Mobility Equipment Supplies

In my previous article, I focused on how medical organizations from around the world try to reduce harm from falls in their own facilities on a macro level. Now I am going to delve on more practical advice on how to reduce the incidence of falls within our homes or workplace.

Risk assessment provides a useful framework when tackling accidents caused by trips, slips and falls. Here is a five-step approach for this:

1. Look out for anything that may cause an accident. It could be objects lying around the floor like toys or rubbish; a wet floor; or basically, the proverbial banana peel that can cause people to slip.

2. Identify and decide who is at risk. It could be young children, the handicapped, or the elderly.

3. Take preventive measures, like doing repairs or renovations, making sure the area is regularly cleaned and cleared of any obstruction.

4. Keep a record of what you have changed. Now this one is a bit of a stretch to expect at home, but for commercial establishments and public places, it is certainly necessary.

5. Continually monitor your living space or work area. This is more of a continuation of the first 4 steps. It wouldn’t be effective if you just stop at recording and don’t follow through, so there has to be constant monitoring.

Now here are more practical tips to prevent the incidence of falls:

- Keep pathways clear. Arrange your furniture in a way that it allows easy movement, and not serve as an obstruction. Clean pathways and remove any unnecessary clutter, like boxes, telephone cords, and loose wires from high-traffic areas. Make pathways that are wide enough for plenty of people to use, to avoid possible collision.

- Provide ample light. Make sure areas like hallways and stairways are well lit. Have rechargeable emergency lights and flashlights handy in case of power outages.

- Safeguard stairways. Keep stairways in good repair. Make sure all stairways have sturdy railings and that steps have a non-skid surface.

- Secure rugs and flooring. Secure loose rugs and carpets with tacks or a slip-resistant backing. Repair frayed carpet and loose floorboards. Avoid small throw rugs as much as possible.

- Keep your bathroom safe. Install grab bars in your shower or bath and near your toilet. Use non-skid mats in the shower or bath.

- Keep necessities handy. Store supplies, clothing, dishes, food, and other everyday items within easy reach.

You can improve your general well-being, and help reduce the risk of trips and falls by keeping yourself active and healthy. A good way to make your muscles stronger and to improve your balance is to have a regular exercise and a proper diet. You do not have to go to the gym to remain active. Simple tasks, like gardening, regular house work, and walking can boost energy levels and improve coordination and balance.

Exercise is very important for older people since they are more prone to falling.

*** For all your disability equipment needs, visit www.doability.co.uk.

So can you spot what’s wrong with this picture? If not, let me give you a hint. It has something to do with the name that you see on the building. If you still do not get it, this article might give you an idea.

How many times have you been to a building with no ramp/s for those on wheelchair? Or go to a parking facility with no parking slots dedicated for the handicapped? Or ride an elevator with no brails on the floor buttons? Hopefully, not too many.

For some of us, these things I mentioned are considered useless and, worse, a waste of precious resources, be it money, work and space. Not everyone realizes though that there is a reason why we have these now, and that people before us fought hard for us to have these “useless” things.

For centuries, people with disabilities have had to battle against biases, stereotypes, and fears. Since the mid 1900s, these people have been fighting for recognition and fair treatment. The stigmatization of disability resulted in the social and economic marginalization of generations of men and women with disabilities, and like many other oppressed minorities, left them in a severe state of impoverishment for centuries. This continued up to the two World Wars. During the 1930s, the United States saw the introduction of many new advancements in technology as well as in government assistance, contributing to the self-reliance and self-sufficiency of people with disabilities. A great advocate for this was the late great US President Franklin Delano Roosevelt, who had a disability himself. In August 1921, before he became president, while the Roosevelts were vacationing at Campobello Island, New Brunswick, Roosevelt contracted an illness believed by his physicians to be polio, which resulted in his total and permanent paralysis from the waist down. This did not stop Roosevelt from dreaming and achieving greater things, making him one of the most popular US presidents in history. In fact, on October 20, 1995, the Franklin and Eleanor Roosevelt Institute and the World Committee on Disability established the Franklin D. Roosevelt International Disability Award to recognize and encourage progress by nations in improving the lives of their disabled citizens. This award is still being given up to now by the United Nations.

In the 1940s and 1950s, disabled World War II veterans placed increasing pressure on government to provide them with rehabilitation and vocational training. World War II veterans made disability issues more visible to a country of thankful citizens who were concerned for the long-term welfare of young men who sacrificed their lives to secure the safety of the United States. Despite these initial advancements made towards independence and self-reliance, people with disabilities still did not have access to public transportation, telephones, bathrooms and stores. Office buildings and work sites with stairs offered no entry for people with disabilities who sought employment, and employer attitudes created even worse barriers. Otherwise talented and eligible people with disabilities were locked out of opportunities for meaningful work. This began to change by the 1960s. By then, the civil rights movement began to take shape, and disability advocates saw the opportunity to join forces alongside other minority groups to demand equal treatment, equal access and equal opportunity for people with disabilities. The advocacy continued until in 1973, the Rehabilitation Act was passed, and for the first time in history, civil rights of people with disabilities were protected by law.

Yet all these advancements were not enough.

In the 1980s, disability activists began to lobby for a consolidation of various pieces of legislation under one broad civil rights statute that would protect the rights of people with disabilities, much like what the 1964 Civil Rights Act had achieved for Black Americans. After decades of campaigning and lobbying, the Americans with Disabilities Act (ADA) was passed in 1990, and ensured the equal treatment and equal access of people with disabilities to employment opportunities and to public accommodations. The ADA intended to prohibit discrimination on the basis of disability in: employment, services rendered by state and local governments, places of public accommodation, transportation, and telecommunications services.

The rest, as they say, is history. And knowing this made me grateful to those who fought for disability rights in the past, and for those who are still fighting for it now. Make no mistake, the struggle continues and it is upon ourselves, the current generation, to make sure that all what the others before us fought for will not go to waste.

Still do not know what’s wrong with the picture? I’m sorry. I gave you all the clues already.

I am no stranger to minor accidents at home and outside. Slips, trips, and falls happen to a lot of people of all ages, from all places, and in all walks of life. These would sometimes lead to injuries which would require hospitalization, or at least a visit to the nearest doctor.

What a lot of us do not realize is that these falls happen to patients in the hospitals and medical facilities, too. There is nothing worse than injuring a person who is already sick, and the cause of such injury is the person who is supposed to be taking care of the patient, like the doctor or nurse. It is like adding injury to an existing injury.

Patient safety has been constantly one of the most pressing challenges in the health care industry, and a significant part of patient injuries come from falls while confined in the hospitals and nursing homes. Reducing harm from falls is becoming one of the top priorities of hospitals and health care organizations around the world. Patients, regardless of age, fall. While certain risk factors are common in younger people, falls are most likely to occur in older patients and they are much more likely to experience serious injuries. A significant number of falls result in injury, or even death, costing millions per annum for immediate health care treatment alone, not to mention the additional costs of rehabilitation and social care. In addition to these financial costs, there are additional costs that are more difficult to quantify. It not only includes the obvious distress, pain, injury, but also loss of confidence and independence to the patient.

There are lots of researches and reports around the internet on patient safety, specifically on how to reduce harm from falls, but it seems that there is not one single guide for all. What is apparent is that non-profit organizations from countries like the UK, Sweden, Australia, Canada and the USA are at the forefront when it comes to these initiatives with The Institute for Healthcare Improvement IHI in Cambridge, Massachusetts providing the main thrust. In the UK, there is Patient Safety First Campaign sponsored by the National Patient Safety Agency, the NHS Institute for Innovation and Improvement and The Health Foundation. In Australia, there is the Australian Patient Safety Foundation. While in Canada, there is the Canadian Patient Safety Institute.

The approaches are varied, localized, and sometimes isolated depending on the case. But what is common is the need to recognize these harms, identify patients prone to falls, record, monitor, and measure these incidents to be able to come up with actionable plans. These are for more organizational solutions though. Ultimately, it all boils down to the care and dedication given by our doctors, nurses, and caregivers that would spell a big difference.

Accidents do happen but a lot of them can also be avoided with the right actions and presence of mind. For those that cannot be avoided totally, there are ways to reduce the harms and risks brought about by these accidents. While this is easier said than done, it is doable with a little effort and good luck.

All walking frames can be folded for storage or transportation and all have some kind of brake. They also all have fixed wheels at the back and swivelling wheels (castors) at the front, like a supermarket trolley.

Three and four-wheeled walking frames

There are two basic varieties of wheeled walking frame – three-wheeled and four-wheeled.

Some people prefer three-wheeled walking frames because they look smaller and less obtrusive. They can also be a bit lighter and easier to manoeuvre than some four-wheeled models.

However, many professionals advise against three-wheelers because they are less stable. It is also easier to use them without unfolding them all the way, which can be even more risky.

Some three-wheelers have a safety feature that makes it harder to use them without unfolding them properly.

Features

Folding

All walking frames can be folded.

Three-wheelers fold like a book.

Four-wheelers fold in one of two ways: in ‘A’-type walking frames, you fold the front wheels and back wheels together and in ‘X’-type walking frames you fold the two sides together.

Folding can be difficult on some models, so you need to make sure that you know how it works, and that you can do it safely.

Things to watch out for:

On some models it is possible to unfold the walking frame without it clicking securely into place. Obviously this can be dangerous. Some walking frames have a catch that shows clearly if it is in place or not.

Some models need two hands to fold them. If the frame is not stable when folded, this might make you lose your balance.

Most walking frames still stand up when they are folded, but some of the A-folding models do not. This may make them harder for you to use.

Make sure you don’t catch your fingers when folding or unfolding the walking frame. Some are better for this than others.

Some walking frames have a clip or catch that secures them in the folded position. This may make them easier for you to use.

Wheels

The size and shape of the wheels can make a big difference to how easy the walking frame is to use. Larger wheels are easier to push on uneven or bumpy surfaces.

There are four main kinds of wheels – balloon, double, solid and rubberised. All the balloon, solid and rubberised wheels are around 200mm (8 inches) across; double wheels are 90mm (3 1/2 inches) across.

Hard, shiny tyres can be slippy on some surfaces, even carpets. Even the brakes can slip, especially if they are not properly adjusted.

• balloon

Most three-wheelers have ‘balloon’ wheels. These are large wheels with fat, quite hard, plastic tyres. The brakes hold quite well on these tyres.

• double

These are pairs of smaller, plastic wheels, like on a push chair. The brakes do hold quite well on these wheels. Some of the people in our tests found them a bit rattly.

• solid

Some of the four-wheelers have solid tyres. These are large wheels with slimmer hard plastic tyres. Some of them were quite slippy in the tests. Some have ridges to give them better grip.

• rubberised

Some of the four-wheelers have rubberised tyres (right). These are large plastic wheels with low profile rubber tyres. They were the grippiest tyers in the tests, though they did still slip on some surfaces.

Holding on

Handles and hand grips are important because they take your weight and you will be holding them for a long time. It’s important to make sure they are in the right position so you are going to be comfortable. Usually you can adjust the height of the hand grips, and on some models the angle as well.

Mostly you hold and steer the walking frame with both hands, holding on to the frame or holding special handles, but if your hands are stiff or painful you can have forearm supports on some models.

It is also possible to adapt some walking frames to be used with just one hand. This is done either by fitting a bar or grip that you can hold in the middle of the walking frame, or simply by connecting both brake cables to the same lever. Be aware that if you are putting all your weight on just one side of the walking frame you might risk overbalancing.

There’s a variety of different hand grips. The simplest are covered with padded tape, like on a bicycle, or have soft foam grips.

Some walking frames have specially shaped hand grips (sometimes called ergonomic or anatomic grips) that are supposed to fit more comfortably in your hand. These can be more comfortable, but if the moulding doesn’t fit your hand, they may become uncomfortable to hold.

Other walking frames have simple plastic hand grips.

Brakes

All walking frames have brakes of one kind or another.

Pressure brakes go on when you push them down. As you push down the wheels spring up so that the frame stands on its rubber feet. They are easy to use because it is easy to use your weight to press down. They only stay on while you are pushing, so you cannot lock the brakes on if you want to stay put for a while. Make sure they are properly adjusted; otherwise they might come on by themselves when you are not expecting it.

Lever brakes work by squeezing a lever, like on a bicycle. They can be used to slow you down as you are going along and can be locked on to keep the frame steady while you sit down, or put things on the tray or basket.

Strap brakes Some walking frames have a strap brake, that works like a lever brake except that you squeeze a loop of the strap instead of a lever. These are quite comfortable to use, but you sometimes have to squeeze quite hard. They can be locked on.

If you are choosing a walking frame with lever or strap brakes, check you can stretch your fingers far enough to reach and squeeze with enough force and that you can comfortably apply the brakes. You also need to be able to push the lever or strap down to lock the brakes on. Some brake levers are shaped to make them easier to use.

Brakes should not need much maintenance if they have been set up properly. Strap and lever brakes may need to be adjusted to allow for wear. Make sure you or someone who may help you knows how to do this. It’s easy, but with some types you will need two spanners (not supplied).

Seats and backrests

All four-wheeled frames have seats. Very few three-wheelers do. Seats can be useful, especially on longer trips. They are meant for short rests, not sitting in for a long time. They are made of fabric, wood or plastic, and may be rigid or flexible. Some are padded and some have backrests.

Try them out to find out which suits you, and take enough time doing so. Check that the seat is the right height for you to sit comfortably, and high enough to let you sit down and get up easily. Some are adjustable and some frames come in a range of sizes. If you need back support check it is at the right height to support you comfortably. A few backrests are adjustable.

Bags, baskets and trays

Many frames come with a bag or basket for carrying things. Some frames can be folded without taking the (empty) bag off, but solid metal baskets must be removed before folding. This means that if you go by car to the shops you have to take all your shopping out before you can get the frame into the car. If you put a shopping bag into the frame’s bag first, you can lift everything out in one go.

Some baskets sit at the front of the frame. If you are worried about bag snatchers look for one where the basket or bag can be closed, or is harder to get at.

Many frames have a tray – useful for carrying things from room to room at home. Check that you can reach it easily (some are very low down) and they are firm enough (some shake around a bit).

Other features

There are many other features that come with some walking frames as standard or as optional extras. These include walking stick holders, drink holders, oxygen cylinder holders and parasols.

Some walking frames have ‘kerb climbers’. These are small pedals attached to the rear wheels that are meant to make it easier to get up kerbs. We found they were quite hard to use.

Some walking frames also have slow-down brakes that can be tightened up on one of the wheels to stop the walking frame running away with you.

Models

We asked a group of experts (an ergonomist, three occupational therapists, two physiotherapists, three people who use walking frames and a mechanical engineer, who carried out a mechanical safety inspection) to look at eighteen walking frames. They looked at the various features that are available and evaluated the walking frames on eleven different points.

In this section, we discuss each model in turn highlighting the good and bad points of each one.

Volaris S7

The Volaris S7 is an X-folding four-wheeled walking frame.

It has rubberised tyres, straight hand grips and lever brakes and a solid plastic seat with a strap backrest.

You can adjust the height of the hand grips (10 positions) and the seat (5 positions). Adjustment is very easy.

It has a removable wire basket and a tray.

Handling was easy.

The hand grips were good.

Brakes were easy to operate and very effective.

Folding was easy, though the two sides didn’t go very close together. The Volaris S7 does stand when folded.

Unfolding was easy and it clicks right into place.

The seat and backrest were comfortable.

The basket is nice and large, but the tray is very low, which makes it hard to use.

Evaluation summary:

• Handling: ok

• Brakes:

• operation: good

• effectiveness: very good

• Folding:

• secure when unfolded: yes

• secure when folded: yes

• stands when folded: yes

• operation: good

• Seat: good

Mechanical safety:

• Frame: 5

• Finger traps: 5

• Stability: 5

• Overall: 5

(1 – considered dangerous, 2 – considered potentially dangerous, 3 – some concerns for safe use, 4 – minor criticisms but still considered safe, 5 – no safety concerns)

Volaris S3

The Volaris S3 is an X-folding four-wheeled walking frame.

It has rubberised tyres, straight hand grips and lever brakes and a solid plastic seat with a strap backrest.

You can easily adjust the height of the hand grips. You can also adjust the angle of the hand grips, though the range is not very great.

It has a removable wire basket and a tray.

Handling was easy.

The hand grips were good.

Brakes were very easy to operate and very effective.

Folding was easy. The Volaris S3 does stand when folded and has a velcro-fastening strap to keep the two sides together.

Unfolding was easy and it clicks right into place.

The seat and backrest were comfortable.

The basket is nice and large, but the tray is very low, which makes it hard to use.

Evaluation summary:

• Handling: good

• Brakes:

• operation: very good

• effectiveness: very good

• Folding:

• secure when unfolded: yes

• secure when folded: yes

• stands when folded: yes

• operation: ok

• Seat: good

Mechanical safety:

• Frame: 5

• Finger traps: 4

• Stability: 5

• Overall: 4

(1 – considered dangerous, 2 – considered potentially dangerous, 3 – some concerns for safe use, 4 – minor criticisms but still considered safe, 5 – no safety concerns)

Exert of report produced by Ricability 2009