Student: Shah, Trishna Review Materials from Exam: Compass Pretest Use of this content is subject to the Terms and Conditions of the Evolve web site. (B from Sorrentino SA, Remmert L: Mosby's textbook for nursing assistants, ed. 8, St. Louis, 2012, Mosby.) 530 400 530 400 80 60 Patients need to possess adequate upper body strength and coordination when using all types of crutches. The crutch-walking pattern employed depends on the extent and nature of the patient's disability. The two-point crutch-walking pattern is used by patients who can bear partial weight on either or both lower extremities. This method provides stability and support for ambulation. Patients move one crutch forward simultaneously with the opposite leg, providing a wide base of support. Three-point crutch walking is employed by patients who have injury to one leg. To begin this gait pattern, both crutches are placed forward, and patients swing their legs through, bearing weight on only the uninjured leg. A similar pattern, commonly referred to as a swing-through gait, is used by paraplegics. In this method, patients place the crutches forward and then swing their lower extremities simultaneously through the crutches to facilitate forward movement. The four-point crutch gait requires partial weight bearing on both lower extremities. This provides more stability than the two-point pattern, because only one of four points of support is lifted off the floor at any time. In this ambulation technique, the patient moves one crutch forward, followed by the opposing leg, and repeats the pattern by moving the opposite crutch and then the leg forward. Skill 28-3 illustrates the different crutch-walking patterns. Figure 28-11 shows a patient with crutches ascending stairs. A gait belt is in place, and a caregiver is spotting. The patient transfers weight from the crutches to the unaffected leg on the stairs. The crutches are then brought up onto the stair and aligned with the unaffected leg. In descending stairs (Figure 28-12), body weight is transferred from the unaffected leg to the crutches. The unaffected leg is then brought down onto the stair and aligned with the crutches. FIGURE 28-11 315 423 315 423 59 79 FIGURE 28-12 205 424 205 424 38 79 Types of crutches. A, Underarm. B, Forearm. Use of crutches to ascend stairs. Use of crutches to descend stairs. Crutches Crutches facilitate increased patient mobility. Different types of crutches may be used on a short-term or longterm basis for patients with lower extremity injury or paralysis (Figure 28-10). Underarm crutches should be fitted to allow approximately 2 inches or three finger widths of space between the top of the crutch and the axilla when the crutch is placed slightly in front of and 6 inches to the side of the foot. The patient's elbow should be comfortably bent to avoid pressure on the nerve running into the axilla. Encourage the patient to immediately report tingling in the hands. Forearm or Lofstrand crutches are traditionally used for patients with long-term or permanent impairment. Forearm crutches are designed with a handgrip and a metal cuff that partially or completely surrounds the lower arm. FIGURE 28-10 Copyright © 2022 Elsevier Inc. All rights reserved.
