Abstract
Study Design
A repeated measurement, single-center, prospective study.
Objective
The purpose of this study is to compare and contrast the benefits of walking sticks versus a walker on the trunk and lower extremity muscular control in patients with adult degenerative scoliosis (ADS).
Summary of Background Data
ADS patients demonstrate an altered gait pattern. Walking aids help maintain mobility in those patients. Whereas a walker forces patients into kyphosis, the higher grips of walking sticks allows for more upright posture, arm swing, and improved sagittal alignment.
Methods
Twenty ADS patients with symptomatic degenerative scoliosis performed over-ground walking at self-selected speed under 3 testing conditions: 1) with walking sticks (WS); 2) with walker (WR); and 3) without any device (ND). Trunk and lower extremity peak muscle activation, time to peak muscle activity, muscle duration, muscle onset, and integrated electromyography (iEMG) were measured and compared.
Results
The use of WS produced increases in muscle activity in the external oblique (WS: 44.3% vs. WR: 7.4% of submaximum voluntary contraction [sMVC], p = .007) and medial gastrocnemius (WS: 78.8% vs ND: 43.7% of sMVC, p = .027) in comparison to the walker and no device, respectively. When using WS, shorter muscle activity time was observed for rectus femoris (WS: 62.9% vs. WR: 88.8% of gait cycle, p = .001), semitendinosus (WS: 64.3% vs. WR: 93.0% of gait cycle, p = .003), tibialis anterius (WS: 59.4% vs. WR: 85.1% of gait cycle, p = .001), and medial gastrocnemius (WS: 67.3% vs. WR: 98.0% of gait cycle, p = .006) in comparison to the walker.
Conclusions
The use of walking sticks can potentially promote trunk and lower extremity neuromuscular control and gait mechanics comparable to gait without any assistive devices. Although the differences in magnitudes between comparisons were small and should be cautiously interpreted on a case-by-case basis, based on this study’s results and our anecdotal experience treating patients with ADS, we recommend the use of walking sticks to assist with their gait prior to and after surgical intervention.
Level of Evidence
Level III.
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Author disclosures: RH (grants from AlphaTec Inc. and the Cervical Spine Research Society), IHL (personal fees and other from Mazor Robotics; other from Bionik Laboratories and Stryker; personal fees from Safe Orthopaedics, Globus Spine, Misonix, Medtronic, and SIBone, outside the submitted work), RSK (none).
Sources of Support: None.
IRB Approval: The study was approved by the Western Institutional Review Board for the Protection of Human Subjects (IRB approval no.: 20151780).
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Haddas, R., Lieberman, I.H. & Kakar, R.S. A Comparison of Muscular Activity During Gait Between Walking Sticks and a Walker in Patients With Adult Degenerative Scoliosis. Spine Deform 7, 454–466 (2019). https://doi.org/10.1016/j.jspd.2018.09.067
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DOI: https://doi.org/10.1016/j.jspd.2018.09.067