ALL ABOUT CRUTCHES


**This was written based on my notes during Adult Rehab + personal research

Basic Requirements for Using Crutches:

  1. You must be able to maintain an upright posture.
  2. Easy control of the outer adjustment of the upper body and the ability to shift your weight.
  3. The wrist should maintain its position.
  4. You should be able to hold the crutches with your arms.
  5. Initially, the crutches should be adjusted to a shorter length.
  6. If possible, maintain a neutral or slightly flexed position in the hip joint.
  7. Auxiliary devices should always be kept perpendicular to the ground.
**Prior to using crutches, upper body muscle strength should be developed first.

Types of Crutches:

  • Standard Axillary Crutch
    • The most commonly used type
    • Features: Adjustable height
    • Components: 2 crutches, handgrips, axillary rests, height adjustment mechanism, crutch tips
  • Canadian Crutch, Elbow Extension Crutch, Triceps Crutch
    • Components: 2 crutches that merge into one, 2 cuffs (supporting the lower and upper arms and the elbow joint), crutch tips
    • Purpose: Used when the triceps muscles are weak and lack support to prevent compression of the axillary nerve
    • Disadvantages: Lack of axillary rests makes it difficult to support body weight when opening doors, balancing is challenging during short-term use, it's harder to walk long distances, and instability when ascending or descending stairs
  • Forearm Crutch (Lofstrand's Crutch)
    • Features: Weight support is provided by a cuff attached below the elbow joint and a handgrip without axillary rests
    • Components: Adjustable aluminum crutches, handgrips, and spring-loaded forearm cuffs
    • Purpose: Suitable for patients with good upper limb function and body balance (4-point gait, 2-point gait, swing-to gait)
  • Forearm Support (Platform) Crutch
    • Features: A modification of the standard axillary crutch where the handgrip is removed and a horizontal plank is fixed on top of the crutch, with a handgrip attached
    • Purpose: Used by patients who cannot fully extend their arms due to joint flexion deformities or have difficulty gripping regular crutches
    • Disadvantages: Challenging when ascending or descending stairs or steep paths
  • Single Crutch Design Clutch
    • A modified design of the standard crutch, allowing folding or rotation of the handgrip.
    • Used when forearm supination and pronation are limited and there is pain

Types of Crutch Ambulation:

  • 4-Point Gait
    • Sequence: Left crutch, right foot, right crutch, left foot
    • Always three points are in contact with the ground, providing the greatest stability
    • Suitable for crowded areas or small spaces
    • Disadvantage: Walking speed is slow
  • 2-Point Gait
    • Simultaneous weight-bearing on the left crutch and right foot, followed by the right crutch and left foot
    • Closely resembles normal walking
    • Faster walking speed
  • 3-Point Gait
    • Weight-bearing on both crutches and the affected limb, followed by the non-affected limb
    • Partial weight-bearing
  • Tripod Gait
    • Sequence: Left crutch, right crutch, both feet are brought forward, or both crutches are advanced, followed by both feet
    • Used when patients with lower limb paralysis are not accustomed to skipping gait
  • Swing-To Gait
    • Both crutches are advanced, and both feet are swung forward to reach the crutch positions
  • Swing-Through Gait
    • Both crutches are advanced, and the feet are swung through past the crutches
    • Allows for the fastest walking and the ability to jump over obstacles

Proper Crutches Usage Tips!

    • If the crutches are too long, the shoulders will rise, making it difficult to lift the feet off the ground and potentially causing crutch palsy by compressing the axillary nerve.
    • If the crutches are too short, the upper body will lean forward.
    • The ideal angle for the elbow joint is 25 to 30 degrees, and the crutch tips should be positioned approximately 15-20 cm in front and to the side of the 5th toe, subtracting 40 cm (16 inches) from the person's height.
    • The length should be 77% of the patient's height.

    Muscle groups needed when using crutches!

    1) Finger and thumb flexor: grasping
    - Flexor digitorum superficialis
    - Flexor digitorum profundus
    - Flexor pollicis longus (flexion of the thumb)

    2) Wrist extension: maintaining the handpiece in the correct position
    - Extensor carpi radialis brevis
    - Extensor carpi radialis longus
    - Extensor carpi ulnaris

    3) Forearm extensors: lifting and supporting body weight
    - Biceps brachii
    - Triceps brachii
    - Anconeus

    4) Shoulder flexor, Shoulder extensor: moving the crutches
    - Shoulder flexor: Biceps brachii, Coracobrachialis, Deltoid, Pectoralis major
    - Shoulder extensor: Latissimus dorsi, Deltoid, Pectoralis major, Teres major, Triceps brachii

    5) Shouler girdle depressors and downward rotation: Using crutches to support the body when taking steps.
    - Shouler girdle depresstion : Lower trapezius, Pectoralis minor
    - Shoulder girdle downward rotation: Rhomboids, levator scapulae, pectoralis minor

        Standard Axillary, Loftstrand's, Canadian: 
        https://www.localguidesconnect.com/t5/image/serverpage/image-id/723940i7ABE17796EC73883/image-size/large?v=v2&px=999

        Forearm Support (Platform) Crutch: 
        https://www.avacaremedical.com/media/catalog/product/cache/5a19780b9c66a352bb116fc4457595ca/d/1/d1200012698666_060520230932.jpg

        Written by @otandbae, based on my perspective as an occupational therapy (OT) student

          Comments

          Post a Comment

          Popular Posts