CANES

CANES

Canes widen the base of support and decrease stress on the opposite lower extremity. Canes can unload the lower limb weight by bearing up to 25% of a patient's body weight.

Canes can be made of wood or aluminum; tubular aluminum is lighter than wood. Aluminum canes are adjustable, which is a characteristic that facilitates their use by patients of all sizes.

Determining the proper cane length is important. A cane that is fitted incorrectly produces an inefficient gait pattern. A short cane reduces support during the stance phase, and it tends to keep the elbow in complete extension.

A long cane causes excess elbow flexion, which leads to increased muscle fatigue on the triceps and shoulder muscles. To determine the proper cane length, measure from the tip of the cane to the level of the greater trochanter while the patient is in an upright position. The elbow should be flexed approximately 20°.

TYPES OF CANES

GENERALLY, THE FOLLOWING 3 TYPES OF CANES ARE USED 

• C CANE - This is the most commonly used cane. Other names used for this device include the crook-top cane, the J cane, and the single-point cane.

• FUNCTIONAL-GRIP CANE

  • This type of cane provides better grip and more controlled balance for patients.

  • The grip of a functional-grip cane is more comfortable than that of a C cane.

  • The ortho cane is an example of a functional-grip cane.

• QUAD CANE

• • Quad canes provide more support than do other standard canes.

  • Narrow- and wide-based forms of quad canes are available.

  • Quad canes are especially helpful for patients with hemiplegia.

  • Slow gait is one disadvantage of quad canes.

OTHER TYPES OF CANES INCLUDE THE FOLLOWING

• WALK CANE (HEMIWALKER)

• • This type of cane combines the features of a walker and a quad cane.

  • Hemiwalkers usually are made of tubular aluminum, are adjustable, and can be folded.

  • Hemiwalkers provide a wider base and more lateral support than do the regular quad canes.

  • Indications for a hemiwalker include the following:

    • Patients with hemiplegia

    • Individuals who need an intermediate step during gait training; often used during the period after use of the parallel bars and before ambulation, which is a time when the patient needs less restrictive assistive devices

• VISUAL IMPAIRMENT CANE

• • Features

    • Lightweight

    • Flexible

    • Easily collapsible

  • The distal inches of the cane are red.

  • To determine the proper length of the cane, measure the distance from the hand to the floor while the shoulder is flexed 90° anteriorly.

BIOMECHANICS

The cane usually is used on the side opposite the affected lower limb. The cane helps decrease the force generated across the affected hip joint by decreasing the work of the gluteus medius-minimus complex.

The force is exerted by the upper extremity through the cane to help minimize pelvic drop on the side opposite the weight-bearing lower limb. If the cane is held on the affected side, the affected hip in turn experiences an increased load of 4 times the body weight during ambulation.

FUNCTIONS

• AMBULATION

  • The cane usually is held on the patient's unaffected side so that it provides support to the opposite lower limb.

  • The cane is advanced simultaneously with the opposite, affected lower limb.

  • The weight is borne through the arm as needed.

  • The patient always should have the unaffected lower limb assume the first full weight-bearing step on level surfaces.

• STAIR CLIMBING

  • The mnemonic "up with the good and down with the bad" can help patients to recall the appropriate step pattern for stair climbing. The cane is used for extra support when ascending/descending stairs. Often, the patient also has a rail to hold on the other side for added safety.

  • Advance the unaffected lower limb first when going upstairs, and advance the affected lower limb first when coming downstairs.

The patient always should have the unaffected lower limb assume the first full weight-bearing step on level surfaces.