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Canes should not be used for patients who have a partial–weight-bearing or non-weight–bearing status because they cannot provide sufficient stability and support to be used safely.
Oxygen consumption is increased when using canes to ascend and descend stairs; therefore, use additional care when guiding patients with cardiac dysfunction who are using canes.1
Canes are used to assist with walking in a variety of reasons, which may include impaired balance, joint instability, pain, fatigue, and a need to reduce weight bearing in the lower extremity. Canes are available in many shapes and sizes: single-point canes (also called straight or standard canes), large- and small-based quad canes, freestanding canes such as the "hurry cane" or "trusty cane," hemi canes, rolling canes, and canes with laser lights to assist in an episode of freezing of gait.3 Canes are typically made from lightweight aluminum and are adjustable via push buttons. Those made from wood can be adjusted by cutting them to the desired length.
The handgrip on a cane should be selected based on patient comfort. There should be adequate surface area on the hand to allow for transfer of weight from the upper extremity to the floor.
Clinicians must provide careful instruction regarding use, fit, and safety with canes because of the risk of falls. Canes that are of improper height can cause disturbances to the walking pattern and can increase the risk for falls. Canes that are too short in length can cause stooped posture, and those that are too long in length do not provide the intended support.
Patients typically are instructed to hold the cane in the hand opposite of (contralateral to) the involved lower extremity. When used in this fashion, canes reduce the biomechanical load on the involved lower extremity, provide a more natural reciprocal gait pattern with the opposite arm and leg moving together, and provide an increased base of support. When the cane is placed in the contralateral hand, there is a reduction in the lateral shifting of the center of mass compared to using the cane on the same side (ipsilateral) as the involved lower extremity.3
There are a variety of commonly used canes, and each type has advantages and disadvantages (Table 1). Selection of the appropriate cane is determined by the patient's diagnosis and needs. This can include the need to reduce forces on the involved lower extremity and the need to provide increased stability. The number of points of contact with the floor determines the cane's stability level. Large-based (or broad-based) quad canes provide the greatest stability, whereas single-tip canes provide the least. Walking with a single-tip cane is more efficient, but less stable than using either a tripod or quad cane. Use of a quad cane is the most stable but least efficient choice. Single-tip canes have also been found to relieve the pain of osteoarthritis2 and are useful before and after joint replacements.
The typical method for determining appropriate cane height begins with the patient standing with his or her feet comfortably apart and shoulders relaxed. The cane tip or the center of the broad-based cane is placed 15 cm (6 in) laterally from the toes. The top of the cane should reach the level of the greater trochanter of the hip, and the elbow should be flexed to approximately 20 to 30 degrees. Because of the differences in trunk and limb length, elbow flexion is the most important determinant of cane height. Having the elbow in 20 to 30 degrees of flexion allows for arm length to change during the different phases of the gait and absorbs forces from the floor.3
Most patients hold the cane on the contralateral side and move it forward simultaneously with the involved lower extremity, followed by the uninvolved lower extremity. For patients with bilateral weakness, the use of two canes may be desired. In this instance, either a two- or four-point gait can be used. In a two-point gait, one cane and the more involved lower extremity are moved forward simultaneously followed by the other cane and the less involved lower extremity. In a four-point gait pattern, the cane is moved forward followed by the most involved lower extremity, then the other cane, followed by the less involved lower extremity (e.g., right cane, left lower extremity, left cane, right lower extremity).
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*In these skills, a "classic" reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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