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Arch Phys Med Rehabil. 2019 Apr;100(4):638-647. doi: 10.1016/j.apmr.2018.10.001. Epub 2018 Oct 24.

Postural and Metabolic Benefits of Using a Forearm Support Walker in Older Adults With Impairments.

Author information

1
Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan Ability Lab, Chicago, IL.
2
Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan Ability Lab, Chicago, IL; University of Applied Sciences, FH AACHEN, Aachen, Germany.
3
University of Applied Sciences, FH AACHEN, Aachen, Germany.
4
Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Center for Bionic Medicine, Shirley Ryan Ability Lab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL. Electronic address: a-jayaraman@northwestern.edu.

Abstract

OBJECTIVE:

To investigate the postural and metabolic benefits a walker with adjustable elbow support (LifeWalker [LW]) can provide for ambulation in population with impairment. The clinical outcomes from the elbow support walker will be compared with standard rollator (SR) and participants predicate device (PD).

DESIGN:

Case-crossover study design.

SETTING:

Clinical laboratory.

PARTICIPANTS:

Individuals aged between 18 and 85 years using a rollator walker as primary mode of assistance and certified as medically stable by their primary physician. Participants (N=30; 80% women [n=24]) recruited from a convenient sample provided voluntary consent and completed the study.

INTERVENTION:

Not applicable.

MAIN OUTCOME MEASURES:

The trunk anterior-posterior (AP) sway (during the 10-meter walk test), oxygen consumption (during the 6-minute walk test), the mean forearm load offloaded to the elbow support as percentage of body weight, and mean peak hand grip load (during the 25-meter walk test) were measured.

RESULTS:

Ambulating with a LW led to (1) reduced trunk sway in the AP direction [(ZLW vs PD= -2.34, P=.018); (ZLW vs SR= -3.461, P=.001)]; (2) reduced erector spinae muscle activation at the left lumbar L3 level [(ZLW vs PD= -2.71, P=.007); (ZLW vs SR= -1.71, P=.09)]; and (3) improved gait efficiency [(ZLW vs PD= -2.66, P=.008) Oxygen cost; (ZLW Vs. SR= -2.66, P=.008) Oxygen cost]. Participants offloaded between 39% and 46% of their body weight through the elbow support armrest while ambulating with the LW. Irrespective of the walker used, participants exerted ∼5%-6% of their body weight in gripping the walker handles during walking.

CONCLUSIONS:

Using the forearm support-based LW led to upright body posture, offloaded portions of body weight from the lower extremity, and improved gait efficiency during ambulation in comparison to the SR and the participants' own PD. Further studies focusing on population-specific benefits are recommended.

KEYWORDS:

Assistive technology; Elbow support; Elderly; Gait; Grip strength; Low back pain; Rehabilitation; Repeated strain injuries; Rollator walker; Trunk posture

PMID:
30367875
DOI:
10.1016/j.apmr.2018.10.001

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