On May 12 the American Parkinson Disease Association (APDA) hosted a 30-minute webinar on the Pros & Cons of Canes and Walkers. Teresa Baker, PT, DPT, explained how a cane or walker helps people with balance and stability. The ‘right’ assistive device is different for each person. Teresa reviewed the pros and cons of two types of walking stick and four types of walkers before answering a few questions.
Teresa’s perspective is that an assistive device is anything that helps you walk farther, faster, and safer – and keeps you physically active and socially engaged.
She endorses the use of hiking poles if that is what makes you most comfortable in a social setting. Pointed tips are good for ground, wider rubber tips are better for pavement. Some poles come with interchangeable tips.
- About 20% of this webinar’s attendees shared in the chat that they use hiking poles.
Teresa suggested that a cane or walker needn’t be used for every step you take. Instead, a cane or walker can be prescribed for specific circumstances, like…
- Walking on uneven surfaces (gardening, walking in the park, etc.), or
- Outings with friends or family, so you don’t slow the group
Some people may find using an assistive device is corrective to their posture, allowing them to stand straighter and relieve back and/or hip pain.
The recording of the webinar is available on the APDA YouTube channel.
The APDA Information & Referral Center at Stanford has a list of physical therapists on the San Francisco Peninsula and in the South Bay.
If you live elsewhere in the Bay Area contact us.
If you live elsewhere in the country, find your closest APDA Information & Referral Center.
And now, on with my notes…
– Denise
“Pros & Cons of Canes and Walkers” – Webinar Notes
Speaker: Teresa Baker, PT, DPT, Center for Neurorehabilitation, Boston University
Webinar Host: American Parkinson Disease Association (APDA)
Webinar Date: May 12, 2022
Summary by: Denise Dagan, Stanford Parkinson’s Community Outreach Program
What is the benefit of using a walking aid?
When we stand or walk the area around the feet form the base of support for the body. For anyone to maintain balance you must keep the center of the body within the base of support. People with Parkinson’s tend to
- stand with their feet close together, creating a narrower base of support
- lean forward, putting the center of the body more forward of the base of support.
These are challenging positions to maintain stability.
But… when someone is using an assistive device, like a cane, it widens the base of support to include the feet and the assistive device, making it easier to stay balanced and keep the center of the body over the larger base of support. As you can imagine, a walker makes an even larger base of support than a cane.
Assistive devices create more stability, making it easier to balance, by creating a larger base of support. They can also provide postural support by properly adjusting the height of the device, allowing the user to hold the trunk of the body in an upright position.
Is an Assistive Device right for me?
It depends on the goal of walking. Your physical or occupational therapist should ask you, is the goal of using a cane or walker…
- Endurance? Might you be able to walk farther?
- Able to do your own shopping without getting too tired.
- Speed? Might you be able to walk faster?
- Able to keep up with family.
- Easier to get to appointments on time.
Balance is a huge consideration. Would using an assistive device make it less likely you will fall and possibly be injured?
The environment is also a safety consideration.
- Do you ever walk on an uneven surface?
- lawn or garden area
- different levels of flooring in your home (tile to carpet, hardwood, or vinyl)
- Are there low light areas in your home?
- going to the bathroom in the night
Assistive devices may be used in certain circumstances and not something they use all the time and in all conditions.
Let’s go over the Pros & Cons of different assistive devices
Keep in mind, a ‘con’ doesn’t mean there is something negative about the device, but it is something to consider when deciding which assistive device is right for you.
Hiking Poles
Pros
- Lightweight
- Assist arm swing – must swing your arm to set the pole on the ground
- Recreational gear – avoids the stigma of using a medical device/cane
Cons
- Consider pole bottom tips with walking surface
- Some are very pointed, which works well on a dirt trail, but may be less useful on pavement or other surfaces
- Not covered by insurance
Canes
Pros
- Variety of styles – different handles, lengths, adjustability, bases/feet
- Lightweight, easy to transport
- Generally inexpensive
Cons
- May not be sufficient for moderate to severe instability because only provide one additional point of support on the floor/ground
No Wheel Walker – (folding, silver/grey hospital model)
Pros
- More stability, provides wider base of support
- Lighter weight
- Covered by insurance
Cons
- May add more complexity to walking
- tennis balls added over the feet reduce friction and allow the walker to be slid
- usually, it is picked up with each step to move the walker along in front
- Possibly more challenge when turning because it must be picked up
Two-Wheeled Walker – (folding, silver/grey hospital model with wheels on the front)
Pros
- Able to roll
- Lighter weight
- Covered by insurance
Cons
- No braking mechanism – stops when the user stops
- No seat
- Possibly more challenge when turning, depending on the user’s style of walking
Four-Wheeled Walker – (many styles to choose from)
Pros
- More mobile, user can walk faster than with other walkers
- Can set the brake, makes walker safe when using the seat
- Has a seat
Cons
- Heavier to lift
- Folding to get into car can be complex
- More expensive
- Insurance coverage varies
USTEP Walker – designed specifically for those with Parkinson’s
Pros
- Specialized walker for PD
- Stable
- Must engage the brake handles to move, rather than stop the walker
- Able to stop quickly when brake handles are released
Cons
- Heavier to lift
- Folding to get into car can be complex
- More expensive
- Insurance coverage varies, Medicare provides some reimbursement
Devices with visual projection (usually a laser light), including laser cane, NexStride laser attaches to assistive devices.
- Laser light provides an external cue to ‘step on the light’
- Very helpful for freezing of gait or initiation of steps
How do I choose an Assistive Device?
Consult a physical therapist. You need someone to help you determine your goals of walking and whether or which assistive device is right for you in what circumstances.
Goals of walking are very individual! Goals of walking may be…
- Walking farther
- Walking in different environments (indoors, gardening, exercise, etc.)
- Improve balance / safety
- Improve quality of walking / posture
- more upright posture improves quality of walking, reduces pain
If you have questions about how to connect with a physical therapist or how an assistive device could , the American Parkinson Disease Association (APDA) Exercise Helpline is available through the Center for Neurorehabilitation at Boston University at:
- phone 888-606-1688
- Instagram or Twitter @NeuroRehabBU
- Facebook @CNRboston
- on the web
Teresa welcomed her colleague at the Center for Neurorehabilitation, Tim Nordahl, PT, DPT, who had been watching the webinar chat during Teresa’s talk. He shared some of the chat highlights and the two of them answered questions from the chat.
About 20% of webinar attendees reported using hiking poles. Tim noted some hiking pole brands come with different tips to use the poles on different surfaces. Teresa agreed a rubber tips with a broader base would be better on pavement.
Question. Which assistive device would be best to walk on grass or garden area.
Answer. It depends on the individual but walking poles or certain types of canes provide more stability. She didn’t recommend walkers with small wheels, but those with larger wheels do better on uneven surfaces.
Question. How do I know how tall I should make my cane?
Answer. Generally, when you are standing with your arms loose at your side the break of your wrist, where your wrist bends, is where you want the top of your cane handle.
That said, for some people that feels too low. For others, it may feel too high.
You want a soft bend in the elbow when using the cane. You don’t want the height of the device to be so high your shoulders are scrunched up by your ears, or you have discomfort in your shoulders or back.
Most of the devices discussed today are adjustable. When we work with someone, we try different heights to see what’s comfortable, achieves the goals of walking, and sets the device in a way the user is willing to use it.
Question. How do I know what brand of walker I should use?
Answer. Some styles of walker have bigger wheels that are great if you are outside on uneven terrain. Some styles of walker have differences in the way the handles are designed or have wires on the outside of the frame. These features have benefits and detriments that work for some users but not others.
Price point is a big factor if insurance is not paying or is only paying part of a walker purchase. So, it can be tricky to make a specific recommendation.
There are some types of walkers for which there is only one manufacturer.
In PT clinics there may be different types of walkers to try before you choose one. Or, if someone in your family has an old cane or walker, take it to your PT to see if it is a good fit for you.
PTs love to be able to see you walk with an assistive device before deciding it works for you. If your PT doesn’t have a selection to try, go to a brick-and-mortar medical supply store with a list from your PT of features to look for in a walker. Try a few before picking one. Ideally, check the return policy when you buy it and take it to your PT for a final evaluation before deciding to keep it or not.<
Question. During her talk Teresa mentioned using an assistive device just for certain activities. Tim asked her to comment on the fear that using an assistive device means they will be dependent on it for the rest of their life.
Answer. That is very common fear when it is recommended to someone that they consider using an assistive device. They fear it means their ability to walk will continue to decline or that PT will no longer help them maintain or improve their ability to walk. But it is an unfounded fear.
If someone notices a dramatic change in their movement, based on where they are in their medication cycle. Perhaps that’s when they use an assistive device to help them move around during an OFF period. If that happens when you are away from home, you may need to get through an appointment or finish your shopping and get home. An assistive device is a life saver in those situations.
Teresa has some patients who use a wheeled walker only when they are out with family so they can keep up and not make everybody wait for them.
Some people find the presence of a cane or walker to be a wonderful signal that they need a little more time or space. That signal can keep people from rushing them, bumping into them, etc.
Tim added that it is always a tricky conversation to suggest someone should use an assistive device, but sometimes it is the only way for some people to keep active. Someone with Parkinson’s may stop doing things, like participating in family activities, or going out to lunch and not realize it is because they don’t feel steady on their feet, or they feel too slow. With the addition of a cane or walker, they can get back out there with friends and family and be social again!
Teresa added that socialization is so important to cognitive and emotional health. And, if you are not exercising because you don’t feel steady on your feel, an assistive device can get you moving again – which is also best for your overall health!