Mobility Assistive Equipment

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Mobility assistive equipment advice.

I recently read a journal article that gave basic guidance to primary care physicians on how to appropriately prescribe mobility assistive equipment to their patients. It got me thinking about my experience with patients in rehabilitation. I have more patients than I can count who already used a mobility assist device before they were even hospitalized with whatever illness or injury that brought them into the hospital.

A large number of these patients had these devices prescribed to them by their physician (usually their primary care physician but sometimes a specialty physician). Many of these patients I am referring to, however, went on their own accord and obtained mobility assistive equipment for themselves, or a family member obtained it for them based on what they thought would benefit them the most.

Some were obtained at stores specializing in durable medical equipment, some were purchased at local pharmacies, some at online marketplaces such as Amazon, and some from thrift stores. It is important to note that mobility assistive equipment does not require a prescription for purchase. In order for the possibility of them to be covered by insurance, however, they do need a physician's prescription. 

(Related blog post: Home Medical Equipment)

Different purpose for different devices.

So back to the article I read. It was titled Mobility Assistive Device Use In Older Adults and was published in the journal American Family Physician. It very clearly described the different assistive equipment available to patients, went through each device's pros and cons, and then listed some indications for the use of each device. While I would encourage everyone to utilize the expertise of a treating physician and physical therapist for the recommendation of the appropriate devices, I know many people would rather avoid the hassle of extra appointments and dealing with insurance and just get the device on their own. Since that is the case, I thought it would be beneficial to go through these various mobility assist devices. 

Cane types.

Let’s start with the cane. A cane is a category in and of itself. There are three different types of canes.

The first is the standard cane that has a curved handle and a single point that makes contact with the ground. It’s the cheapest of all canes. The next type is the offset can. It is very similar to the standard straight cane with the key difference being that the handle has a straight grip with an offset angle, which allows the force of weight bearing to move straight down through the shaft of the cane to the ground. Again, it has a single point making contact with the ground. The third category is the quadripod cane. In general, the handle is the same as the offset cane, but instead of a single point, it has four legs making contact with the ground, thus increasing the base of support and stability.

The cane is the mobility assist device I see most commonly obtained on one’s own. In general, it’s the least expensive. It provides the least amount of assistance and is the least stable of all mobility assistive equipment. Many will use the cane to help take the pressure off of a painful joint, i.e. arthritic hip. It might also be used to increase the base of support for those with balance deficits. 

(Related blog post: Should I Get A Knee Replacement?)

Types of walkers.

Now, I will move onto the more substantial mobility assist devices, the walkers. The two basic types are rollators (has four wheels) and a standard walker, which can have two wheels added to the front, making it a two-wheeled walker. The rollator is a popular choice for the majority of my patients. The draw of the rollator is that it is easy to propel, easy to maneuver and has a seat to rest and a basket to store things. I think the seat and the basket are the biggest draw for patients.

It is certainly a nice device, however, if you were to poll physical therapists on their least favorite assist devices that patients obtain on their own, they will more often than not say it is the rollator. It is good for those with a generalized decrease in endurance, support for those with spinal stenosis (leaning forward posture), and those with generalized fatigue that requires frequent rest breaks.

Where they can be dangerous is that they have four wheels, thus can get away from the patients quite easily. It can be hard for people to remember to manually engage the brakes when they do want to stop and rest. Also, because of the seat, the user is not able to walk within the support, thus it promotes the leaning forward posture and does not provide much in the way of improving balance and preventing falls.

(Related blog post: Falls At Home)

While the rollators do have several negatives, they certainly do have their place, however. So, the standard walker and the two-wheeled walkers are great for those who require more stability because they can walk within the walker, thus allowing for better assistance with balance and promoting a more upright posture. And for those of you whose loved ones just love the basket on the rollator but really need the standard walker or two-wheeled walker, spend a little extra to get the nice attachments to the walkers that allow for items to be carried. 

How to decide which device is best for your situation.

Now that I have reviewed the different types of mobility assistive equipment and their subgroups, I wanted to try to walk through the decision making process for determining which assist device would be best for you or your loved one.

The first question to ask is whether the mobility limitation can be resolved with a cane or walker. If that answer is yes, then try to determine if your loved one needs to use one or both upper extremities to get around. If it is just one arm, then it would be appropriate to look at a cane. If just a bit of weight bearing through the one arm is needed, then a standard cane would be appropriate. If your loved one is more intermittent in putting added weight through the arm, then go with the offset can. If they are putting near constant force through that arm, then go for the quadripod cane.

Now, let’s back up. If your loved one seems to be relying on both arms to get around, then a walker would be the way to go. If they really are not bearing weight through the arms but are using it more for postural support and endurance, then it might be worth looking at getting the rollator. If they are putting intermittent or frequent weight through the arms and/or their balance is poor, then consider the standard or the two wheeled walker. 

It is worth noting that the mobility assistive equipment is covered under Medicare Part D, which is considered medically necessary when it is prescribed by a physician. I would be remiss to not remind and recommend going to your loved one’s primary care provider or other established physician (physiatrist) in order to obtain the order. The reasoning behind the strong recommendation is to 1) save money for your loved one so that the equipment will be covered and 2) better ensure that the appropriate assist device is recommended/ordered to maximize your loved one’s safety with mobility. 

Let me know in the comments if you have purchased mobility assistive equipment for your loved one on your own and if you felt the device was the one your loved one needed once they started to use it. 

© 2021 Jessica Kluetz, DO