CRUTCH WALKING ortho theory notes

CRUTCH WALKING

• function to prevent weight bearing – eventally to walk unaided
• muscles required for using crutches are
• flexors of fingers and thumb to hold the hand grip firmly
• dorsiflexion of wrist and stabilize the wrist in dorsiflexion
• extensors of elbow to stabilize elbow in slight flexion – to take the body wt through upper limb
• flexion of shoulder to move the walking aid forward
• depression of shoulder girdle to support the body wt

• ability to use crutches efficiently depends on
  • strength of the muscles required
  • selection and adjustment of crutches
  • sense of balance
  • familiarity and manintance of crutches
  • crutch stance
  • knowledge of how to stand and balance on crutches before step
  • gait pattern
  • energy necessary for the gait pattern
• Crutch stance for the axillary crutch
  • patient against wall – crutches placed under each arm
  • correct stance – head up – back straight – pelvis over feet – shoulder depressed – axillary pads of crutches gripped between the lateral wall of chest and medial aspect of arm , 2 inches below the anterior axillary fold – crutch tips 6 inches forward and 6 inches out from tip of toes – palms of hands on hand grips of crutches – elbows in 30⁰ flexion – body wt taken mainly on hands
• Gait patterns
  • swinging crutch gait
    • swing to crutch gait
    • swing through crutch gait
  • four point crutch gait
  • two point crutch gait
  • three point crutch gait
  • selection of gait depends on
    • ability of the patient to step forward with either one or two feet
    • ability to bear weight and keep balance on one or both feet
    • ability to push body forward by presssing down both crutches
    • ability to maintain body errect
    • ability to control the crutches
  • all assisted gaits need more energy
    • 2 and 3 point partial weight bearing gaits need 33% more energy than normal gait
    • 3 point non weight bearing and swing through gait need 78% more energy
• Swinging Crutch gait
  • body wt can be taken through both lower limbs together
  • but uncapable of moving his lower limbs due to paralysis
  • calipers are used to stabilize the limbs – limbs are moved by the muscles acting on pelvis
  • stable position is of tripod – triangular base – apex on shoulder
    • crutches form two anterior legs
    • trunk and lower limbs form the posterior leg
  • paralytic is stable in this position – except no FFD of hip, knee, ankle
  • knees braced in extension – centre of gravity falls in front of the hip joint
  • swinging to crutch – advances the crutch – swings the body to crutches
  • swinging through crutch – body swings through beyond the crutches
• Four point crutch gait
  • when all/ part of body wt can be taken on each foot – but patient is unsteady and needs wide based gait
  • as condition improves – moves to two point gait
  • right crutch – left foot (body wt on right hand) – left crutch – right foot ( body wt on left hand)
• Two point crutch gait
  • to reduce the amount of body wt taken on both foot – some body wt can be taken by both l/l – good balance – both lowerlimbs painful/ weak
  • right crutch and left foot simoultanously ( taking part of body wt on left foot) - left crutch and right foot simultanously (taking part of body wt on right foot)
• Three point crutch gait
  • when one limb can support the whole body wt and other cant
  • both crutches support the weak limb – stronger limb takes the whole body wt without support of crutches
  • both crutches and weak limb together – stronger lower limb

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