Effects of one-point and four-point canes on balance and weight distribution in patients with hemiparesis

OBJECTIVE: To examine the effects of one-point and four-point canes on postural sway and on the distribution of weight between the lower extremities and the walking aids in hemiparetic patients. SETTING: Flieman Geriatric Rehabilitation Hospital, Haifa, Israel. SUBJECTS: Thirty hemiparetic patients following a unilateral stroke, with moderate functional impairment, and 20 age-matched healthy subjects. INTERVENTION: Subjects were tested on two forceplates, which were placed at a 30 degrees angle from each other with the heel end of the plates separated by 3 cm. Each subject was tested under three conditions: with no cane, with a one-point cane, and with a four-point cane. Testing time was 30 seconds, and order of testing was randomized. OUTCOME MEASURES: Weight borne by the lower extremities and by the walking aids expressed as a percentage of overall body weight, and Sway Index indicating vertical pressure fluctuations over both feet. RESULTS: In both subject groups, the one-point cane did not reduce sway significantly in comparison with no cane, while the four-point cane reduced sway significantly in comparison with both no cane and one-point cane. Neither cane type affected weight-bearing on the paretic leg, while significantly reducing weight-bearing on the uninvolved extremity. Mean percentage of body weight on the four-point cane was significantly higher than on the one-point cane CONCLUSIONS: A four-point cane increases stability of moderately involved hemiparetic patients during stance more than a one-point cane. The noted shift of weight toward the walking aid does not adversely affect weight-bearing on the paretic limb.