Walker Facts

Cerebral Vascular Accident
Case Study

Diagnosis:

The patient is a 78 yr old female, diagnosed with a Right Cerebral Vascular Accident. She is 6 months post stroke. On the Chedoke McMaster Stroke Assessment, she scores at a Stage 5 leg/foot and Stage 6 arm/hand. A Stage 7 would indicate no functional impairment. This patient is also diagnosed with chronic renal failure and low haemoglobin.

Challenges and Strengths:

• 32/56 on the Berg Balance Scale. This score indicates difficulty with dynamic standing activities. She is at risk of falling without a mobility aid because of her balance impairment.
• Osteoarthritis, left worse than right in her lower extremities.
• Chronic fatigue.
• Recently relocated from multi-storey house to apartment with elevators.
• Patient motivated to access community and understands the benefits of daily fitness walks in the apartment corridor.
• Patient has the cognitive ability to learn and apply safe use of a mobility aid.
• Supportive spouse is willing to be trained in the use of the rollator and provide some supervision.

Solution:

Standard Frame Walker with fixed wheels progressing to Rollator

During the 6 month recovery period, the patient initially walked with a standard frame walker with 2 fixed front wheels and progressed to 4 fixed wheels on the same frame. The front wheels were replaced with swivel wheels as her balance improved and she learned to handle the increased manoeuvrability while maintaining her balance and walking speed. This ability resulted in increased endurance, improved quality of gait, and introduced the possibility of using a rollator as her permanent walking aid.

A variety of rollators constructed for indoor/outdoor use were trialled using a vendor of the patient's choice. Stability over manoeuvrability was favoured in the rollator, thus, the more stable “H frame” designs were included in the trial, rather than the more manoeuvrable “A frame”. Lighter weight construction was also a criterion over heavier models for the patient’s energy conservation and ease of portability for the spouse. A maximum rollator width of 19" was needed in order to go through doorways in the apartment. Since the patient sat periodically due to arthritis in her lower extremities and fatigue, she opted for the padded back strap support option.

Decreased likelihood of falling, enhanced community access, and lightened care giver burden are the result of using this rollator. Optimistically, the disadvantages of a daily sedentary life style on the patient's health will be reduced.