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At least 19 recordsLinked to original sources
PubMed1990

Energy expenditure of ambulation using the Sure-Gait crutch and the standard axillary crutch.

Energy expenditure is increased for ambulation with various assistive devices such as canes, walkers, and crutches compared with unassisted ambulation. The purpose of the present investigation was to determine whether a significant difference in oxygen consumption and heart rate existed during ambulation with two different types of crutches. Ten healthy male subjects between the ages of 40 and 60 years participated in this study. Each subject ambulated at 1.5 mph on a treadmill using two different types of crutches--the standard axillary crutch and the Sure-Gait crutch. After walking on the treadmill without an assistive device, subjects ambulated using a three-point, swing-to gait pattern with one of the two types of crutches. This procedure was repeated using the other type of crutch. Oxygen consumption and heart rate were analyzed using an analysis of variance for repeated measures design. The results of the study showed a significant difference (p less than .01) between ambulation with crutches and unassisted ambulation for oxygen consumption and heart rate. No difference, however, was found between the two crutch types.

Adult↗
PubMed1982

Energy expenditure during ambulation with ortho crutches and axillary crutches.

Thirteen normal male college students were studied during unassisted ambulation and nonweight-bearing ambulation with Ortho crutches and axillary crutches to determine energy expenditure. Subjects walked at self-selected velocities. Energy expenditure was determined by analyzing expired air collected by a calorimeter. Heart rate was monitored by telemetry. During the first 2.5 minutes of walking, heart rate and energy expenditure were significantly greater for ambulation with axillary crutches than with Ortho crutches. After 11.5 minutes of walking, no difference in energy cost was found between crutch types; however, heart rate increased significantly (p less than .01) during ambulation with axillary crutches. Differences in energy cost and heart rate were attributed to increased upper extremity work performed when using axillary crutches. We concluded that during nonweight-bearing ambulation for short periods of time or over a short distance, the Ortho crutch is less taxing in terms of energy cost and heart rate demands.

Adult↗
PubMed1997

The influence of forearm crutches on pelvic and hip kinematics in children with myelomeningocele: don't throw away the crutches.

Gait analysis was performed on 16 children with high-sacral-level myelomeningocele who walked with and without crutches to evaluate the influence of crutches on their unique walking pattern. All of the patients used solid ankle-foot orthoses (AFOs). Deviations in coronal and transverse planes improved with assisted walking. The timing of stance phase pelvic depression and the magnitude of stance phase hip abduction improved with crutch walking. Pelvic rotation, which was seven times the normal range of motion during no-crutch walking, decreased to four times normal with crutches. Walking velocity was not significantly different between conditions. The results demonstrated that deviations in pelvic and hip kinematics are related to muscle weakness and improve with crutch use. Crutches enable the patient to transfer some weight bearing to their upper extremities which decreases the demand on weak lower-extremity musculature. This allows them to maintain functional ambulation with a closer to normal gait pattern.

Adolescent↗
PubMed1994

Improved harness crutch to reduce upper limb effort in swing-through gait.

A novel crutch, the harness crutch, is described which reduces loading on the arms during the swing phase of swing-through gait. The device was fabricated by attaching a modified mountaineering harness by two side straps, to modified axillary crutches. The harness crutch was compared with the saddle crutch, described by Taylor in 1883. The saddle crutch produced pressures in excess of 500 mmHg in the perineal area; no pressures were produced in this area with the harness crutch. Ischial pressures produced by both systems were similar. In six out of eight non-impaired subjects, significantly more force was transmitted to the harness crutch (an average 47% of body weight) than to the saddle crutch (an average 40% of body weight). A comparison of the oxygen cost of swing-through gait was made between the harness crutch and unmodified axillary crutches; with the harness crutch oxygen cost was significantly lower (p < 0.01) and there were no significant differences in speed and stride length.

Arm↗
PubMed1996

Metabolic evaluation of the criteria used to fit elbow crutches by measurement of oxygen consumption.

OBJECTIVE: To investigate if elbow crutches fitted using conventional guidelines are the most metabolically efficient. DESIGN: Repeated measure connivance sample using crutch length as the independent variable. SETTING: A university exercise physiology laboratory. OTHER PARTICIPANT: Connivance sample of 10 students free from cardiovascular disease, with previous experience in crutch ambulation, and between heights of 160 and 175 cm. Four potential subjects refused to participate in the study. INTERVENTIONS: Crutch length was adjusted using conventional guidelines, and to lengths 2.5 cm above and below this setting. Oxygen consumption was measured using indirect open-circuit spirometry during the final 3 minutes of ambulation using self-selected walking speeds. MAIN OUTCOME MEASURE: Crutches adjusted to the convention setting are not the most efficient in terms of metabolic energy expenditures. RESULTS: A significant reduction in oxygen rate (p = .012), oxygen cost (p = .010), and respiratory exchange ratio (p = .009) were observed when comparing crutches adjusted to -2.5 cm of the standard height with conventional crutch height. Crutches adjusted 2.5 cm above the standard height also required less energy, but these values failed to reach any statistical significance (p > .05). CONCLUSION: The importance of fitting crutches to the correct length using conventional guidelines has not been substantiated in this study. Clinically, there should be a move away from adherence to crutch-fitting criteria and more incorporation of patient feedback to fit crutches to the optimal height. Future research should evaluate the reliability of practical clinical measures such as heart rate and perceived exertion to fit crutches to the optimal height.

Adult↗
PubMed1993

[Dynamic roles of the upper extremity during axillary crutch gait].

To ambulate successfully with an axillary crutch, the upper extremities play an important part in supporting the body's entire weight. To evaluate the roles of the upper extremity during axillary crutch gait 15 normal adult subjects, 23 patients with an affected single leg, and 3 patients with rheumatoid arthritis (RA), were investigated. The gait patterns using crutches were: the one-leg swing-through crutch gait and three-point crutch gait for both normal subjects and patients with an affected single leg, and the three-point crutch gait for RA patients. The real-time motion analysis system "Quick-MAG", force plates, and a VTR system were used for data acquisition. The forces at the arm-pit and the hands during the swing-through crutch gait decreased when the cadence increased from 60 to 100 steps per minute. However, the floor reaction curve suggested distortion of the rubber at the crutch tip when the cadence reached 100. In the plane of progression during the crutch stance phase, the elbow flexion angle was about 14 degrees, and the wrist radial flexion angle about 23 degrees in the middle of the crutch stance phase. This position might be the best for efficient force exertion from the upper extremity. The unloading ratio during the three-point crutch gait was 35 percent in the normal subjects, 49 percent in patients with an affected single leg, and 14 percent in the RA patients. The results of the unloading ratio, indicated that elbow and wrist joint impairment prevented the RA patients from sustaining enough posture to support body weight during the three-point crutch gait.

Adolescent↗
PubMed1988

Some biomechanical aspects of crutch and cane walking: the relationship between forward rate of progression, symmetry, and efficiency--a case report.

The purpose of this case report is to review the progression of crutch ambulation typically used in the management of lower extremity injuries, and to describe some biomechanical parameters of gait using assistive devices. A comparison is made between weight bearing status and the use of different devices (that is, axial crutches, cane). Unilateral versus bilateral and nonreciprocal versus reciprocal crutch gait patterns are evaluated. Review of the data showed bilateral use of crutches helped to maintain the symmetry of gait as was demonstrated when right and left cycle times and right and left stride lengths were compared. Symmetry was maintained for most bilateral crutch gaits with the exception of the NWB (three-point) pattern. This trial represents, by definition, an asymmetrical condition. The comparison of nonreciprocal versus reciprocal FWB crutch gaits revealed little objective difference in the parameters studied. However, it is the authors' view that a two-point reciprocal crutch gait more closely approximates normal gait, and therefore should be encouraged. It is possible that consideration of different parameters (for example, electrogoniometric analysis of joint angles) might demonstrate an objective difference between nonreciprocal and reciprocal gait patterns. When a single assistive device was used (crutch or cane) asymmetries were demonstrated. When single crutch and single cane trials were compared obvious asymmetries in cycle time and stride length were noted in the former. A single axial crutch splints the upper trunk, thereby decreasing pelvic/trunk rotation and reducing reciprocal arm swing. Using a cane substantially improves symmetry and forward rate of progression by increasing rotation and reciprocal arm swing. The authors believe this finding is significant and should be considered when selecting a unilateral device. Indeed, these findings suggest it may, under certain circumstances, be more appropriate to forego the use of a unilateral crutch. Perhaps the most obvious effect assistive devices have on gait is to decrease the rate of forward progression. When (unassisted) PRA was compared with trials in which assistive devices were used, velocity and cadence decreased. Asymmetries of gait lead to distortions in the path of the center of gravity, which manifest as increased energy expenditure. Energy expenditure is similarly affected when the rate of forward progression varies from an optimal rate. Using an inappropriate assistive device decreases forward rate of progression and therefore may lead to inefficient ambulation under certain circumstances.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2003

[Is it possible to propose the abolition of crutches according to the gait speed in patients with total knee arthroplasty?].

OBJECTIVE: To determine the stop of crutches to walk in patients with total knee arthroplasty from the test of maximal gait speed. METHOD: 46 patients (73.6 +/- 4.6 years) carried out the maximal gait speed test on a 10-meter track, with two crutches, at the 3rd week after a total knee arthroplasty surgery for gonarthrosis. Two groups were separated according to the need of crutches to walk. Various threshold values of maximal gait speed were then determined (ROC curve) to know if this parameter could define the stop of crutches to walk (Predictive value). RESULTS: Patients able to stop crutches (n = 27) walk faster, than the patients who still need crutches (n = 19), (0.86 +/- 0.17 m/s vs 0.65 +/- 0.14 m/s; p < 0.01). According to the ROC curve, two speeds were chosen: 1.11 m/s (9 s) and 0.55 m/s (18 s). A gait speed superior or equal to 1.11 m/s presents a positive predictive value of 86% to authorize to stop crutches. Below 0.55 m/s, the positive predictive value is 83% to keep crutches. Between these two speeds, the test of maximal gait speed does not help the clinician to decide to stop crutches. CONCLUSION: The test of maximal gait speed brings a help to decide to stop crutches only for speeds superior to 1.11 m/s.

Aged↗
PubMed2001

Locomotor-respiratory coupling during axillary crutch ambulation.

OBJECTIVE: To test the hypotheses that locomotor-respiratory coupling occurs in humans using axillary crutches in a swing-through ambulation pattern and that expiration occurs during crutch-stance phase during locomotor-respiratory coupling. DESIGN: Eighteen able-bodied persons were trained in one-footed swing-through gait with axillary crutches. Then, as subjects walked at "somewhat hard" speeds (Borg) on a motorized treadmill for 5 min, we recorded signals from a crutch pressure switch and a mouthpiece-mounted thermocouple. Coupling was defined as being present when the onset of inspiration varied by < or = 5% with respect to the onset of the crutch gait cycle for a minimum of 10 consecutive gait cycles and when there was no drift on a raster plot of the respiratory phases relative to the onset of the gait cycle. RESULTS: Ten (56%) of the 18 subjects exhibited locomotor-respiratory coupling on 1-4 occasions each, with episodes lasting 11.3-148 sec. In 17 (89%) of the 19 episodes of 1:1 locomotor-respiratory coupling, expiration occurred during the crutch-stance phase of the gait cycle and inspiration occurred during crutch swing. CONCLUSIONS: Transient 1:1 locomotor-respiratory coupling occurs in many able-bodied subjects ambulating with axillary crutches and a swing-through gait. Expiration is most often associated with the crutch-stance phase of the gait cycle. This study may have implications for training axillary crutch users.

Adult↗
PubMedDate not supplied

Heart rate evaluation of axillary and elbow crutches.

The aim of this study was to compare the possible effect on heart rate in patients with a walking disability using 11 different crutch designs. Eighteen patients, over the age of 18 years, who had used crutches for a minimum of 2 weeks before the study were divided into two groups: elbow and axillary crutch users respectively. The former tested six different designs of elbow crutches and the latter five different pairs of axillary crutches. Heart rate was recorded, using a portable digital pulse monitor during a 5-min walk on the level at self-selected velocities. Walking heart rates increased between 28.6 and 58.8% compared with the resting phase. No differences were found in either heart rate or walking speed between elbow crutches. However, a significant difference (p less than 0.001) in heart rate was noted between elbow crutch users who were non-weight bearing on their injured leg compared with those who were partial-weight bearing. The Canadian axillary crutch showed the lowest increase in heart rate at comparable walking speeds compared with other axillary crutches. Prescribers should be aware that the reduced energy requirements of the Canadian crutch would benefit patients with reduced cardiorespiratory function.

Adult↗
PubMed2000

Crutch length: effect on energy cost and activity intensity in non-weight-bearing ambulation.

OBJECTIVE: To investigate the effect of forearm crutch length on energy cost in three-point, non-weight-bearing (NWB) ambulation. DESIGN: Double-blind repeated measures design using crutch length as the independent variable. SETTING: Overland walking circuit at a university campus. PARTICIPANTS: Volunteer, convenience sample of 20 subjects consisting of university students and staff without cardiovascular, respiratory, or orthopedic conditions. INTERVENTION: Subjects used a three-point, NWB gait with forearm crutches set to length using conventional guidelines, and at 2.5 cm above and below this value. MAIN OUTCOME MEASURES: Oxygen consumption, carbon dioxide production, heart rate, speed of ambulation, and perceived exertion under steady-state conditions. RESULTS: In terms of oxygen cost, ambulation with crutches set to the length recommended in conventional guidelines was not significantly more energy efficient than ambulation with either the longer or shorter crutches. Using crutches set 2.5 cm longer than conventional guidelines produced the lowest respiratory exchange ratio (Vco2/Vo2) and the lowest ratings of perceived exertion. However, none of these differences reached statistical significance. CONCLUSION: Since exact crutch length was not critical in terms of oxygen cost, walking speed, or perceived exertion during NWB ambulation, the importance of rigidly adhering to specific guidelines for setting crutch length was not substantiated in this study. Clinically, consideration of patient preference regarding crutch length (within 2.5 cm) can be advocated.

Adolescent↗
PubMed1985

Elbow moment and forces at the hands during swing-through axillary crutch gait.

We investigated swing-through axillary crutch gait (nonweight bearing on the left lower extremity) to determine the effects of gait speed, crutch length, and handle position on the forces exerted at the hands and on the moments exerted about the elbow joints. Ten healthy subjects, skilled in swing-through crutch gait, walked at three speeds using fitted crutches, at a fixed speed with four different crutch lengths, and at a fixed speed with four different handle positions. We collected ground reaction forces that exerted simultaneously on the right crutch and motion data with a force plate and three high-speed movie cameras. A biomechanical model was developed to calculate the forces exerted at the right hand and the moments exerted about the right elbow joint. Changing gait speed from slow to the normal gait of the subject showed statistically significant effects (p less than .05) on the forces at the hand. When we changed crutch heights for the subjects, we found no significant effects on the forces at the subjects' hands. Changing handle position significantly affected the moment at the elbow. Increasing the elbow-flexion angle above 30 degrees by raising the crutch handle 1 to 2 in resulted in a 100 percent increase in elbow-extension moment. We found a correlation of .82 between actual average elbow-flexion angle and elbow-extension moment. Changing gait speed or crutch length did not affect elbow moment.

Adult↗
PubMed1990

Energy cost, exercise intensity, and gait efficiency of standard versus rocker-bottom axillary crutch walking.

The purpose of this study was to investigate differences in selected biomechanical and physiological measurements and subjective preferences for ambulation with the standard single-tip axillary crutch versus the rocker-bottom-type axillary crutch. Self-selected walking velocities (S-SWVs) and stride length for each crutch type were determined for a two-point, non-weight-bearing, swing-through gait in 24 healthy volunteers. Relative exercise intensity, oxygen uptake (VO2), and gait efficiency were assessed for each crutch type at both S-SWVs. Subjects negotiated two architectural barriers (stairs and ramp) and completed a subjective questionnaire concerning crutch preferences. Walking with either crutch type resulted in slower S-SWVs, greater VO2, higher relative exercise intensity, and reduced gait efficiency compared with values for normal unassisted ambulation. An analysis of variance for these variables revealed nonsignificant between-crutch differences. Based on the subjective data, a preference for the standard single-tip crutch was evident. Within the scope of the study, the results supported no apparent advantage relative to energy expenditure to using the rocker-bottom crutch.

Adult↗
PubMed1989

The mechanical performance of ambulation using spring-loaded axillary crutches. A preliminary report.

Crutches with the extension post replaced by a spring-loaded post were compared with standard axillary crutches with respect to stresses developed during the stance phase of locomotion. Seven subjects were tested using both standard and spring-loaded crutches. The crutches were fitted with strain gauges; crutch length and grip location were adjusted for each subject using accepted standards. Subjects ambulated using a three-point "swing-through" gait pattern while strain gauge data were recorded. Spring-loaded axillary crutches had 22% smaller shock waves upon initial contact and 24% smaller peak stresses (P less than 0.05). Subjects reported improved endurance and comfort with the spring-loaded crutch. Although larger trials will be necessary, these initial results show promise in reduction of impact-loading of the upper extremity of patients using axillary crutches.

Crutches↗