A cane in hand, a mind in mind - how to choose a cane after hemiplegia

Photo/Xiao Zihao Shanghai Ruijin Rehabilitation Hospital

Reviewer/Jia Yongxing Executive Editor of Popular Medicine Magazine, Shanghai Science and Technology Press

For many hemiplegic patients, canes become their "third leg" after the onset of the disease, but patients and their families often complain to therapists: "Why am I not stable after using a cane?" "Why can't I climb the stairs with a cane?" These problems may be related to the patient's improper selection and use of the cane. Now, let professional therapists teach you how to correctly select and use the right cane!

Warm reminder 1: This article mainly introduces the relevant knowledge of selecting suitable canes and adjusting the height of canes for patients with hemiplegia after stroke, and the specific method of walking without a cane.

1. Learn some small knowledge about walking sticks

Before choosing a cane, let’s take a brief look at it!

1. What is a cane?

A cane is a type of mobility assistive device, and like a cane, axillary cane, and walker, it is a branch of walking assistive devices [1]. A cane is usually made of metal or hard wood, with a handle, and is a tool that supports one hand to help walking.

Figure 1 Copyright image, no permission to reprint

2. What is the function of a cane?

There are two main functions of a cane: one is to reduce the load on the lower limbs, and the other is to facilitate the patient's movement while maintaining balance[2]. Based on these two functions, walking with a cane has many advantages: ① Since the load on the affected lower limb is reduced, pain is relieved, joint movement is more stable, and the originally twisted gait is partially restored; ② Because the patient can use the cane to maintain balance while moving, safety is greatly improved, and the patient can use the cane to go to more places or places that were previously inaccessible, carry out more daily activities, and interact with more people and things.

3. What kind of patients are suitable for using a cane?

The cane is suitable for patients with unilateral lower limb movement disorders but strong upper limb ability and good hand grip strength on at least one side, such as hemiplegic patients and the elderly.

Through the above three questions, you must have a preliminary understanding of canes and have made basic preparations for choosing a suitable cane. But when you walk into a medical device store or enter "cane" in the search bar of an online shopping mall, you will find a wide variety of products for you to choose from. At this time, the question arises again - why do some canes have only one "leg" and some have four "legs", which one should I choose? The following is an in-depth analysis of the advantages and disadvantages of different types of canes, and teach you how to choose the right cane for you!

Tip 2: There is no optimal solution for the selection of assistive devices. Just like choosing chopsticks, you cannot determine which is better, four-sided chopsticks or six-sided chopsticks. The same is true for choosing a cane. Only the one that suits you is better. You can weigh the pros and cons of each cane and choose the right style based on your condition. If you are unable to make a decision, you can also consult a professional therapist to help you choose.

2. Cane Classification Competition

1. Standard walking stick

A standard cane is usually made of a solid stick of wood or metal with a curved or "T" shaped handle and a rubber foot at the bottom for stability and anti-slip.

Figure 2 Copyright image, no permission to reprint

The biggest advantage of a standard cane is that it is cheap and easy to use. Its single-leg design also means that it does not take up too much space. When the patient does not need to use it, the cane can be hung on the edge of a table or the back of a chair with the help of a handle. However, the disadvantages of a standard cane are also obvious: ① The inability to adjust the height makes it unsuitable for patients of different heights. Even for the same patient, the thickness of the sole will affect its use. ② Because the support point of a standard cane is forward during use, the patient's center of gravity moves forward over a large range every time the cane touches the ground. Therefore, a standard cane is also one of the most unstable canes.

Combining the above advantages and disadvantages, the standard cane is suitable for adult hemiplegic patients with relatively good balance ability.

2. Adjustable walking stick

The body of an adjustable cane is made of hollow metal tubes nested together, and the other accessories are basically the same as those of a standard cane.

One of the major advantages of an adjustable cane is that the height can be adjusted quickly and the operation is relatively simple. Moreover, since the length can be shortened, the cane is more flexible to store than a standard cane and can be stored in a smaller space. The hollow cane body makes it generally much lighter than a standard cane. However, the increase in functions brings an increase in price (generally speaking, the more functions an assistive device has, the more expensive it is), and the instability caused by the front support point of a standard cane is not improved in an adjustable cane.

Combining the above advantages and disadvantages, the adjustable cane is more suitable for hemiplegic patients with relatively good balance ability. However, due to its adjustable height, it can be shared by multiple people and can also adapt to the patients' shoes with different sole thicknesses.

Figure 3 Copyright image, no permission to reprint

3. Adjustable offset walking stick

Adjustable offset canes are also called "swan neck" canes. The name comes from the curved upper part of the cane. The materials and accessories are basically the same as those of adjustable canes.

The swan neck cane has all the advantages of an adjustable cane, and also corrects the common disadvantage of the first two canes - stability. Due to the offset of the upper part of the cane, the support point is always directly below the palm when used by the patient. The patient does not need to move the center of gravity forward over a large range every time when walking, so the stability is much higher than the first two canes. In addition, the single-foot design also gives patients greater freedom to adjust their walking rhythm. Although the enhancement of functions has brought about an increase in price, the disadvantages do not outweigh the advantages.

The swan neck cane should be the better choice for hemiplegic patients in the later stages of recovery, especially when their balance function has improved significantly, for long-distance walking.

Figure 4 Copyright image, no permission to reprint

4. Four-legged cane

The biggest difference between the quadruped cane and the previous canes is that it has a four-legged base with different sizes. This four-legged base not only brings good stability to the cane itself, but also allows the user to always control the support center of the cane directly under the palm, which greatly improves the safety factor. The general four-legged canes on the market can quickly adjust the height and can meet the needs of patients of different body shapes. But the design of the base is to some extent a "choice of losing a spear and gaining a spear". The increase in weight and the slowdown in walking speed are the disadvantages of the quadruped cane, and the oversized base will also make it difficult to climb stairs. Therefore, hemiplegic patients must choose under the guidance of therapists based on their own physical condition and walking pattern. Therapists usually recommend the use of a quadruped cane in the early stages of recovery of hemiplegic patients and when their balance function is poor.

Figure 5 Copyright image, no permission to reprint

After reading the above introduction, I believe you have already had some preliminary thoughts on what kind of walking stick to choose. When you buy an adjustable walking stick, the immediate question you will face is "what height is suitable for you". The following will teach you how to adjust the walking stick to the appropriate height.

3. How to adjust the height of the cane

Before adjusting the height of the cane, the user should first hold the cane handle and place the cane in front of the toe on the same side, so that the bottom of the cane (the center of the base of the four-legged cane) is 15 to 20 cm away from the outside of the toes; then adjust the height of the cane, and observe the user's elbow flexion angle when adjusting. When it reaches 20° to 30°, the adjustment is complete. At this time, the user's upper arm can comfortably and safely support most of the body weight through the cane to complete the walking action.

Figure 6 Copyright image, no permission to reprint

Figure 7 Copyright image, no permission to reprint

In the classic novel "Journey to the West", the golden hoop is often compared to the walking stick of Sun Wukong. In fact, it is a homophone of "advocacy", which means that Sun Wukong has the golden hoop and has his own ideas, which can help him slay demons and clear away obstacles. A suitable cane is like the golden hoop for hemiplegic patients, which can help them clear away walking obstacles on the road to recovery and move towards a more independent and wonderful life. I hope this article can help the majority of hemiplegic patients and their families solve some doubts about the selection and use of canes. It is also recommended that patients communicate with therapists in a timely manner to obtain more information on mobility assistive devices. I wish you a speedy recovery!

【References】

[1] Wang Jiacong. Daily living skills and environmental transformation. Beijing: Huaxia Publishing House, 2011.

[2] Susan BO, Thomas JS, George DF. Physical rehabilitation.6th ed. Philadelphia: FA Davis Company, 2014.