6.11 Standing from lying position with crutches

When in bed, the user first moves to a sitting position and maintain balance. The user then inches forward to the edge of the bed or the chair (users can also first transfer to an armless chair). The user picks up the crutches with upper limb of the affected side. Both axillary crutches are then placed upright and same side of the injured side. Using the armrest of the chair and the crutches handgrips as support, the user slowly moves the injured leg forward, moving out of the chair and rising up on the uninjured leg and the crutches. The user then position the crutches properly and then balances up in preparation to move, using any of the available weight bearing status that can be accommodated based on the user's condition.

### 6.12 Sitting with crutches

On getting to the chair, the user is instructed to turn and back up against the chair, moving backward until the back of the legs touches the chair. While bearing weight on the uninjured leg, and the crutches on either side of the user, the injured


are placed side by side on the injured side, and held at the hand grips. The user holds both handgrips together with the hand of the affected side and reaches back for the armrest of the chair with the other hand. Using the armrest of the chair and the crutch handgrips as support, the user slowly moves the injured leg forward and lowers himself into the chair. The axillary crutches are placed nearby. Standing them on the axillary pads, when possible, makes it less likely that they will tip over

Climbing stairs with axillary crutches requires strength and flexibility. If the user is unsure of his strength, he should be instructed to turn around and sit on the stairs and scoot himself up one stair at a time using his uninjured leg to propel

Where strength is available, the user is instructed to keep the axillary crutches in

Note that someone should always be at the back of the user learning to climb the

Going down stairs with axillary crutches also requires strength and flexibility. If the user is unsure of his/her strength, he should sit down and scoot down the stairs one at a time, bracing himself with the unaffected leg. The user should keep

When going down stairs with axillary crutches, the user should lead with the affected/involved lower limb and the axillary crutches (the unaffected limb carries the whole body at this period) and then bring the unaffected lower limb down from

If the stairway has a handrail, the user should hold both axillary crutches at the hand grips and opposite the hand on the handrail. With the user's weight on the unaffected/uninvolved lower limb, the user moves the axillary crutches and the affected/involved lower limb down the stairs; with the user bearing weight on the handrail and the handgrips of the crutches and brings the unaffected/uninvolved lower limb down the stairs. The user should take time to regain balance. The process is repeated as the user moves forward. The users are given a prior instruction that

behind (Figure 11) and then bring the unaffected lower limb down behind.

the axillary crutches in one hand and take it along on the way down.

they can rest when the need arises as they move down the stairs.

one hand and bring them up with him/her. When climbing stairs with axillary crutches, the user leads with the uninjured leg and brings the injured leg and axillary crutches up behind him (Figure 10). If the stairway has a handrail, the user should place both axillary crutches under the arm opposite the handrail and grip the handgrips together in one hand. The user places his weight on the handrail and the handgrips, leans slightly forward, and brings his uninjured leg up one step. He then brings the axillary crutches and the injured leg up the step and advances his hand up the handrail. Once the user has regained his balance, the process is repeated. The user should be instructed to take his time and rest halfway up the stairs if necessary. To climb stairs with no handrail, the user leans slightly forward and puts his weight on the handgrips of the axillary crutches. The user moves the uninjured leg up the step. He then shifts his weight to the uninjured leg and brings the axillary crutches and injured leg up the step. His foot and axillary crutch tips are kept in the middle of the step, away from the edge to avoid slipping. The user is instructed to take his time, rest as needed, and ask for help if necessary. Going up the stairs with axillary crutches stay with the affected leg behind and the uninjured leg goes up first.

and fall away from the user.

stair with axillary crutches.

79

6.14 Going down stairs with crutches

himself.

6.13 Climbing upstairs with crutches

Ambulatory Devices: Assessment and Prescription DOI: http://dx.doi.org/10.5772/intechopen.89886

#### Table 4.

Ambulation with crutches [19].

leg is advanced slightly forward. Both crutches are rolled out of the axilla and held by the hand grip. Then, the crutches on the unaffected side is then moved across and on the outer border of the crutch on the affected side, such that both crutches

are placed side by side on the injured side, and held at the hand grips. The user holds both handgrips together with the hand of the affected side and reaches back for the armrest of the chair with the other hand. Using the armrest of the chair and the crutch handgrips as support, the user slowly moves the injured leg forward and lowers himself into the chair. The axillary crutches are placed nearby. Standing them on the axillary pads, when possible, makes it less likely that they will tip over and fall away from the user.

### 6.13 Climbing upstairs with crutches

Climbing stairs with axillary crutches requires strength and flexibility. If the user is unsure of his strength, he should be instructed to turn around and sit on the stairs and scoot himself up one stair at a time using his uninjured leg to propel himself.

Where strength is available, the user is instructed to keep the axillary crutches in one hand and bring them up with him/her. When climbing stairs with axillary crutches, the user leads with the uninjured leg and brings the injured leg and axillary crutches up behind him (Figure 10). If the stairway has a handrail, the user should place both axillary crutches under the arm opposite the handrail and grip the handgrips together in one hand. The user places his weight on the handrail and the handgrips, leans slightly forward, and brings his uninjured leg up one step. He then brings the axillary crutches and the injured leg up the step and advances his hand up the handrail. Once the user has regained his balance, the process is repeated. The user should be instructed to take his time and rest halfway up the stairs if necessary. To climb stairs with no handrail, the user leans slightly forward and puts his weight on the handgrips of the axillary crutches. The user moves the uninjured leg up the step. He then shifts his weight to the uninjured leg and brings the axillary crutches and injured leg up the step. His foot and axillary crutch tips are kept in the middle of the step, away from the edge to avoid slipping. The user is instructed to take his time, rest as needed, and ask for help if necessary. Going up the stairs with axillary crutches stay with the affected leg behind and the uninjured leg goes up first.

Note that someone should always be at the back of the user learning to climb the stair with axillary crutches.

#### 6.14 Going down stairs with crutches

Going down stairs with axillary crutches also requires strength and flexibility. If the user is unsure of his/her strength, he should sit down and scoot down the stairs one at a time, bracing himself with the unaffected leg. The user should keep the axillary crutches in one hand and take it along on the way down.

When going down stairs with axillary crutches, the user should lead with the affected/involved lower limb and the axillary crutches (the unaffected limb carries the whole body at this period) and then bring the unaffected lower limb down from behind (Figure 11) and then bring the unaffected lower limb down behind.

If the stairway has a handrail, the user should hold both axillary crutches at the hand grips and opposite the hand on the handrail. With the user's weight on the unaffected/uninvolved lower limb, the user moves the axillary crutches and the affected/involved lower limb down the stairs; with the user bearing weight on the handrail and the handgrips of the crutches and brings the unaffected/uninvolved lower limb down the stairs. The user should take time to regain balance. The process is repeated as the user moves forward. The users are given a prior instruction that they can rest when the need arises as they move down the stairs.

leg is advanced slightly forward. Both crutches are rolled out of the axilla and held by the hand grip. Then, the crutches on the unaffected side is then moved across and on the outer border of the crutch on the affected side, such that both crutches

Crutch placement (to support the affected limb) when descending stair case using axillary crutches.

Non-weight bearing (NWB) and touch down weight bearing (TDWB)

gait

Pattern sequence

Prosthesis

Table 4.

Three point axillary crutch

First move both axillary crutches forward and then weaker lower limb forward. Then bear all the weight down through the axillary crutches, and move the stronger or unaffected lower limb forward (Figure 9)

Advantage Eliminates all weight bearing on the affected leg

coordination is required

confident he may progress from a swing to gait to a swing through gait, where the unaffected leg is placed ahead of the crutches

Disadvantage Good balance and

Progression As the user becomes

Ambulation with crutches [19].

Partial weight bearing (PWB), weight bearing as tolerated (WBT) and full weight bearing (FWB)

gait

gait

pattern

Two point axillary crutch

Left axillary crutch and right foot together, then the right axillary crutch and left foot together (Figure 9)

Faster than the four point

Can be difficult to learn the

Four point axillary crutch

Left axillary crutch, then right foot, followed by right axillary crutch, and then left foot (Figure 9)

Provides excellent stability as there are always three points in contact with the ground

Slow walking speed and difficult to learn

gait

Figure 11.

78

### Prosthesis

To go down the stairs with no handrail, the user bearing weight on the unaffected/uninvolved lower limb and the handgrips of the axillary crutches, moves the axillary crutches and the affected/involved lower limb forward down the stairs. The user keeps the foot and the tips of the axillary crutch at the middle of the step, away from the edge to avoid slipping. Are given a prior instruction that they can rest when the need arises as they move down the stairs. For safety reasons, someone (i.e., therapist) can walk in front of the users as they move down the stairs. This person can assist the user into a sitting position if users become fatigued. Going down the stairs with axillary crutches stay with the affected leg behind.

Hemi cane: this also has four point of support for floor contact but the legs are

The ideal cane measurement is obtained by placing the centre of the cane base at 6 inches lateral and anterior to the border of the fifth toe. Then the proximal part

angled from the shaft to increase stability of the cane.

Ambulatory Devices: Assessment and Prescription DOI: http://dx.doi.org/10.5772/intechopen.89886

2.Fit easily on every environment including stairs.

3.Use more for support than weight bearing.

1.Not a good weight bearing ambulatory device.

2.Cannot be used by fearful user.

7.5 Fitting of cane for ambulation

7.3 Advantages

7.4 Disadvantages

Figure 13.

81

Standing using the cane (full weight bearing).

1.Cane is inexpensive.
