A crutch is a

mobility aid A mobility aid is a device designed to assist walking or otherwise improve the mobility of people with a mobility impairment. There are various walking aids which can help people with impaired ability to walk, and wheelchairs or mobility scoot ...

that transfers weight from the

legs A leg is a weight-bearing and locomotive anatomical structure, usually having a columnar shape. During locomotion, legs function as "extensible struts". The combination of movements at all joints can be modeled as a single, linear element ...

to the upper body. It is often used by people who cannot use their legs to support their weight, for reasons ranging from short-term injuries to lifelong disabilities.

History

Crutches were used in ancient Egypt. In 1917, Emile Schlick patented the first commercially produced crutch; the design consisted of a walking stick with an upper arm support. Later, A.R. Lofstrand Jr. developed the first crutches with a height-adjustable feature. Over time, the design of crutches has not changed much, and the classic design continues to be the most commonly used.

Types

There are several types of crutches:

Underarm or axillary

Axillary crutches are used by placing the pad against the ribcage beneath the armpit and holding the grip, which is below and parallel to the pad. They are usually used to provide support for patients who have temporary restriction on ambulation.Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 1042-1043. With underarm crutches, sometimes a towel or some kind of soft cover is needed to prevent or reduce armpit injury. A condition known as ''crutch paralysis,'' or ''

crutch palsy Radial neuropathy is a type of mononeuropathy which results from acute Physical trauma, trauma to the radial nerve that extends the length of the arm. It is known as Paresthesia, transient paresthesia when sensation is temporarily abnormal. Sign ...

'' can arise from pressure on nerves in the armpit, or

axilla The axilla (also, armpit, underarm or oxter) is the area on the human body directly under the shoulder joint. It includes the axillary space, an anatomical space within the shoulder girdle between the arm and the thoracic cage, bounded superior ...

. Specifically, "the

brachial plexus The brachial plexus is a network () of nerves formed by the anterior rami of the lower four cervical nerves and first thoracic nerve ( C5, C6, C7, C8, and T1). This plexus extends from the spinal cord, through the cervicoaxillary canal in th ...

in the axilla is often damaged from the pressure of a crutch...In these cases the

radial Radial is a geometric term of location which may refer to: Mathematics and Direction * Vector (geometric), a line * Radius, adjective form of * Radial distance, a directional coordinate in a polar coordinate system * Radial set * A bearing f ...

is the nerve most frequently implicated; the

ulnar nerve In human anatomy, the ulnar nerve is a nerve that runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is ...

suffers next in frequency." An uncommon type of axillary crutches is the spring-loaded crutch. The underarm pad is a curved design that is open in the front with the grips for the hands shaped for maximum comfort and to reduce the prevalence of overuse injuries. These crutches also contain a spring mechanism at the bottom. The idea behind this design is to allow the user to propel themselves further, resulting in quicker movement from place to place, though research has shown that the difference in speed is very small when comparing standard axillary crutches to spring-loaded crutches.

Forearm

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.

Platform

These are less common and used by those with poor hand or grip strength due to

arthritis Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In som ...

cerebral palsy Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensa ...

, or other conditions. The forearm rests on a horizontal platform and is usually strapped in place with velcro-type straps that allow the platform or trough to release in case of a fall. The hand holds an angled grip which, in addition, should allow adjustment of length from trough to grip and side-to-side sway depending on the user's disability.

Leg support

These non-traditional crutches are useful for users with an injury or disability affecting one lower leg only. They function by strapping the affected leg into a support frame that simultaneously holds the lower leg clear of the ground while transferring the load from the ground to the user's knee or thigh. This style of crutch has the advantage of not using the hands or arms while walking. A claimed benefit is that upper thigh

atrophy Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations (which can destroy the gene to build up the organ), poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply t ...

is also reduced because the affected leg remains in use. Unlike other crutch designs these designs are unusable for pelvic, hip or thigh injuries and in some cases for knee injuries also.

Walking stick A walking stick or walking cane is a device used primarily to aid walking, provide postural stability or support, or assist in maintaining a good posture. Some designs also serve as a fashion accessory, or are used for self-defense. Walking sti ...

s or canes serve an identical purpose to crutches, but are held only in the hand and have a limited load bearing capability because of this.

Types of gaits

A student nurse, acting as physical therapist 8b07715v

One crutch

When using one crutch, the crutch may be placed on the side of the unaffected leg or used to bear the load of the affected leg.

Four-point gait

Those who can tolerate partial weight bearing on both legs usually use the four point gait. The sequence is right crutch, left leg, left crutch, right leg. This is the slowest of all gaits but also the safest in that three of the four points are in contact with the ground at any given time.Walk Easy > Explore > Crutch Gaits
Retrieved on May 19, 2018.

Two-point gait

Those who can tolerate partial weight bearing on both legs but require less support than a four-point gait usually use the two-point gait. The sequence is right crutch with left leg and then left crutch with right leg.

Three-point gait

The three point gait is usually used by those who cannot bear weight on one leg. Both crutches are advanced while bearing weight on the unaffected leg. Then the unaffected leg is advanced while bearing weight on the crutches.

Swing-to gait

A person with a non-weight bearing injury generally performs a "swing-to" gait: lifting the affected leg, the user places both crutches in front of himself, and then swings his uninjured leg to meet the crutches. A similar "swing-through" gait is when both legs are advanced in front of the crutches rather than beside them.

Stairs

When climbing up stairs, the unaffected leg is advanced first, then the affected leg and the crutches are advanced. When descending stairs, the crutches are advanced first and then the affected leg and the unaffected leg.

Alternative devices

The

knee scooter A knee scooter or knee walker is a two, three or four-wheeled alternative to crutches or a traditional walker as an ambulation aid. It is known by many other names, such as knee coaster, knee cruiser, knee caddy, orthopaedic scooter, or leg ...

and the

wheelchair A wheelchair is a chair with wheels, used when walking is difficult or impossible due to illness, injury, problems related to old age, or disability. These can include spinal cord injuries ( paraplegia, hemiplegia, and quadriplegia), cerebr ...

are possible alternatives for patients who cannot use or do not like crutches. These wheeled devices introduce an additional limitation, however, since most cannot negotiate stairs.

Materials

* Wood * Metal

alloy An alloy is a mixture of chemical elements of which at least one is a metal. Unlike chemical compounds with metallic bases, an alloy will retain all the properties of a metal in the resulting material, such as electrical conductivity, ductility, ...

s (most often steel,

aluminium alloy An aluminium alloy (or aluminum alloy; see spelling differences) is an alloy in which aluminium (Al) is the predominant metal. The typical alloying elements are copper, magnesium, manganese, silicon, tin, nickel and zinc. There are two principal ...

titanium alloy Titanium alloys are alloys that contain a mixture of titanium and other chemical elements. Such alloys have very high tensile strength and toughness (even at extreme temperatures). They are light in weight, have extraordinary corrosion resista ...

s) * Carbon or glass fiber reinforced composites *

Thermoplastic A thermoplastic, or thermosoft plastic, is any plastic polymer material that becomes pliable or moldable at a certain elevated temperature and solidifies upon cooling. Most thermoplastics have a high molecular weight. The polymer chains associate ...

Carbon fiber reinforced polymer Carbon fiber-reinforced polymers (American English), carbon-fibre-reinforced polymers (Commonwealth English), carbon-fiber-reinforced plastics, carbon-fiber reinforced-thermoplastic (CFRP, CRP, CFRTP), also known as carbon fiber, carbon compo ...

References

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