How to Choose a Cane, Walker or Crutches

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By Richard O’Boyle, Publisher

Perhaps your loved one has suffered a stroke or has recently received an artificial hip. Maybe old age and frailty have impaired her balance and stability. Finding the appropriate mobility aid, such as a cane, walker, or crutches, can speed rehabilitation and provide secure footing.

Finding the right mobility aid requires a little research: one size does not fit all. Once the device has been obtained, it is important to be shown how to use it properly with the assistance of a rehabilitation specialist, physical therapist, or your healthcare provider. The benefits of these devices can be enormous in enhancing safety and promoting independence.

Cane

A cane is used when the individual needs limited support and has good balance. According to the Center for Assistive Technology at the University of Buffalo, the cane is the most widely used assistive device. “In the United States alone, over 4 million people use canes. Canes support up to 25% of a person’s weight and may prevent many falls,” the Center says.

We are all familiar with the standard “candy cane” style cane with a curved top and straight shaft. But you can also find canes with other types of hand grips that are designed for people with limited strength in their hands or arthritis. For people with balancing problems, special “quad” canes with three or four feet at the base. It is important to select a cane that is not too heavy or cumbersome. Canes are not intended to support more than 300 pounds.

Canes come in many materials (wood, alloy or metal) and sizes (heights, adjustable, etc.). The proper cane height is generally determined by measuring from the ground up to the crease of the wrist with the arms hanging loosely. Alternatively, some professionals recommend that canes be measured from the hip joint down. The cane is held with the arm at a slight angle away from the body. Hold the cane in the hand opposite to the side that needs the most support.

Walker

Walkers can provide an individual who has limited strength and balance with added support and mobility. CAT says, walkers are “able to support up to 50% of a person's weight, walkers are more stable than canes. Walkers are helpful for people with arthritis, weak knees or ankles, or balance problems.”

A walker provides more support than a cane because it transfers the body’s weight from just the legs to both the legs and hands/arms. Walkers may have wheels or have flat bases like a cane, and may come in models that fold up for easy carrying and travel. Newer models of walkers, sometimes called “rollators,” may have hand brakes, seats, and carrying baskets. Generally the more complex the walker, the more it costs. When choosing a walker, use the same height guidelines as with a cane.

Walkers with baskets are particularly useful for individuals who need to carry portable oxygen tanks with them, or for active people who just need that additional safety and support.

Caution should be used in choosing a walker to make sure that it both fits the body of the user, and can be used safely. Walkers are not intended to be used on stairs unless the user has special training from a professional. Walkers with wheels may be hard to use on rough or heavily carpeted surfaces. Some people with more than one level to their home have one walker or other appropriate assistive device on each floor.

Crutches

Crutches should have comfortable grips and padding. They should be adjusted for length so that the crutch does not press on your underarm. Crutches are often used as a pair. The long shafts have padded cushions for placement under the arms.

When fitting crutches, the bottom tips should be placed six inches to the front and six inches to the outside of the feet. “Crutches fit correctly when the top of the crutches rest on the chest cavity two inches below the armpit and the elbow is bent 15 to 30 degrees,” recommends Gene LeBouef, author of “LeBoeuf’s Home Healthcare Handbook.” The weight of the body is then borne by the arms and hands, not the armpits.

The West Penn Allegheny Health System recommends that when you use the crutches, resist leaning or resting your underarms on the crutch. “Putting pressure on your underarms is easy to do with crutches, but it can cause problems” such as numbness and tingling or even permanent nerve damage.

The individual’s physical therapist will recommend the proper manner of walking with crutches since that depends on the type of injury and the patient’s abilities. “When you use crutches don't place the crutches too far ahead of you in an effort to ‘speed walk.’ Trying to walk too fast can lead to difficulties,” West Penn says.

A special word of caution: Canes, walkers, and crutches often have rubber tips that may become slippery when wet. Dry off all tips when coming indoors. Replace tips when they become worn. Replacement cane tips can often be purchased from pharmacies and home health supply stores.

What Medicare Pays For

Don’t assume that Medicare will cover the purchase or rental cost of canes, walkers, or crutches. These assistive devices must be purchased from a certified supplier after a doctor specifically recommends and approves their use. According to the Center for Medicare Education, “Medicare’s coverage requirements and related rules for getting medical equipment are complex and often confusing. Durable medical equipment is primarily medical, and the entire process of acquiring Medicare-covered equipment starts with [the individual’s] physician.”

For example, while Medicare will cover the cost of a cane or walker, which is viewed as a medical necessity, they will not cover the cost of a stair lift, which is viewed as a convenience. Also, Medicare will pay for equipment that is mainly for use around the house, even a power scooter, but it will not pay for the scooter of it is primarily for use while outside the house, for example grocery shopping. These are only a few examples.

An individual’s best strategy is to work closely with the doctor to ensure from the outset that the certificate of medical necessity and accompanying paperwork is in order before ordering the assistive device. Then the device should be ordered from a certified Medicare supplier.

Sources

 - Center for Assistive Technology, University of Buffalo http://cat.buffalo.edu/rerc-aging/rerca-canes.htm
 - “Medicare and Durable Medical Equipment,” Issue Brief Vol. 3 No. 10, 2002, Center for Medicare Education http://www.medicareed.org
 - “Helping You Choose Canes, Walkers, and Crutches,” Carex HealthCare Products http://www.apex-carex.com
 - “Canes, Walkers, and Crutches: Choosing What’s Right,” Mayo Foundation for Medical Education and Research 2000.
 - “Canes, Crutches and Walkers,” West Penn Allegheny Health System http://www.asri.edu/wph/doctor/w07canes.html
 - “A Guide to Wheelchair Selection: How to Use the ANSI/RESNA Wheelchair Standards to Buy a Wheelchair” by Peter Axelson, Jean Minkel, and Denise Chesney. Paralyzed Veterans of America. 1994.
 - “LeBoeuf’s Home Healthcare Handbook: Eldercare Edition,” by Gene LeBoeuf. Noel Press. 1996.

Available from ElderCare Online™             www.ec-online.net             2010 Prism Innovations, Inc.