Proper Ambulation with a Cane

Introduction Ambulation It is defined as the ability to walk from place to place independently with or without assistive device (Moorhead, S., Johnson, M., & Maas, M. (Eds.) (2004). Nursing Outcomes Classification (NOC) (3rd ed.) St. Louis, MO: Mosby. ). There are many different cases or instances in which mobility is impaired and ambulation with an assistive device (canes, walkers, crutches, etc.) is needed. Cane A cane is an ambulatory assistive device generally prescribed for people with moderate levels of mobility impairment. A cane is typically used when minimal stability is needed. Types of canes and their uses. A detailed understanding of the different types of ambulatory assistive devices and their types, modifications, fitting, stability and indications is essential in prescribing one. (Ambulatory Assistive Devices in Orthopaedics: Uses and Modifications Safi R. Faruqui; Todd Jaeblon American Academy of Orthopaedic Surgeon. 18(1):41–50, JAN 2010). There are different types of canes and the type used is dependent on the type of gait disturbance. Gait disturbances can be divided into 3 useful categories: a. Balance (including sensory and cerebellar systems), b. Motor (including cerebral initiation of walking and muscular strength), and c. Joint or skeletal problems.1 The types of canes include: 1 The standard cane (Figure 1): This is generally used for mild sensory or coordination problems found in visual, auditory, vestibular, peripheral proprioceptive, or central cerebellar disease.2 It can help stabilize a patient’s gait by providing an extra contact point with the ground, therefore, increasing the base of support. 2 Offset cane: This is used for patients that cannot bear weight on the affected side or limb and need to transfer weight to the cane, like those with osteoarthritic hip or knee pain. This cane will provide greater stability, as it allows force to be placed directly along the cane’s shaft. 3 Offset 4-legged quad cane: This type of cane is prescribed when there is substantial weight bearing required, such as in a hemiplegic patient.

Patient assessment There are many factors involved in prescribing the appropriate ambulatory assistive device. The patient’s upper body strength, balance and coordination, overall physical strength and endurance, level of impairment, cognitive function, vision and living environment must be taken into account. The patient’s upper body strength should be evaluated to determine whether one or both of the upper extremities would be needed to bear weight or achieve balance. If only one upper extremity is needed then a cane would be the proper device, while those needing two upper extremities would benefit from a walker or a pair of crutches. Also the degree or amount of the patient’s weight needed to be borne by the device would aid the Physiotherapist in choosing the appropriate device.