MANAGEMENT OF PATIENTS WITH crutch walking.pptx
- 2. Definition: Assisting patient to walk using crutches while providing support and as a convenient method of getting from one place to another. Gait: Gait is a term to describe human locomotion, it is pattern of walking or a sequence of foot movements.
- 3. Walking aids Walking aid is a device designed to assist walking and improve the mobility of people who have difficulty in walking or people who cannot walk independently. Purpose of walking aids: • Increase area of support or base of support • Maintain center of gravity over supported area • Redistribute weight-bearing area by decreasing force on injured or inflamed part or limb • Can be compensate for weak muscles • Decrease pain • Improve balance
- 4. Different Types of Walking Aids: Walker Cane/ stick Crutches
- 5. Crutches These are devices which are used to reduce weight bearing on one or both legs and also give support where balance is impaired and strength is inadequate. Prerequisites for crutches: *Good strength of upper limb muscles is required. *Range of motion of upper limb should be good. *Shoulder adductors *Elbow and wrist extensors *Finger flexors
- 6. Crutch gaits
- 7. Types of crutches: 1. Axillary crutches/ under arm crutches 2. Elbow crutches or Lofstrands crutches 3. Forearm support crutches (gutter crutches)
- 8. Axillary crutches They are made of wood or metal with an Axillary pad, a hand piece and a rubber ferrule. Two upright shafts connected by axillary piece on top. Hand piece in the middle Extension piece below Extension piece and shafts has numerous holes at regular intervals so the total length of crutch and height of handle is easily adjustable.
- 9. Cont… A large suction tip (rubber ferrule) is attached to extension piece to allow total contact with floor. The Axillary pad should rest beneath the apex of axilla and hand grip in slight flexion when weight is not being taken. When weight is being taken through axillary pad, the elbow will go into extension and weight is transmitted down the arm to hand piece.
- 10. Advantages of Under Arm Crutches: *Convenience for temporary injuries *A large degree of support for the lower body *Available at low cost. *Axillary crutches allow the patient to perform a greater variety of gait patterns and ambulate at a faster pace.
- 11. Disadvantages of Under Arm Crutches: *Limited upper body freedom *Axillary crutches require good standing balance by the patient. *Improper use of crutch can cause injury to axillary region, and Strain on the arms and upper body which can lead crutch paralysis. *Geriatric patient may fell insecure or may not have the necessary upper- body strength to use axillary crutches
- 12. Precautions: • Have someone nearby for assistance until accustomed to the crutches. • Frequently check that all pads are securely in place • Check screws at least once per week. • Clean out crutch tips to ensure they are free of dirt and stones. • Remove small, loose rugs from walking paths. • Beware of ice, snow, wet or waxed floors • Avoid crowds, leave class early. • Never carry anything in hands, use a backpack.
- 13. Elbow crutches /Lofstrand crutch: They are made of metal an aluminum tubular shaft with a handgrip and have a metal or plastic forearm band. Forearm piece bent backward and extended to 2 inches below the elbow. Both handgrip and forearm piece are adjustable in length by means of a press clip or metal button and have a rubber ferrule. These crutches are suitable for patients with good balance and coordination with strong arms. Weight is transmitted exactly the same way as for axillary crutches.
- 14. Advantage of elbow crutches: • Light weight • Easily adjustable • Freedom for hand activities • Using forearm crutches requires no more energy, increased oxygen consumption or heart rate than axillary crutches. • Being easily stored and transferred. • There is no risk of injury to the neurovascular structures in the axillary region when using this type of crutches.
- 15. Disadvantages of forearm crutches: • Forearm crutches are less stable . • They require good standing balance and upper- body strength. • Geriatric patient sometimes feel insecure with these crutches. They may not have the necessary upper-body strength to use forearm crutches.
- 16. Forearm support crutches/gutter crutches They are made of metal with a padded forearm support Platform, Velcro strap an adjustable hand piece and a rubber ferrule. These are used for patients with Painful wrist and hand condition or elbow contractures, or weak hand grip Elbow flexed 90 degrees, The hand rests on a grip which can be angled appropriately, depending on the user's disability.
- 17. Advantages: • As similar like elbow crutch • These are easily adjustable. • More cosmetic than other crutches. Disadvantages: • Provide less lateral support due to absence of axillary pad. • Cuffs may be difficult to remove. • These can be expensive.
- 18. Measurement of crutches *Crutch pad distance from armpits: The crutch pads (tops of crutches) should be 1½" to 2" (about two finger widths) below the armpits, with the shoulders relaxed. *Handgrip: Place it so that the elbow is slightly bent enough so one can fully extend the elbow when taking a step.
- 19. Cont… *Crutch length (top to bottom): The total crutch length should equal the distance from the armpit to about 6" in front of the shoe. Crutches that are too tall or too short can affect balance and also cause back pain. Incorrectly fitted crutches or poor posture can cause a disorder called crutch palsy in which the nerves under the arm mostly radial nerve (brachial plexuses) are temporarily or permanently damaged, causing weakened hand, wrist and forearm muscles.
- 20. Types of crutch walking: NWB - Non weight bearing TDWB (OR) TTWB - Touch down weight bearing (OR) Toe touch weight bearing PWB - Partial weight bearing WBTT - Weight bearing to (or) tolerance FWB - Full weight bearing
- 21. Non weight bearing walking instructions: Place no weight on the affected limb Do not touch the ground with the affected limb while standing or walking. Bear the full weight through the normal limb and crutches while standing and walking.
- 22. Balanced standing (Tripod position): Use this position when at start or end a gait or when standing for any length of time. Move crutches to the front about 12 inches. find the balance. Don't rest the armpits on the crutch pads. Bear weight through normal limb and the hand grips of the crutches.
- 23. Non weight bearing: Stand on unaffected leg, lift both crutches at the same time and place the crutches one step’s length in the front. Push down on the handgrips with hands while squeezing the top of the crutches between the chest and upper arms. Putting the weight through the handgrips, hop forward with the unaffected leg to meet the crutches.
- 24. Touch down weight bearing (or) toe touch weight bearing walking instruction: Standing on the unaffected leg, lift both crutches at the same time and place the crutches one step’s length in front. Bring the affected leg forward so that it is in line with the crutches. Only put toes down on the ground up to a maximum of 4 kg of pressure. Push down on the handgrips with hands while squeezing the top of the crutches between chest and upper arms. Putting weight through the handgrips, hop forward with unaffected leg to meet the crutches, or slightly ahead of the crutches, making sure that only 4 kg of pressure is put through the affected leg.
- 26. Partial weight bearing walking instructions: Bear some weight about 50 per cent on affected limb as one walks. Standing on unaffected leg, lift both crutches at the same time and place the crutches one step’s length in front. Bring the affected leg forward so that it is in line with the crutches. Only put up to 50% of body weight on this leg as place it on the ground. Push down on the handgrips with hands while squeezing the top of the crutches between your chest and upper arms. Putting your weight through the handgrips, hop forward with unaffected leg to meet the crutches, or slightly ahead of the crutches, making sure that only 50% of body weight is put through the affected leg.
- 28. Full weight bearing walking instruction: Bear most of the weight on affected limb as tolerated. Place only a little remaining weight on crutches. Standing on both legs with crutches at the side for support, lift both crutches at the same time and place the crutches one step’s length in front. Bring the affected leg forward so that it is in line with the crutches.
- 29. Push down on the handgrips with hands while squeezing the top of the crutches between chest and upper arms. Putting some weight through handgrips and as much weight as one can through the affected leg, step forward with unaffected leg.
- 30. Ascending the stairs: Face the stairs holding onto crutches and standing on affected leg. Only put as much weight as allowed as per orders on the affected leg. If non weight-bearing – one can chose to keep knee in bent position as shown in the diagram if possible. Put pressure through crutch handgrips as hop up with your unaffected leg onto the next step. Then bring affected leg and crutch up to that step.
- 31. Descending stairs: * Stand at the top of the stairs with the toes of unaffected leg close to the edge of the step and holding onto two crutches, one on either side. * Place crutches onto the lower step, bringing affected leg forward at the same time. Only put affected leg down on the step if allowed. * Putting weight through your crutches, slowly lower unaffected leg onto the lower step, remembering to only put weight through affected leg if allowed as per doctor’s orders.
- 32. Patient education to help cope with disabilities: Take control of your life: Face the reality of your disability. Emphasize areas of strength. Remain outward looking. Seek inventive ways to tackle problems. Share concerns and frustrations. Maintain and improve general health. Plan for recreation.
- 33. Cont… Have well-defined goals and priorities: Keep priorities in order; eliminate nonessential activities. Plan and pace your activities. Organize your life: Plan each day. Organize work. Perform tasks in steps. Distribute heavy work throughout the day or week.
- 34. Control your environment: Try to be well organized. Keep possessions in the same place, so that they can be found with a minimum of effort. Store equipment in a box or basket. Use energy-conservation and work-simplification techniques. Keep work within easy reach and in front of you. Use adaptive equipment, self-help aids, and labor- saving devices. Recruit assistance from others, delegate when necessary. Take safety precautions.
- 35. Nursing diagnosis: Impaired physical mobility related to restricted movement of the fractured limb. Activity intolerance Risk for injury Impaired skin integrity related to immobility, decreased sensory perception, decreased tissue perfusion, decreased nutritional status, friction and shear forces, excessive moisture, or advanced age. Impaired urinary elimination related to UTI, detrusor instability, neurologic impairment, bladder contracture, inability to reach toilet in time.