Overview
This lecture covers the proper fitting and use of crutches, canes, and walkers, including fitting guidelines, safe movement techniques, stair navigation, and sit-to-stand instructions.
Crutches: Fitting and Use
- Crutches must be adjusted for patient height, including the handgrip and crutch length.
- There should be a 2-3 finger (1-1.5 inch) gap between the axilla (armpit) and crutch rest pad.
- Handgrips should align with the top of the hip line, elbow bent at ~30 degrees when holding.
- Weight should be on handgrips, not underarms, to prevent nerve damage.
Crutches: Gaits and Mobility
- Begin with a gait belt and start in tripod position (crutches 6 inches diagonal from feet).
- 2-point gait: Move opposite crutch and foot together (right crutch/left foot, left crutch/right foot).
- 4-point gait: Move each crutch and foot separately in sequence.
- 3-point gait: Move both crutches and injured leg together, then the non-injured leg.
- Swing-to gait: Both crutches forward, then legs swing to crutches.
- Swing-through gait: Both crutches forward, then legs swing past crutches.
Crutches: Stairs and Chairs
- Going up stairs: "Good up, bad down" — step with the good leg first, followed by crutches and bad leg.
- Going down stairs: Crutches and bad leg first, then good leg.
- To sit: Back to chair, move crutches to injured side, grip handgrips, extend injured leg, sit.
- To stand: Crutches on injured side, extend injured leg, push up with non-injured leg and handgrips.
Cane: Fitting and Use
- Adjust cane so the top is at the greater trochanter or wrist crease when standing.
- Elbow should be flexed 15-30 degrees.
- Hold cane on the strong side.
- To walk: Move cane and weak leg forward together, then strong leg.
- To ascend stairs: Good leg, then cane and bad leg; to descend: cane and bad leg, then good leg.
- To sit: Back to chair, cane on side, hands on armrests, sit with weak leg extended.
- To stand: Place cane on strong side, lean forward, push down on cane and armrest, stand with strong leg.
Walker: Fitting and Use
- Adjust walker so wrist crease lines up with handgrips; elbows flexed 15–30 degrees.
- To walk: Place walker so back legs align with middle of feet, lift and set all four points down, move weak leg, then strong leg.
- Patient should look ahead, not at their feet.
- To sit: Back until chair touches legs, extend weak leg, hands on armrests, sit.
- To stand: Walker in front, hands on armrests, lean forward, extend weak leg, push up, then grab walker handgrips.
Key Terms & Definitions
- Tripod Position — Standing with both crutches 6 inches diagonally from feet for stability.
- 2-point/4-point/3-point Gaits — Crutch walking patterns for different levels of weight bearing.
- Swing-to/Swing-through Gaits — Patterns where both legs swing to or past crutches.
- Gait Belt — Safety belt used to assist patients during ambulation.
Action Items / Next Steps
- Take the free quiz on assistive devices.
- Review procedures for fitting and assisting with crutches, canes, and walkers.