The effect of walking aids on balance and weight-bearing patterns of patients with hemiparesis in various stance positions.

BACKGROUND AND PURPOSE Standard and quad canes are often prescribed to patients with hemiparesis, yet their effect on postural control remains unclear. Thus, the objective of this study was to examine the effects of standard and quad canes on postural sway and on weight-bearing patterns in patients with hemiparesis. SUBJECTS Thirty subjects with a diagnosis of unilateral hemiparesis following a stroke (patient group; mean age=71.2 years, SD=7.0) and 20 age-matched, community-dwelling volunteers without hemiparesis (comparison group; mean age=72.1 years, SD=5.2) participated in the study. METHODS Postural sway and percentage of body weight (%BW) borne by each extremity were measured in 3 positions: with the heels aligned with each other (aligned position) and in staggered foot positions with either the affected or unaffected extremity placed forward (affected FW and unaffected FW positions). All subjects were tested in each position with no cane, a standard cane, and a quad cane. The order of tests was randomized, and analysis of data included use of an analysis of variance and adjusted Tukey-Kramer tests. RESULTS In both the aligned and unaffected FW positions, postural sway was reduced only with the quad cane. Both types of canes reduced postural sway in the affected FW position; however, the quad cane had a greater effect. An asymmetrical weight distribution between the lower extremities did not change in the patient group across positions, even with walking aids. DISCUSSION AND CONCLUSION A quad cane appears to be more effective than a standard cane in decreasing postural sway in patients with moderate impairment secondary to hemiparesis during stance. The greatest effect on postural sway occurred when the assistive device was contralateral to the foot placed forward. The use of a cane does not appear to adversely affect the asymmetrical weight-bearing pattern during stance that is characteristic of patients with hemiparesis, even when balance is challenged by decreasing the base of support.

[1]  C A Smith,et al.  Objective measurement of the benefit of walking sticks in peripheral vestibular balance disorders, using the Sway Weigh balance platform , 1995, The Journal of Laryngology & Otology.

[2]  D. Wade,et al.  The Barthel ADL Index: a standard measure of physical disability? , 1988, International disability studies.

[3]  P. Davies,et al.  Steps to Follow: The Comprehensive Treatment of Patients with Hemiplegia , 2000 .

[4]  K. An,et al.  Influences of cane length on the stability of stroke patients. , 1997, Journal of rehabilitation research and development.

[5]  D. Ma,et al.  Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. , 1987 .

[6]  E. K. Alpar,et al.  Joint structure & function: A comprehensive analysis , 1983 .

[7]  P J Holliday,et al.  Clinical and laboratory measures of postural balance in an elderly population. , 1992, Archives of physical medicine and rehabilitation.

[8]  T. J. Breen,et al.  Biostatistical Analysis (2nd ed.). , 1986 .

[9]  Nadina B. Lincoln,et al.  Physiotherapy treatment for stroke patients: A survey of current practice , 1996 .

[10]  Standard and four-footed canes: their effect on the standing balance of patients with hemiparesis. , 1993, Archives of physical medicine and rehabilitation.

[11]  Y. Laufer.  Effects of one-point and four-point canes on balance and weight distribution in patients with hemiparesis , 2002, Clinical rehabilitation.

[12]  Vertical force loaded on walking canes in hemiparetic patients , 1993 .

[13]  S. Garland,et al.  Standing balance during internally produced perturbations in subjects with hemiplegia: validation of the balance scale. , 1996, Archives of physical medicine and rehabilitation.

[14]  M W Rogers,et al.  Alterations in weight-transfer capabilities in adults with hemiparesis. , 1994, Physical therapy.

[15]  R. Kohen-Raz,et al.  An Initial Evaluation of Work Fatigue and Circadian Changes as Assessed by Multiplate Posturography , 1996, Perceptual and motor skills.

[16]  J Engel,et al.  Walking cane designed to assist partial weight bearing. , 1983, Archives of physical medicine and rehabilitation.

[17]  T. Kuan,et al.  Hemiplegic gait of stroke patients: the effect of using a cane. , 1999, Archives of physical medicine and rehabilitation.

[18]  K. M. Gill,et al.  Clinical Gait Assessment in the Neurologically Impaired , 1984 .

[19]  N. Alexander,et al.  Postural Control in Older Adults , 1994, Journal of the American Geriatrics Society.

[20]  M. Wong,et al.  Temporal stride and force analysis of cane-assisted gait in people with hemiplegic stroke. , 2001, Archives of physical medicine and rehabilitation.

[21]  Richard W. Bohannon,et al.  Rehabilitation goals of patients with hemiplegia , 1988 .

[22]  J. Bamford,et al.  Classification and natural history of clinically identifiable subtypes of cerebral infarction , 1991, The Lancet.

[23]  S. Tyson,et al.  Trunk kinematics in hemiplegic gait and the effect of walking aids , 1999, Clinical rehabilitation.

[24]  U Oppenheim,et al.  Postural characteristics of diabetic neuropathy. , 1999, Diabetes care.

[25]  R L Kirby,et al.  Canes, crutches and walkers. , 1991, American family physician.

[26]  R. Kohen-Raz.  Application of Tetra-Ataxiametric Posturography in Clinical and Developmental Diagnosis , 1991, Perceptual and motor skills.

[27]  J. Bernhardt,et al.  Changes in balance and locomotion measures during rehabilitation following stroke. , 1998, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[28]  J. Jeka,et al.  Light touch contact as a balance aid. , 1997, Physical therapy.

[29]  R. Dickstein,et al.  Weight-bearing shifts of hemiparetic and healthy adults upon stepping on stairs of various heights , 2000, Clinical rehabilitation.

[30]  J. Ashton-Miller,et al.  A cane reduces loss of balance in patients with peripheral neuropathy: results from a challenging unipedal balance test. , 1996, Archives of physical medicine and rehabilitation.

[31]  S. O'Sullivan,et al.  Physical Rehabilitation: Assessment and Treatment , 1980 .