We begin to crawl on four limbs and progress to two as we assume the erect posture. In time we may use three “legs” (adding a stick to our two legs) and later six (a walking frame). Many neurological conditions affect mobility and balance. The use of mobility aids can restore confidence, often by signaling to others that the user is unsteady. They can compensate for weakness, alleviate pain, improve posture, correct abnormal gait patterns, and enable people to walk further and more safely. Yet simple mobility aids are rarely described in neurological texts and doctors, including neurologists, may feel inadequately prepared to recommend or examine them.

In this article, we will focus on the various types of sticks and frames, the indications for their use, and how to assess them. We will also cover wider issues that the clinician might consider when managing someone with impaired balance or mobility. We will present the evidence base, such as it is, for our recommendations, together with tips and guidelines for situations where there is no firm scientific basis.

WALKING STICKS

Sticks (or canes as they are called in the US) have been used for centuries as weapons and as signs of status (the mace; a doctor’s gold-topped stick, etc) as well as aids to mobility.¹ In general, they should be considered for anyone whose mobility is impaired.

STICKS FOR NEUROLOGICAL DISORDERS

Stroke

In the early stages after a stroke, it is particularly important for a physiotherapist to assess the patient. Some patients overcompensate and develop abnormal gait patterns if supplied with the wrong walking aid. A stick can improve standing balance and also reduce postural sway.² It also encourages a better gait pattern³ and provides support, as well as a braking function.⁴ Stroke patients using sticks have a longer stride; the stick enhances push-off …