Benefits of Walking Sticks in Patients with Adult Degenerative Scoliosis

International Society for the Advancement of Spine Surgery (ISASS17) Meeting Highlight

Many patients with adult degenerative scoliosis often require pre- and post-operative use of a walking aid. Noting that walkers force patients into kyphosis, Ram Haddas, PhD, MEng, MSc, Director of Research at Texas Back Institute in Plano TX, explains that substituting walking sticks for walkers promotes a more upright posture and improved sagittal alignment, as a result of their higher grips. Pre-operatively, walking sticks afford benefit in terms of deformity progression and line of sight. Post-operatively, they help patients maintain surgical correction of their kyphotic deformities.

Dr. Haddas presented results of a study on gait analysis in patients with adult degenerative disease comparing these two walking aids at the 17th Annual International Society for the Advancement of Spine Surgery Conference in Boca Raton, FL.

The study evaluated spatiotemporal relationships and kinematics of the lower extremities and spine during gait with walking sticks compared with a walker in 20 patients with scoliosis. Spatiotemporal relationships include walking speed, stride length, cadence, stride time, and rhythm. Kinematics evaluated joint angular range of motion (ROM), such as ankle and knee ROM, and hip extension.

gait analysis walking sticks versus walkerThe study evaluated spatiotemporal relationships and kinematics of the lower extremities and spine during gait with walking sticks compared with a walker in 20 patients with scoliosis.All patients had symptomatic degenerative scoliosis and were deemed to be appropriate surgical candidates. A week prior to surgery, all patients underwent gait analysis under 3 testing conditions: with walking sticks, with a walker, and without any walking aid.

In order to obtain fully body three-dimensional kinematics, 51 reflective markers were attached to the patients, and 10 cameras were used. Investigators used 3 parallel force plates to measure ground reaction forces (GRFs). Patients walked along a 10m walkway, in self-selected speeds. Using kinematic and kinetic data, clinical gait analysis parameters were calculated using spatiotemporal parameters, lower extremity and spine joint angles at initial contact, ROM, and peak GRF.

Study Results
Using walking sticks versus a walker led to statistically significant differences in walking speed, cadence, and step time(s). Walking sticks were associated with significantly slower walking speed (0.49 + 0.2 m/s versus 0.65 + 0.2 m/s, P<0.014) and cadence (58.92 + 17.3 steps/m versus 76.00 + 14.7, P<0.010) when compared to walkers, but longer step time (10.8 + 0.3 steps/min versus 0.82 + 0.1 steps/min, P<0.001). Step time was also longer with the walker than with no walking aid (10.8s versus 0.71s, P<0.001).

Stride times were longer with walking sticks compared with the walker (2.26s vs 1.64s, respectively; P<0.002) and with no device (2.26s vs 1.40s, respectively; P<0001). There were no significant differences in either step length (m) or width (m).

Dr. Haddas explained that the observed slower cadence and walking speed associated with the use of walking sticks was likely attributable to patient unfamiliarity with these aids, as the study was the first time the patients had ever used walking sticks. However, he explained, the learning curve for acclimating to the use of a walker was pretty quick—“as quickly as 10 minutes for some patients, but no longer than a few days for others.”

Dr. Haddas noted significantly increased lower extremity range of motion in the ankle (21.6-degrees, P<0.002), knee (24.6-degrees, P<0.015) and hip (15.0-degrees, P<0.001) during gait using walking sticks compared to a walker. He emphasized that this finding is particularly important because walkers, which are supposed to help patients recover from surgery, are actually limiting ROM and may prolong rehabilitation.

Walking sticks resulted in significantly larger dorsiflexion angle at initial contact (Right: 6.9-degrees, P<0.02, Left: 6.4-degrees, P<0.033) versus a walker. Walking stick use increased lower extremity ROM compared to a walker.

Head orientation presented with a less extended position using the walking stick versus walker (-12.09 vs -18.56-degrees, respectively; P<0.050), and using no walking aid versus a walker (-11.79 vs -18.56-degrees, respectively; P<0.050). Specifically, the study found more chin tuck position when patients used walking sticks versus walkers. There was also greater knee (15.6-degrees, P<0.001), hip (3.9-degrees, P<0.001) and head (4.0-degrees, P<0.001) range of motion in the frontal plane associated with the use of walking sticks versus walkers.

Conclusions
Dr. Haddas reported the gait analysis study verified the clinical findings of less kyphotic posture with the use of walking sticks versus a walker, as supported by the clear improvements in sagittal kinematic parameters. “Bending with the walker limits their lower extremity range of motion; walking sticks allow patients to engage their trunk and leg muscle activity and stand straight.” In addition, use of walking sticks engages arm swinging and trunk movement, which is otherwise very limited with the use of a walker. Patients can discard use of walking sticks as soon as they feel secure, although some like the added support of the additional 2 legs.

He concluded that patients can experience improvement in both spatiotemporal and kinematics with preoperative training with walking sticks, along with surgical correction of the deformity and postoperative use of walking sticks compared to a walker.

Updated on: 02/08/18
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