Choosing the Right Walking Aid

Choosing a technical walking aid (TWA) is not just about preferring a cane to a walker. It’s based on a detailed analysis of several functional and clinical factors. Understanding these parameters allows for prescribing a device adapted to the patient’s situation, rehabilitation goal, and environment.

Main Selection Criteria

Here are the elements to consider when determining the most appropriate aid:

• Number of ground supports: depending on whether you’re looking to stabilize, partially or completely unload a limb.
• Support mode: continuous (permanent) or intermittent (occasional).
• Lateralization of the impairment: unilateral (e.g., hemiparesis) or bilateral (e.g., myopathic impairment).
• Number of available hands: one or two, depending on potential limitations (injuries, need to keep a hand free, etc.).

Types of Walking Aids and Associated Clinical Situations

Classic Walker

• Support: bilateral, symmetrical, and continuous
• Support rhythm: 3-3-3-3…
• Objective: triple each support to optimize stability

Benefits

• Great stability and comfort
• Symmetry of support
• Constant and smooth assistance

Disadvantages

• Bulky, not well-suited for confined spaces
• Requires the use of both hands

Two Crutches – Case 1: Alternating Partial Unloading

• Support: bilateral, symmetrical, and intermittent
• Rhythm: 3-1-3-1-3-1…
• Objective: triple only one support (e.g., after surgery or unilateral injury)

Benefits

• Good maneuverability
• Allows for modulating unloading
• Suitable for various terrains

Disadvantages

• Requires some coordination
• Often induces step asymmetry
• Intermittent, non-permanent assistance
• Both hands used

Two Crutches – Case 2: Complete Unloading

• Support: bilateral, symmetrical, and intermittent
• Rhythm: 1-2-1-2-1-2…
• Objective: completely replace one support (no weight-bearing on one limb)

Benefits

• Allows for complete unloading
• Valuable when weight-bearing is contraindicated

Disadvantages

• Requires significant upper limb strength
• Less smooth
• Tiring over long distances
• Both hands used

Two Crutches – Case 3: Balanced Alternating Support

• Support: bilateral, alternating, and intermittent
• Rhythm: 2-2-2-2…
• Objective: double each support while maintaining a balanced rhythm

Benefits

• Good compromise between stability and autonomy
• Suitable for smoother walking

Disadvantages

• Motor coordination essential
• Requires the use of both hands

One-handed Walker (Wheeleo®)

• Support: unilateral and continuous
• Rhythm: 2-2-2-2…
• Objective: double each support with unilateral assistance

Benefits

• Continuous aid without bilateral encumbrance
• Frees one hand to interact with the environment
• Promotes smooth and natural walking
• Good maneuverability

Disadvantages

• Maximum efficiency on even ground
• Less suitable for irregular or complex outdoor environments

One Crutch

• Support: unilateral and intermittent
• Rhythm: 2-1-2-1-2-1…
• Objective: temporarily double one support

Benefits

• Lightweight device, easy to carry
• One hand remains free
• Suitable for moderate disorders

Disadvantages

• Requires good postural balance
• Stabilizes only one side

Interpreting Support Rhythms

Each walking rhythm indicates a level of stability:

• 1: single-leg support (unstable)
• 2: one foot + one support (moderate balance)
• 3: one foot + two simultaneous supports (maximum stability)

An unstable patient will spontaneously seek to avoid single-leg support and adopt a three-beat gait, which is more secure.

Conclusion

There is no universal aid: each clinical situation calls for individualized consideration. The number of support points, their continuity, the lateralization of the impairment, and the patient’s functional capabilities will guide your choice. The goal is not simply to offer assistance, but to support a process of functional recovery, empowerment, or sustainable compensation.