Project 1
PROJECT - FOREARM CRUTCH
Introduction :-
- Crutches are medical devices designed to aid in ambulation, by transferring body weight from the legs to the torso and arms. They are mainly used to assist individuals with lower extremity injuries and/or neurological impairment. This activity describes the types of crutches, their indications, and contraindications and highlights the role of the interprofessional team in proper evaluation and training of patients needing ambulatory devices.
- Crutches are medical devices designed to aid in ambulation, by transferring body weight from the legs to the torso and arms. They are mainly used to assist individuals with lower extremity injuries and/or neurological impairment. Most crutches classify into the following three categories: axilla, forearm, and platform.
- Forearm crutches are better for long-term use. The weight of the user is transferred mainly to their entire upper arms. The user needs good upper body strength to use these crutches properly. Individuals with long-term disabilities looking to be more active or participate in sports may choose forearm crutches as an option.
- A forearm crutch (also commonly known as an elbow crutch, Canadian crutch or "Lofstrand" crutch due to a brand by this name) has a cuff at the top that goes around the forearm.It is used by inserting the arm into the cuff and holding the grip. The hinged cuff, most frequently made of plastic or metal, can be a half-circle or a full circle with a V-type opening in the front allowing the forearm to slip out in case of a fall.
- Forearm crutches are the dominant type used in Europe, whether for short or long term use. Outside of Europe forearm crutches are more likely to be used by users with long-term disabilities, with axillary crutches more common for short-term use.
There are three types of crutches: axilla crutches, elbow crutches and gutter crutches.
- Axilla or underarm crutches: They should be positioned with 2 fingers of distance between the axilla and the axilla pad with the elbow flexed between 20-30 degrees. The design includes an axilla bar, a handpiece and double uprights joined distally by a single leg. They are adjustable in height; both the overall height and handgrip height can be adjusted (adjustable approximately 48 to 60 inches / 12 to 153 cm).
- Forearm crutches: (or lofstrand, elbow or Canadian crutches). Their design includes a single upright, a forearm cuff and a handgrip. The height of forearm crutches is indicated from handgrip to the floor (adjustable from 29 to 35 inches / 74 to 89 cm).
- Gutter Crutches: (or adjustable arthritic crutches, forearm support crutches) An additional type of crutch, which is composed of a padded forearm support, made up of metal, a strap and adjustable handpiece with a rubber ferrule. These crutches are used for patients who are partial weight bearing, and are particularly useful for clients with rheumatoid conditions.
- The design includes an axilla bar, a handpiece and double uprights joined distally by a single leg.
- They are adjustable in height; both the overall height and handgrip height can be adjusted (adjustable approximately 48 to 60 inches / 12 to 153 cm).
Materials:-
- Wood.
- Metal alloys ( steel ,aluminium and titunium alloys)
- carbon or glass reinforce composites.
- thermoplastics
- carbon fiber reinforcement polymer.
Construction parts of crutches:
Body:
- Unibody vs. body from several parts
- Air-tight
- seamless aerospace grade titanium tubing
- with/without internal elastic cord
Grips:
- Shock-absorbing
- Gel-filled
- Tapered
Tips:
- Shock-absorbing
- Pivoting
- Larger than conventional
- Round vs. angular (square, hexagonal)
Underarm Cradle:
- Curved vs. Streight
- Stabilized behind the user
Cuffs:
- with armature inside vs. without armature inside
- rotatable vs. Fixed
- with/without padded inserts
- closed (full) vs. open (half full) armband
Possible materials
Body:
- Wood (rosewood, oak, rock maple)
- Aluminum Alloys
- Steel
- Titanium
- End-plugs from solid brass
- Iron- tube
- Carbon Fiber
- IMD Plastic
- IMR Plastic
Grips & Underarm Cradle:
- Rubber (latex free)
- Leather Saddle
- PVC vinyl
- closed cell polyurethane pad covered with leather
- Urethane foam
- Neoprene Foam (with a nylon skin)
- Wood
- PP
- TPE
Tips:
- Rubber (latex free)
Cuffs:
- Stiff metal armature (inside)
- Nylon
- PA
- PP
Finish:
- natural luster
- black powder coating
There are several different walking patterns an individual using crutches may adopt, including:
- Two-point crutch gait: Please note the difference between two-point gait and two-point crutch gait. In two-point crutch gait, the crutches and the non-weight bearing / affected limb (due to fracture, amputation, joint replacement etc) make up one point and the uninvolved leg makes up the other point. The crutches and affected limb are advanced as one unit, and the uninvolved weight-bearing limb is brought forward to the crutches as the second unit. This gait pattern is less stable as only two points are in contact with floor. Thus, good balance is needed to achieve two-point crutch gait.
- Two-point gait: the right foot and left crutch are advanced simultaneously, followed by the left foot and right crutch. There are two points in contact with the floor at any one time!
- Three-point: this gait pattern is used when one of the lower extremities (LE) is unable to fully bear weight (due to fracture, amputation, joint replacement etc). There are three points of contact with the floor. The crutches serve as one point, the involved leg as the second point, and the uninvolved leg as the third point. Both crutches move forward, the affected limb then steps up to the crutches. This is followed by the weight-bearing limb which steps through, beyond the crutches. There are always three points of contact with the floor at any given time.
- Four-point: this gait pattern is used when there is a lack of coordination, poor balance and muscle weakness in both LE. This is because it provides a slow and stable gait pattern with four points of support. Point one is the crutch on the involved side, point two is the uninvolved leg, point three is the involved leg, and point four is the crutch on the uninvolved side. The crutches and limbs are advanced separately, with three of the four points on the ground and bearing weight at any given time.
- Step-to: the fractured/injured limb is advanced, and then the intact limb is brought to the same position. When weight-bearing status is restricted to partial, toe-touch, or as tolerated, crutches or a walker are necessary. They help the patient step to the fractured/injured limb by pushing down with the upper extremities, thus transferring weight from the fractured/injured limb to the assistive device.
- Step-through: the intact leg is advanced, and then the fractured/injured leg is advanced past it. With restricted weight-bearing, crutches are used instead of the injured limb; the patient steps past the crutches with the weight-bearing lower extremity. Thus, the gait assumes a two-point or three-point pattern.
Complications
- The user’s strength and coordination should undergo evaluation before issuing them a set of crutches. The use of the wrong crutches can lead to injury. Most injuries are a direct result of falling.
- Crutch palsy is observable in axilla crutch users who rest their weight on the shoulder rest. The pressure on the brachial plexus can result in palsy to the radial and ulnar nerves. Extra padding on the shoulder rest can aid in preventing crutch palsy. Education should be provided to patients to discourage supporting body weight on the shoulder rest. With treatment, this can be a repairable injury.
Preparation:-
- All crutches should undergo proper fitting to the user to avoid serious injury.
- Axilla crutches: The shoulder pad should sit 2 inches (2 finger widths) below the axilla when the shoulder is relaxed. The hand grip should be adjusted to allow for a 30-degree flexion to the elbow. The crutch should sit about 6 inches outside of your feet, with instruction provided not to rest axilla directly on the shoulder pad.
- Forearm crutches: The hand grip should allow for 30-degrees of elbow flexion. The cuff should be 1.5 inches below the elbow, and the crutch should sit 4 inches outside of the patient's feet.
- Platform crutches: The platform can vary by design from a flat surface with hand grips to a fully adjustable composite with elbow guards and hand grips. The fitting should ensure that the angulation promotes stability and does not allow for elbow rubbing.
Techniques:-
- Patients can receive training for different gait patterns depending on their current injury and coordination level.
- One crutch gait: This pattern utilizes only one crutch. Crutch positioning is on the side of the uninjured lower extremity. The crutch and the injured leg are advanced forward. Then the uninjured leg proceeds while the crutch supports the user's weight.
- Two-point gait: The left crutch and right leg move forward followed by the right crutch and left leg.
- Three-point gait: This is the most used technique. The left and right crutch along with the injured leg are both advanced while the uninjured leg supports the body weight. Next, the uninjured leg is advanced.
- Four-point gait: This technique provides the most support. The left crutch is advanced followed by the right leg, right crutch and at last the left leg.
- Swing-to gait: The left and right crutch are advanced. Then the left and right legs are advanced
conclusion:
Forearm crutches are better for long-term use. The weight of the user is transferred mainly to their entire upper arms. The user needs good upper body strength to use these crutches properly. Individuals with long-term disabilities looking to be more active or participate in sports may choose forearm crutches as an option.