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Crutches

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Contents

Introduction

Crutches are assistive devices that are used to provide the user with more stability and balance during gait or standing. They can also provide sensory cues through the hands, unloading of the lower limbs, and enable the user to be upright and to maneuver into areas not accessible by wheelchair.[1]

Types of crutches

Underarm Crutches

Description

These crutches can be made of wood, aluminum or titanium. They are manufactured to fit children and adults and have adjustable heights. The very top of the crutch is usually covered with a material with a high coefficient of friction to decrease movement under the arms. Although these style crutches are called "underarm" crutches they are not to be used directly in the arm pit due to sensitive anatomy and important blood vessels and nerves in this area. [1] 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 nonaxillary or forearm crutches, and patients can free their hands for activities by leaning on the shoulder piece. [2] The handle of the crutch is covered with a cushioned material to protect the user's palm. The tip of the crutch is usually made out of rubber to ensure traction.[1]

Underarm crutches
Underarm crutches
Potential Users

Underarm crutches can be used by any patient who needs extra stability or balance, especially if a limb needs to be offloaded. Common examples of underarm crutches users include those with fractures of the lower extremity, those with soft tissue damage to the lower extremity and unilateral lower limb amputees. The soft tissue in the axillae and chest should be in good condition and the user should have sensation in their hands and chest.

Measurement

The measurement prescription for axillary crutches is determined in the following manner: 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. [2]

Triceps Crutches

Description

Triceps crutches are also known as Warm Springs crutches because they were developed at the Roosevelt Institute for Rehabilitation in Warm Springs, GA. They were originally designed for polio patients. [1] The triceps weakness orthosis resembles the axillary crutch but ends proximally at the midarm level. [2]These crutches offer additional bands for the arm to ensure that the elbow remains extended despite upper extremity involvement.[1]

Warm Springs or Triceps crutch
Warm Springs or Triceps crutch
Potential Users

These crutches mimic the triceps muscle so any user with upper extremity deficits would benefit from this design.

Measurement

The upper cuff should contact the upper third of the arm, about 5 cm below the fold of the underarm. The lower cuff should be 1 to 4 cm below the elbow to avoid making contact with it. [1]

Forearm/Loftstrand Crutches

Description

Forearm crutches are made of aluminum or titanium and have a vinyl covered steel forearm cuff. The height and cuff position of the crutch are adjustable.[1] The open end of the cuff is placed on the lateral aspect of the forearm to permit elbow flexion and grasping without dropping the crutch. The top of the crutch is angled at 20° to provide a comfortable, stable fit. Many people prefer forearm crutches to underarm crutches because ambulation is safer and easier, the forearm support stabilizes the wrist during weight bearing, the user's hands are free to perform various tasks while the individual's body weight is supported through the forearm by the forearm cuff pivots and the patient does not have to worry about dropping the crutches. [2] A leather cuff can also be used. This was developed by Sister Kenny and is known as the Kenny Armband. [1]

Forearm crutches
Forearm crutches
Potential Users

This design was originally developed for patients with poliomyelitis. It is especially appropriate for patients who have good proximal upper limb strength but weak distal strength and who are unable to hold and control the orthosis effectively. [2]

Measurement

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. [2]

Platform Crutches

Description

Platform crutches have a trough for the forearm to fit into at the very top. [1] A vertical handgrip is placed at the end of the platform. Velcro straps are applied around the forearm to keep it in place. This orthosis is very helpful for patients with a weak hand grip. [2]

Platform crutches
Platform crutches
Potential Users

This design is specifically fore users that cannot bear weight through their hands. [1]

Measurement

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.[2]

Gait Patterns

External Links


References

References should be marked up. An example of a web page reference is below.

  • [1] Divakara Kedlaya, MBBS. Updated: Jun 17, 2008. Accessed on Oct 14, 2009.
  • AAOS Atlas of Orthoses and Assistive Devices. Eldenstein, J.(2008). Canes, Crutches and Walkers.In Hsu, J; Michael, J; Fisk, J (Ed.), AAOS Atlas of Orthoses and Assistive Devices.(pp. 533-542). Philadelphia, PA: Mosbey Elsevier.