CRUTCHES

CRUTCHES

Crutches have 2 points of contact with the body, providing better stability than do canes.

Two types of crutches (ie, axillary, nonaxillary) currently are in use.

AXILLARY CRUTCHES

An axillary crutch is a type of orthosis that provides support from the axilla to the floor. Wood and aluminum axillary crutches, both of which are adjustable, are available. 

An extension crutch (ie, one with an adjustable length) is heavier than a regular crutch because of the extra piece of wood. Standard axillary crutches have double uprights with a shoulder piece, as well as a handgrip or bar.

The primary advantage of an axillary crutch is that it allows transfer of 80% of the individual's body weight. Axillary crutches provide better trunk support than do non-axillary or forearm crutches, and patients can free their hands for activities by leaning on the shoulder piece.

However, the patient should be advised of the possibility of sustaining compressive brachial neuropathies with the use of axillary crutches. The axillary crutch is not designed to be rested on for body support. Patients should avoid resting their body weight on the axillary area. Providing extra padding to the axillary area should be discouraged for this reason.

MEASUREMENT PRESCRIPTION FOR AXILLARY CRUTCHES

• With the patient standing, determine the crutch length by measuring the distance from the anterior axillary fold to a point 6 inches lateral to the fifth toe.

• With the proper crutch length determined and the crutch then placed 3 inches lateral to the foot, proper handpiece location can be measured. The patient's elbow should be flexed 30°, the wrist should be in maximal extension, and the fingers should be held in a fist.

• The patient should be able to raise his/her body 1-2 inches by performing complete elbow extension.

ORTHO CRUTCH

• A single-bar aluminum crutch with a contoured underarm piece

• Has an adjustable handpiece

• Lighter than a regular crutch

NONAXILLARY CRUTCHES

Nonaxillary crutches allow the transfer of 40-50% of the patient's body weight. Also called forearm or arm canes (or forearm or arm orthoses), these devices require good trunk control. The patient needs confidence in his/her ambulation skills.

LOFSTRAND CRUTCHES / CANADIAN CRUTCHES

• Most popular of nonaxillary crutches

• Most useful substitute for canes

• Most often used bilaterally

• Made of tubular aluminum

• Padded hand bar

• Forearm cuff

  • The open end of the cuff is placed on the lateral aspect of the forearm to permit elbow flexion and grasping without dropping the orthosis.

  • The proximal portion of the orthosis is angled at 20° to provide a comfortable, stable fit.

• Measurement prescription - With the proper crutch length determined and the crutch then placed 3 inches lateral to the foot, the proper handpiece location can be measured. The patient's elbow should be flexed 20°, the wrist should be in maximal extension, and the fingers should be held in a fist.

• Advantages associated with Lofstrand crutches include the following:

  • Ambulation is safer and easier.

  • This type of crutch is a good substitution for the cane, because the forearm support stabilizes the wrist during weight bearing.

  • The patient's hands are free to perform various tasks while the individual's body weight is supported through the forearm by the forearm cuff pivots. The patient does not have to worry about dropping the crutches.

  • These crutches are shorter than axillary crutches.

• The disadvantage of Lofstrand crutches is that they provide less support for ambulation than do axillary crutches.

WOODEN FOREARM ORTHOSIS

• The wooden forearm orthosis, also known as the Kenney stick (named after Sister Kenney), resembles the axillary crutch but ends proximally, with a leather band situated around the proximal portion of the forearm.

• Indications for this orthosis include the following:

  • Originally developed for patients with poliomyelitis

  • For patients who have good proximal upper limb strength but weak distal strength and who are unable to hold and control the orthosis effectively

• An advantage to this type of crutch is that use of the closed leather band will prevent the patient from dropping the orthosis. (This is even truer than it is with the Lofstrand forearm orthosis.)

PLATFORM FOREARM ORTHOSIS

• A platform is placed on the top level of the crutch.

• A vertical handgrip is placed at the distal end of the platform.

• Velcro straps are applied around the forearm.

• This orthosis is very helpful for patients with a weak handgrip

• The measurement prescription is arrived at by having the patient stand upright, with his/her elbow flexed 90°; the proper length for the orthosis is determined by measuring from the patient's resting forearm to the ground.

• An advantage to this orthosis is that the patient's body weight is borne mostly by the forearm instead of by the hand.

• Indications for the platform forearm orthosis include the following:

  • Painful wrist and hand conditions (eg, arthritis)

  • Weak handgrip because of pain and deformities of the hands and wrists

  • Elbow contractures

TRICEPS WEAKNESS ORTHOSIS

• Other names for this device include the following:

  • Triceps weakness crutch

  • Warm Springs crutch or Everett crutch (a metal version)

  • Canadian crutch (a wooden version)

• The triceps weakness orthosis resembles the axillary crutch but ends proximally at the midarm level.

• Two cuffs, one above and one below the elbow, support the elbow in extension.

• The triceps weakness orthosis was originally developed for patients with poliomyelitis; it is used by patients who need help preventing the elbow from buckling during gait.

OTHER CRUTCH COMPONENTS

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

o    Made of rubber and attached to the foot of the crutch

o    Should be at least 1.5 inches in diameter

o    Can have a retractable, metal-spiked tip for use on ice, enhancing patient safety by preventing slippage; absorbs shock but may be uncomfortable for the patient

v  Handgrips

o    Made of sponge rubber

o    Can be built up or contoured according to the needs of the patient

o    Reduce pressure on the hands

o    Enhance safety (prevent slippage)

v  Axillary pads

o    Made of sponge rubber

o    Prevent unnecessary pressure under the axillary region

v  Triceps band

o    Made of metal or stiff leather and is attached to the upper part of the crutch

o    Assists the patient in maintaining elbow extension during weight bearing

o    Very helpful for patients with weak triceps

v  Wrist strap

o    Made of either leather or plastic

o    Assists patients in making their handgrip

o    Very helpful for patients with weak wrist extensors

CRUTCH GAITS USED FOR SPECIFIC INDICATIONS