WALKING AIDS

CRUTCHES
 Crutches may also be of wood or metal and
should be adjustable both in hand grip to
ground length and in Axilla to hand grip
length
 Purpose:
 To reduce weight bearing on one or both legs
 To give additional support in case of impaired
balance and inadequate strength.
TYPES OF CRUTCHES
 3 basic types of crutches
 Axillary crutches
 Elbow crutches
 Fore arm bearing/Gutter crutches
AXILLARY CRUTCHES
 These should be used when weight must be
relieved from one leg and can be used to
train partial weight bearing before
progressing to sticks.
 The length is important as the Axillary pad
must not push up into the Axilla, but must be
high enough to allow it to be held between
the upper arm and the chest wall when
weight is put on the crutch
 Usually made up of wood with an axillary
pad, a hand piece and a rubber ferrule
 The position of hand piece and total length
are usually adjustable
 Axillary pad must rest against the chest wall
approx. 5 cm below the apex of the axilla.
 Weight transmission from arm to hand piece.
 Neuropraxia of radial nerve or brachial
plexus
MEASUREMENT
 With shoes off: from the apex of the axilla to
the lower margin of the medial malleolas
 With shoes on: 5 cm vertically down from
the apex of the axilla to a point 20 cm
lateral to the shoe heel
 Measurement from axillary pad to the hand
grip should be taken with the elbow slightly
flexed( about 15 degree) from a point 5 cm
below the apex of the axilla to the Ulnar
styloid
 Don’t allow the axillary pads to press against
the axilla
ELBOW CRUTCHES
 These are essentially sticks of adjustable
length with a horizontal hand grip
 A metal forearm rest which may be in the
form of a spring band which is sufficiently
elastic to allow the arm to be put through
the opening, but tight enough to stay in
position on the forearm should the patient
release his grip on the hand piece.
 These crutches are not as stable as axillary
crutches
 it is possible to achieve balance and to let go
of a crutch without losing it, in order to
perform some manual task, e.g. opening a
door, putting shopping in a bag
 Measurement is taken with the patient in lying
position with shoes on
 Elbow is flexed 15 degree and measurement taken
from the Ulnar styloid to the point 20 cm lateral to
the shoe heel
FOREARM BEARING (GUTTER)
CRUTCHES
 These are metal adjustable crutch legs with
a gutter splint mounted on the top with,
usually, a handle at the front which can be
set at an adjustable angle.
 The forearm is held in the gutter splint by
straps of Velcro or leather and the hand grips
the adjusted handle.
 These crutches are used when weight cannot
be taken through the forearms and hands,
e.g. in fractures of these parts or in
rheumatoid arthritis of the wrist and hand
A, A wooden axillary crutch – length and handle adjustable; B, A metal
axillary crutch – length and handle adjustable; C, French type axillary
crutch; D, A gutter crutch, length adjustable; E, An elbow crutch
adjustable above and below the hand grip.
 Measurement: from elbow to floor if patient
is able to stand
 With lying and shoes on : from point of
flexed elbow to the 20 cm lateral to shoe
heel
 Special considerations for Rheumatoid
arthritis: flexion deformities of hip and knee
can be compensated
FRAMES
 These are essentially large-based frames
having four points and two or three sides.
They are used by picking them up, moving
them forwards, putting them down, leaning
upon them and walking into the frame.
 They should be adjustable in height
VARIATIONS
 A reciprocal mechanism which allows right
hand movement with left leg movement, but
this type is often disliked by unsteady
patients
 Two front legs and two rear wheels with
brakes which operate on downward pressure
on the wheels
 Wheels on all four legs, with or without
brakes
 Square' wheels
 A mechanism which allows them to be
folded. This facilitates travelling with an aid
and also allows the aid to be carried up and
down stairs
SAFETY
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Pick-up aids or frames: A, with three fixed sides; B, with two
fixed sides and folding; C, with three fixed sides and folding.
PREPARATION FOR CRUTCH WALKING
 ARMS:
 Power of extensors, adductors of shoulder
 Extensors of the elbow
 Hand grip
 These will determine type of crutch used
 LEGS:
 NON WEIGHT BEARING
 Mobility and strength of unaffected leg
should be assessed paying particular
attention to the Hip Abductors& Extensors
and planter flexors of the ankle
 These muscles must be sufficiently strong to
take the weight
 Hip Hitching is taught on non weight bearing
side
 Partial Weight Bearing:
 The mobility and strength of both legs should
be assessed and muscles strengthened where
necessary.
 Balance:
 Sitting and standing balance must be tested
and trained if necessary
 Demonstration:
 Physiotherapist must demonstrate the
important points to the Patient, Emphasizing
the important points.
CRUTCH WALKING
 Physiotherapist should have an assistant
when the patient is to walk for the first time
 This person may be another physiotherapist,
PTA or Nurse, relative etc
 Physiotherapist should instruct the assistant
on how to hold the patient upright and how
to transfer a patient on to the crutches.
NON WEIGHT BEARING
 3 Point Walking:
 SWING TO:
 The crutches start in front of the supporting
leg.
 They are lifted and placed further in front,
weight is taken on them and the sound leg is
bent and swung to just behind the crutches.
 The disabled leg should be held clear of the
ground and in front of the body
 SWING THROUGH:
 The above procedure is followed but the
sound leg is swung through the crutches and
the foot is put down in front of them.
 This technique is for stronger patients
 Both these techniques may be used with any
type of crutch.