Canes – selection and use
by Dolores Carron
How do we know when it’s time to start using a cane or walker? Balance problems or difficulty with weight bearing (you are unable to carry all of your weight on your lower extremities) are significant markers for need. Are you compensating in inappropriate or harmful ways such as holding on to furniture or walls? Improper posture to compensate for one-sided weakness, foot drop, etc. can cause back or hip pain due to poor body alignment. Usually, canes are for balance and walkers are for additional support. But there are no absolutes, so a walker may be appropriate for more serious balance challenges or one-sided weakness. A traditional cane can offer balance aid and a "quad" cane, one with a little platform with 4 feet may offer even better balance support.
A lightweight, adjustable aluminum cane is recommended. It should be fitted to you so that when you stand with your shoes on and your arms hanging loosely at your sides, the top of the cane should be at the crease where your hand and wrist join. When using the cane, your elbow should be bent at an angle of about 15 to 30 degrees. Wooden canes are fine but they are not as lightweight as aluminum. There are different style handles, but usually you choose the type that is the most comfortable for you.
In which hand should you hold the cane? If one leg is weaker than the other or is injured, you should hold the cane with the opposite hand. Biomechanically, you can take more weight off the weaker leg if you hold the cane with the opposite hand. If you are using the cane only for balance, then hold it on whichever side feels most comfortable.
In using a cane on the stairs, the rule is "up with the good, down with the bad". So, in climbing the stairs step first with the cane and the good foot and follow with the weaker side. When going down the stairs, step first with the bad foot and follow with the cane and the good foot. Additionally, keep your free hand on the railing.
If you have a slight problem with balance, a cane will work fine, but if you have a more significant balance problem of need assistance with supporting your weight, a walker is probably what you’ll need. Walkers can either be standard or rolling. The rolling walker decreases the amount of energy you expend but still provides the stability you need. The correct height should be determined by a professional but you can estimate it by the same elbow angle as described in the previous information on canes. There are many models of walkers including 3 wheeled, 4 wheeled, ones with seats, carrying baskets, and brakes. A physiatrist or physical therapist can help you determine what is best for you.
A final comment, but an important one, is a reminder to remove or secure any loose rugs or runners in your home. This will reduce your risk of slipping and falling while using your cane or walker.
Saturday, September 8th, 2012