Habituation to a unilateral walking device after stroke: new considerations for an old habit, a case series

Abstract

Background/aims Unilateral walking devices, including single-point canes, quad canes and single crutches, are often prescribed in the acute phase of rehabilitation for patients who have had a stroke and have hemiparesis. However, the literature suggests that the usefulness of this practice is questionable. Unilateral walking devices are provided to patients to allow immediate or short-term improvement in their stability and in their walking ability, yet long-term effects include dependency, decreased use of the more affected side, increased risk of falls and decreased social participation. This case series demonstrates changes in walking that occur in the presence of unilateral walking devices, discusses their possible implications for the rehabilitation of this population, and presents them as a consideration worthy of future examination regarding the prescription of unilateral walking devices. Methods A total of 14 videos of seven patient evaluations were retrospectively analysed using still pictures taken from the videos. The pelvic (centre of mass) shift over the points of contact (feet) while walking with a unilateral walking device was measured, as well as walking without them. Results When walking with a unilateral walking device, the centre of mass (ie the mid-pelvic point) shifted significantly more toward the less-affected side than to the more-affected side (0.689 ± 0.143 vs 0.924 ± 0.065, P=0.014). When walking without a device, the shift is more symmetric (0.860 ± 0.166 vs 0.849 ± 0.098, P=0.817). Confounding variables in this case series, including the type of device used or side of paresis, were examined by separate t tests and were not found to be significant. Conclusions The cases demonstrate a possible consideration in the prescription of unilateral walking device for hemiplegic patients. Gait symmetry was analysed using a mediolateral shift of the centre of mass. The descriptive result of these cases points to a decreased symmetry while using a unilateral walking device. This is a presentation of one aspect of gait analysis, among others, and is only being raised as a possible additional consideration in the prescription of unilateral walking devices.