What Role Does a Cane Play in Your Life?

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* 1. What role does a cane play in your life?

I use a cane always, as my primary walking aid.

I use a cane often as a primary walking aid.

I sometimes need a cane as a primary walking aid, but sometimes I can walk without assistance, or use the walls. ;)

I don't use a cane for walking assistance, but sometimes I need help from a support person, a wall, or a piece of furniture to steady myself.

I primarily use a walker/scooter/or wheelchair, but I use a cane to help me get from my device help me move from my device. (Transfer to a bed, toilet, or another place.)

I walk without assistance, but I would consider a cane if I need it later.

I use my cane in another way:

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* 2. What kind of cane do you use?

I use a cane with a four point base.

I use a foldable cane.

I use an expandable cane.

I use a cane that is one piece, and doesn't extend.

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* 3. Does your cane adequately support you?

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

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* 4. I forget where I put my cane.

Always

Usually

Sometimes

Rarely

Never

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* 5. I have fallen when I didn't have my cane with me.

Every time I don't have an assistive device I'm in danger of a fall.

I have often fallen when I don't have an assistive device.

I have sometimes fallen when I didn't have an assistive device.

I rarely fall when I don't have an assistive device.

I have never fallen because of not having my assistive device.

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* 6. I feel like I waste energy looking for my cane.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree