Review article
Assistive devices for balance and mobility: Benefits, demands, and adverse consequences

https://doi.org/10.1016/j.apmr.2004.04.023Get rights and content

Abstract

Bateni H, Maki BE. Assistive devices for balance and mobility: benefits, demands, and adverse consequences.

Objectives

To provide information on the advantages and possible disadvantages of using canes and walkers.

Data sources

English-language articles were identified by searching MEDLINE and PubMed (1966–May 2003) for key words cane or walker, excluding articles unrelated to mobility aids. Bibliographies were reviewed and ISI Web of Science citation searches were run to identify additional references. Over 1000 articles were selected for further evaluation.

Study selection

We extracted all studies of single-tip canes or pickup walkers addressing: (1) functional, biomechanic, or neuromotor benefits; (2) biomechanic, attentional, neuromotor, metabolic, or physiologic demands; and (3) falls, injuries, or other problems. We included approximately 10% of the articles originally identified.

Data extraction

The methodology of each selected article, and findings relevant to the benefits, demands, or adverse effects of cane or walker use were summarized.

Data synthesis

Findings were synthesized by considering their relation to basic biomechanic principles. Some biomechanic findings appear to support the clinical view that canes and walkers can improve balance and mobility for older adults and people with other clinical conditions. However, a large proportion of users experience difficulties, and the use of such devices is associated with increased risk of falling. A small number of studies have characterized some of the specific demands and problems associated with using mobility aids.

Conclusions

Clinical and biomechanic evaluations of canes and walkers confirm that these devices can improve balance and mobility. However, they can also interfere with one’s ability to maintain balance in certain situations, and the strength and metabolic demands can be excessive. More research is needed to identify and solve specific problems. Such research may lead to improved designs and guidelines for safer use of canes and walkers.

Section snippets

Methods

We identified English-language articles by searching MEDLINE and PubMed (1966–May 2003) for key words cane or walker; articles unrelated to mobility aids (eg, baby walkers, Dandy-Walker syndrome, Walker tumor) were excluded. Bibliographies were reviewed and ISI Web of Science citation searches were run to identify additional references. More than 1000 articles were selected for further evaluation. We then extracted all studies of single-tip canes or pickup walkers that addressed: (1)

Conclusions

There appears to be ample clinical evidence that canes and walkers can improve balance and mobility in older adults, as well as in patients with different clinical conditions. There is also supporting biomechanic evidence from a small but increasing number of studies, although many of the studies have been limited in sample size and/or control over confounding variables. Conversely, it has been established that a large proportion of mobility-aid users have difficulties using their devices and

Acknowledgment

We thank Amy Peters for her comments and assistance in the preparation of the manuscript.

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    Supported by the Canadian Institutes of Health Research (CIHR). Maki is a CIHR Senior Investigator.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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