When might a cane be necessary for walking following a stroke?

BACKGROUND

For individuals with lateral postural imbalance after stroke, the decision to adopt a cane for walking often is not based on objective findings.

OBJECTIVE

The authors investigated the explanatory value of 2 posturographic criteria for lateral postural imbalance on the walking abilities of poststroke subjects.

METHODS

Indices of postural asymmetry (percentage of body weight on the less loaded lower limb) and instability (mediolateral variance of center-of-pressure displacements) were measured in 40 healthy individuals and 52 patients (mean 94.2 days after first hemispheric stroke), who stood still on a double force platform. Cut-off values (mean ± 2 standard deviations) were calculated and compared. The predictive value of both postural indices on walking abilities with or without a cane was analyzed.

RESULTS

Of the patients, 34.6% were unstable along the mediolateral axis (variance >7 mm(2)), and 44.2% were asymmetrical (body weight <40%); 30% needed a technical aid and 35% walked without a cane. The probability of being able to walk without a cane was less than 5% if the paretic lower limb was not loaded more than 40%. The postural instability index was less informative.

CONCLUSIONS

This study suggests that patients who do not load more than 40% of their body weight on their paretic lower limb may benefit from the prescription of a cane.