Crutch walking

crutch walking
- definition
- purpose
- crutch walking gaits
- general instruction

1. CRUTCH WALKING
DEFINITION OF CRUTCHES
Crutches are simple assistive devices to help patients who cannot walk by
themselves due to various reasons either temporarily or permanently
The nurse should teach the patient about the proper use of crutches. One of the pre-
requisites is to develop power in the shoulder girdle and upper extremities, which
will bear the patient’s weight while he is crutch walking. One way to strengthen
these muscles is to use parallel bars. The following muscle groups are important
for crutch walking.
 Arm flexors to move the crutches forward
 Fore arm flexors to hold the crutch at the correct angle
 Finger and thumb flexor to grip the crutches.
 Wrist and dorsi flexors to keep hand on the hand pieces.
 Shoulder girdle depressors and downward rotators to support the
body on the crutches when the body is raised from the floor.

PURPOSE
 To ambulate deformed patients
 To provide rest to the injured or fractured limb
 To develop weight bearing capacity
 To promote healing of fractures
 To prevent complications
 To prevent normal functioning of healed, injured or fractured part
of the patient.

INDICATIONS
 Used after operation of the hip
 Following amputation of leg
 Injuries of legs when mobility is desirable

2.  Patient with one leg plaster
 Lower limb prosthesis

CRUTCH WALKING GAITS
There are five gaits commonly used in crutch walking. All these
gaits begin with a tripod position (three legged support) i.e. two
crutches and the feet.
 TWO – POINT GAIT- this is a gait similar to walking. In
this gait, weight bearing is permitted equally on both feet.
The sequence of movement are as follows-
a) Tripod position
b) Left crutch and right foot are placed forward.
c) Right crutch and the left foot are placed forward.
 THREE POINT GAIT (orthopaedic gait) – this gait is used
when complete weight bearing is allowed on one foot and
partial or no weight bearing is allowed on the other foot. It is
faster then the four point gait. The sequence of movements of
the crutches and feet are as follows-
a) Tripod position
b) Both crutches and the non-weight bearing foot are placed
forward.
c) Weight bearing foot is placed forward.
 FOUR POINT ALTERNATE CRUTCH GAIT
This gait is used by the clients who can bear partial weight on
both of their feet (example cerebral palsy). It is more safe
than the other gaits, because there are three point of support
on the floor at one time. The movement of the crutches and
the feet are as follows-

3. a) Tripod position – a position in which both feet are placed
together and two crutches are in front and lateral to the
feet.
b) Right crutch forward
c) Left foot forward
d) Left crutch forward
e) Right foot forward.
 SWING TO CRUTCH GAIT
In this gait both crutches are placed ahead of the client and
the client then swings forward to crutches. Since the muscles
of lower extremity are not used in walking, prolonged use of
these gaits result in atrophy of the unused muscles.
 SWING THROUGH CRUTCH GAIT
In this gait both crutches are placed ahead of the client and
the client then swings through the crutches and advances to a
position in front of the crutches. This gait allows the client to
a movement faster than any other gaits or even normal
walking.
TYPES OF CRUTCHES AVAILABLE
 Armpit rest ( axillary bar)
 Adjustable hand grip
 Upright rods
 Adjustable extension rod
 Rubber crutch tip

PREPARATION OF THE CLIENT FOR CRUTCH WALKING
The psychological preparation of the client is exigent for the crutch
walking. The nurse should win the confidence and co-operation of the
client, for his successful crutch walking. If the client is afraid of fall
during crutch walking he may not tempt for it.

4. Prior to crutch walking, the clients should do some exercises and that
will strengthen the muscles of arms, hands, shoulder girdle and that of
the lower limbs. These exercises also will help to prevent contractures
and deformities in the hip and knee joint. The important exercises that
are to be included are –
1. Exercises that prevent flexion contracture of the hip joint
To prevent flexion contracture of the hip joint, the client after
the amputation of the lower limb should be asked to lie on the
abdomen for some time following the operation. The time should
be increased day to day. If the client has an amputation below the
knee, the client can begin to hyperextend his thigh and leg as he
lies on his abdomen. If the client has an amputation above the
knee, wait for specific orders from the doctor because this exercise
will induce tension on the sutures and may cause hemorrhage.
2. Exercises that prevent flexion contracture of the knee joint
In order to prevent flexion contracture of the knee joint, the client
may be asked to sit at the edge of the bed and extend his lower
limb. While the client is lifting the lower limb the nurse give
resistance to the leg by pressing them down.
3. Exercises that strengthen the abdominal muscles
The client should practice lifting the stump and the buttocks off the
bed while he is lying flat on his back. This exercise will help to
develop abdominal muscles and are necessary to stabilize the
pelvis when the client stoops or bends
4. Exercises for the upper limbs
In order to extend the elbow and to strengthen the triceps muscles,
the client should lie on the abdomen and does push up exercises
several times a day. This can be done in another way also. The
client may be asked to sit up on the edge of the bed with his feet on
a chair. While pressing his palms against the mattress, he tries to
lift his buttocks off the bed. This exercise strengthen the triceps
muscle, extends the elbow and helps the client to become

5. accustomed to rest his weight on his hands, because in crutch
walking the client’s weight is borne not in the axilla but on the
palms of the ahnds with the arms extended.
5. Exercise for the prevention of deformities
The exercises carried out by the client should include exercises for
the unaffected limbs also. If the unaffected limb develops
deformities such as foot drop, it will affect the ambulation of the
client.
GENERAL INSTRUCTION

1. It is imperative to have a crutch of proper length. Therefore it
should be measured carefully.
2. Frequent assessment of the height of the crutches should be
made –
a) When the client’s posture improves
b) When the child grows tall
c) When the shoe height is changed
If the re-adjustments are not made from time to time, they may
develop postural deformities.
3. Make sure that the crutches are safe and properly fastened. All
bolts should have wing nuts which must be tight
4. The extension rod and the upright rods should have an adequate
number of grooves to adjust the height of crutches as well as the
hand grips.
5. The crutches should have a rubber tip (castors) to prevent
slipping.
6. Before the crutch walking is attempted, stress the importance of
maintaining correct posture and balance of the body. The
crutches and the feet are placed in tripod position thus
producing a wide base of support. To provide stability, a greater
height requires a broad base. Thus, a tall person requires a wider
base than a short person.

6. 7. To maintain a correct posture the client should keep his knees
and hips extended, the back straight and the head held straight
and the head held straight and high. There should be no hunch
on the shoulders.
8. Before teaching the crutch walking, the nurse should make sure
that the client have not altered level of consciousness or
equilibrium that may interfere with the safe use of crutches.
9. There should be no injury or limitation of the movement of the
hands, arms, shoulders or back that may interfere with the
client’s ability to bear weight on hands or mobilize.
10. The floor surface must be non-slippery and free of obstacles.
11. The practice area should be sufficiently large and free of
traffic and distractions
12. The client should wear sturdy flat shoes to prevent slipping
13. The client should not wear loose fitting garments that may be
caught in crutches
14. The nurse should practice crutch walking before she attempts
to teach the client about crutch walking, so that she cam learn
the hazards associated with the crutch walking and warn the
client about it. She should have a pair of crutches adjusted to her
height in order to demonstrate crutch walking correctly.
15. The client should be made conscious of the hazards
associated with the crutch walking (e.g., crutch paralysis, falls,
back pain).
16. The nurses should have patience and tact when she deal with
the client who are crippled because they would make a very
gradual process
17. Client should have an adequate support and encouragement
when they learn to use crutches. Disabled clients are afraid and
anxious to use crutches for the fear of fall. Therefore, the nurse
should stand close to the client to support him if a fall is
anticipated.

7. 18. In preparation for crutch walking, the clients should have
exercises which strengthen the muscles of the upper and the
lower limbs, abdomen etc. These exercises will help the client
to balance his body weight.
19. There should be rest periods between the crutches walking
because crutch walking is tiresome. There must be chair or
bench nearby on which the client can rest.
20. The client should be taught to bear his body weight on the
hand grip rather than on the axillary bar. If the pressure is
applied on the axillary bar, the client may develop crutch
paralysis
21. When a client gets his crutches in the initial stage of his
practice, the axillary bar should not be padded because it
encourages him to learn on it while walking, thus increasing the
danger of pressure upon the brachial nerve plexus,
22. Every client should learn at least 2 gaits – one for the rapid
movement and another for walking in crowded situations
23. Before a client is sent home on crutches, the nurse should
make sure whether the client can act spontaneously, get in and
out of the chairs, on and off the toilet, in and out off the toilet, in
and out of the doors, ups and down the stairs and the ramps,can
wear clothes etc.