Crutch walking

CRUTCH WALKING

واحدی هوشنگ دکترامیرو فیزیکی طب متخصص

توانبخشی

1. Axillary/Regular/StandardCrutches transfers ~80% body weight

2. Non-axillary/Forearm Crutches transfers ~40-50% body weightLoftstrand or Canadian crutchesTriceps Weakness Crutch subtypesWooden Canadian TricepsPlatform CrutchesWooden Forearm Crutch/Kenny StickWarm Springs/Everett Crutch/Aluminum Canadian Triceps

PARALLEL BARSWALKERS

AXILLARY CRUTCHESFOREARM CRUTCHES

BILATERAL CANES

SINGLE CANE

1. Platform crutch. 2. Forearm aluminum

crutch

1. Adjustable axillary crutch 2. Permanent axillary crutch.3. Forearm crutch with closed leather

circle cuff.4. Ortho crutch.

Crutch Components

1. Crutch tips - Crutches without rubber tips or with inadequate rubber tips are dangerous.

2. Handgrips -Made of sponge rubber3. Axillary pads -Made of sponge rubber 4. Triceps band -Made of metal or stiff

leather and is attached to the upper part of the crutch

5. Wrist strap -Made of either leather or plastic

1. Axillary/Regular/Standard Crutches

advantagesimproves balance and lateral stabilityprovides for functional ambulation and

restricted weight bearingadjustablecan be used for stair climbinginexpensive (depends on material)

disadvantagestendency to exert axillary pressur (crutch

palsy)difficult to use in stairstripod stance (4" anterior and lateral)

increases BOS

Measurement standing

2" below ant. axillary fold to 2" lateral and 6" anterior to 5th toe2" below ant. axillary fold to 4-6" anterolateral to 5th toesubtract 16" from pt height or use 77% of pt heighthandpiece must always allow 20-30° elbow flexion with shoulders relaxed

supineant. axillary fold to a point 6-8" from lateral border of heel1-2" from ant. axillary fold to heel; then add 2"

seated (weird!)one UE abd 90° with elbow flx 90°; other UE in 90V shoulder abd with elbow extmeasure from tip of olecranon of flexed elbow to the tip of middle finger of arm with extended elbow

advantagesmay release grip without dropping crutcheasily adjustedallows functional stair climing (esp. pt with bilat.

KAFO)more cosmeticeasy to transport d/t decreased height

disadvantagesexpensivedecreased lateral support (no axillary bar)cuffs may be difficult to remove, esp. during falls

Measurement with elbow in 20-30° flexion crutch should be ~4-6" anterolateral to 5th toe or 2" lateral and 6" anterior to footforearm cuff ends 1-1.5" below olecranon process

2.Loftstrand or Canadian crutches

3.Platform Crutches allows transfer of body weight through forearm elbow held in 90° flexion patients who:

cannot bear weight on wrists or handshave elbow flexion contracturesforearm or hand fracturesweakness of triceps or grasping musclesmeasurement:

flex elbow 90°measure from lower border of forearm in neutral to a point 4-6" anterolateral to 5th toe

Crutch length: measure the distance from the anterior axillary fold to a point 6 inches lateral to the fifth toe with the patient standing with the shoulders relaxed.

Handpiece: measure with the patient's elbow flexed 30°, the wrist in maximal extension, and the fingers forming a fist. This is measured after the total crutch height is determined with the crutch 3 inches lateral to the foot.

Alternating (reciprocal) gait pattern stable and less stressful on the cardiovascular system and the upper limbsmovement may be slow.

Swinging (simultaneous) gait patternsrequire rhythmic use of a pair of axillary or forearm crutches to eliminate load from both feet by forceful shoulder depression.and elbow extension.

Alternating (reciprocal) gait pattern

1. Four-point gait2. Three-point gait3. Two-point gait

Swinging (simultaneous) gait patterns

4. Swing-to gait5. Swing-through gait 6. Drag-to gait

The swing-through gait The fastest mode of crutch ambu]ation but requires the most f]oor space. The patient must be able to support the trunk and lower limbs long enough to allow the legs to swing from behind to a position in front of the crutches.

CRUTCH-WALKING GAITS

Weight bearing status1. None weight bearing (NWB)2. Toe touch weight bearing (TTWB, TDWB)3. Partial weight bearing (percentage of the

body weight) (PWB) we need to use weight scale

4. Weight bearing as tolerated (WBAT)5. Full weight bearing (FWB)

Stairsascending

4-point(R) LE-(L) LE-(R) crutch-(L) crutch

3-pointNWB: good leg-2 crutchesPWB: good leg-bad leg+crutches

2-pointgood leg-bad leg+crutches

descending4-point

(R) crutch-(L) crutch-(R) LE-(L) LE3-point

NWB: 2 crutches-good legPWB: bad leg+crutches-good leg

2-pointcrutches+bad leg-good leg

Gait Training and Pre ambulation Exercises

1. Aerobic conditioning exercises2. Coordination and balancing exercises3. ROM of both upper and lower limbs4. Muscle strengthening of both upper

and lower limbs

upper limb strengthening exercises is one of the most important components of the pre ambulatory exercise program.Important muscle groups targeted include the following:

1. Shoulder depressors2. Latissimus dorsi3. Lower trapezius4. Pectoralis minor5. Shoulder flexors6. Elbow and wrist extensors7. Finger flexors8. Trunk (deep back) muscles - To help improve

balance and endurance

CRUTCH-WALKING EXERCISE

Ankle Pumps Slowly, move your feet up and down and then in circles. Try to do five to ten repetitions every 15 minutes.

Straight Leg Raise Bend your unaffected leg so your foot is flat on the bed. Keep your affected leg straight and lift, then lower to the bed. Do not hold your breath.

Quad Sets Tighten the muscles on top of your thigh by pushing your kneedown into the bed. Hold for the count of six, then relax. Repeat.

Hamstring Sets Bend your knee slightly. Push your heel into the bed, hold forthe count of six, then relax. Repeat.

Active Knee Extension Sit up straight in a firm chair or on the side of the bed. Put your feet flat on the floor. Straighten your knee and point your toes toward your nose. Stretch and hold. Return your foot to the floor. Repeat.

Active Knee Flexion Bend your operative leg back as far as possible. You may use the unaffected leg to help push your operative leg further into bending. Kick the leg back out and repeat the bending movement