CRUTCH WALKING دکترامیر هوشنگ واحدی متخصص طب فیزیکی و توانبخشی

1.Axillary/Regular/StandardCrutches transfers ~80% body weight 2.Non-axillary/Forearm Crutches transfers ~40-50% body weight Loftstrand or Canadian crutches Triceps Weakness Crutch subtypes  Wooden Canadian Triceps  Platform Crutches  Wooden Forearm Crutch/Kenny Stick  Warm Springs/Everett Crutch/Aluminum Canadian Triceps

PARALLEL BARS WALKERS AXILLARY CRUTCHES FOREARM 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 rubber 3.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 advantages  improves balance and lateral stability  provides for functional ambulation and restricted weight bearing  adjustable  can be used for stair climbing  inexpensive (depends on material) disadvantages  tendency to exert axillary pressur (crutch palsy)  difficult to use in stairs  tripod stance (4" anterior and lateral) increases BOS

Measurement standing 2" below ant. axillary fold to 2" lateral and 6" anterior to 5th toe 2" below ant. axillary fold to 4-6" anterolateral to 5th toe subtract 16" from pt height or use 77% of pt height handpiece must always allow 20-30° elbow flexion with shoulders relaxed supine ant. axillary fold to a point 6-8" from lateral border of heel 1-2" 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 ext measure from tip of olecranon of flexed elbow to the tip of middle finger of arm with extended elbow

advantages  may release grip without dropping crutch  easily adjusted  allows functional stair climing (esp. pt with bilat. KAFO)  more cosmetic  easy to transport d/t decreased height disadvantages  expensive  decreased 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 foot forearm 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 hands have elbow flexion contractures forearm or hand fractures weaknessweakness of triceps or grasping muscles measurement: 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 limbs movement may be slow. Swinging (simultaneous) gait patterns require 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 gait 2.Three-point gait 3.Two-point gait Swinging (simultaneous) gait patterns 1.Swing-to gait 2.Swing-through gait 3.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 status 1.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)

Stairs ascending 4-point (R) LE-(L) LE-(R) crutch-(L) crutch 3-point NWB: good leg-2 crutches PWB: good leg-bad leg+crutches 2-point good leg-bad leg+crutches descending 4-point (R) crutch-(L) crutch-(R) LE-(L) LE 3-point NWB: 2 crutches-good leg PWB: bad leg+crutches-good leg 2-point crutches+bad leg-good leg

Gait Training and Pre ambulation Exercises 1.Aerobic conditioning exercises 2.Coordination and balancing exercises 3.ROM of both upper and lower limbs 4.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 depressors 2.Latissimus dorsi 3.Lower trapezius 4.Pectoralis minor 5.Shoulder flexors 6.Elbow and wrist extensors 7.Finger flexors 8.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 knee down 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 for the 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