Gait Patterns in Persons Relying on Canes
Persons with hemiplegia or antalgia who rely on canes typically demonstrate a hemiplegic gait pattern with increased triple and double support phases, decreased single support phase, and asymmetrical weight distribution between lower extremities.
Hemiplegic Gait Characteristics When Using a Cane
Temporal-Stride Parameters
- Triple and double support phases occupy most of the gait cycle (approximately 90%)
- Single support phase is significantly reduced (only about 10% of gait cycle) 1
- Walking speed is typically slow, ranging from 4.2 to 35.8 cm/s in people with hemiplegic stroke 1
- Cadence (steps per minute) decreases when using a cane compared to unaided walking 2
Weight-Bearing and Force Distribution
- Asymmetrical weight distribution between lower extremities persists even with cane use 3
- Patients apply:
- 89.7% to 97.6% of body weight as vertical forces on feet
- 2.2% to 4.8% as propulsive forces
- 2.9% to 3.9% as braking forces
- 5.5% to 6.7% as lateral shear forces 1
- Less than 25% of body weight is typically applied to the cane as vertical force 1
Functional Patterns
- Greater propulsive forces and impulses on the sound foot
- Greater braking forces and impulses on the affected foot and cane 1
- Cane provides both support and braking function for people with hemiplegia
Energy Expenditure and Efficiency
The energy cost of walking is significantly elevated in hemiplegic patients compared to able-bodied individuals of comparable body weight 4. This increased energy expenditure is due to:
- Degree of weakness and spasticity
- Level of training and rehabilitation
- Use of bracing and assistive devices
- Mechanical inefficiency that can increase energy cost up to 2 times that of able-bodied persons 4
Types of Canes and Their Effects
Standard Single-Point Canes
- Need to be properly fitted to the patient
- Should have rubber tips to improve traction 4
- Less effective in reducing postural sway compared to quad canes 3
Tripod or Quad Canes
- Provide more stability with 3-4 points of contact
- More effective in reducing postural sway in patients with hemiparesis 3
- Greatest effect on postural sway occurs when the cane is contralateral to the foot placed forward 3
- Heavier, bulkier, and more awkward to use than single-point canes 4
Rolling Canes (Wheeled Canes)
- Can significantly improve walking parameters in adults with hemiparesis:
- Increase walking speed by 22-30% during short distances
- Increase walking speed by 50% and distance by 49% during 6-minute walk tests
- Improve frequency of 2-step gait 5
- Do not increase fall risk compared to standard canes 5
Clinical Implications
- Both ipsilateral and contralateral cane use effectively reduce load on the affected limb 2
- Cane use does not appear to correct the asymmetrical weight-bearing pattern characteristic of patients with hemiplegia 3
- The greatest stability benefit occurs when the cane is used on the side opposite to the affected limb 3
- Walking assistive devices should be recommended to help with mobility efficiency and safety when needed 4
Pitfalls and Caveats
- Canes should be properly fitted to the patient to avoid additional biomechanical stress
- Patients may develop dependence on the assistive device if not regularly reassessed for improvement
- Improper cane use can reinforce abnormal gait patterns and potentially increase energy expenditure
- Patients should be trained in proper cane technique to maximize stability and minimize energy cost
- Regular reassessment is needed as recovery progresses to determine if the assistive device is still appropriate
Understanding these gait characteristics helps clinicians better assess the nature of cane assistance and plan appropriate therapeutic strategies for people with hemiplegia or antalgia.