Numerous types of brakes and wheels, various wheel sizes, as well as options for gliders, seats, and even baskets...Today's standers and walkers offer a variety of features, making it more possible to meet the mobility needs of virtually every patient, but also making it increasingly more complex to select which one is best for each patient. Fortunately, there are key criteria that can assist with selection.

NEW DEVELOPMENTS

Naturally, when looking to identify appropriate features for a patient's mobility aid, it is quite helpful to be aware of options that are available. So, what are some of the newer developments in standers and walkers?

What are the physiological benefits for a patient of standing? Find out in our October 2006 article, "Continuing To Stand Tall."

Recently, an elliptical component was introduced in the EasyStand products for standers. This has made it much easier for the therapist to customize the stander patients to size, medical needs, posture, and pressure relief; and easier for patients to use the stander independently. Many of the patients we have treated seem to prefer the EasyStand Evolv Glider. It is available in multiple versions—for children and youth, smaller teens and adults, and for taller teens and adults. It features an open base and a wide seat that can help ease independent and assisted transfers.

Described by the manufacturer as having a modular design, the EasyStand Evolv Glider allows for options and configurations including a shadow tray and a self-propelled mobility aid.

A variety of attachments that can improve functionality and can be customized to patient need are also available for walkers. These attachments include different types of brakes and wheels, as well as wheel sizes. Gliders, seats, and baskets are available for most types of walkers.

In addition, different types of walkers are available. For instance, some walkers are designed to be placed behind patients instead of in front of them. Such walkers can assist with a patient's gait and balance needs.

A trend that is quickly developing is different colors and designs on walkers. This has been particularly evident among younger patients. An active standing glider option is now available for younger users; previously, it was offered only for adult-sized equipment. The elderly population seems to prefer walkers with seats, baskets, and hand brakes.

NEEDS ASSESSMENT AND SELECTION

The most important step in selecting a stander is identifying the patient's level of independence and function, and environmental and lifestyle needs. Taking these considerations into account is vital. If the product's features are not a match with the patient's needs and level of mobility, even the most advanced offerings will fall short.

Therapists should conduct a home visit to observe the home setup and, if applicable and appropriate, the patient's work area and type of vocation. It is also important to consider the amount of assistance that is available to the patient at both home and work.

During observation, be sure to notice the types of terrain that the patient will need to negotiate, as this will affect product selection.

For walker selection, therapists need to look at the patient's physical attributes as well as abilities. Height, weight, and weight-bearing status are key factors. Other considerations should include the duration the patient will need the device, the distance and terrains the patient will need to negotiate, the patient's upper-extremity abilities and limitations, and the patient's level of cognition.

Therapists also need to keep a patient's independence needs in mind; this is vital not only to functionality, but also to mental well-being. Most of the newer walkers offer features such as seats, hand brakes, and glide brakes. Items such as these can make a significant difference in how the patient navigates his or her life.

Prior to purchasing equipment, always have the patient try the product in the clinic. Also, do not hesitate to ask your vendors to assist with fitting patients for standers.

CASE STUDY

To help illustrate how a match between patient and mobility aid can have a positive effect on patient outcomes, we take the case of John*, age 43.

Patient Background
John was an incomplete T12 SCI with some return of motor to his legs. He was overweight. He was independent in unlevel transfers; he had no support at home. His goal was independent household ambulation with braces and a walker.

Physical Evaluation and Assessment
John's mobility issues included weakness in his legs, especially in his extensors; increased tone; and range-of-motion (ROM) problems at his ankle (because of tone). He needed to increase his endurance in the upright position and wanted a stander that would involve the use of his legs.

We evaluated John for the EasyStand Evolv Glider for home use because he needed to undergo cardiovascular workouts to control his weight, as well as weight-bearing exercises to decrease his tone and increase his ankle ROM.

In addition, he needed to be able to safely use the equipment alone. We fitted him according to his height and ensured he could demonstrate independent use of the equipment.

Outcome
Today, John uses the equipment daily, at home, which now allows his therapy sessions to focus on gait and balance. In 2 weeks, his walking endurance had doubled in therapy.

ADDITIONAL RESOURCES

Two Web sites that may be useful in product selection are www.EasyStand.com and www.ableproject.org. We have found that many of the EasyStand products are well-received by patients and helpful to achieving positive outcomes. The AbleProject site features a mobility and adaptive product search that allows therapists to search for potential products by certain criteria.

* Not patient's real name.

Susan Golden, PT, is the director of Neurological Rehabilitation for the Good Shepherd Network. With 27 years of experience, she treats patients with various neurological problems. She holds a vestibular certification and a neurodevelopmental certification. Nate Diffenbaugh, MS, PT, also treats patients with various neurological problems, including CVA, brain injuries, balance and vestibular issues, SCI, and multiple sclerosis. He holds a vestibular certification. For more information, contact .