A look at how weight-bearing, balance, and other factors influence the type of walker that is best for patients.

Walking is an essential part of life. It is a simple means of mobility that permits a person to explore his or her environment, and it is incorporated into keeping healthy, socializing, and learning. Socializing and learning are much easier when one can get around to different places to access what they need and explore their environment. Daily walking may seem simple enough for most, but it is challenging for others. Assistance with balance, weight-bearing, posture, and endurance are only some of the reasons why independent walking can be compromised. Fortunately, there are numerous devices to help one achieve independent or assisted walking ability or ambulation. Some options are: canes, crutches, or walkers.

Deciding which device to use can be a daunting task. A common debate is when to use a wheeled versus a standard walker. Not surprisingly, there are many factors to consider. Here are a few common ones.

Choosing the Right Walker

Weight-Bearing: Depending on a person’s medical condition, he or she may sometimes have to limit the amount of weight that travels through his or her lower extremities (for example, with a fracture, after an amputation, or after surgery, such as a total knee or hip replacement). If a person is given a restricted weight-bearing status (such as nonweight-bearing, partial weight-bearing, or touch-down weight-bearing), the debate of what device is more appropriate may arise.

For someone with nonweight-bearing status, a standard walker may be recommended because of the added stability provided by the four legs. This larger base of support stays in contact with the ground and can support one’s body weight, even when he or she is hopping forward. Mobility can be difficult and taxing if one has low endurance or a weak upper body as a result of picking up the walker and advancing it forward.

With a different weight-bearing status, one may prefer the standard walker—unless he or she is unable to use it. The ease of pushing a walker forward may be better for him or her as long as his or her full weight is not expected to pass through their arms, enabling him or her to hop on one foot. (In this case, the wheels may slide out from under the patient.)

Balance: This may be an issue with the elderly, people with vertigo/inner ear problems or a history of falls, and children who toe walk or are low tone. When weight-bearing is not necessarily the issue, but added support is necessary to help keep a person balanced, new things come to mind. When this situation arises, the wheeled walker is good for the ease of advancement by merely being pushed forward. A person is not required to stand on his or her lower extremities independently, as he or she would do when picking up a standard walker to advance it forward. The wheeled walker still provides the added support, enabling him or her to lean forward to distribute weight over a larger base of support. Still, some patients feel uncomfortable with a wheeled walker, afraid it will slide out from underneath him or her. If this is the case, a person’s comfort would supersede my initial preference, and I would proceed with a standard walker.

Endurance: It is not uncommon for patients to present with limited endurance, especially when chronic obstructive pulmonary disease is involved. If one’s endurance with ambulation is limited due to shortness of breath, the use of a wheeled walker (or a respiratory walker to which an oxygen tank can be attached, if needed) should be encouraged. While the upper body is supported by the wheeled walker, as he or she leans forward onto it, the respiratory muscles are also supported—like what happens when he or she sits down and braces the upper body on extended arms. It also seems to be less physically taxing to roll or push the walker forward rather than to pick it up.

Environment: A person’s home environment plays an important role in determining where he or she wants to go. Grass and gravel are not very safe or ideal grounds on which to travel with a wheeled walker. Pavement and carpeting are manageable with a wheeled walker. Climbing up stairs is not necessarily the most ideal situation with either walker, but if it must be done, a standard walker is more realistic (especially if a railing is used).

Posture: If a person tends to lean forward with possibly some kyphosis—a forward-head posture and rounded shoulders—a wheeled posterior walker would be a possibility. Due to its design, this walker fits behind the user, forcing a more ideal, erect posture. The user pulls it behind him or her, and he or she is still able to use it for balance and support.

Besides weight-bearing, balance, endurance, environment, and posture, other factors may come into play when choosing between using a wheeled walker or a standard walker. These include other equipment to be used and other extremities to be involved, such as amputation or cognitive ability. Still yet, many factors play a part in even selecting to use a walker rather than another type of assistive device, such as a cane, crutches, or a wheelchair. This decision-making process is not all that simple, and it should be based on knowledge about a person; clinic applications of devices; one’s environments, expectations, and fears; and physician and medical recommendations.

Essentially, I choose a standard walker for more support and a wheeled walker for more efficient and coordinated ambulation, or if the person is too weak to lift and move a standard walker.

Alison Kreger, DPT, MS, is a pediatric and acute care physical therapist at the Ohio Valley Medical Center, Wheeling, WV. She can be reached at akreger@peoplepc.com.