Answering All of Your Questions About Assistive Devices

As a physical therapist, I get a lot of questions from my patients about “should I use a cane or should I be using a walker?” “Is there a specific type of cane or type of walker I should get?” 

In the clinic, I can test specific muscle groups and perform balance tests in order to provide concrete evidence to support my recommendation for my patient to use- or not use- a device, and what kind of device. The purpose of this post is to provide some guidelines to help you determine whether you (or a loved one) would benefit from using an assistive device. 

So, without further ado, your first question undoubtedly is:

Should I be using some type of assistive device?

To help you answer this question, I have put together a list of signs that a device would be beneficial for you: 

• you’ve had 1 or more falls in the past year 

• you find yourself “furniture cruising” at home, which means you frequently touch or hold onto your counters, your tables, or your walls as you walk around your home

• you feel more steady and stable when you use the shopping cart at the store

• you often find yourself holding loved one’s arms when walking for extra stability

• you notice you walk significantly slower than you used to

• you have a “weak” side of your body or a “bad” leg

If one or more of these statements resonated with you, there’s a good chance that an assistive device would be helpful for you! Now for your next question: 

Which device do I choose? 

Single point cane (also called a straight cane):

Single point canes have one point that touches down on the ground, and if you let go of it, the cane would fall over. That is, it doesn’t have the extra support that other canes have to remain standing alone. These are wonderful devices for those that don’t need a lot of extra weight support, but they do need just a little extra balance support. Straight canes are not meant to take much weight through them, meaning you shouldn’t be leaning your body weight onto it with each step. Rather, they serve as an extra balance point that can really make a big difference in your confidence. Choose an adjustable one so you can ensure it’s the correct height for you. 

Small base quad cane (common brand “HurryCane”):

image from Hurrycane.com

Small base quad canes have a bit larger footprint compared to a straight cane, because there are 4 small prongs at the base of the cane. This type of cane will remain upright if you let go of it altogether. They provide a bit more support compared to a straight cane, but still are not made to take much of your body weight. Their purpose is to provide that extra ounce of balance support as you walk. Specifically the “HurryCane” brand is nice because they have a pivoting joint between the cane itself and the support piece at the bottom, so as you walk the base remains in contact with the ground for longer. These are adjustable so you can fit it to you, and they also fold up for easy traveling.  

Large base quad cane:

A large base quad cane also has the 4 prongs at the base like the small base quad cane does, but, as you guessed, it is larger. These canes are best for people that truly are very slow walkers. The reason is that the full base of the cane (all 4 prongs) need to be fully in contact with the ground prior to its user taking a step for it to be safe and effective. These canes provide significantly more balance support and you can put a bit more weight through it as well compared to the small base & straight canes. They are heavier and more bulky, which is a drawback. They also significantly limit how quickly you can walk, since you have to ensure it is fully flat with each step like previously mentioned. Like the small base version, these are also adjustable so you can adjust the height to fit you. 

2-wheeled walker:

When you’re needing a device to really take more of your bodyweight as you walk, or you need much more balance support, a 2-wheeled walker is a great option. It is safe to put 100% of your bodyweight through a 2-wheeled walker, if necessary. To safely use a 2-wheeled walker, you want to stand within its frame. This way you can stand fully upright as you walk with it, and if your legs buckle and you suddenly have to put all of your weight onto the walker, it will keep you from falling because your pressure will be straight down onto it. 

Note: these walkers also have an option without any wheels (just 4 straight legs), however this version can be cumbersome to get around as it forces you to physically lift the walker with each step, so I typically don't recommend this version. 

Rollator (walker with 4 wheels):

Rollators, or 4-wheeled-walkers, generally come with brakes and a seat. The wheels all swivel so they are not fixed in one plane of motion. They are not my favorite device, by a long shot. People love them because they feel they can “zip around” easily, and since they have both hands holding on, they certainly are getting good balance support. However, since the seat is in the middle section where you would normally want to be standing, this type of walker forces its user to stand further back behind it when walking. The downsides to this are twofold: #1, It promotes poor posture as you have to lean forward to hold onto your walker and #2, If your legs happen to buckle on you, to where you have to suddenly put weight through the walker, since you are standing behind it, the walker is going to just slide forward, right out from under you, and won’t give you any support - you’ll be right on the floor. 

How do I ensure my device fits me properly?

Whether you are using a cane or a walker, the rule of thumb is the same: the handle of the device should hit the inside of your wrist, right where your wrist bends, when you are standing up straight and tall with your arm down at your side. This way, when you hold the device, your elbow should have a slight bend in it. Watch my video demonstrating this by clicking HERE to watch on Instagram or by clicking HERE to watch it on Facebook.

Canes: which side do I hold it on? 

Most people are surprised by this answer, but you’re actually going to hold your cane on the opposite side as your “bad” side, or weaker side. So if your left leg is weaker, hold the cane in your right hand. If your right hip is painful, hold the cane in your left hand. This actually provides you with more support to the side that needs it, compared to holding it on the same side. If this means holding your cane in your non-dominant hand, this may take some getting used to, as it may feel a bit awkward at first.

Do you wish you could ditch your device, and get back to getting around safely without having to use it? The biggest barrier for most people in this situation is inadequate strength and balance. A great place to start is right here: my Top 3 Balance-Building Exercises. You can do these at home without any equipment. Click HERE to fill out the form and I’ll send you the exercises straight to your inbox, for free!