Assistive Devices for Walking
A crutch is an ambulatory aid that provides support and balance to patients. It is a convenient method of getting a patient from one place to another. For crutch walking to be possible, good balance and erect posture are essential.
Who can use crutches?
- Patients who are prescribed partial weight-bearing or non-weight bearing ambulation may use crutches.
Who determines if crutches are appropriate ambulatory aids for the patient?
- The nurse or physical therapist determines if crutches are appropriate ambulatory aids for the patient.
To promote safety when crutch walking the following is important to keep in mind:
- Crutches should have large rubber suction tips.
- Patients should wear well-fitting shoes that have firm soles.
- Crutches must be adjusted to the patient.
Before a patient walks using crutches, preparatory exercises are done. These exercises are aimed at strengthening the shoulder girdle and the upper extremity muscles which bear the patient’s weight when crutch walking. The muscle groups that are vital to crutch walking are the following:
- Shoulder depressor muscles which stabilize the upper extremity and prevent shoulder hiking.
- Shoulder adductor muscles which hold the crutch top against the chest wall.
- Arm flexor, extensor and abductor muscles which move crutches forward, backward and sideward.
- Forearm extensor muscles which prevent flexion or buckling and are important in raising the body in swinging gait.
- Wrist extensor muscles which enable weight bearing on hand pieces.
- Finger and thumb flexor muscles which grasp the hand piece.
Measuring for Crutches
The patient may be measured standing or lying to determine the approximate crutch length. The patient’s height may also be used.
- Position the patient against the wall with feet slightly apart and away from the wall.
- Mark out 5 centimeters or 2 inches to the side from the tip of the toe.
- Measure fifteen centimeters or 6 inches straight ahead from the first mark. Mark this point.
- Measure 5 centimeters or 2 inches below the axilla to the second mark for the approximate crutch length.
- Measure from the anterior fold of the axilla to the sole of the foot. Add 5 cm or 2 inches to this measure.
USING THE PATIENT’S HEIGHT
- Subtract 40 cm or 16 inches to obtain the approximate crutch length.
In general the hand pieces should be adjusted to allow 20 to 30 degrees of flexion at the elbow. The wrist should be extended and the hand is dorsiflexed. A foam rubber pad on the under arm piece may be used to relieve pressure of the crutch on the upper arm and thoracic cage.