Canes: Difference between revisions
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== Introduction == | == Introduction == | ||
Canes are ambulatory | Canes are ambulatory assistive 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 aluminiium. The wooden sticks usually have a crook handle and cannot easily have mult ipoint tips. Alumiiium 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.<br> | ||
Multipoint walking sticks include tripods and quadripods, both of which can have either flat, swan-neck or ergonomic handles. | Multipoint walking sticks include tripods and quadripods, both of which can have either flat, swan-neck or ergonomic handles. | ||
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== Types of canes<ref>Bradley SM, Hernandez CR. Geriatric Assistive Devices. Am Fam Physician. 2011;84(4):405-411.</ref><ref>Sadowski C, Jones A. Ambulatory assistive devices. How to appropriately measure and use canes, crutches and walkers. Pharmacy Practice 2014;1(10):24-31.</ref> == | == Types of canes<ref>Bradley SM, Hernandez CR. Geriatric Assistive Devices. Am Fam Physician. 2011;84(4):405-411.</ref><ref>Sadowski C, Jones A. Ambulatory assistive devices. How to appropriately measure and use canes, crutches and walkers. Pharmacy Practice 2014;1(10):24-31.</ref> == | ||
A detailed understanding of the different types of ambulatory assistive devices and their types, modifications, fitting, stability and indications is essential in prescribing one<ref name=":12">Faruqui SR, Jaeblon T. Ambulatory assistive devices in orthopaedics: uses and modifications. American Academy of Orthopaedic Surgeon 2010;18(1):41–50.</ref>. There are different types of canes which can be classified based on the number of legs it has and the amount of body weight it can support or its use. The type used is dependent on the type of gait disturbance. | |||
Gait disturbances can be divided into 3 useful categories<ref name=":02">Robert Lam. Choosing the correct walking aid for patients. Can Fam Physician 2007;53(12):2115–2116</ref>: | |||
#a. Balance (including sensory and cerebellar systems), | |||
#b. Motor (including cerebral initiation of walking and muscular strength), and | |||
#c. Joint or skeletal problems. | |||
'''1.''' '''Single canes:''' | '''1.''' '''Single canes:''' | ||
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These are canes with only one leg. They include: | 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 | 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, 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 | ||
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. | 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. | ||
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<references /> | <references /> | ||
O'Sullivan SB, Schmitz TJ, Fulk G. Physical rehabilitation. FA Davis; 2013 Jul 23. | O'Sullivan SB, Schmitz TJ, Fulk G. Physical rehabilitation. FA Davis; 2013 Jul 23. | ||
[[Category:Open_Physio]] | [[Category:Open_Physio]] | ||
Revision as of 21:51, 9 September 2018
Original Editor - The Open Physio project.
Top Contributors - {{Special:Contributors/Template:Ginika Jemeni}}
Introduction[edit | edit source]
Canes are ambulatory assistive 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 aluminiium. The wooden sticks usually have a crook handle and cannot easily have mult ipoint tips. Alumiiium 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[edit | edit source]
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[1][2][edit | edit source]
A detailed understanding of the different types of ambulatory assistive devices and their types, modifications, fitting, stability and indications is essential in prescribing one[3]. There are different types of canes which can be classified based on the number of legs it has and the amount of body weight it can support or its use. The type used is dependent on the type of gait disturbance.
Gait disturbances can be divided into 3 useful categories[4]:
- a. Balance (including sensory and cerebellar systems),
- b. Motor (including cerebral initiation of walking and muscular strength), and
- c. Joint or skeletal problems.
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, 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
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[5]: 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[7][edit | edit source]
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)[8]. This formula shall give the appropriate cane length.
Gait pattern for use of canes[edit | edit source]
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[edit | edit source]
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.
References[edit | edit source]
- ↑ Bradley SM, Hernandez CR. Geriatric Assistive Devices. Am Fam Physician. 2011;84(4):405-411.
- ↑ Sadowski C, Jones A. Ambulatory assistive devices. How to appropriately measure and use canes, crutches and walkers. Pharmacy Practice 2014;1(10):24-31.
- ↑ Faruqui SR, Jaeblon T. Ambulatory assistive devices in orthopaedics: uses and modifications. American Academy of Orthopaedic Surgeon 2010;18(1):41–50.
- ↑ Robert Lam. Choosing the correct walking aid for patients. Can Fam Physician 2007;53(12):2115–2116
- ↑ Van Hook FW, Weiss BD. Ambulatory devices for chronic gait disorders in the elderly. Am Fam Physician 2003;67(8):1717-1724
- ↑ physicaltherapyvideo. Walking Canes: How to choose, measure and use. Available from: http://www.youtube.com/watch?v=8nvPeXIglI8
- ↑ Zi Ying Li and Chinmei Chou. The effect of cane length and step height on muscle strength and body balance of elderly people in a stairway environment. Journal of Physiological Anthropology 2014;33:36.
- ↑ (Jones A. Alves ACM, Magalhães de Oliveira L, Saad M, Natour J. Energy expenditure during cane-assisted gait in patients with knee osteoarthritis. Clinics 2008;63(2).)
O'Sullivan SB, Schmitz TJ, Fulk G. Physical rehabilitation. FA Davis; 2013 Jul 23.
