Canes

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Introduction

Canes are ambulatory assitive devices used for improving postural stability. Canes in common day to day usage are known as walking sticks. A cane can either be made of wood or a light metal such as aluminium. The wooden sticks usually have a crook handle and cannot easily have multipoint tips. Aluminium walking sticks can either have a flat or "swan-neck" top and have the advantages of being adjustable in length and are able to have multiple points e.g. a tripod.

Multipoint walking sticks include tripods and quadripods, both of which can have either flat, swan-neck or ergonomic handles.

Handgrips

A variety of styles and sizes are available. The type of hand grip prescribed or used depends on two important factors: firstly, the comfort of the patient and secondly, the grip's ability to provide adequate surface area to allow effective transfer of weight from the upper extremity to the floor. There are many types of hand grips available like the shotgun handle, crook handle, piston handle etc.

Types of canes.

The types of canes can be classified based on the number of legs it has and the amount of body weight it can support or its use.  There are single canes and multiple legged canes.

1.      Single canes:

These are canes with only one leg. They include:

a.      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. This cane can be used for patients with vestibular dysfunction, visual impairment, or sensory ataxia.

b.      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:

These are canes with multiple legs. They include:

a.      Quadripod (Quad) cane: This is a four-legged cane usually made of aluminum. 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.

b.     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

In measuring a cane height, the cane is placed approximately 6 inches (15.24cm) from the lateral border of the toes.

These are the various ways to determine the appropriate cane length:

1.      Elbow Angle: The patient should stand erect and hold the cane with the elbow flexed at 20 to 30 degrees. The angle of elbow flexion is measured using a goniometer.

2.      The floor to the greater trochanter: The patient should stand erect and the distance from the floor to the greater trochanter measured to give the length of the cane.

3.      The distal wrist crease to the floor: The patient should stand erect with arms hanging loosely by the side and the distance from the distal wrist crease to the floor measured to get the cane length.

4.      Use the formula: Length of cane = Height of the Individual (meters) x 0.45 + 0.87 m. (L = H x 0.45 + 0.87 m). This formula shall give the appropriate cane length.

Gait pattern for use of canes

A cane is held in the upper extremity opposite the affected limb. When teaching the patient we should instruct the patient to move the cane and involved lower extremity followed by the unaffected lower extremity. We should make sure to see that the cane should be relatively close to the body and should not be placed ahead of the toe of involved extremity. When bilateral involvement is there, a clinical decision has to be made as to which side of the body the cane will be held or a bilateral use of cane is necessary or a walker needs to be prescribed.

Stair Climbing with cane

When ascending, the unaffected lower extremity leads up and then the cane and affected lower extremity follows. When descending the cane is moved followed by the affected lower extremity and then the unaffected lower extremity.

Recent Related Research (from Pubmed)

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References

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O'Sullivan SB, Schmitz TJ, Fulk G. Physical rehabilitation. FA Davis; 2013 Jul 23.