Walking aids are used to assist individuals to keep a good balance and maintain steadiness while performing tasks in daily life such as walking, standing up from sitting, walking upstairs, and many more. These devices help their users to maintain balance by decreasing the pain and fatigue felt by them besides reducing the weight bearing on lower limbs. (REFER). According to a study in 2017, the number of older adults was estimated to double to 22% between the years 2000 and 2050. The same trends are seen in Malaysia, where the country will be an aging nation by the year 2035 as older adults are expected to own 15% of the total population. (ARTICLE 4)
Other than that, a study in 2016 stated that to support physical disabilities while walking, older adults started using walking sticks to have external support. Walking sticks may help to prevent falling due to postural disorders and reduction of balance that was experienced by older adults. (14) Reduction in muscle mass, vestibular function, postural stability, and muscle strength causes changes in their physical performance such as gait, balance, and others. This concern older adult especially when they have a stroke or other disabilities which it may causes limitation in their functional mobility (4) This is all part of the aging process. The aging process causes neuromuscular apparatus to undergo alteration which causes a decrease in muscle strength and power generation reduction. (17) Thus, requiring some of them to use walking aids in their daily life.
In addition, quadruped canes are known to give better balance and stability compared to single canes due to their larger base of support, however, they also may increase the risk of falls in certain situations because of their potential for foot-device collisions. As for the tripod cane, it may reduce the chance of falling because it has a smaller size compared to quadruped. (5) Assistive devices such as walking sticks, quadruped, and others are also used to provide more stability and reduce pain felt on the joint which indirectly improves their users to have more confidence. (22)
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Balance (TUG) with walking aids
Time up and go (TUG) test will be used to assess mobility and balance in the study. The patient is asked to stand up from sitting position to walk approximately 3 meters, turn around and walk back to the chair and sit. The time will be recorded as the subject stand up and end with the subject sitting back down. (21) The TUG protocols state an instruction where it indicates the patient should use a walking aid in the test does not take the potential effect of the walking aids as an assistive device on the performance. (5) Other than that, the TUG test has shown to be easy and quick to perform and to be valid in several populations despite being inexpensive. TUG test also shows significant scores correlated with walking speed, balance, and also functional capacity in older adults that have the risk of fall which indicate that this TUG test might be useful to evaluate mobility skills (17) Shumway-Cock, Brauer, and Woollacott found that TUG test has a specificity of 87% and sensitivity of 87%, according to a study that was done in 2019 (21). Using walking aids in the TUG test also recorded longer times due to the restrictive devices. Previous studies examined the impact of using walking aids on the times to complete the TUG test. In the latter study, it showed that using a rolling walker as the walking aid takes longer times to complete the test where it was 5.23 seconds slower compared to the group using walking sticks or canes as walking aids. (5)
Gait speed
A study in 2018 showed that there's a reduction of responsiveness in the subject that uses walking aids to measure positive exercise effects, where the effects were observed in term of balance. Walking aids conceal the ratio of changes to time in gait speed. It is important to measure gait including unsupported to understand the progression and the severity of the impairment. The study also has limitations since some of the subjects were unable to perform the test without their walking aids. (18) Gait speed may also be applied to determine if older adults are at risk of early mortality. A slower gait speed record is correlated with a higher risk of falls. Gait speed reflects older adults' health, functional status, and survival. According to the data from the cohort study, if the gait speed was faster than 100cm per second suggests better life expectancy. In addition, a study by Quach et al. concludes that a gait speed lower than 60cm per second increase the risk of indoor falls, and a gait speed higher than 130cm per second increased the risk of outdoor falls. The normal gait speed is between 100 to 130 centimeters per second. Walking speed or gait speed is used to measure and determine mobility widely. The assessment of gait speed is suitable as it can be quick, inexpensive, practical and reliable. (15)
Gait with walking aids
Other studies, stated that the use of a cane or walking sticks and rollator show gait patterns much like the people walking without using walking aids, however, the speed decreased significantly when using a cane. Other than that, both devices provide stability and help to improve stride length. Using a single crutch to walk results in using a cane. Next, using walkers without wheels causes asymmetric walking patterns as those of using crutches. Since the users have to move before each step, the gait speed and stride length will be decreased. In addition, using crutches causes a longer stride phase and stance phase compared to swing.
Higher stability does not really associates with a safer gait and lower fall risk. During walking uphill with the use of a rollator, gait speed was slower compared to normal walking and the walking ratio was a little worse due to the decrease in stride length. During walking downhill using a rollator, no change in gait speed was recorded when comparing it to level walking but theres an increase in cadence and decrease in stride length slightly.
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