not provide sufficient stability. The maximum user weight tolerated by stick seats varies according to their design. You are advised to check the manufacturer’s details for weight tolerance. It is also advisable to discuss the suitability if this type of stick with your GP or physiotherapist.

Walking sticks for blind or partially sighted users

Symbol canes enable people who are blind or visually impaired to establish the nature of their immediate surroundings. They also act as guides by locating obstacles in the path of the user. They are white in colour and therefore act as an indicator to those around that the user has a visual impairment. Various options are available including:

• different types of handgrip
• folding or rigid canes
• reflective markings
• roller tips to increase the sensitivity of the cane.

White walking sticks are also available as walking aids for those people who are blind or visually impaired and also have difficulty mobilising.

Red tape can be wrapped around canes and sticks to indicate that they are being used by people who are both deaf and blind.

Tripods and quadrupods

These walking aids have a walking stick style shaft and a three or four point base. They are therefore freestanding and are more stable than standard walking sticks. They are usually used singly rather than in pairs; if used in pairs, the narrow base styles occupy less floor space and are therefore more practical.

All tripods and quadrupods are made of metal, usually aluminium or steel, and have a telescopic mechanism for adjusting height using spring-loaded catches. It is very important to have the tripod or quadrupod at the correct height for use.

As with other walking aids, the usual measurement to take is the distance between the wrist crease and the ground (read more on the correct height below).

Tripods and quadrupods are available in narrow and wide based versions, the wide base offering greater stability. All can be used right or left-handed; the handgrip can be rotated through 180 degrees so that the spread of the base is away from the user.

Some quadrupods incorporate an extension above the handgrip that terminates in an elbow cuff, similar to the cuff found on elbow crutches. This gives added security, by retaining the forearm in a position immediately above the handgrip.

Tripods and quadrupods are sometimes used by people who have had a stroke, although nowadays the focus of rehabilitation has changed to encourage equal use of the affected and unaffected sides. Consequently, they are used less frequently because they tend to encourage an asymmetrical gait with the stronger, unaffected side leading.

Features to consider

Size of base

Tripods and quadrupods are available in narrow and wide based versions, the wide base offering greater stability. All can be used right or left-handed; the handgrip can be rotated through 180° so that the spread of the base is away from the user.

Elbow cuff

Some quadrupods incorporate an extension above the handgrip that terminates in an elbow cuff, similar to the cuff found on elbow crutches. This gives added security, by retaining the forearm in a position immediately above the handgrip.

Household trolleys

Household trolleys are not walking aids, but if your main difficulty is carrying items such as meals and hot drinks between rooms, then you may wish to try out a household trolley in an equipment demonstration centre.

Household trolleys are designed for indoor use and their main advantage is that they enable items to be carried safely from room to room. You push them in front of you and should consider them as an aid to confidence rather than for transference of body weight. Some are height adjustable to an extent, but may not be suitable for a taller person. They are not suitable for outside use.

Features to consider

• Material Wooden trolleys have wooden frames with melamine shelves. Metal trolleys tend to have metal frames and plastic trays, they may be fixed or height adjustable. Height adjustment is via telescopic legs.
• Shelves Trolleys are available with one or two shelves; the bottom shelf is sometimes recessed to give greater space for your legs when stepping forwards. Some trolleys have removable trays which may help when transferring items or cleaning the tray.
• Wheels The size of wheel will affect how smoothly the trolley travels over carpets and thresholds. Generally, larger wheels cope better than smaller wheels over higher thresholds and thick pile carpets. Front fixed wheels facilitate travel in a straight line; swivel wheels improve manoeuvrability in tight spaces and around corners.

Shopping trolleys

Shopping trolleys are not walking aids, but if you are steady on your feet but lack walking stamina (for example a breathing difficulty or a heart condition, which may be made worse by carrying heavy loads) you may benefit from a shopping trolley that incorporates a seat. Some models fold so that they can be stored discreetly.

Accessories for walking equipment

Ferrules

Standard ferrules

Ferrules must be replaced as soon as they show signs of excessive wear and tear. Different sizes are available to fit different diameters of shaft.

Replacements are usually available from the issuing authority if the walking aid has been loaned to you, otherwise contact the retail outlet that supplied your walking aid.

Pivoting ferrules

These have a large, swivel base, which enable the walking stick or crutches to maintain full contact with the ground when used at an angle or on uneven surfaces.

Shock-absorbing ferrules

These incorporate a mechanism to absorb shock and may be particularly appropriate for people who are full-time users of crutches.

Ice ferrules

These have a metal spike which provides a firm grip on snow and ice. The spike can be flipped up when it is not needed.

Holders

Props

These can be clipped around walking sticks or crutches. Several styles are available but they are all designed to support a stick in an upright position against, for example a table edge.

Clips

These are U-shaped clips, which can be attached to wheelchairs or walking frames, and are used to secure sticks or crutches when not in use.

Wrist loops

These can be attached to the top of a walking stick, and the loop can be placed around the person’s wrist to keep the stick at hand

Comfort handgrips

These can be fitted over the top of standard walking sticks and crutches to make them more comfortable to hold. They may be made of fleece, foam, rubber, terry-towelling or gel.

Bags, baskets and trays

A bag, basket or tray can be attached to some walking frames. Trays can be clipped onto the top of the frame and folded forward or detached when not in use. Carrying items like this on mobile frames will be more successful than on those that need picking up to be moved forwards. Care should be taken when using accessories that attach to the front of a walking aid as they will alter the balance of the device and may make it unstable. Net bags, apron style bags with pockets and wire baskets are available. Bags should not be attached to walking sticks or crutches. A shoulder bag worn diagonally across the shoulders may provide a solution to carrying less bulky items.

Useful addresses

Association of Occupational Therapists of Ireland (AOTI)
Office 1 & 2
1st Floor
Haymarket House
Smithfield
Dublin 7
Tel: 01-874 8136
Email: info@aoti.ie
Website: www.aoti.ie
Irish Society of Chartered Physiotherapists (ISCP)
Royal College of Surgeons
St Stephen’s Green
Dublin 2
Tel: 01-402 2148
Email: info@iscp.ie
Website: www.iscp.ie
Shopmobility (a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
Liffey Valley Shopping Centre
Quarryvale
Clondalkin
Dublin 22
Tel: 01-620 8731
Shopmobility(a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
Mahon Point Shopping Centre
Mahon
Cork
Tel: 021-431 3033
Shopmobility (a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
Red Car Park (Level 2M)
Dundrum Town Centre
Dundrum
Dublin 14
Tel: 01-298 7982
Shopmobility (a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
Blanchardstown Shopping Centre
Red Car Park – Marks and Spencers Entrance
Blanchardstown
Dublin 15
Tel: 01-821 1911
Shopmobility (a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
Green Car Park
Whitewater Shopping Centre
Cutlery Road
Newbridge
Co Kildare
Tel: 045-450736
VAT (Unregistered) Repayments Section
Revenue Commissioners
FREEPOST
Central Repayments Office
M: TEK II Building
Armagh Road
Monaghan
Tel: 047 62125 or 047 62124
LoCall: 1890 60 60 61
Email: cromon@revenue.ie
Website: www.revenue.ie
Disabled Living Foundation (DLF) (UK charity providing advice and information and a comprehensive up-to-date database of disability equipment available in the UK)
England
Tel: 0044 207 289 6111
Email: info@dlf.org.uk
Website: www.dlf.org.uk
Research Institute for Disabled Consumers (RIDC) (independent research body in UK which produces guides for older and disabled consumers based on professional research – formerly known as RICA)
England
Tel: 0044 207 427 2460
Email: info@ridc.org.uk
Website: www.ridc.org.uk