Canes

Original Editor - The Open Physio project.

Top Contributors - Ginika Jemeni, Justin Bryan, Ammar Suhail, Lucinda hampton, Admin, Kim Jackson, Abbey Wright, Naomi O'Reilly, Lauren Lopez, Larisa Hoffman, WikiSysop, Jess Bell, Rachael Lowe, Karen Wilson and Amanda Ager

Introduction

Walking sticks are designed to:

• provide balance support in standing and walking
• take some pressure off one or both legs
• improve feeling of safety and security when walking

There are lots to choose from, from wood and metal right up to state-of-the-art carbon fibre. They can be traditional or come in a range of modern colours and patterns. There are some sticks that fold right up to fit in a carrying case or handbag and some are adjustable to make it easier to get the right length stick.

A range of handle styles are available including t-shaped, offset, crook, swan neck and ergonomic (or arthritic) handles, which are designed to provide additional support under the palm. Four-point sticks (also known as quad sticks) provide a wider base of support than the more common single point walking stick, however, they can also create a potential tripping hazard due to their increased side width.

Walking sticks are used widely reduce pain and improve stability and balance. However, they are frequently used incorrectly and can be dangerous if not properly maintained. It is important to educate patients on how to obtain greatest benefit from their walking stick and of the necessity to check it regularly for defects to ensure safe usage.

Handgrips

Type of Handgrip and Benefit

• T Handle……Good grip and control.
• Crook Handle……Useful for hanging up the stick
• Swan Neck Handle……Makes the stick feel more balanced
• Ergonomic Handle……Fits your hand closely. Good if you have very stiff or painful hands. Left and right-hand handles are different.

Types of Canes

A detailed understanding of the different types of ambulatory assistive devices and their types, modifications, fitting, stability and indications is essential in prescribing one. The type used is dependent on the type of gait disturbance.

Gait disturbances categories:   

• Balance (including sensory and cerebellar systems),
• Motor (including cerebral initiation of walking and muscular strength), and
• Joint or skeletal problems.

1.      Single Point Walking Stick (SPS)

•    Standard canes: This can also be called a straight cane and it is generally made of wood or aluminum. They are lightweight and inexpensive. The length of the wooden standard canes must be custom fitted to the specific patient while the aluminum standard cane have pins for length adjustment so there is no need for custom fitting. These standard canes are useful for patients that need just an additional point of contact with the floor for balance with little or no weight bearing needed, therefore, increasing the base of support. This cane can be used for patients with.mild sensory or coordination problems found in visual, auditory, vestibular, peripheral proprioceptive, or central cerebellar disease
•   Offset canes: These canes are usually made from aluminum and the lengths are also adjustable with no need for custom fittings. These canes allow for the patient's weight to be displaced over the shaft of the cane. This cane provides more stability and can be used for occasional weight bearing. The type of patients in need of this cane are those with painful gait disorders like that of mild to moderate antalgic gait gotten from hip or knee osteoarthritis.

2.      Multiple-legged canes:

•    Quadripod (quad) cane: This is a four-legged cane usually made of aluminium. This cane permits more weight bearing, increases base of support and provides more stability for the patient. It can also stand by itself freeing the patient to use his or her hands. The only disadvantage is that all four legs of the cane must be in contact with the floor during gait to provide stability which hinders fast gait. It is also not suitable for stair climbing. It can be prescribed for hemiplegic patients or patients with moderate to severe antalgic gait from osteoarthritis.
• Hemi walker: This is also known as a walk cane. It is made of aluminum and has a vertical component with a handle and two legs, and another component with two additional legs angled away from the patient. This cane provides more broad based support than the other canes. It is used by patients requiring continuous weight bearing through one upper extremity like stroke patients with hemiparesis who have moderate to severe lower extremity disability.

Measuring Canes

To measure the height of any walking stick, the base of the stick should be placed approximately 15cm from the outside of the foot and the handle height should be set at the wrist crease height. The elbow should be bent slightly (generally between 15 and 30 degrees) when holding the stick and standing upright.

• Put on the user's walking shoes.
• Have the user stand naturally upright as much as possible.
• Have their arms fall to the sides naturally with a normal relaxed bend at the elbow. (Please see Diagram A for correct posture)
• Using a tape measure, measure the distance from their wrist joint (bottom crease at the wrist) down to the floor. Round up to the nearest half cm.

How to Ambulate With a Cane

Walking sticks are usually used on the unaffected or strongest side of the body (the “good leg”) but this may depend on individual preference and abilities. The stick should be placed forward at the same time as the affected leg and then the unaffected leg follows.

• If using two sticks at the same time, a four-point gait may be used by bringing one stick forward, then the opposite leg, then the other stick, followed by the other opposite leg.
• Four point sticks with an offset base should be positioned so that the straight side of the base is nearest to the body. All points of the stick should maintain contact with the ground when the stick is placed down.
• To negotiate going up steps and stairs, lift the unaffected leg up first, then the stick and the affected leg onto the same step. To travel down, the stick and the affected leg should be lowered first, then the unaffected leg down to the same step.
• From Sitting to Standing
  1. Position the cane on the unaffected side of the patient.
  2.  Advise the patient to move to the edge of the seat, hold the cane handle and bear weight on the unaffected leg and cane to come up to the standing position.
  3. Make sure the height of the cane is appropriate (level of greater trochanter), ensure elbow flexion is 20° to 30° and that the cane is 2” in front of the affected leg and 6” to the side of the affected leg.

• Standing to Sitting
  1. Instruct the patient to approach the chair (or bed), and turn in small circles toward the stronger side till the back is facing the chair or bed.
  2. Assist the patient to back up to the chair until the chair can be felt against the back of the patient’s legs.
  3. Instruct the patient to reach for one arm rest at a time.
  4. The patient lowers to the chair in a controlled manner

Safety tips

Inspect cane on a regular basis. Make sure the cane has a rubber top for shock absorption and grip to prevent slipping. Always check the cane for worn tips and handles Always make sure that cane is at proper height to avoid imbalance and bad postures

Conclusion

Many people have disabilities that require an ambulatory assistive device in order to ambulate independently. Some people are prone to self-treat as canes are easily accessible and do not require a prescription before being purchased. This increases the risks of falls, especially in elderly patients, and risk of musculoskeletal injuries or adaptations due to bad posture gotten from incorrect way of using or holding the assistive devices.

Many of the pharmacies and stores selling these equipment do not have health professionals that are equipped with the knowledge to choose the appropriate device, fit them properly and specifically to the patient. One study has shown that pharmacists do not feel equipped with the knowledge to fit a device for a patient.

Therefore, ambulatory assistive devices should be sold where appropriate health professionals can advise the buyers on the proper way to use them. Health professionals like pharmacists can be trained in this area as they also sell such in their pharmacies. This would aid in ensuring that people learn the proper way to ambulate with these assistive devices.