Kinematic comparison of the use of walking sticks versus a rolling walker during gait in adult degenerative scoliosis patients.

Abstract

A repeated-measurement, single-center, prospective study. To compare the spatiotemporal and kinematic data using gait analysis in adult degenerative scoliosis (ADS) patients using walking sticks (WS) versus rolling walkers (RW). ADS patients undergo compensatory changes that can result in an altered gait pattern. RW are frequently prescribed, but result in a forward flexed kyphotic posture during ambulation. Gait using WS allows for more upright alignment in ADS patients. Fifty-three ADS patients with symptomatic degenerative scoliosis performed over-ground walking at self-selected speed with WS and with a RW. Trunk and lower extremity angles along with spatiotemporal parameters were measured and compared. When using WS, patients exhibited less flexion at the head (WS: - 4.8° vs. RW: 11.0°, p = 0.001), and lumbar spine (WS: - 0.9° vs. RW: 4.2°, p = 0.001); while there was significantly more extension, of the cervical spine (WS: - 1.6° vs. RW: - 7.4°, p = 0.002) when using the RW. At the initial contact phase of gait, patients using WS showed decreased flexion at the ankle (WS 0.7° vs. RW: 3.8°, p = 0.018), knee (WS: 0.3° vs. RW: 4.8°, p = 0.001), hip (WS: 22.6° vs. RW: 27.3°, p = 0.001), and pelvis (WS: 10.2° vs. RW: 14.8°, p = 0.001). In contrast, the use of WS resulted in slower ambulation (WS: 0.6m/s vs. RW: 0.7m/s, p = 0.001). In ADS patients who have not undergone surgical correction, the use of WS resulted in a more upright posture, which may be more beneficial to the compensatory changes that lead to gait disturbance in ADS patients. Ambulation using WS resulted in slower gait versus a RW, due to the momentum induced by the forward flexed posture when using a RW. We recommend the use of WS for patients with ADS as it improves gait kinematics and may be a safer option.