Crutches Research Articles

Augmenting forearm crutches with wireless sensors for lower limb rehabilitation

Forearm crutches are frequently used in the rehabilitation of an injury to the lower limb. The recovery rate is improved if the patient correctly applies a certain fraction of their body weight (specified by a clinician) through the axis of the crutch, referred to as partial weight bearing (PWB). Incorrect weight bearing has been shown to result in an extended recovery period or even cause further damage to the limb. There is currently no minimally invasive tool for long-term monitoring of a patient's PWB in a home environment. This paper describes the research and development of an instrumented forearm crutch that has been developed to wirelessly and autonomously monitor a patient's weight bearing over the full period of their recovery, including its potential use in a home environment. A pair of standard forearm crutches are augmented with low-cost off-the-shelf wireless sensor nodes and electronic components to provide indicative measurements of the applied weight, crutch tilt and hand position on the grip. Data are wirelessly transmitted between crutches and to a remote computer (where they are processed and visualized in LabVIEW), and the patient receives biofeedback by means of an audible signal when they put too much or too little weight through the crutch. The initial results obtained highlight the capability of the instrumented crutch to support physiotherapists and patients in monitoring usage.

A new upper extremity sparing non-weight bearing orthosis

Objectives Axillary and forearm crutches are commonly utilized in the treatment of foot and ankle injuries. In order to decrease the energy expenditure during mobilization, to prevent upper extremity complications, and to let the upper extremity free for other usages, we designed a new orthosis. The study is conducted to compare walking energy parameters of this newly designed orthosis with the axillary and forearm crutches. Materials and methods 10 healthy young male volunteers walked on treadmill with three different orthoses in randomized order. Oxygen expenditure, oxygen cost, rate of perceived exertion (Borg scale), and observer stability assessment were analyzed. Results Concerning oxygen consumption, perceived exertion, and observer stability assessment, the new device was found superior to the other devices ( P < 0.05). The new orthosis was superior to forearm crutches concerning oxygen cost ( P = 0.027) but not significantly different from the axillary crutches ( P = 0.062). Discussion Compared to frequently used orthoses, the developed device provides mobilization using less or similar amount of energy. Additionally it spares one upper extremity to be used for other activities.

Upper extremity inverse dynamics model for crutch-assisted gait assessment

Current inverse dynamics models of the upper extremity (UE) are limited for the measurement of Lofstrand crutch-assisted gait. The objective of this study is to develop, validate, and demonstrate a three-dimensional (3-D) UE motion assessment system to quantify crutch-assisted gait in children. We propose a novel 3-D dynamic model of the UEs and crutches for quantification of joint motions, forces, and moments during Lofstrand crutch-assisted gait. The model is composed of the upper body (i.e., thorax, upper arms, forearms, and hands) and Lofstrand crutches to determine joint dynamics of the thorax, shoulders, elbows, wrists, and crutches. The model was evaluated and applied to a pediatric subject with myelomeningocele (MM) to demonstrate its effectiveness in the characterization of crutch gait during multiple walking patterns. The model quantified UE dynamics during reciprocal and swing-through crutch-assisted gait patterns. Joint motions and forces were greater during swing-through gait than reciprocal gait. The model is suitable for further application to pediatric crutch-user populations. This study has potential for improving the understanding of the biomechanics of crutch-assisted gait and may impact clinical intervention strategies and therapeutic planning of ambulation.

Axillary or Forearm Crutches: Velocity of Postural Sway in Single Limb Stance and Perceptions of Safety.

Axillary or Forearm Crutches: Velocity of Postural Sway in Single Limb Stance and Perceptions of Safety.

Operationstechnik und klinische Ergebnisse des DUROM™-Hip-Resurfacing-Systems mit dem lateralen Zugang

Objective Bone-preserving hip resurfacing in young and active patients using a soft-tissue-sparing, modified transgluteal, lateral approach. Primary hip osteoarthritis in physically active, working patients aged < 65 years (males) and < 60 years (females). Good bone quality. Male patients > or = 65 years of age, female patients > or = 60 years of age. Necrosis of the femoral head. Varus deformity of the femoral neck with a reduced horizontal femoral offset. Femoral head cysts (> 1 cm in diameter). Infection. Osteoporosis. Rheumatoid arthritis. Tumor. Reduced renal function. Leg length difference (> or = 1 cm). Metal allergy. Previous femoral neck fracture. Previous intertrochanteric femoral osteotomies. Supine position of the patient. Modified transgluteal, lateral approach to the hip joint. Luxation of the femoral head. First, reaming of the femoral head to improve visualization of the acetabular cup. Central positioning of the guide wire in the femoral neck in a slight valgus position of approximately +5 degrees to the anatomic collodiaphyseal (CCD) angle using the mechanical targeting device. Overdrilling of the central guide wire to the appropriate depth for the implant. Central insertion of the guide rod. Preparation of the femoral head over the guide rod using cylinder cutters one or two sizes larger than the smallest possible femoral component. Cement-free implantation of the acetabular component according to the predetermined definitive size of the femoral component. Final preparation of the femoral head using profile, surface and forming cutter. Following cemented implantation of the femoral component, repositioning of the hip joint and conclusion of the surgical procedure. Mobilization of the patient using two forearm crutches as of the 1st day after surgery. Removal of the Redon drains after 24 h. Partial weight bearing of 20 kg for 3 weeks under continuation of thrombosis prophylaxis. Limitation of hip flexion to 90 degrees during the first 6 postoperative weeks, and no adduction and forced external rotation allowed in order to avoid luxation. Avoidance of sports involving the loads of jumping and axial impact loading for 12 postoperative months. Analysis involved the pre- and postoperative functions of 72 patients with a total of 82 prostheses and a mean durability time of 29.2 +/- 11 months based on the Harris Hip Score (HHS), the modified UCLA (University of California, Los Angeles) activity index, and the Merle d'Aubigné Score. Postoperatively, prosthetic angle and femoral offset as well as periprosthetic signs of loosening/lytic areas were assessed by means of radiology and compared with the preoperative CCD angle and femoral offset. Compared to the preoperative evaluation, follow-up yielded a significant increase in the average HHS values (94 +/- 4.6 vs. 40.1 +/- 7 points), the modified UCLA activity index (8.9 +/- 2.6 vs. 4.6 +/- 2.2), and the Merle d'Aubigné Score (17.9 +/- 1.9 vs. 7.3 +/- 2.4; p < or = 0.05). In 98.8%, a solid osteointegration of the cup and femoral components was observed. The average deviation of the physiological CCD angle (136.6 degrees +/- 3.6 degrees ) from the postoperative angle of the prosthesis (142.6 degrees +/- 4.9 degrees ) was 6 degrees +/- 2.8 degrees . The postoperative femoral offset was reduced by an average of 2.3 mm compared to the preoperative offset. During clinical follow-up n = 2 prostheses (2.5%) required revision (one femoral neck fracture; one periarticular ossification [Brooker III]).

An instrumented crutch for monitoring patients’ weight distribution during orthopaedic rehabilitation

This paper discusses an instrumented forearm crutch that has been developed to monitor a patient’s weight bearing over the full period of their recovery, and that can potentially be used in a home environment. The crutch measures the applied weight, crutch tilt, and hand position on the grip. Data are transmitted wirelessly to a remote computer, where they are processed and visualized in LabVIEW. The results obtained from a successful pilot study highlight both the need for such an instrumented crutch and its ability to measure the weight being applied through a patient’s lower limb.

Total knee arthroplasty in a spinal cord-injured patient: A case report

Patients with spinal cord injuries are prone to knee hydrarthrosis (also known as “water on the knee”), which can cause pain, functional impairment and the restriction of social activities. Total knee arthroplasty is a potentially appropriate treatment. Here, we report on a patient presenting partial T12 AIS grade C paraplegia who was able to walk with two forearm crutches, an ankle-foot orthosis on the right leg and a knee-ankle-foot orthosis on the left leg. Thirteen years after the spinal cord injury, the patient presented with septic arthritis of the right knee, complicated by recurrent hydrarthrosis during standing and walking. Arthroscopy revealed advanced osteoarthritis. Total knee arthroplasty was performed, with very good functional and social outcomes two and half years after surgery.

Factors contributing to possession of walking aids among persons with osteoarthritis of the knee

To investigate the possession and use of walking aids among patients with knee osteoarthritis (OA), and to identify factors contributing to possession and actual use of these aids A random sample of 90 patients with OA was derived from a database of 3,500 registered patients. A total of 80 (88.8%) patients with OA completed a questionnaire on possession and use of walking aids. Demographics, disease-related characteristics, and information about possession and use were assessed. Logistic regression analyses were used to determine which factors are associated with the possession and use of walking aids. Sixty (75%) of the OA patients owned a walking aid. Canes, forearm crutches and walkers were most frequently possessed. Age, frequency of pain, and disability were associated with possessing a walking aid. Of the sixty patients that possess walking aid 25 (41.7%) of them are active walking aid users while the remaining 58.3% are non users. Factors associated with the actual use of an aid included higher age, a high intensity of pain, more disability, decrease in morning stiffness by the aid, and a positive evaluation of the aid More than half of the patients with OA possess a walking aid. Disability, pain, and age-related impairments seem to determine the need for a walking aid. Nonuse is associated with less need, negative outcome, and negative evaluation of the walking

Percutaneous compressive screw fixation for float injury to pubic symphysis

Objective To discuss the functional results of percutaneons compressive screw fixation for float injury to the pubic symphysis. Methods From March 2003 to March 2007, 48 cases of float injury to the pubic symphysis were treated with percutaneons compressive screws, including 27 males and 21 females with an average age of 29.4 years. Of them, 39 eases were complicated with injury to the pelvic posterior ring. Emergency surgery was done for 13 cases, 27 cases were operated on within 3 to 7 days after injury and 8 within 7 to 14 days. Guided pins and screws were used during dosed reduction and percutaneous pelvic fixation was done under the guidance of intraoperative fluoroscopic imaging. Float injury to the pubic symphysis was amended by percutaneous fixation after dosed manipulation. Results The average operation time for the48 patients was 55 (31 to 100) min. The intraoperative bleeding averaged 20 to 30 mL. Satisfactory reduetian and fixation was achieved in 41 cases, but 7 cases had poor reduction. All the fractures healed 3 to 6 months postoperatively without infection, nonunion or injury to vessels, nerves or organs. All the patients could turn the body freely in bed the day after operation. Those without injury to the pelvic posterior ring could walk with crutches 3 days after operation. By the Orlando evaluation system for pelvic fractures, 37 eases were rated as excellent, 7 as good, 3 as fair and I as poor. Conclusions The percutaneous compressive screw fixation may decompress the pelvic hematoma, allowing early definitive fixation without the risk of additional hemorrhage. Complications associated with open posterior pelvic surgical procedures may be avoided by using percutaneons techniques. Key words: Pelvis; Surgical procedure, minimally invasive; Public symphysis

Accepting Our Limitations: The Textbook as Crutch and Compromise

Accepting Our Limitations: The Textbook as Crutch and Compromise

Microinvasive craniopuncture and sof tube drainage applied to curing intracranial hematoma

Objective To discuss curative effect and unique advantage of microinvasive craniopuncture and sof tube drainage applied to curing intracranial hematoma.Methods 487 patients with intracranial hematoma final diagnosed by computer tomography were cured by way of microinvasive craniopuncture and sof tube drainage.Results ADL scale(Activity of Daily Living Scale,ADL) was used to evaluate outcome of these patients when they were discharged from hospital:Ⅰ class:97 cages,recovered daily life completely;Ⅱ class:204 cages,partly recovered or rived independently;Ⅲ class:113 cases,need help from others and can go about on crutches;Ⅳ class:32 cages,lie in bed but keep consciousness;Ⅴ class:15 cases,turned out to be persistent vegetable state.26 cases died.Conclusion Indeed therapeutical,quickly,secure,convenient,with tiny damage and low cost,microinvasive craniopuncture and sof tube drainage applied to curing intracranial hematoma is especially applicable to grassroot hospital. Key words: Micruinvasive craniopuncture; Soft tube drainage; Intracranial hematoma

Internal fixation of femoral neck fractures in the elderly

Objective To evaluate the outcome of the old patients who were treated for femoral neck fractures in our hospital during 2000-2007. Methods A retrospective study was conducted to evaluate outcomes of the 139 old patients who had received internal fixation for femoral neck fractures in our department during 2000-2007. The mechanism of injury, duration between injury and hospitalization, severity of fracture, anamnesis, time of hospital stay, anaesthesia, operation, postoperative complications, fracture healing, in-cidence of avascular necrosis of femoral head, failure of fixation, and functional restoration of the patients were documented. Results Fracture healing was found in 126 cases (90.6%). Time to healing ranged from 2 to 20 months (average, 6.2 months). Failure of fixation and nonunion were found in 13 cases (9.4%). Avascular necrosis of femoral head occurred in 9 cases (6.5% ). Of them, 81 patients(58.3%) restored their gait as normal as before whereas 50 patients(36.0%) walked with crutches. Conclusions Internal fix-ation can be suggested for old patients with femoral neck fracture, considering a high rate of fracture healing and a low rate of avascular necrosis of the femoral head. Early operation is recommended if the general con-dition of the patient has been well controlled. Key words: Femoral fractures; Fracture fixation, internal; Aged

Technical Notes and Tips: The Use of an Axillary Crutch as a Knee Flexion Contracture Correction Device

We describe a simple, patient-controlled technique for the treatment of early flexion contracture following total knee replacement. An axillary crutch may be used to aid passive extension in the postoperative period. The leg is placed through the inverted crutch and a foam pad is positioned between the patient's heel and the axillary pad (Fig. 1). The hand grip is then adjusted to the level of the knee joint and is wrapped with a wool dressing. The patient exerts a downward pressure on the foot of the crutch to gain knee extension. Figure 1 The axillary crutch.

Ulnar Nerve Compression Neuropathy at Guyon's Canal Caused by Crutch Walking: Case Report With Ultrasonographic Nerve Imaging

Ginanneschi F, Filippou G, Milani P, Biasella A, Rossi A. Ulnar nerve compression neuropathy at Guyon's canal caused by crutch walking: case report with ultrasonographic nerve imaging. This report is the first account of Guyon's syndrome after the bilateral use of forearm crutches. Crutch palsy is usually neuropraxic in nature and associated with clinical and electrophysiologic recovery of nerve function, especially if patients are instructed to not bear excessive weight on the wrist. The present case history follows this pattern. In establishing the diagnosis of a focal compression neuropathy, a combination of clinical assessment and neurophysiologic studies are typically used. This report describes the additional application of ultrasound imaging to verify the diagnosis and to track changes in the appearance of the nerve during follow-up.

Safety of Intrathecal Baclofen Therapy in a Patient with Sleep Apnea Syndrome

We report a 30-year-old man with an extensive cerebral contusion. He presented with severe left upper and lower limb paralysis and mild right lower limb palsy. He was diagnosed with severe sleep apnea syndrome and was treated with nighttime nCPAP (nasal Continuous Positive Airway Pressure). Four years after the injury, he was able to walk with Lofstrand crutches. However, he gradually began to have difficulty standing, walking and driving his wheelchair because his spasticity developed markedly. He received ITB (intrathecal baclofen) therapy and noted a reduction in spasticity. He was once again able to drive his wheelchair and to walk with support. In addition, his respiratory function didn't show any deterioration. Spasticity is a common complication after cerebral or spinal cord injury, for which treatment has been difficult. ITB therapy can dramatically reduce spasticity, but has been demonstrated that it may also depress respiratory function in patients with respiratory insufficiency. This case suggests that ITB therapy may reduce spasticity without affecting respiratory function even in patients with a respiratory disorder.

Crutch-Induced Axillary/Brachial Artery Injury-Two Case Reports

Acute ischemia of the upper extremity secondary to chronic crutch use was uncommon. Long term improper usage of the axillary crutches may lead to axillary/brachial artery stenosis or aneurysms formation. Aneurysms formation may be complicated by acute thrombosis or embolization of distal vessels. We reported two postpoliomyelitis patients with crutch-induced axillary/brachial aneurysm complicated with acute upper limb ischemia. One was treated by thromboembolectomy and later unavoidable below-elbow amputation due to progressive gangrenous change of distal limb. The other was treated by both aneurysm resection and thromboembolectomy, and the critical limb was rescued. To salvage an ischemic limb successfully, prompt diagnosis and correct surgical treatment with thromboembolectomy, aneurysm resection and reconstruction is necessary. The roles of treatment modalities and the instructions on correct usage of axillary crutches were discussed.

Accuracy of Partial Weight Bearing After Autologous Chondrocyte Implantation

Ebert JR, Ackland TR, Lloyd DG, Wood DJ. Accuracy of partial weight bearing after autologous chondrocyte implantation. Objective To determine whether patients can accurately replicate and retain weight-bearing restrictions in both stationary (static) and dynamic conditions after autologous chondrocyte implantation (ACI). Design Case series. Setting Rehabilitation clinic. Participants A consecutive sample of patients (N=48) who had undergone ACI to a medial or lateral femoral condylar defect in the knee. Interventions Patients were trained to partially weight bear using bathroom scales and forearm crutches prior to assessment. Main Outcome Measures A force platform was used to measure peak vertical ground reaction forces in patients during static and dynamic conditions immediately after weight-bearing instruction and training, and again during gait 7 days after training. Results Immediately after instruction and weight-bearing practice on a set of scales, patients exerted a mean of 15.8% body weight more than expected during walking for 20% weight-bearing trials, 8.3% more for the 40% trials, 11.9% more for the 60% trials, and 1.2% less for the prescribed 80% trials. Accuracy of weight-bearing replication improved across all weight-bearing levels when assessed 7 days later, when patients exerted a mean of 6.6% body weight more than expected during walking for 20% weight-bearing trials (9.2% body weight improvement), 4.2% more for the 40% trials (4.1% body weight improvement), 9.9% more for the 60% trials (2% body weight improvement), and 0.2% more for the 60% trials (1% body weight improvement). Conclusions Patients were unable to follow weight-bearing restrictions after instruction and practice on a set of scales, and patients were unable to replicate weight-bearing levels in both static and dynamic conditions.

INTRODUCTION OF CHRONICAL WOUNDS HEALING WITH LUCILIA SERICATALARVAE IN SLOVENIA

BACKGROUND Due to infection of chronic wounds with antibiotic resistant bacterial strains, their healingcan be very difficult. The main purpose of the presented research study was the introductionof a new method for chronic wounds healing, using Lucilia sericata fly larvae intoSlovenia. METHODS For chronic wound healing sterile larvae of L. sericata fly were prepared from a continuousfly culture, maintained at the Department of Biology, Biotechnical Faculty, Universityof Ljubljana. In this way 32 wounds of 30 patients were treated. Larvae were appliedon the wounds for two to three days. Than they were washed off and replaced, if necessary.Microbiological smears were collected before and after the application of the larvae on thewounds. Microorganisms were then isolated and identified. During larval therapy healingimprovement, patient’s general state, potential presence of pain, mobility, patient’s independenceand psychological reaction to the therapy were monitored. RESULTS Using biosurgical therapy 24 (75 %) out of 32 wounds were cleaned and healed. In thecase of combined arterio-venous leg ulcers one wound was completely healed and eight ofthem were cleaned of necrosis and infection. In the case of a venous leg ulcer, six diabeticulcers, eight cases of chronic postoperative wounds and pressure ulcers, wounds were completelycleaned after the treatment. 16 patients reported unpleasant feeling during larvaltreatment and two patients felt pain which diminished after the treatment with analgesics.17 (57 %) patients had to use crutches during biosurgical treatment and the same numberof patients felt uncomfortable, frightened and depressed during the application oflarvae. CONCLUSIONS The method of healing chronic wounds with L. sericata larvae was successfully introducedinto Slovenia. Due to its simplicity and effectiveness biosurgery should be accepted as astandard method in Slovene clinical practice. With the help of biosurgical method chronicwounds heal faster, further inflammation and tissue decomposition are prevented andpatients can integrate faster into normal everyday life

Use of Strutter Orthoses for an Adolescent with Myelodysplasia

To describe the functional gains made through the use of the Strutter Functional Orthosis System (SFOS) in an adolescent with myelodysplasia. A 12-year-old boy with lumbar level myelodysplasia was not functional when ambulating with Lofstrand crutches. He required a wheelchair for community mobility because of complaints of fatigue and upper extremity discomfort. He was introduced to the SFOS and became a functional community ambulator, reporting greater walking endurance and decreased pain. This report provides some case evidence to suggest that the SFOS can improve functional mobility in a child with myelodysplasia. With the SFOS this child progressed from being nonfunctional when ambulating to being classified as a "community ambulator," resulting in physiological, functional, and psychosocial gains. We suggest future investigations to explore the reasons for greater walking ability with the SFOS.

Commentary

The proximal femur is the most frequent operative site for metastasis, but there is no consensus between internal fixation and hip replacement. The present multicenter retrospective observational study sought: (1) to compare early clinical results between internal fixation and hip replacement for proximal femoral metastasis (PFM), and (2) to assess events affecting survival.The study hypothesis was that internal fixation and hip replacement give comparable clinical results, operative site complications rates and survival.The series comprised 309 cases, 10 of which were bilateral, in 182 females and 117 males, with a mean age of 67.2 ± 11.5 years and 62.5 ± 13.2 years, respectively. Primaries were mainly breast (118; 38.2%), lung (85; 25.5%) or kidney (40; 12.9%). PFM was revelatory in 114 cases (36.9%). There was visceral involvement in 142 patients (46%), multiple peripheral bone involvement in 212 (68.6%), and spinal involvement in 134 (43.4%). There were 124 pathologic fractures (40%), 51 of which were revelatory. Metastases were cervicocephalic in 135 cases (43.7%), metaphyseal in 166 (53.7%) and both in 8 (2.6%). PFM was osteolytic in 90% of cases, managed by hip replacement in 161 cases and internal fixation in 148 (12 screwed plates, 136 nails). Seventy-seven patients had postoperative radiation therapy.After hip replacement (n = 144), walking was normal in 35 cases (24.3%), impaired but unassisted in 53 (36.8%), with 1 forearm crutch in 24 (16.6%), 2 crutches or a frame in 26 (18%), and impossible in 6 (4.1%). After nailing (n = 125), results were respectively 38 (30.4%), 47 (37.6%), 15 (12%), 18 (14.4) and 7 (5.6%). Recovery of normal walking capacity did not significantly differ according to technique (p = 0.162); nor did pain or function. Recovery of normal walking capacity was better after preventive surgery (p < 0.001). Perioperative complications comprised: 10 cases of severe blood loss, 7 pulmonary embolisms, 6 digestive hemorrhages, and 5 lung infections. Secondarily, there were 11 infections (7 after hip replacement, 2 after nailing, 2 after plate fixation), 7 progressive osteolyses and 5 fractures. Complications rates were significantly higher with plate fixation, with no difference between nailing and hip replacement. Survival did not significantly differ between hip replacement (12 months [95% CI: 7–19]), nailing (7 months [95% CI: 6–11]) and plate fixation (16 months [95% CI: 6-not calculable]).Clinical results and survival were comparable between hip replacement and nailing, confirming the study hypothesis, in agreement with the literature. Each technique has its indications. Patients with severely impaired walking capacity benefited greatly from surgery. The importance of preventive surgery was highlighted.IV, retrospective study.