When helping a resident who has visual impairment to walk where should the nursing assistant be?

Mobility aids are devices designed to help people who have problems moving around enjoy greater freedom and independence.

Typically people who have disabilities or injuries, or older adults who are at increased risk of falling, choose to use mobility aids.

These devices provide several benefits to users, including more independence, reduced pain, and increased confidence and self-esteem.

A range of mobility devices is available to meet people’s needs – from canes and crutches to wheelchairs and stair lifts.

The type of mobility aid required will depend on the mobility issue or injury. The most common types of mobility aids include:

Canes

Canes are similar to crutches in that they support the body’s weight and help transmit the load from the legs to the upper body.

However, they take less weight off the lower body than crutches and place greater pressure on the hands and wrists.

Assistive canes are useful for people who have problems balancing and who are at risk of falling. In the United States (U.S.), it is estimated that 1 in every 10 adults over the age of 65 uses a cane.

Common types of canes include:

• White canes. These are designed specifically for assisting people who are visually impaired. White canes are longer and thinner than traditional canes and enable the user to detect objects in their path. They also inform other people that the user is blind or visually impaired.
• Quad canes. These have four feet at the end of the cane, providing a wider base and greater stability.
• Forearm canes. Offering extra forearm support, these canes allow greater weight to be distributed from the wrist to the arm.

Some canes are adjustable or foldable. Canes which are used for non-medical purposes, such as by hikers, are known as walking sticks.

Crutches

Crutches help to transfer weight from the legs to the upper body. They can be used singly or in pairs. Crutches help keep a person upright and may be used by those with short-term injuries or permanent disabilities.

There are many different types of crutches, including:

• Axillary (underarm) crutches. One part of an axillary crutch is placed against the ribcage under the armpits, while users hold onto the hand grip. These crutches are typically used by those with short-term injuries.
• Lofstrand (forearm) crutches. This type of crutch involves placing the arm into a metal or plastic cuff and holding a hand grip. Forearm crutches are more commonly used by people with long-term disabilities.
• Platform crutches. With platform crutches, the hand holds a grip while the forearm rests on a horizontal platform. Platform crutches are not commonly used, except by people with a weak hand grip due to conditions such as arthritis or cerebral palsy.

Walkers

Walkers, also known as Zimmer frames, are made up of a metal framework with four legs that provide stability and support to the user. These very stable walking aids are used by 4.6 percent of adults in the U.S. over 65.

Basic walkers have a 3-sided frame that surrounds the user. Users lift the frame and place it further in front of them, they then step forward to meet it, before repeating the process.

Some walkers have wheels or glides on the base of the legs, which means the user can slide the walker rather than lift it. This is especially helpful for people with limited arm strength.

Types of walkers beyond the basic model include:

• Rollators. This common style of walker consists of a frame with four wheels, handlebars, and seat so the user can rest as needed. Rollators also include hand breaks as a safety feature.
• Knee walkers. Similar to a rollator, this device allows the user to rest their knee on a padded cushion while propelling themselves forward with their stronger leg.
• Walker-cane hybrids. A cross between a cane and a walker, this mobility aid has two legs rather than a full frame. It can be used with one or both hands and provides greater support than a standard cane.

Wheelchairs

Wheelchairs are used by people who should not put weight on their lower limbs or who are unable to walk. They can be more suitable than walkers for people with severe disabilities or when travel over greater distances is required.

Wheelchairs can be manually propelled by the user, pushed by someone else, or electrically powered. A wheelchair that can be propelled by neural impulses was designed in 2016.

Examples of specialized types of wheelchairs include standing wheelchairs, where users are supported in an almost upright position, and sports wheelchairs, which have been developed for use during specific sports.

Mobility scooters

Similar to a wheelchair, these devices have a seat set on top of either 3, 4, or 5 wheels.

The user’s feet rest on foot plates, and there are handlebars or steering wheels to control direction. They are typically battery powered.

Mobility scooters are beneficial for those without the upper body strength or flexibility to use a manual wheelchair. Many scooter users report a positive impact on their lives due to their choice of mobility aid.

Rules for the use of mobility scooters on sidewalks and roads vary by location. Training is usually available for people wanting to use a mobility scooter for the first time.

Guide dogs

Guide dogs are specially trained service animals used to escort people who are blind or visually impaired by helping the owner navigate obstacles.

Having a guide dog or therapy animal also has positive psychological, physiological, and social effects.

In the U.S. and several other countries, service animals must legally be allowed access to any business or agency where the general public is permitted (except where health or safety risks exist).

Safety Modifications

Several home or office modifications can be made to help navigate within a building or in other areas where there are changes in surface heights.

These include:

• Ramps. Access ramps are especially important as some people, including those with wheelchairs and scooters, cannot manage stairs. People with walkers, canes, and crutches may also find that ramps provide easier access than steps.
• Stair lifts. These devices move people and wheelchairs up and down stairs, either through the floor or along the staircase.
• Hand rails. Special handrails are fitted in many restrooms and by entrances to provide support and stability to people with mobility issues.

Anyone who has a mobility issue, either temporary or long-term, can benefit from mobility aids. The type of mobility aid used will depend on the needs of the individual.

Mobility aids may be beneficial for people with:

• arthritis
• cerebral palsy
• developmental disabilities
• diabetic ulcers and wounds
• difficulties maintaining balance
• fractures or broken bones in the lower limbs
• gout
• heart or lung issues
• injury to the legs, feet, or back
• obesity
• spina bifida
• sprains and strains
• walking impairment due to brain injury or stroke
• visual impairment or blindness

Older adults, people who have had an amputation, and those recovering from surgery also benefit from the use of mobility aids.

While mobility aids provide a number of benefits to users, there is a risk of injury associated with their use.

For example, underarm crutches may lead to a condition called crutch paralysis, which is caused by excess pressure on the nerves in the armpit.

Improper or excessive use of mobility aids may contribute to other injuries. Research indicates that many users are not properly trained in the use of their mobility aid, with only one-third of users receiving their mobility aid from a medical professional, and only 20 percent receiving training.

People using a new mobility aid should make an appointment with a doctor or physical therapist to learn how to properly use the device.

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