Standard and four-footed canes: their effect on the standing balance of patients with hemiparesis.

We studied 14 patients to test the hypotheses that, when patients with hemiparesis use a cane to assist standing balance, their postural sway decreases and the average position of their center of pressure (COP) shifts forward and towards the cane side, and that there is no difference in either of these parameters between standard and four-footed canes. Each subject stood on a Kistler force platform for three ten-second intervals: one without a cane, one with a standard cane, and one with a four-footed cane. Matched-pairs t tests revealed a significant decrease in both the mediolateral (ML) and anteroposterior (AP) travel (postural sway) when the subjects used the standard cane. There was also a significant shift of the average ML position of the COP toward the cane side when they used a standard cane, but no significant difference in the average AP position. When they used the four-footed cane, neither the differences in travel nor the differences in COP position were significant, although they were similar in magnitude to those measured when they used the standard cane, compared with which there was no significant difference. Two conclusions appear warranted. First, a standard cane has a significant effect on force-platform measures of the standing balance of persons with hemiparesis of mild-to-moderate severity--specifically a reduction in the extent of ML and AP postural sway and a shift in the mean position of the COP toward the cane side. Second, as regards such measures of standing balance, a four-footed cane appears to offer no advantage over a standard one.