Axillary Crutches Research Articles

Effects of spring-loaded crutches on gastrocnemius activity and upward displacement of the body during gait

[Purpose] This study investigated the effects of spring-loaded crutches on gastrocnemius muscle activity and upper body displacement in the sagittal plane during gait. [Subjects and Methods] The study involved 12 healthy males. All subjects performed crutch gait by using spring-loaded crutches and axillary crutches. During this gait, the gastrocnemius muscle activity was measured using a wireless electromyography system, and upward displacement of the body was measured using a three-dimensional motion analysis system. [Results] The gastrocnemius activity was significantly lower but upward displacement of the body was significantly greater with the spring-loaded crutches than with axillary crutches. [Conclusion] Spring-loaded crutches allow efficient crutch gait and involve less effort from the gastrocnemius muscle.

Total Hip Replacement after Failed Internal Fixation of Trochanteric Femoral Fractures

Background: Failure of fixation of trochanteric fractures of the femur results in great disability and pain. Hip arthroplasty is a helpful reconstructive procedure in patients with poor bone stock, avascular necrosis of the femoral head, associated with damaged acetabular articular cartilage. Objective: This prospective study is to evaluate clinically and radiologically, the early results of total hip arthroplasty in a group of patients with failed internal fixation of trochanteric femoral fractures. Patients and Methods: Total hip replacement was done for fifty patients with failed treatment of proximal femoral fractures, only forty two patients 29 males and 13 females completed the follow up and eight were lost. The procedure was carried out through a lateral exposure in all cases. Harris Hip Score (HHS) was used for clinical evaluation preoperatively, postoperatively. Radiographic evaluation comprising anteroposterior radiographic views of the pelvis and femur and a lateral view of the femur were performed at follow-up visits. Results: The mean time of follow up was 42 months (range from 30-72 months). The mean Harris Hip Score was improved from a mean of 24 points preoperative to 88 points at final follow up. Pain relief and gait correction were noted at the final follow up. Thirty patients (72%) could freely walk outdoors using a cane or elbow crutch; eight patients (19%) had a limited walking ability using two axillary crutches, and four patients (9%) were able to walk indoors only. Conclusion: Total hip arthroplasty is an accepted procedure after failed internal fixation of trochanteric femoral fractures. Individualization of the implant selection according to patient age, level of activity, the bone stock of proximal femur, and the condition of the acetabulum.

Using a Pressure Mapping System to Evaluate Contact Pressure on Hands During Use of Axillary Crutches.

The aim of this study was to evaluate different handles used in axillary crutches with a Pressure Mapping System. The Grip Versatek system from Tekscan Inc. was used to measure the levels and the distribution of contact pressure in the hands during a simulated activity of ambulation with crutches. The sample included ten able-bodied subjects: five men and five women. The results show that the different models of handles appear to have influenced the pressure levels measured during the activity. Therefore, the measurement equipment provides parameters that allow the comparison among different designs and assess their contribution to the comprehension of the demands of ergonomic handles.

2E3-2 スプリング内蔵型松葉杖が杖歩行時の上肢体幹筋活動および荷重安定性に及ぼす影響

2E3-2 スプリング内蔵型松葉杖が杖歩行時の上肢体幹筋活動および荷重安定性に及ぼす影響

Mechanical and Cardiopulmonary Responses To The Use of a Newly Designed Leg Simulator

Axillary crutches are convenient for use but they impose certain physical and cardiovascular demands that not everyone can tolerate. ED LegsimTM is a newly designed assistive device considered as a viable alternative for assisted ambulation. In this study, Twenty-seven normal participants walked using the ED leg simulator, axillary crutches and unassisted. Participants reported that the simulator had less cardiopulmonary impact, as indicated by heart rate response and perceived exertion, when the six-minute walk test was performed. Participants exhibited similar impact patterns and vertical ground reaction force values to that of normal walking as measured by force plates. Given these important findings, practitioners should examine the effectiveness of the ED LegsimTM for individuals with lower extremity impairments, restricted weight-bearing status, particularly those with a compromised cardiopulmonary system.

Early weight-bearing after periacetabular osteotomy leads to a high incidence of postoperative pelvic fractures.

BackgroundIt has not been shown whether accelerated rehabilitation following periacetabular osteotomy (PAO) is effective for early recovery. The purpose of this retrospective study was to compare complication rates in patients with standard and accelerated rehabilitation protocols who underwent PAO.MethodsBetween January 2002 and August 2011, patients with a lateral center-edge (CE) angle of < 20°, showing good joint congruency with the hip in abduction, pre- or early stage of osteoarthritis, and age younger than 60 years were included in this study. We evaluated 156 hips in 138 patients, with a mean age at the time of surgery of 30 years. Full weight-bearing with two crutches started 2 months postoperatively in 73 patients (80 hips) with the standard rehabilitation protocol. In 65 patients (76 hips) with the accelerated rehabilitation protocol, postoperative strengthening of the hip, thigh and core musculature was begun on the day of surgery as tolerated. The exercise program included active hip range of motion, and gentle isometric hamstring and quadriceps muscle sets; these exercises were performed for 30 minutes in the morning and 30 minutes in the afternoon with a physical therapist every weekday for 6 weeks. Full weight-bearing with two axillary crutches started on the day of surgery as tolerated. Complications were evaluated for 2 years.ResultsThe clinical results at the time of follow-up were similar in the two groups. The average periods between the osteotomy and full-weight-bearing walking without support were 4.2 months and 6.9 months in patients with the accelerated and standard rehabilitation protocols (P < 0.001), indicating that the accelerated rehabilitation protocol could achieve earlier recovery of patients. However, postoperative fractures of the ischial ramus and posterior column of the pelvis were more frequently found in patients with the accelerated rehabilitation protocol (8/76) than in those with the standard rehabilitation protocol (1/80) (P = 0.013).ConclusionThe accelerated rehabilitation protocol seems to have advantages for early muscle recovery in patients undergoing PAO; however, postoperative pelvic fracture rates were unacceptably high in patients with this protocol.

Recurrent brachial artery embolism caused by a crutch-induced axillary artery aneurysm: report of a case

We report a case of axillary artery aneurysm with brachial artery embolism in a 60-year-old man who had walked with the assistance of axillary crutches all of his life since poliomyelitis during infancy had left him with lower limb paralysis. We performed bypass grafting from the axillary to brachial artery with exclusion of the aneurysm. An axillary artery aneurysm is rare, but potentially lethal for the upper extremity; therefore, surgical treatment should be considered.

Mechanical Efficiency of Walking with Spring-loaded Axillary Crutches

ABSTRACT The objective of this study was to investigate the effect of using spring-loaded crutches on mechanical efficiency in comparison to the use of standard crutches. Seven healthy male participants were recruited for this experiment. They were instructed to walk around a track on two types of crutches for five minutes under four controlled conditions. Ground reaction force and motion trajectories were recorded, which were used to calculate mechanical energy expenditure. Simultaneously, portable gas analysis machinery was used to collect the metabolic parameters of participants, in order to determine mechanical efficiency, the ratio of mechanical energy expenditure to metabolic energy expenditure. It was found that the mechanical efficiency was significantly higher when participants walked with spring-loaded crutches than when they walked with standard crutches. There were no significant differences in metabolic energy expenditure between the spring-loaded crutch conditions and standard crutch conditions.

Recurrent upper limb ischaemia due to a crutch-induced brachial artery aneurysm

An 83-year old man who had used bilateral axillary crutches for 67 years was referred to our hospital for acute left upper limb ischaemia. He underwent successful recanalization through emergent catheter thromboembolectomy. However, a crutch-induced left brachial artery aneurysm was subsequently detected by computed tomography. Therefore, we performed aneurysm exclusion and subsequent saphenous vein bypass grafting. When a crutch user presents with upper limb ischaemia, a high index of suspicion and early identification of the crutch induced vascular injury are mandatory for appropriate treatment.

Effects of Axillary Crutch Length on EMG Activity of the Trunk Muscles and Range of Motion of the Lumbar Spine, Pelvis, and Hip Joint in Healthy Men

This study investigated the effects of axillary crutch length on trunk muscle activity and lumbo-pelvic-hip complex movements during crutch gait. Eleven healthy men participated in this study. The participants performed a three-point gait with optimal, shorter, and longer crutch lengths. Weight-bearing (WB) side was determined as the dominant leg side. The electromyography (EMG) activity of the bilateral rectus abdominis (RA) and erector spinae (ES) muscles and lumbo-pelvic-hip complex movements were monitored using a three-dimensional motion system with wireless surface EMG. Differences in the EMG activity of RA and ES muscles and range of motion (ROM) of lumbar spine, pelvis, and hip among conditions were analyzed using one-way repeated-measures analysis of variance, and a Bonferroni correction was conducted. There was less RA muscle activity on the WB side under the optimal crutch length condition compared with shorter and longer crutch length conditions (p<.05). The EMG activity of the RA muscle on the non-WB side and ES muscle on the WB side were significantly decreased under the optimal crutch length condition compared with shorter crutch length condition (p<.05). No significant differences in the EMG activity of the ES muscle on the non-WB side and ROM of lumbo-pelvic-hip complex were found among conditions (p>.05). These findings indicate that the optimal crutch length improves the trunk muscle efficiency during crutch gait.

Experimental characterization of axillary/underarm interface pressure in swing-through crutch walking

Supporting weight on the upper support of crutches is not recommended because it can lead to axillary nerve damage. Despite this warning, improper axillary loadings may still occur because of a lack of arm strength or fatigue. It is generally accepted that improper use of conventional axillary crutches contributes to axillary nerve damage, but surprisingly there are no studies characterizing axillary support/underarm configurations. In this study, we compared traditional and horizontal axillary support designs by measuring various biomechanical parameters on the axillary support during a swing-through gait while supporting weight on the axillary support. Subjects found the axillary support that remains horizontal to be more comfortable than the axillary support of axillary crutches. The higher perceived comfort may be attributed to the lower force and contact area, both average and maximum, developed on the horizontal axillary support and/or shorter excursion of the position of the center of force during a stride. These findings suggest that avoiding all weight bearing on the axillary support may be an overly conservative recommendation for supports that remain horizontal. Individuals with insufficient arm strength may benefit by considering this type of support, but because further study is needed, a physical therapist should be consulted.

In vivo measurement of shoulder joint loads during walking with crutches

BackgroundFollowing surgery or injury of the lower limbs, the use of walking aids like crutches can cause high loads on the shoulder joint. These loads have been calculated so far with computer models but with strongly varying results. MethodsShoulder joint forces and moments were measured during crutch-assisted walking with complete and partial unloading of the lower limbs. Using telemeterized implants in 6 subjects axillary crutches and forearm crutches were compared. A force direction was more in the direction of the long humeral axis, and slightly lower forces were assumed using axillary crutches. Similar force magnitudes as those experienced during previously measured wheelchair weight relief tasks were expected for complete unloading. The friction-induced moment was hypothesized to act mainly around the medio-lateral axis during the swing phase of the body. FindingsMaximum loads of up 170% of the bodyweight and 0.8% of the bodyweight times meter were measured with large variations among the patients. Higher forces were found in most of the patients using forearm crutches. The hypothesized predominant moment around the medio-lateral axis was only found in some patients. More often, the other two moments had larger magnitudes with the highest values in female patients. The assumed different load direction could only be found during partial unloading. InterpretationIn general the force magnitudes were in the range of activities of daily living. However, the number of repetitions during long-lasting crutch use could lead to shoulder problems as a long-term consequence. The slightly lower forces with axillary crutches could be caused by loads acting directly from the crutch on the scapula, thus bypassing the glenohumeral joint. The higher bending moments in the female patients could be a sign of lacking muscle strength for centring the humeral head on the glenoid.

Comparison of energy cost in transtibial amputees using “prosthesis” and “crutches without prosthesis” for walking activities

BackgroundIn a survey of 100 transtibial amputees (TTA) in the study place, it was noticed that nearly 30% of total activities performed by crutches. It was recorded nearly 52% of the amputees were totally independent, 39% had to use a crutch or cane and only 9% need not used any devices simply because they are unaware of current technology or availability. Out of 39 TTA, nine used crutches only for performing daily activities while 30 used both prosthesis and crutch. Walking is a major activity in lower limb amputees and therefore it is imperative to know the energy cost in both the mobility devices (prosthesis and crutches without prosthesis) for walking activities. ObjectivesThe purpose of this study was to quantify and compare the difference in energy cost between the two most commonly used assistive devices (prosthesis and axillary crutches) in adults with Transtibial amputation by indirect calorimetric method at the self-selected speed in plane surface walking. MethodsThirty adults who had a unilateral transtibial amputation participated in this study. Oxygen consumption was measured with a Cosmed K4 b2 oxygen analysis telemetry unit (Rome, Italy) as the participants walked over level ground for 30 meters at a self-selected speed. The variables that were analyzed were VO2 rate (mL/min), VO2 cost (mL/kg/m), heart rate (bpm), self-selected walking velocity (m/min) and energy expenditure per minute (Kcal/min). ResultsIt was observed that VO2 uptake rate and EE comparisons were highly significant for both prosthesis and crutches without prosthesis walking in adults with transtibial amputation (P<0.025). There was significant difference between prosthesis walking and crutches without prosthesis walking in terms of VO2 uptake rate (P<0.005) and EE/min (P<0.00001). It was noticed the adults with transtibial amputation using prosthesis walked with 21% more efficient in terms of VO2 uptake rate and 92% more efficient in terms of EE/min as compared to crutches without prosthesis. ConclusionsThe data on energy cost indicates that all below knee amputee groups walk with less effort by using prosthesis. It may be concluded that crutches without prosthesis may not be used as a permanent rehabilitative measure in transtibial amputations.

Late presentation with whole limb gangrene following open traumatic hemipelvectomy

Traumatic hemipelvectomy is a rare type of devastating injury with a very high mortality rate and often the result of high energy transfer trauma. Most patients, who survive this injury, do so on the basis of prompt and immediate advanced medical care. Abdominal and pelvic visceral injuries are frequently seen in those cases that survive. We present an unusual case of a 17-year-old patient who survived this injury after presenting 4 days following a motor cycle crash with whole limb gangrene and clinical evidence of septicaemia and without associated abdominal and pelvic visceral injury. She had successful management of her wound and was rehabilitated with axillary crutches and without a prosthetic limb due to financial constraints. The possible mechanism of injury was reviewed and peculiarities of management of this case in our environment were highlighted.

Bilateral Radial Nerve Compression (crutch palsy): A Case Report

Background: Bilateral radial nerve compression due to axillary crutches is a relatively rare entity with few well documented cases in the literature. Case Report: The purpose of this paper is to present a case of bilateral radial nerve palsy in a man after using axillary crutches for 3 weeks. The axillary crutches were discontinued upon diagnosis; he was started on rehabilitation therapy immediately and showed rapid improvement within days, with full recovery at 5 weeks after presentation. Conclusion: Crutch palsy occurs from improper use of crutches causing prolonged compression of radial nerve. Proper fitting and education on correct usage of crutches may prevent this complication. A thorough history, physical exam and electrodiagnostic study are helpful in the diagnosis and prognosis of the illness.

Auxiliary locomotion device to unload lower limbs, using user´s own secondary support

The systematic of device development for support in the period after surgery and for consolidation of fractures of lower limb, manufactured in aluminium alloy and PVC, integrated with quick fixes, cleanliness simplified, retractable, and adaptable to wide range of biotope. Has as value-added a possibility of transforming an axillary crutch in Canadian and, where necessary, the transformation of the Canadian crutch in cane to aid the balance and safety on return to walk independently. The proposed instrument enhances the limited movement capabilities and mobility by ensuring greater security and versatility of the beginning of the user's recovery until the end of his convalescence.

Biomechanical Evaluation of an Innovative Spring-Loaded Axillary Crutch Design

ABSTRACT We evaluated an innovative spring-loaded crutch design by comparing its performance with standard crutches through a biomechanical approach. Gait analysis was conducted for 7 male subjects under two conditions: walking with standard crutches and with spring-loaded crutches. Three-dimensional kinematic data and ground reaction force were recorded. Spatiotemporal variables, external mechanical work, and elastic energy (for spring crutches) were calculated based on recorded data. The trajectories of vertical ground reaction forces with standard crutches had two main peaks before and after mid-stance, and those with optimized spring-loaded crutches had only one main peak. The magnitude of external mechanical work was significantly higher with spring-loaded crutches than with standard crutches for all subjects, and the transferred elastic energy made an important contribution to the total external work for spring-loaded crutches. No significant differences in the spatiotemporal parameters were observed. Optimized spring-loaded crutches can efficiently propel crutch walkers and could reduce the total energy expenditure in crutch walking. Further research using optimized spring-loaded crutches with respect to energy efficiency is recommended.

Metabolic Energy Expenditure During Spring-Loaded Crutch Ambulation

Individuals using traditional axillary crutches to ambulate expend approximately twice as much energy as individuals who perform able-bodied gait. A relatively novel spring-loaded crutch now being marketed may reduce metabolic energy expenditure during crutch ambulation. This idea, however, had not yet been tested. To determine whether the novel spring-loaded crutch reduces oxygen consumption during crutch ambulation, relative to traditional-crutch ambulation. A secondary purpose was to evaluate the design for subject-perceived comfort and ease of use. Within-subject. Indoor track. 10 able-bodied men and 10 able-bodied women. The independent variable was crutch design. Each subject ambulated using 3 different crutch designs (traditional, spring-loaded, and modified spring-loaded), in a randomized order. The primary dependent variable was oxygen consumption. Secondary dependent variables were subject-perceived comfort and ease of use, as rated by the subjects using a 100-mm visual analog scale. Dependent variables were compared among the 3 crutch designs using a 1-way repeated-measures ANOVA (α = .05). Oxygen consumption during spring-loaded-crutch ambulation (17.88 ± 2.13 mL · kg⁻¹ · min⁻¹) was 6.2% greater (P = .015; effect size [ES] = .50) than during traditional axillary-crutch ambulation (16.84 ± 2.08 mL · kg⁻¹ · min⁻¹). There was no statistically significant difference (P = .068; ES = -.45) for oxygen consumption between spring-loaded-crutch ambulation and ambulation using the modified crutch (17.03 ± 1.61 mL · kg⁻¹ · min⁻¹). Subjects perceived the spring-loaded crutch to be more comfortable (P < .001; ES = .56) than the traditional crutch. There was no difference (P = .159; ES = -.09) between the spring-loaded and traditional crutches for subject-perceived ease of use. Compared with traditional axillary crutches, the novel spring-loaded crutch may be more comfortable but does not appear to benefit subjects via reduced metabolic energy expenditure.

Unilateral lower limb suspension: integrative physiological knowledge from the past 20 years (1991–2011)

In 1991, Hans Berg and colleagues published the first research investigation using unilateral lower limb suspension (ULLS) as a human model to study the influence of unloading on skeletal muscle. ULLS requires a participant to perform all activities with axillary crutches while wearing one thick-soled shoe. The elevated shoe eliminates ground contact with the adjacent foot, thereby unloading the lower limb. Today, ULLS is a well-known ground-based analog for microgravity. The present review will synthesize the physiological findings from investigations using ULLS to study the deleterious effects of unloading. Compromised human performance and the neuromuscular, musculoskeletal and circulatory mechanisms leading to altered function will be a major emphasis of the work. Results from prolonged bed rest will also be included in order for general comparisons to be made between analogs. Finally, the efficacy of exercise to mitigate the negative consequences of unloading is presented.

A Kinematic Comparison of Spring-Loaded and Traditional Crutches

A novel spring-loaded-crutch design may provide patients additional forward velocity, relative to traditional axillary crutches; however, this idea has not yet been evaluated. To quantify elastic potential energy stored by spring-loaded crutches during crutch-ground contact and determine whether this energy increases forward velocity for patients during crutch ambulation. Because elastic potential energy is likely stored by the spring-loaded crutch during ambulation, the authors hypothesized that subjects would exhibit greater peak instantaneous forward velocity during crutch-ground contact and increased preferred ambulation speed during spring-loaded-crutch ambulation, relative to traditional-crutch ambulation. Within-subject. Biomechanics laboratory. 10 healthy men and 10 healthy women. The independent variable was crutch type: Subjects used spring-loaded and traditional axillary crutches to ambulate at standardized and preferred speeds. The primary dependent variables were peak instantaneous forward velocity and preferred ambulation speed; these variables were quantified using high-speed videography and an optoelectronic timing device, respectively. Between-crutches differences for the dependent variables were evaluated using paired t tests (α = .05). Elastic potential energy stored by the spring-loaded crutches during crutch-ground contact was also quantified via videography. Peak forward velocity during crutch-ground contact was 5% greater (P < .001) for spring-loaded-crutch ambulation than for traditional-crutch ambulation. Preferred ambulation speed, however, did not significantly differ (P = .538) between crutch types. The spring-loaded crutches stored an average of 2.50 ± 1.96 J of elastic potential energy during crutch-ground contact. The spring-loaded crutches appear to have provided subjects with additional peak instantaneous forward velocity. This increased velocity, however, was relatively small and did not increase preferred ambulation speed.