The effect of an arm sling used for shoulder support on gait efficiency in hemiplegic patients with stroke using walking aids

BACKGROUND: The effects of an arm sling on the physiological costs of walking are not known. Even though a previous study reported that an arm sling can improve gait efficiency, its entrance criteria was only hemiparetic patients able to walk without walking aids independently. AIM: The aim of this study was to investigate the effect of shoulder support by an arm sling on gait efficiency in hemiplegic stroke patients using walking aids. DESIGN: Randomized crossover design. SETTING: Rehabilitation department of a university hospital. POPULATION: A total of 57 hemiplegic patients with shoulder subluxation dependent on canes were grouped into single cane (N.=30) and quad cane groups (N.=27) as walking aids. METHODS: All patients performed a walk with their own walking aid with and without an arm sling in randomized order, on the same day. We measured the energy cost and energy expenditure using a portable gas analyzer and heart rate during a 6-minutes Walk Test and a 10-m Walk Test. We analyzed all outcomes measures with and without an arm sling between the patients who were grouped according to their walking aids using 2-way repeated ANOVA. RESULTS: The energy cost (0.068 +/- 0.023 mL/kg/m) and oxygen expenditure (8.609 +/- 2.155 mL/kg/minutes) were lower with the arm sling (P<0.05) than without the arm sling (0.074 +/- 0.029 mL/kg/m, and 9.109 +/- 2.406 mL/kg/minutes, respectively), and the walking endurance (138.942 +/- 47.043 m) were longer (P<0.05) with the arm sling among the hemiplegic patients with single cane. CONCLUSIONS: Among the hemiplegic patients with a single cane, the walking endurance achieved with an arm sling significantly improved than those achieved without an arm sling, and the energy expenditure and energy cost was significantly lower. CLINICAL REHABILITATION IMPACT: The hemiplegic arm support with an arm sling may be beneficial for gait efficiency in hemiplegic patients using a single cane, which lead to decreased oxygen use at a given speed.