Goals:
To limit the weight-bearing on the injured leg and improve the range of motion and self-care ability.

How to adjust the length of crutches:
  1. Crutches:
    1. Length can be calculated by subtracting 40 cm from the patient's height. 
    2. The top of the crutches should be below one’s armpits by about two fingers’width.
    3. The handgrips should be adjusted to an appropriate height, in which one’s elbows are able to slightly flex about 20–30 degrees when holding the handgrips.
  2. Walker:
    The walker should be adjusted to an appropriate height, in which one’s elbows are able to slightly flex about 20–30 degrees when holding the handle.
 
Three-Point Crutches Gait:
  1. Crutches (Figure 1):
    1. Put weight on the uninjured leg and move both crutches forward at the same time.
    2. Swing the injured leg forward.
    3. Put weight on both crutches and then move the uninjured leg forward.
      ef9f39cf7b2507637cdb3b81cc997d4a.png
  2. Walker (Figure 2):
    1. Place both hands on the handle, and balance yourself.
    2. Move the walker forward 25 to 30 cm.
    3. Move the injured leg forward.
    4. Put weight on both hands and then move the uninjured leg forward..
      0ade1907b830ee1085ee5cd8edb5df25.png
 
Going upstairs and downstairs using crutches:
  1. Going upstairs (Figure 3):
    1. Stand up straight and use both crutches for body-weight support.
    2. Use the uninjured leg to step up first.
    3. With the uninjured leg as body-weight support, bring both crutches and the injured leg step up together.
      bf1e9d845a7675eafffbbbd654ea951d.png
  2. Going down stairs (Figure 4):
    1. Use the uninjured leg for body-weight support with the knee slightly flexing and then allow both crutches step down first.
    2. Let the injured leg step down.
    3. Using both crutches as body-weight support, allow the uninjured leg to step down.
      25828c09910b29d27884d4dd1e22a563.png
 
Caution in daily life:
  1. If it is the first time using crutches or walker, the nurses will adjust the crutches or walker to an appropriate height and teach you through assistance.
  2. Before getting out of bed and walking, please confirm that you are prepared.
    1. Wear well-fitted pants and good walking shoes to prevent a fall.
    2. When walking with both crutches, the rubber pads should be attached properly at the bottom, and you should check them regularly. You must check the screws and rubber mat and make sure the crutches are sturdy before beginning any walk.
    3. Be aware of the surface on which you are walking. It should be clean, flat, and dry, in order to prevent a fall.
  3. Please pay attention to the following when walking.
    1. Stand steadily before you walk and take small steps to walk.
    2. Use hands and arms as body-weight support during standing. To avoid brachial plexus compression, adjust the proper height of the crutches. The height of the crutches should be below your armpits by about two fingers’ width. Keep the crutches about 10 cm out from the anterior aspect of your feet when you are standing up.
    3. Look straight ahead when walking, rather than down at your feet. Each step should be equal. You should not jump when using crutches.
    4. According to your physical condition, the level of activity can be increased gradually when you walk with crutches.
    5. Improper use of auxiliary tools may cause a fall, damage the brachial plexus, and/or affect the recovery of the injured leg. Follow the nurse's instructions to use the auxiliary tools.
  4. To avoid sand or stone attachment, keep the crutches clean and in shape.
  5. You can lift sandbags or do push-ups every day to strengthen the muscles of your upper extremities.
 
Reference
  1. Laplante, N. (2017). Exercise and mobility. In Perry, A. G., Potter, P. A., & Ostendorf, W. R (Eds.), Clinical nursing skills and techniques (9th ed., pp. 433-445). St. Louis, MO: Elsevier.
  2. Misawa, Y., & Takeishi, K. (2018). Crutch Walking-Induced Neurovascular Complications. Open J Surg Case Rep,1, 01-03. doi:10.33513/OJSC/1801-03
  3. Rasouli, F., & Reed, K. B. (2019). Walking Assistance Using Crutches: A State of the Art Review. Journal of Biomechanics, 109489. doi.org/10.1016/j.jbiomech.2019.109489
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