What action would you take while assisting a resident who is learning to use a walker?

According to the Centers for Disease Control and Prevention (CDC), falls are a leading cause of injury among older adults. Therefore, knowing what action would you take while assisting a resident who is learning to use a walker is crucial for safety and confidence-building.

Quick Summary

The most appropriate action is to stand slightly behind the resident and use a gait belt for support. This technique ensures safety by providing a secure way to assist with balance and prevent falls, while still allowing the resident to practice their movements independently. Correct positioning, communication, and environmental awareness are also critical components.

Key Points

• Use a gait belt and stand behind the resident: The most important action is to provide support and stability from behind using a gait belt, which allows you to safely assist with balance and prevent falls.

• Ensure proper walker height: Before beginning, adjust the walker so the handles are at the resident's wrist level, with elbows slightly bent for comfort and proper posture.

• Instruct on the correct gait pattern: Teach the resident to move the walker forward a short distance, step with the weaker leg first, then follow with the stronger leg.

• Emphasize safety during transfers: Remind the resident to use chair armrests to push up when standing and to back up until they feel the chair before sitting down.

• Protect against and manage falls: Remain vigilant for signs of fatigue. If a fall occurs, widen your stance and guide the resident to the floor safely using the gait belt, protecting their head.

• Clear the environment of hazards: Before starting, remove any loose rugs, cords, or clutter that could create a tripping hazard during the training session.

Prioritizing Safety and Technique During Walker Training

When assisting a resident who is learning to use a walker, the primary action is to prioritize safety through proper technique and active support. Standing slightly behind the resident and using a gait belt is the safest and most effective method. This position allows you to provide stability without interfering with the resident's natural walking rhythm, fostering a sense of security and encouraging independence. The gait belt, a robust transfer belt placed securely around the resident's waist, offers a firm grip for the caregiver to provide support and react quickly if the resident loses their balance.

Step-by-Step Guide for Assisting a Resident with a Walker

1. Preparation and Positioning

• Proper Attire: Ensure the resident is wearing sturdy, non-skid footwear. Avoid loose clothing that could interfere with the walker or cause a trip.
• Adjust Walker Height: Check that the walker is adjusted to the correct height for the resident. When the resident stands inside the walker with their arms relaxed at their sides, the handles should align with the crease of their wrists, allowing for a slight bend in the elbows when they grip the handles.
• Apply the Gait Belt: Securely fasten the gait belt around the resident's waist, ensuring it is snug but not too tight. Position it over their clothing, not directly on their skin.
• Initial Standing: Instruct the resident to push up from the chair's armrests, not to pull on the walker, as this can cause it to tip. Stand in a wide, stable stance, holding the gait belt from behind as they rise.

2. The Walking Process

• Position Yourself: Stand slightly behind the resident, on their weaker side if applicable, maintaining a wide base of support. Hold the gait belt with an underhand grip, keeping your back straight.
• Initiate Movement: Instruct the resident to move the walker forward a short, comfortable distance—typically a step's length. Ensure all four legs or wheels are firmly on the ground before they shift their weight.
• Step with the Weaker Leg: Cue the resident to step forward with their weaker or injured leg first, into the center of the walker.
• Follow with the Stronger Leg: Instruct them to push down on the walker handles for balance as they bring their stronger leg forward, stepping past the weaker leg.
• Maintain Posture: Remind the resident to look forward, not down at their feet, to maintain proper posture and avoid tripping.

3. Turning and Sitting Down

• Turning: When turning, advise the resident to take small, gradual steps rather than attempting to pivot or spin quickly. Continue to provide support via the gait belt.
• Sitting: Guide the resident to back up slowly until they feel the chair against the back of their legs. Instruct them to reach back for the chair's armrests, not the walker, before leaning forward slightly and lowering themselves into the chair in a controlled manner.

Comparison of Assisting with Standard vs. Wheeled Walkers

Aspect	Standard (Non-Wheeled) Walker	Wheeled Walker (Rollator)
Resident's Need	Maximum stability and weight-bearing support.	Balance support and maneuverability; less weight-bearing.
Caregiver Action	Assist the resident in lifting and placing the walker before each step.	Guide the resident in pushing the walker smoothly forward.
Gait Pattern	Requires a "lift, place, step" motion, which can be slower and more cumbersome.	Allows for a more continuous, fluid walking pattern.
Turning	Resident must lift and turn the walker in small increments.	Resident can take small steps while steering the walker, with the caregiver helping to guide the turn.
Environment	Best for stable, even indoor surfaces.	Better for navigating longer distances, turns, and slightly varied terrain.

Potential Challenges and Fall Management

Even with the best training, challenges can arise. Fatigue, frustration, or a momentary loss of focus can increase fall risk. In the event of a fall, the caregiver's response is critical to protect both the resident and themselves from injury.

Fall Prevention and Mitigation

• Monitor Fatigue: Watch for signs of fatigue, such as shuffling feet or unsteady balance, and suggest breaks as needed.
• Stay Attentive: Never leave a resident unattended while they are learning to use a walker. Your constant, close supervision is the best form of protection.
• Controlled Lowering (If Fall Occurs): If the resident begins to fall, do not attempt to catch them fully, as this can cause serious back injury to the caregiver. Instead, widen your stance, pull the resident's body close to you, and use your thigh strength to slowly and gently slide them down your bent leg to the floor. Protect their head from hitting the ground.
• Post-Fall Procedure: Once the resident is safely on the floor, do not move them. Notify a nurse or supervisor immediately for assessment and follow facility protocol for using a mechanical lift to transfer them back to a safe position.

Conclusion

Assisting a resident who is learning to use a walker requires a calm, patient, and methodical approach focused on safety and skill-building. The cornerstone of this process is the proper use of a gait belt, allowing the caregiver to provide secure, reactive support while the resident develops confidence. Consistent practice, attention to technique, and proactive fall prevention strategies are essential for a successful rehabilitation journey. By understanding the nuances of different walker types and knowing the correct response to a potential fall, caregivers can effectively empower residents to regain their mobility and independence in a safe environment.

Cleveland Clinic is an excellent resource for detailed, step-by-step instructions on walker usage.

Frequently Asked Questions

What is the primary action when a resident is learning to use a walker?

The primary action is to stand slightly behind the resident and use a gait belt for support. This technique provides stability, encourages confidence, and allows the caregiver to react quickly to prevent a fall.

How should a resident stand up from a chair with a walker?

Instruct the resident to push off from the chair's armrests, not to pull on the walker, which can cause it to tip. Once they are standing and balanced, they should grasp the walker handles.

What is the correct walking technique with a walker?

The resident should move the walker forward one comfortable step, then step into the center of the walker, leading with their weaker or injured leg. The stronger leg follows, completing the step.

What should be done if a resident starts to fall while walking?

Do not attempt to catch them fully, as this could cause back injury to the caregiver. Instead, widen your stance, bring the resident close, and use the gait belt to slowly lower them to the floor while protecting their head.

Why is it important to ensure the walker is the correct height?

A correctly adjusted walker ensures the resident can maintain proper posture, reducing strain on the back and shoulders and lowering the risk of falls. The handles should be at wrist height when the arms are relaxed at the sides.

How does assisting with a wheeled walker differ from a standard walker?

With a wheeled walker, the caregiver guides the resident as they push the walker forward in a continuous motion. With a standard walker, the caregiver helps the resident lift and place the walker before each step, requiring a slower, more deliberate process.

How should a resident safely sit down in a chair using a walker?

Guide the resident to back up until they feel the chair against their legs. Instruct them to reach back for the chair's armrests with one hand at a time before lowering themselves slowly and carefully.