Canes and Walkers

Assistive devices only prevent falls when they are used correctly. A cane held in the wrong hand or a walker used incorrectly can actually increase fall risk. This lesson gives you the knowledge to ensure every client is using their device correctly — and to recognize when something is wrong.

Section 01

The Cane — Correct Use

🚨 The most common assistive device error

The single most common cane use error — and the one that turns a fall prevention device into a fall risk — is holding the cane in the wrong hand. The cane must be held in the hand OPPOSITE the weak or painful leg. This is counterintuitive but biomechanically correct: the cane supports the stance phase of the stronger leg, allowing the weaker leg to swing through safely. Check this at every visit.

Correct cane technique:

Height: The cane handle should be at wrist level when the client stands upright with arms at their sides. Too short forces a stoop; too tall prevents proper weight bearing.
Movement pattern: Move the cane and the weak leg forward together, then advance the strong leg. Cane and weak leg move as a unit.
Tip condition: The rubber tip must be checked regularly — a worn tip is like a bald tire. If the tip looks smooth rather than textured, report for replacement immediately.
Quad cane: A four-pronged cane provides a wider base of support than a standard cane — all four tips must be in contact with the floor for it to function correctly.

Types of Walkers

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Standard walker (pickup walker)

Four legs, no wheels. Must be lifted and placed forward with each step. Provides maximum stability but requires some upper extremity strength to lift. Best for clients who need the most support and can lift the device safely.

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Two-wheel walker (front-wheeled)

Wheels on the front two legs, rubber tips on the back two. Slides forward but has resistance from the back tips. A middle option between standard and four-wheel.

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Four-wheel rollator

Wheels on all four legs with handbrakes. Allows continuous motion without lifting — easier to use but requires the client to manage the brakes. Must lock brakes before sitting on the seat. A rollator used without brake management is a fall risk.

Correct Walker Use

Height: Handles at wrist level when standing upright. Elbows slightly bent (approximately 15–20 degrees) when grasping handles.

Movement pattern: Advance the walker first, then step into it. Do not step past the walker — this creates a forward lean that risks falling over the front.

Sitting with a rollator: Back up until the backs of the legs touch the seat, lock the brakes, then sit. Never sit without locking the brakes.

Stairs with a walker: Walkers are generally not appropriate for stair use. A railing should be used instead. Report if a client attempts to navigate stairs with a walker.

Device Maintenance Checks

⚠ Check at every visit

Rubber tips: Check all tips — cane and walker — for wear. Smooth tips = no grip = fall risk. Report immediately.
Rollator brakes: Test that brakes lock securely. A rollator with faulty brakes is dangerous.
Walker height: Has it been adjusted? Is it still correct for this client?
Structural integrity: Any bending, cracking, or instability must be reported. A compromised device should not be used until assessed.

When Clients Resist Using Their Device

✓ Strategies for device compliance

Resistance to assistive devices is extremely common. Effective responses:

Understand the reason: "I feel old with it," "It gets in the way," "I can manage without it"
Connect to what matters: "Using the walker means you can keep going to [activity they value]"
Frame positively: "This is what lets you stay in your home — it's independence, not the opposite"
Document any refusal and report to the supervising nurse

Never force a device on a client — but always document refusal. Your documentation protects both the client and you.