econ, falls prevention elderly, assistive mobility d
evices
Introduction
Mobility aid prescription is a critical component of falls prevention, functional independence, and quality-of-life outcomes in older adults. Selecting the most appropriate mobility equipment requires balancing clinical assessment, environmental context, cognitive capacity, and progression of functional decline.
Inappropriate mobility aid selection is associated with increased fall risk, poor adherence, and reduced participation.
Clinical Rationale for Mobility Aid Prescription
Mobility aids are prescribed to:
- Compensate for balance, strength, or endurance impairments
- Reduce biomechanical load on joints
- Improve gait stability and safety
- Enable participation in ADLs and community mobility
- Reduce falls and fall-related injuries
Evidence indicates that mobility aids are most effective when prescribed following professional assessment and training, rather than self-selection.
Comprehensive Clinical Assessment
Best practice recommends a multidimensional assessment, including:
Physical Factors
- Gait pattern and velocity
- Lower limb strength
- Postural control and balance
- Pain, joint integrity, and endurance
Cognitive & Perceptual Factors
- Ability to dual task
- Insight into limitations
- Capacity to use brakes and manoeuvre safely
Medical Considerations
- Neurological conditions (e.g. stroke, Parkinson’s disease)
- Cardiopulmonary limitations
- Post-operative restrictions
Environmental Assessment
- Internal and external surfaces
- Thresholds, gradients, and access points
- Storage and manoeuvring space
Occupational therapy home assessments are particularly valuable in identifying equipment-environment mismatches that contribute to falls.
Clinical Overview of Mobility Aid Options
1. Canes
Indications
· Mild unilateral weakness
· Minimal balance impairment
Clinical Considerations
· Quad canes may improve static stability but can impede gait flow
· Limited efficacy in moderate to severe balance deficits
2. Walkers
a) Standard (Pick-Up) Walkers
· High stability requirement
· Reduced gait speed
· Higher upper-limb demand
b) Two-Wheeled Walkers
· Improved gait efficiency
· Suitable for indoor use with moderate support needs
c) Rollator Walkers
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- Appropriate for community ambulation
- Require adequate cognition, grip strength, and brake control
- Seats assist with endurance limitations
Clinical studies indicate rollators may increase walking distance, but inappropriate use can increase falls without training.
View our canes here: Walking Sticks & Canes – 99Mobility
View our walkers here: Seat Walkers / Rollators – 99Mobility
3. Bathroom Aids
Indications
· Inability to walk safely to the bathroom due to pain, weakness, or fatigue
· Frequent rest breaks required and unable to tolerate distance to toilet
· Uses a wheelchair or walking frame and cannot perform bathroom transfers
View our bathroom aids here: Bathroom Aids – 99Mobility
4. Wheelchairs & Transport Chairs
Indications
· Severely limited mobility
· Significant fatigue or cardiorespiratory compromise
· Palliative or progressive neurological conditions
Clinical Considerations
· Manual vs powered access
· Carer capacity and environment
· Risk of deconditioning with prolonged use
View our wheelchairs here: Wheelchairs – 99Mobility
Fit, Prescription, and Adjustment
Incorrect fit significantly increases musculoskeletal strain and falls risk.
Clinical Fitting Parameters
- Handle height at ulnar styloid (standing)
- Elbow flexion approximately 15–30°
- Appropriate frame width for gait pattern
- Weight rating exceeding client body weight
Regular review is essential as functional capacity changes.
Environmental & Risk Management Considerations
OTs and case managers should evaluate:
· Door widths and turning circles
· Floor transitions and outdoor terrain
· Compatibility with ramps, lifts, and vehicles
· Storage and transport feasibility
Where necessary, environmental modification should be considered alongside equipment prescription.
Training, Education, and Review
Evidence supports structured training to:
- Improve gait safety
- Reduce misuse
- Increase adherence
Education should include:
- Safe turning and braking techniques
- Fatigue management
- When not to use the aid (e.g. stairs)
Scheduled reassessment is recommended following:
- Falls
- Hospitalisation
- Disease progression
- Reports of discomfort or instability
Implications for Aged Care and NDIS Case Management
For case managers, mobility aid selection intersects with:
- Falls risk assessments
- Care plan development
- Equipment funding (HCP, CHSP, NDIS)
- Coordination with allied health providers
Clear documentation of clinical rationale supports funding approvals and continuity of care.
Conclusion
Appropriate mobility aid prescription is a clinical intervention requiring professional assessment, environmental consideration, and ongoing review. When selected and implemented correctly, mobility aids play a vital role in reducing falls, supporting independence, and enabling older adults to engage safely in daily life.
Occupational Therapists, physiotherapists and case managers are central to ensuring equipment selection aligns with functional goals, safety, and long-term care planning.