Crutch Use
Crutches remove weight from one or both legs, enabling the patient to support himself with his hands and arms. Typically prescribed for the patient with lower-extremity injury or weakness or one who has had a surgical procedure on the lower limbs, crutches require balance, stamina, and upper-body strength for successful use. Crutch selection and walking gait depend on the patient’s condition. The patient who can’t use crutches may be able to use a walker.
Equipment
Crutches with axillary pads, handgrips, and rubber suction tips ▪ Optional: walking belt.
Three types of crutches are commonly used. Standard aluminum or wooden crutches are used by the patient with a sprain, strain, or cast. They require stamina and upper-body strength. Aluminum forearm crutches have a collar that fits around the forearm and a horizontal handgrip that provides support, allowing these crutches to provide stability and moderate support; they’re are useful for patients with generalized weakness in the lower extremities, such as those with paraplegia or cerebral palsy. The patient using forearm crutches generally uses the swing-through gait.
Platform crutches are used by a patient who has an upper-extremity deficit that prevents weight bearing through the wrist, such as in those with arthritis or an upper-extremity fracture. These crutches provide padded surfaces for the upper extremities.
Preparation of Equipment
After choosing the appropriate crutches, adjust their height with the patient standing or, if necessary, recumbent. (See Fitting a patient for a crutch.)
Implementation
Verify the doctor’s order.
Consult with the physical therapist to coordinate rehabilitation orders and teaching.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.1
Explain the procedure to the patient and answer any questions to decrease anxiety.
Determine the patient’s weight-bearing status to help determine which gait to teach the patient.
Describe the gait you will teach and the reason for your choice.
Place a walking belt around the patient’s waist, if necessary, to help prevent falls. Tell the patient to position the crutches and to shift his weight from side to side.
Place the patient in front of a full-length mirror to facilitate learning and coordination.
Teach the four-point gait to the patient who can bear weight on both legs. Although this is the safest gait because three points are always in contact with the floor, it requires greater coordination than others because of its constant shifting of weight. Use this
sequence: right crutch, left foot, left crutch, right foot. Suggest counting to help develop rhythm, and make sure each short step is of equal length. If the patient gains proficiency at this gait, teach him the faster two-point gait. (See Crutch gaits, page 222.)
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
