2011 Annual Conference

Guild, Jeffrey

Canes are often used by older adults to increase stability and mobility during ambulation. Due to the different number of tips at the cane’s bottom, the single tip cane (STC), tri-tip cane (TTC, also called Flex Stick), and small quad cane (SQC) may theoretically provide differences in gait stability and mobility during ambulation. The purpose of this study was to compare the gait parameters on normal subjects ambulating with these three types of canes.

Twenty healthy physical therapy students, aged 21-31 years old, were recruited from a local university.

Gait data, including force and impulse, were collected using a Tekscan Gait Walkway during ambulation. Force is how much pressure a foot applies on the ground during ambulation and impulse is the amount of force with respect to time. All subjects held their canes with the right hand during ambulation.

One way ANOVA with post hoc tests were used for comparison of different cane conditions and paired t-tests with Bonferroni adjustment were used for comparison between left and right foot under each cane condition.

No significant differences were identified in forces of either left or right foot, in stance time and swing time of left foot, and in impulse of left foot when compared different cane conditions. However, significant differences were identified in cadence, velocity, stance time of right foot, swing time of right foot, and impulse on right foot (p < .05) with one-way ANOVA. In the order from STC, TTC, to SQC, subjects showed decreased cadence, decreased velocity, decreased swing time and increased stance time and increased impulse on right foot. Further, the Post Hoc tests demonstrated there were no statistical differences (p > .05) on cadence (between STC and TTC), on velocity and impulse on right foot (between TTC and SQC).  When comparing these variables between the left and right foot, the right foot showed significantly higher forces (under all three cane conditions) and higher impulse (only under  TTC and SQC conditions) than the left foot (all p < .01) during ambulation, although there was no difference of impulse between the TTC and SQC. 

By using a cane in the order from single tip cane, tri-tip cane, to quad cane, subjects ambulated in decreasing gait speed, steps per minute, and swing time of right foot, but increasing stance time and increasing pressure applied to ground per minute from right foot.  Also, the right foot demonstrated more pressure applied to ground than the left foot at any cane conditions, and such applied pressure to the ground per minute was more obvious when using the tri-tip (flexStick) cane or the quad cane. These results may indicate that a cane with more tip at its bottom may increase the subject’s gait stability (stance time), but it can also decrease the mobility (speed, cadence, swing time). In this study, everyone used the right hand for holding the cane to purposely reduce load on the left lower extremity, so, it makes sense why the right foot applied more forces to the ground than the left one during ambulation.

Clinically, when one is selecting a cane, consideration of preference to either mobility or stability may decide what type cane will be chosen. The tri-tip FlexStick cane may be the useful transitional one from quad cane to single tip cane during progress of rehabilitation.