Choosing the right mobility aid

Selecting a mobility aid can be a daunting process. It can be easiest to think about mobility aids in different categories, such as canes, walkers, rollators, manual wheelchairs, power wheelchairs and scooters.

The information that follows provides an overview of these devices and their features. While it does not substitute for the recommendations of your therapist, it may help you make an informed decision.

Generally, the purchase of a mobility device starts with an assessment from a therapist or qualified healthcare professional. This person will ask about your general health, where you like to go, any falls you have had and any mobility challenges you face. These healthcare providers are in the best position to help you determine the type of equipment you need, as well as the features of that equipment that will best suit your individual needs.

You may have to pay for this assessment, but it will be money well spent to ensure you get the right piece of equipment. Rates can vary depending on the degree of involvement required, so be sure to ask about costs before making an appointment. As an example, a therapist in Ontario might charge $80 for a walker assessment, $125 for a manual wheelchair assessment and $200 for a power wheelchair assessment.

First things first
Regardless of the type of mobility product you purchase, it is important that it is set up and adjusted specifically for you. An improper “fit” can result in injury or difficulties with getting around.

Sad but true
At least 30 per cent of assistive devices are abandoned by their users. This doesn’t mean that the device is not needed, just that it is not being used for various reasons, including that it didn’t provide the type of assistance required, it was too embarrassing to use, it didn’t feel right or it drew unwanted attention. Choose a device that is adjusted appropriately and one that you like and feel comfortable using.

Last, check the weight capacity. Using a device with too low a weight capacity could cause injury.

A cane can help with balance or taking the weight off an injured leg. If you still feel unsteady using a cane, or if you have fallen or others are concerned for your safety, it might be time to consider a walker or rollator for greater balance and support. The main difference is that a rollator has a seat and four wheels, two of which swivel; while a walker doesn’t have a seat and may have four legs or a combination of legs, wheels and carpet skis. In addition, a walker usually enables you to support more of your body weight through your arms.

Canes, walkers and rollators
Walkers, $150 • Canes, $25 – Walkers come in folding and non-folding models for indoors, short distances or to help with therapy. If you want to transport your walker from place to place, or if you use a wheelchair or scooter part of the time, then consider a folding device.

Many walkers can be adapted with skis or wheels in the front to make moving the walker easier. Forearm attachments allow weight-bearing through the forearms for those who have problems gripping. Other optional attachments include a carrying bag or a tray. Auto-stop wheels are available on some models. These move freely when your weight is off the walker, yet “lock” when your weight is on it. This makes the walker easy to push but still stable when you put your weight on it for balance.

Rollators, $500 –  Most rollators come with a braking system, and many have a “slow down” style brake to improve control on inclines. They also have a locked position for safety when reaching for the rollator or sitting on the seat.
• Basket styles and sizes vary. Think about what you would like to carry and how easily it can be accessed or removed.
• Most rollators fold front-to-back with accessories left in place for easy transport.

Scooters and wheelchairs
Scooters, $3,500 – A scooter is a great way to increase outdoor mobility and independence. Generally scooters are too large for functional mobility within the home. Find a secure, sheltered location outdoors with easy access to an electrical outlet for charging.

Make sure you can get on and off the scooter easily and that the tiller (drive control) can be adjusted so that it is comfortable and safe for you to drive. Many scooters are equipped with baskets, but baskets mounted on the tiller make driving more difficult.

Manual wheelchairs, approximately $500 to 5,000 – With so many choices available, how do you select the right one? Think about where and when you will need the wheelchair.

Is it to travel for longer distances outside? Do you need to use the chair within your home? Would having a wheelchair help you to be more mobile and participate in more activities? If so, which activities are important to you? The more clearly you can define your needs, the more likely you will end up with the best chair for you.

Travel chairs, $200 – If you just need a wheelchair for longer distances, such as going to appointments or to the mall, and someone is available to push you then a lower-cost alternative is a lightweight travel chair that folds easily. These chairs generally do not provide much support, are difficult for the seated person to propel independently and are generally not suitable for daily or prolonged use.

Folding manual wheelchairs, $2,500–$4,500 – If you need a wheelchair on a regular basis then a conventional folding chair might be the right choice. These chairs fold by pulling up on the seat upholstery. Some also come with easy-to-remove rear wheels so you can make the chair smaller and lighter to lift into the trunk of a car.

Rigid chairs, $4,500–$6,000 – These do not fold in the conventional way. Instead, the wheels are removable and the backrest folds down over the seat. This type of wheelchair is generally recommended for younger active users—often someone with a spinal cord injury, for example. However, rigid chairs can still be appropriate for older manual wheelchair users, as the location of the wheels can be changed to make propelling the chair easier.

Manual wheelchairs have many basic features:
• Armrests:
Height adjustability allows positioning for comfort and everyday use. Some are removable or flip back to allow easier transfers.
• Foot and leg rests: Most foot rests swing to the side or under the chair. This important feature ensures that the front of the chair is free from obstacles while you are transferring or being transferred. Some chairs have leg rests that elevate. Be aware that elevating leg rests are heavier and bulkier than normal, and tend to increase the overall length of the chair.
• Wheels: These can be solid, air-filled (pneumatic) or semi-pneumatic. Generally, pneumatic tires offer a smoother ride as the air in the tire cushions the bumps; however, you do need to monitor the air pressure—just like a bicycle tire, it is possible to get a flat.
• Back canes: These usually form the push handles at the back of the wheelchair. If you are pushing the chair yourself, make sure they don’t get in
your way. If someone is pushing you, the back canes should be high enough to allow that person to stand up straight.
• Cushions ($350.00–1,000.00): If you will be spending any length of time in a wheelchair then it is critical to have a quality wheelchair cushion— a bed pillow or couch cushion is not sufficient. One of the risks of prolonged sitting is pressure ulcers, which can be painful and difficult to heal. Therefore, make sure the cushion does not cause redness on your bottom. In addition, it is important to shift your weight off your bottom periodically.

Power wheelchairs, $10,000 – For people who have difficult propelling a manual wheelchair, a power wheelchair can offer increased mobility.

Most power wheelchairs are driven with a joystick, but other options are available if you cannot use your hands. It is critical that you (and those around you) feel confident in the safety of your driving skills. While power wheelchairs can enhance independent mobility, they also pose a risk to others if you do not pay attention or are a poor driver. Consider how much help you will need to learn to drive the chair, and where you will do this. Large, open, non-crowded spaces are best for starting out. As you get comfortable driving you can progress to smaller spaces with more turns and obstacles.

Power chair considerations include battery life, and the expandability of the electronics to accommodate different types of drive controls or other equipment.

Finding funding
Depending on where you live and your situation, some funding may be available. Funding sources include the government, private insurance and local charities. A healthcare provider or sales representative at a wheelchair company may be able to help you find local programs in your area.

A therapist can help to identify which features are needed and recommend the most appropriate piece of equipment. The funding available and the processes used to access such funding vary greatly by province. In some cases, devices may be rented or obtained from a loan cupboard.

Final thoughts
It can be hard to pursue the purchase of a mobility aid with the same excitement as when buying other equipment…After all, most of us would prefer not to use a mobility device at all. But the reality is that a mobility aid can help you maintain your safety and independence. It is important that you participate in understanding your options and choosing a device that will meet your needs. In addition, make sure the device is adjusted specifically for you and you have considered the appropriate
weight capacity.

Linda Norton, MSCH, BSc, OT, OT Reg (Ont), is the Rehabilitation Education Coordinator with Shoppers Home Health Care.

 

The right fit

Choosing a walker or rollator that fits is hugely important. When you are standing erect, the device’s grips should be the same height as your wrist joint. This means that when your hands are on the grips, your elbows will be slightly bent. Note that a walker’s four legs adjust independently; when you are trying one for size, make sure that all the walker legs are level.

Funding assistance
These sources might be able to help steer you in the right direction:
• BC Ministry of Social Development: bit.ly/bc_msd   
• Alberta Aids to Daily Living: bit.ly/albertaaids  
• SMD Assistive Technology Support Program: bit.ly/smd_ assistivetechnology   
• Ontario MHLTC Assistive Devices Program: bit.ly/omhltc  
• Veterans Affairs Canada: bit.ly/veteransaffairs

 

Tips for bathing and toileting By Christine Stewart

When providing bathing or showering assistance to the person you care for, be patient and allow as much privacy and independence as possible, without risking safety. Here are some ways to keep bathing pleasant:

• Help to wrap a towel or cloth around private body parts and pin it together with either Velcro tabs or a clothespin.
• Use a hand-held shower head if possible; this facilitates washing and rinsing.
• Use a liquid soap dispenser and large sponge.
• Test that the water temperature.
• Keep the surrounding bathtub or shower area dry to avoid slips.

Assisting the person you care for with toileting may not only be uncomfortable for both of you, but signal a loss of his or her privacy and independence. You can make it an easier process with the following:

Don’t differentiate toileting from any other help.
• Find a comfortable bedpan and put baby powder around the top to prevent skin from sticking.
• Before using the bedpan, ensure that any damp skin is cleansed and dried, to prevent bedsores.
• The use of incontinence or bed pads may help. Always keep them fresh to prevent discomfort and skin irritation.

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