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Help with convincing a patient to use a roller walker.
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Help with convincing a patient to use a roller walker. - February 13, 2007 6:22:00 AM
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VagusX
Posts: 215
Joined: March 26, 2003
From: Savannah, GA, USA
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We all have run into patients that are less than willing to turn to a walker to assist their gait. I have used tons of different approaches from telling them stories of previous patients falling, to dressing it up in different fabrics, to having them see for themselves how much more stable they can walk with the use of one, but some are still too stubborn or proud to pick one up.
What are the techniques that the rest of you all are using to work with this type of patient?
Thanks
Dan
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Re: Help with convincing a patient to use a roller walker. - February 13, 2007 7:26:00 AM
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USAPT
Posts: 278
Joined: January 14, 2004
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How old is your pt and why do they require a walker? Is it temporary or is pt declining and it's a fall risk situation?
You can only do so much. Document, speak to family members and the referring MD. Can have one of your other pts (currently using a walker)speak to them. It has worked for me. They believe another pt over you sometimes...craziness but it happens.
If all fails, than let it go and realize you did all you can.
_____________________________
Jason, PT
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Re: Help with convincing a patient to use a roller walker. - February 13, 2007 1:01:00 PM
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jlharris
Posts: 477
Joined: April 12, 2006
From: Nebraska
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I use balance instruments such as the Tenetti, Berg, and my favorite, the Dynamic Gait Index. I administer the instrument, score it and then (assuming their scores puts them at an increased risk of falling) point out how this instrument given to thousands of people shows that they have a high chance of falling. I especially like the DGI as it is up the pt whether they test using an assistive device or not. This helps take out the subjective nature of your claim that they need assistance just because of your experience - even though your experience is most likely spot on!
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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Re: Help with convincing a patient to use a roller walker. - February 13, 2007 1:32:00 PM
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nyptjen
Posts: 7
Joined: October 23, 2006
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I have to say that one time when working in a SNF we had a guy that did so much better with a walker but didn't want to look old. I made a "deal" with him and showed him all the little old ladies with walkers. I told him that we had so many that we weren't sure were safe and asked if he could help us out. He was to "test" a walker for a week (to give us a true picture) and then report how it handled and whether it was safe to give someone else. Then he would trade in the walker he was using for that week and get one for the next week.
As for the people in the community, I've always had a tough time with that and as much as I've pushed and educated them I know that most of the time there won't be much carryover.
Good luck though.
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Re: Help with convincing a patient to use a roller walker. - February 13, 2007 2:30:00 PM
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jma
Posts: 2414
Joined: August 24, 2000
From: NY
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Getting them to use a walker can be tricky. You can tell if there is one patient who does not want to use it. They are the ones who don't want to use one during the evaluation but prefer to walk holding on to objects or use the wall to get around. Ironically, they are also the ones who I pushed harder to get them back on their feet, whether is was injury or post surgery. They didn't exactly like it but telling them that they would go through the exact same thing if they didn't use their walker and came back because of a fall, made them use it more often than not.
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Re: Help with convincing a patient to use a roller walker. - February 14, 2007 1:29:00 AM
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PTupdate.com
Posts: 1477
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Hey Dan, long time no talk! I may be travelling to Savannah in the Spring, so will let you know. I remember we never got to hook up last St. Pats Day
These patients are always so tough to treat...usually stubborn men. I have to admit I use scare tactics...how falls can lead to hip fracture, which has a high death rate that's not quick, but lingering and miserable.
I should switch to Jason's method, where solid assessment tools are used, giving these people good solid evidence that they will likely fall. Then, I can throw on the death stuff at the end.
One problem is the walker itself. So many older people live in homes that have narrow hallways (they bought the house new in 1947, etc), filled with all the junk that 50 years of marriage can provide. A more narrow, home-onlly walker would be great, if anybody ever wante to tackle the liability and hard work with creation of such a new product.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Help with convincing a patient to use a roller walker. - February 16, 2007 9:58:00 AM
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VagusX
Posts: 215
Joined: March 26, 2003
From: Savannah, GA, USA
Status: offline
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Good input everybody. Patient is 84 recovering from hydrocephalus. She is all over the place, but hasn't fallen at all since coming out of the hospital 3 months ago. I've gone the route of showing her the Tinnetti score, and she keeps on telling me that she will give it a try, but I don't think she's going for it.
I really like Jenn's quality control approach. I had to laugh after reading that.
I will also try some other tests to give her some solid numbers indicating her risk for falls. I have never used the the Dynamic Gait Index, looks good. I searched for it and found it online if anybody wants it.
http://web.missouri.edu/~proste/tool/Dynamic-Gait-Index.rtf
Can somebody tell me how to score it?
There is a walker out there that works well to collapse and still be effective in a narrow hallways. The one with 3 wheels and handbrakes, shaped like a triangle. My patient's use it around their house in a half opened position to navigate the narrow areas. the only modification I would throw on it is an adjustable locking mechanism along the hinge to keeps the walker spread. Heres a pic of one.
http://www.home-med-equip.com/walker-rollators/winnie-deluxe.html
Duffy
Glad to here you may be coming down. Another St. Patty's day coming around the corner soon. This year I believe it to be landing on a Friday or Saturday, so it should have a great turn out. And better yet, one of my patient's ran a Family Tree on me and I found out that I have some Irish in me! THis will better justify the 10 am whisky rush for me!
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Re: Help with convincing a patient to use a roller walker. - February 16, 2007 11:36:00 AM
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james097
Posts: 178
Joined: January 27, 2005
From: West Vancouver BC
Status: offline
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John, You say "Filled with all the junk that 50 years of marriage can provide".
I was stirred to action on reading your post and carted off several hundred pounds of useless stuff to the local disposal unit. We still have some unused wedding presents given to us over 50 years ago, they may come in handy one day. Luckily neither of us needs a walker as yet but the one described by vagusx looks good, shall add it to my favourites list!
Jim McGregor
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Re: Help with convincing a patient to use a roller walker. - February 16, 2007 12:01:00 PM
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jlharris
Posts: 477
Joined: April 12, 2006
From: Nebraska
Status: offline
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Vagus,
Here is information on scoring the DGI:
DYNAMIC GAIT INDEX (DGI)
Test: 8 item exam that assesses gait and has a maximum score of 24
Instructions to Patient: Included on score sheet
Cut-off: Scores of 19 or less are correlated to falls in community dwelling elderly adults.
Considerations: Easy to perform. Equipment needed – shoebox, two cones, and stairs.
Excellent interrater reliability and test-retest reliability.
Reference:
Shumway-Cook, A, Woollacott, MH. Motor Control: Theory and Practical Applications.
Baltimore, MD: Williams & Wilkins; 1995.
Shumway-Cook, A, et al: Predicting the Probability for Falls in Community-Dwelling
Older Adults. Physical Therapy. 77:812-819, 1997.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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