Crutch walking. دکترامیر هوشنگ واحدی متخصص طب فیزیکی و توانبخشی. Axillary /Regular/ StandardCrutches transfers ~80% body weight Non- axillary /Forearm Crutches transfers ~40-50% body weight Loftstrand or Canadian crutches Triceps Weakness Crutch subtypes - PowerPoint PPT Presentation
Axillary/Regular/StandardCrutches transfers ~80% body weightNon-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 BARSWALKERSAXILLARY CRUTCHESFOREARM CRUTCHESBILATERAL CANESSINGLE CANEMOST STABLELEAST STABLE
Platform crutch. Forearm aluminum crutch
Adjustable axillary crutch Permanent axillary crutch.Forearm crutch with closed leather circle cuff.Ortho crutch.
Crutch ComponentsCrutch tips - Crutches without rubber tips or with inadequate rubber tips are dangerous.Handgrips -Made of sponge rubberAxillary pads -Made of sponge rubber Triceps band -Made of metal or stiff leather and is attached to the upper part of the crutch Wrist strap -Made of either leather or plastic
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 standing2" 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 process2.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 90measure 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.
15Alternating (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 patternFour-point gaitThree-point gaitTwo-point gait
Swinging (simultaneous) gait patternsSwing-to gaitSwing-through gait 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.
26Weight bearing statusNone weight bearing (NWB)Toe touch weight bearing (TTWB, TDWB) Partial weight bearing (percentage of the body weight) (PWB) we need to use weight scaleWeight bearing as tolerated (WBAT)Full weight bearing (FWB)
Stairsascending4-point(R) LE-(L) LE-(R) crutch-(L) crutch3-pointNWB: good leg-2 crutchesPWB: good leg-bad leg+crutches2-pointgood leg-bad leg+crutchesdescending4-point(R) crutch-(L) crutch-(R) LE-(L) LE3-pointNWB: 2 crutches-good legPWB: bad leg+crutches-good leg2-pointcrutches+bad leg-good leg
Gait Training and Pre ambulation Exercises
Aerobic conditioning exercisesCoordination and balancing exercisesROM of both upper and lower limbsMuscle 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:
Shoulder depressorsLatissimus dorsiLower trapeziusPectoralis minorShoulder flexorsElbow and wrist extensorsFinger flexorsTrunk (deep back) muscles - To help improve balance and endurance
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