Canes

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Introduction

Canes or walking sticks are designed to:

• Provide balance support in standing and walking
• Take some pressure off one or both legs
• Improve sensory feedback for safety and security when walking

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

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.

Canes or walking sticks are used widely to 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 the greatest benefit from their canes or walking stick and of the need to regularly check the cane for defects that might impact safety.

Handgrips

Type of Hand Grip	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/fisher stick handle	Fits your hand closely, good for stiff or painful hands

Types of Canes

A detailed understanding of the different types of ambulatory assistive devices and their types, modifications, fitting, stability and indications is essential when prescribing a cane. 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)
• Joint or skeletal problems (e.g. osteoarthritis)

Single Point Walking Stick (SPS)

Standard Canes

Standard canes (also known as straight canes) are generally made of wood or aluminium. They are lightweight and inexpensive.

Wooden standard canes must be custom fitted for each user to ensure they are the correct length. Aluminium standard canes have pins to adjust their length, so there is no need for custom fitting.

These standard canes are useful for patients who need just an additional point of contact with the floor for balance, thus increasing the base of support. There is little or no weight bearing required through the cane.

This cane can be used for patients with mild sensory or coordination problems such as visual, auditory, vestibular, peripheral proprioceptive, or central cerebellar disease.

Offset Canes

Offset canes are usually made from aluminium. Their length is adjustable, so there is 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.

Individuals who would benefit from an offset cane include those with painful gait disorders such as mild to moderate antalgic gait associated with hip or knee osteoarthritis.

Multiple-Legged Canes

Quadruped (Quad) Cane

The quad cane is a four-legged cane usually made of aluminium.

This cane permits more weight bearing, increases the base of support and provides more stability for the patient. It can also stand by itself freeing the patient to use their hands.

A 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.

Quad canes can be prescribed for hemiplegic patients or patients with moderate to severe antalgic gait from osteoarthritis.

Hemi Walker

A hemi walker is also known as a walk cane. It is made of aluminium and has a vertical component with a handle and two legs, as well as another component with two additional legs angled away from the patient.

This cane provides a 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 their sides naturally with a normal relaxed bend at the elbow
• 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
• Adjust the stick according to the measurement

How to use a Cane

Gait

Walking sticks are usually used on the unaffected/strongest side of the body (the “good leg”). However, 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.

Stairs

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.

Sit to Stand

From sitting to standing:

1. Position the cane on the unaffected side of the user
2.  Ask the user 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 inches in front of the affected leg and 6 inches to the side of the affected leg.

Standing to sitting:

1. Instruct the user to approach the chair (or bed), and turn in small circles toward the stronger side until the back is facing the chair or bed
2. Assist the user to back up to the chair until the chair can be felt against the back of their legs
3. Instruct the user to reach for one arm rest at a time
4. The user then lowers themselves into the chair in a controlled manner

Safety Tips

Inspect the 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 the cane is at proper height to avoid imbalance and bad posture.

Conclusion

Many people have disabilities that require an ambulatory assistive device in order to ambulate independently. Some people may "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. There is also a risk of musculoskeletal injuries or postural adaptations if individuals use / hold the assistive device incorrectly.

Many of the pharmacies and stores selling canes / assistive devices do not employ health professionals equipped with the knowledge to choose the appropriate device or fit them properly for the user. One study has shown that pharmacists do not feel they have sufficient knowledge to fit a device for a patient.

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 help to ensure that users learn the proper way to ambulate with these assistive devices.