Walking Aids After a Stroke: Stick, Quad Stick, Walker or Chair

First, what happens to walking after a stroke

A stroke damages part of the brain, and the effects depend on where. Many survivors have weakness on one side of the body (hemiparesis), sometimes with changes in sensation, balance, coordination, vision and awareness of the affected side. Common walking problems include:

• A weak leg that gives way or swings out to the side.
• Foot drop, when the front of the foot does not lift, so the toes catch on the floor.
• Poor balance, especially when turning or when distracted.
• A weak or stiff arm that cannot hold an aid or needs support.
• Neglect, where the person does not notice the affected side, so they bump into things.
• Fatigue, which comes quickly.
• Fear of falling, which can restrict activity.

Recovery is usually fastest in the first weeks and months, and continues more slowly after that. Aids therefore change over time.

The stages of mobility after a stroke

Early stage (first days to weeks). In hospital, the team will assess standing and walking. Many people use a wheelchair for travel and practise standing and stepping with help from therapists, sometimes with a frame, parallel bars or a harness.

Rehabilitation stage (weeks to months). The person practises walking with a suitable aid, building strength and balance. Therapists may use a walking frame, a quad stick, a stick and sometimes a foot or ankle support.

Home and community stage (months onwards). The person walks at home and outdoors with the least support that is safe, perhaps using a wheelchair for long outings.

Your parent's aid should always match their current stage, not their previous one, and should be reviewed regularly.

The main aids

### Walking frames and walkers

A frame or wheeled walker is often used early, since it gives a wide base and two points of support. However, it needs two hands. If the affected arm is weak or cannot grip, a frame can be hard to use. Some frames have special forearm supports or one-handed designs; ask the therapist. See walking frame buying guide and two-wheeled walkers.

### Quad sticks

A quad stick, held in the stronger hand, adds stability while one hand is free. It suits people who can walk with moderate help and have a functioning hand on the stronger side. See quad stick buying guide and using a quad stick after a stroke.

### Single walking sticks

When recovery is good and balance is fair, a single stick may be enough. Note that the stick is held in the stronger hand, usually opposite the weaker leg. See how to choose a walking stick.

### Hemi-walkers and side walkers

A hemi-walker is a one-handed walker, a frame that is held in one hand. It gives more support than a quad stick, but less than a two-handed frame. It is used less often and should be recommended by a therapist.

### Ankle-foot orthoses (AFOs) and foot supports

If foot drop causes tripping, a physiotherapist or orthotist may recommend an ankle-foot orthosis, a lightweight brace that holds the foot at a right angle, or a simpler foot-up support. These should be prescribed and fitted professionally. See ankle supports for weak ankles for general information, though a stroke brace needs specialist advice.

### Wheelchairs

A wheelchair is useful for outings, long distances and when fatigue is severe, even if the person walks at home. It should not replace walking practice. See buying a wheelchair in India and transit wheelchair or standard wheelchair.

How a therapist chooses

The therapist considers:

• strength and control in each leg;
• balance sitting and standing;
• the function of each arm and hand;
• awareness, vision and attention;
• ability to follow instructions and learn;
• fatigue and heart or lung conditions;
• the home environment; and
• the person's goals.

They then select an aid, set the height and teach how to use it. An aid chosen without this assessment may encourage poor habits, such as leaning on the strong side or dragging the weak leg.

Using aids safely on the weak side

A few principles apply to most stroke survivors. Always follow the specific advice of your therapist.

• Hold the aid in the stronger hand, usually on the opposite side to the weak leg, unless told otherwise.
• Move the aid and the weaker leg together, then step through with the stronger leg.
• Use the handrail on stairs on the stronger side, if possible, with "up with the good, down with the bad."
• Protect the weak arm. Do not let it hang; use a sling or support if advised, so the shoulder is not damaged.
• Check the weak side. Look at the weak foot, to see that it is placed properly, and watch for catching.
• Take your time. Rushing causes stumbles.
• Rest when tired. Fatigue is a major cause of falls after stroke.
• Wear proper shoes, with good grip and fit. See walking aids and footwear.

Home set-up after a stroke

The home may need changes. A few priorities:

• Clear paths, remove rugs and add good lighting.
• Install grab bars in the bathroom and by the bed; see bathroom safety after a stroke.
• Use a shower chair and a raised toilet seat.
• Place frequently used items at waist height on the stronger side.
• Consider a bed at the right height and a bed rail only if advised; see bed rails guide.
• Fit a handrail on the stronger side of stairs.

For a broader look, read stroke recovery at home guide.

How families can help

• Learn the technique from the therapist, including how to guard (stand slightly behind and to the weaker side) without taking over.
• Encourage walking several times a day, in short sessions.
• Do not do everything for them. Independence drives recovery.
• Be patient. Progress is uneven; good days and bad days are normal.
• Watch for fatigue and mood. Depression is common after stroke; see depression in older adults.
• Ask for reviews. As strength returns, the aid should change.
• Keep medicines and blood pressure controlled, since another stroke is a risk; see preventing a second stroke.

Common mistakes

• Buying equipment before an assessment.
• Using a quad stick or frame for too long when a simpler aid would encourage better walking, or too short a time, with a fall as the result.
• Letting the weak arm hang and injure the shoulder.
• Walking too fast.
• Ignoring foot drop.
• Not practising. Recovery depends on repetition.
• Forgetting the stronger side. The strong leg and arm also tire.
• Hiding falls. Report them to the therapist.

When to call for urgent help

Call emergency services at once for signs of a new stroke: sudden weakness or numbness on one side, drooping face, slurred speech, sudden confusion, loss of vision or severe headache. In India, dial 112. Time matters. Also seek urgent medical help after any fall with head injury or severe pain.