Standard Crutches Research Articles

A Morphological Analysis of Ergonomic Design Reconfigurations for Crutch Versatility in the Environment of Use

Nowadays, there are complications in the environments where the crutch is being used, which cause discomfort for users throughout the use and therapy period. There are many flaws in cities’ infrastructure. Using a simple search on the internet, it can be claimed that standard crutches have an array of design faults and ergonomic problems, and users seek to fix the problems with non-industrial solutions and home treatments. For this reason, various accessories for crutches are being produced, and even designers have proposed new types of crutches as replacements. However, the majority of them still didn’t pass the human-centered research procedure.

Standard Crutches vs Rolling Knee Scooters: Analysis of Patient Satisfaction and Risk of Falling after Foot and Ankle Surgery

Category: Other; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Rolling knee scooters and standard crutches are commonly used following foot and ankle surgery for patients who are required to keep weight off the extremity. In all non-weight bearing situations, muscle atrophy, lack of stability, and decreased blood flow increasing the risk of clots. Postoperative falls within 30 days after surgery have been shown to significantly increase morbidity and correlate directly with age. While it is known that falls following procedures are a definitive concern and should be guarded against, there is a deficiency in reporting with regards to the use of knee scooters and the commonality of falls in the postoperative period while using them in comparison to more traditional means of ambulatory aid like crutches. Methods: From June 2021 to February 2022, 120 patients were prospectively enrolled after foot and ankle procedures at a single institution that required a non-weight bearing period of at least 2-weeks. Patients completed surveys at each post-operative visit until they were weight-bearing asking them to report ambulatory aid device utilized, level of satisfaction, time using the device, number of falls, and complications. Patient demographics, including sex, age, BMI, smoking history, co-morbidities were retrospectively collected and analyzed using descriptive statistics (means, standard deviations, ranges). The relative incidence of a fall occurring was calculated among the entire cohort, with each separate fall counting individually. A regression analysis was performed to identify any patient factors associated with the occurrence of falls. T-tests will be performed to compare the relative chance of a postoperative fall or device-related complication between patients using rolling scooters and those using crutches and assess for significance (p<.05). Results: 106 patients (59 female and 47 male) either used a rolling knee scooter or crutches. For 65 ankle procedures and 41 forefoot procedures, the average age was 51.6 +- 16.0, BMI was 28.6 +- 5.59. Regression analysis of all falls found that only age (p=0.058) was slightly, but not significantly associated with a greater fall risk. Demographic factors such as sex, BMI, procedure type (forefoot vs. hindfoot), and previous experience with the device were not associated with a greater fall risk (p>0.05). Patients were more likely to have used crutches for a previous injury compared to knee scooters (p=.006). Knee scooters were used significantly more often and had higher patient satisfaction compared to crutches (p=0.043, p=0.03). Patients using crutches reported a total of 22 falls compared to 14 total falls knee scooters (p=0.188). Overall, patients would rather use knee scooters than crutches for future foot and ankle surgeries (p=0.001). Conclusion: Both standard crutches and rolling knee scooters are safe and effective methods of non-weight bearing ambulatory aid after foot and ankle procedures. Older patients may be associated with a greater risk of falling regardless of ambulatory aid device utilized. Although there were no significant differences in number of falls between patients who used crutches vs. scooters, patients were significantly more satisfied with rolling knee scooters and more likely to use them in the future.

Comparison of Hip and Low Back Loads between Normal Gait, Axillary Crutch Ambulation and Walking with a Hands-free Crutch in a Healthy Population.

BackgroundInstead of using axillary crutches, using a hands-free crutch (HFC) has been associated with higher functional outcome scores. However, hip and back pain have been reported as side effects.Purpose/HypothesisThe purpose of this study was to compare range of motion and joint reaction forces at the hip and low back between HFC walking, normal walking, and standard crutch walking. It was hypothesized that hip joint reaction forces and low back joint reaction forces would be higher with HFC walking compared with normal walking and axillary crutch walking.Study DesignControlled Laboratory StudyMethodsUsing 3D motion analysis and force plates, kinematics and ground reaction forces were measured in 12 healthy subjects during gait, crutch ambulation and HFC walking. Gait speed, hip and trunk range of motion, and hip and low back reaction forces, were compared using repeated-measures ANOVA.ResultsGait speed during HFC ambulation was reduced 33% compared to crutch ambulation (P<0.001) and 44% compared to normal gait (p<0.001). Hip range of motion was reduced during both crutch conditions compared to gait (p<0.001). Trunk range of motion was greatest during HFC walking compared to both gait and crutch ambulation (p<0.001). Peak hip joint reaction force during HFC walking was 11% lower than during gait (p=0.026) and 30% lower than during crutch walking (p<0.001). Peak low back reaction force during HFC walking was 18% higher than during gait (p=0.032) but not different than during crutch walking.ConclusionHip joint reaction forces during HFC walking did not exceed those during gait or axillary crutch ambulation. However, a reduction in hip motion using the HFC was associated with increases in trunk motion and low-back loading. These could be a cause for reports of low-back pain accompanying HFC usage.Level of EvidenceLevel 3

Analysis of hand pressure in different crutch lengths and upper-limb movements during crutched walking

Hand pressure in crutch is important as it is directly related to the comfort of the patients using crutches. However, little research has been done on dynamical hand pressure during crutched walking. This study investigated hand pressures and joint movements in the upper limb with the different crutch lengths during crutched walking. Twelve healthy male adults participated in the study, and performed crutch-supported walking at bi-crutch and single-foot way. A specific mat of pressure sensors was designed to measure the hand pressure of the palm and fingers and a motion capture system used to capture the movements at the shoulder and elbow. It was found that when walking speeds were between 0.5 and 1.0 m/s, maximum pressure and force were approximately 120 kPa and 100 N respectively in the hand; the ranges of motion were from 28 to 60 deg at the shoulder and from 15 to 30 deg at the elbow. The results showed that the pressure-time integral and force-time integral in the hand are higher when using a traditional standard crutch length than using longer or shorter lengths. The visual analogue scores of conformable degree showed that the participants are favourite for a traditional standard crutch length. The pressure and kinematic data collected provide a set of database available for crutch manufacturer, glove designer and clinicians as reference when they need. Relevance to industryCrutched walking usually causes hand uncomfortable or injury. Our study provides the first experimental data of hand pressures and the joint movements in the upper limbs at different crutch lengths. These results are valuable for devising gloves for patients, thus improving the life quality of the patients using crutch.

Feature reduction and multi-classification of different assistive devices according to the gait pattern

Total knee arthroplasty (TKA) is a surgical procedure used in patients with Osteoarthritis to improve their state. An understanding about how gait patterns differ from patient to patient and are influenced by the assistive device (AD) that is prescribed is still missing. This article focuses on such purpose. Standard walker, crutches and rollator were tested. Symmetric indexes of spatiotemporal and postural control features were calculated. In order to select the important features which can discriminate the differences among the ADs, different techniques for feature selection are investigated. Classification is handled by Multi-class Support Vector Machine. Results showed that rollator provides a more symmetrical gait and crutches demonstrated to be the worst. Relatively to postural control parameters, standard walker is the most stable and crutches are the worst AD. This means that, depending on the patient’s problem and the recovery goal, different ADs should be used. After selecting a set of 16 important features, through correlation, it was demonstrated that they provide important quantitative information about the functional capacity, which is not represented by velocity, cadence and clinical scales. Also, they were capable of distinguishing the gait patterns influenced by each AD, showing that each patient has different needs during recovery.Implications of RehabilitationAn understanding about how gait patterns of post-surgical patients differ from person to person and how they are influenced by the type of device that is prescribed during their recovery might help in physical therapy. Research specifically addressing these issues is still missing.Inter-limb asymmetry and postural control features can be evaluated in an outpatient setting, supplying important additional information about individual gait pattern, which is not represented by gait velocity, cadence and scales usually used.The features calculated in this study are able to provide complementary information to gait velocity, cadence and clinical scales to assess the functional capacity of patients that passed through TKA. The selected parameters make a new clinical tool useful for tracking the evolution of patients’ recovery after TKA.

The Effect of a Shock Absorber on Spatiotemporal Parameters and Ground Reaction Forces of Forearm Crutch Ambulation

Forearm crutches are a commonly used assistive device to aid the ambulation of people with lower limb impairment. Due to the structure of the joints of the upper limb, the loading patterns during crutch-walking can be detrimental to the user. Shock-absorbed or compliant crutches may reduce ground contact impact, potentially benefitting the user. In this study, the authors performed a biomechanical evaluation of a shock absorber crutch, which uses an elastomeric system to absorb impact. Ground reaction forces (GRFs) and spatiotemporal parameters were compared between shock absorbed and standard crutches. Results indicate no significant differences to spatiotemporal parameters and peak ground reaction forces between the crutches. There is an initial impact spike during crutch strike when using shock absorbed crutches, after which the rate of force development is moderately decreased when compared with a standard crutch. The practical benefit of a small reduction in force is questionable and more work must be undertaken to further optimise shock absorber design.

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.

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.

Optimal Control and Biomechanics of Ambulation with Spring-Loaded Crunches

Standard underarm or forearm crutches have some drawbacks induced by their rigid legs. Spingloaded crutches can reduce the impact effect. However, whether or not they also improve propulsion is an open problem. We formulate a problem of the optimal performance of spring-loaded crutches and propose a numerical approach to solve the problem. Then, the numerical optimal values are incorporated to the innovative design of a pair of spring-loaded crutches. To evaluate the crutches' performance, we have conducted standard biomechanical experiments for a number of male subjects under two conditions: walking with standard crutches and with spring-loaded crutches. Three dimensional kinematic data and ground reaction force were recorded and analysed. It was observed that optimized spring-loaded crutches can efficiently propel the crutch walkers, which conforms to the theory.

Optimization of Spring-Loaded Crutches via Boundary Value Problem

The objective of the work is to optimize the design of spring-loaded crutches by choosing appropriate spring stiffness based on their dynamic characteristics. It was shown in the literature that ambulation with spring-loaded crutches reduces the initial impulse yielded by ambulation with standard crutches and provides a propulsion mechanism. This research not only provides a genre of the spring-loaded crutches via compliance, but also proposes an approach to optimize the stiffness of the helical spring through studying the dynamics of crutch stance. The method is developed using a boundary value problem and its solution method and is studied numerically. Experiments were carried out on four subjects in a biomechanics laboratory. It suggests that the optimized spring-loaded crutches guarantee the propulsion mechanism at the right time and right position during dynamical ambulation.

The use of a hands-free crutch in patients with musculoskeletal injuries: randomized control trial

Unilateral musculoskeletal below-knee injuries occur with great frequency. Patients who cannot bear weight on an injured limb usually mobilize themselves with standard crutches. When the patient also has an upper limb injury, however, mobilization might be impossible, and can result in a lengthy in-patient stay. A randomized control trial was conducted on 80 patients to share our experience with the innovative 'hands-free crutch', and to discuss the potential of this device for more frequent use in orthopaedic surgery. We present its value in facilitating early discharge in patients with both upper and lower limb injuries. We show the cost benefit of the decreased in-patient stay that the hands-free crutch provides.