By lisasolonynko on Morguefile
We’ve all seen them. Most people look away quickly or stare while they pass.
Crutches, canes, and walkers are more common than we realize.
In this second installment of my Science of Injury series, you’ll see videos and hopefully understand how to walk and use the above mentioned devices correctly.
Since I’m not much of a Halloween fan, I decided against any sort of themed post today, although I guess injury can be a bit of a dark topic at times.
One of my biggest pet peeves in television and in books is when writers inaccurately portray someone with a walking impairment with either the incorrect type of assistive device, or the incorrect gait (walking) pattern while using one of them.
For the purposes of this post, I’ll discuss them separately and explain how/when/why to use them. I won’t get too much into the physics of it because, really, most people don’t care. But at least you’ll know the correct usage of them.
Please remember tips like these and others when writing about characters with injuries. This will be a VERY basic post. You must also take into account any other co-morbidities of your characters, such as: arthritis, anxiety, depression, cancer, history of surgeries, etc, when writing about their injuries.
Canes are typically used when someone has a minor walking impairment that either has to do with a slight balance or strength impairment, or when they have minor weakness of one leg. Not both. That would require a walker, crutches, or a wheelchair, which will be covered in a separate post.
There are different kinds of canes. Some have four prongs on the bottom, called a quad-cane. Others have four prongs and a significant width between each one. This one is called a hemi-cane and is primarily used with people who have hemiplegia, which is significant one sided weakness of both the upper and lower extremities. This is typically seen after people have a stroke or brain injury of some kind.
Please google images of these canes. Due to licensing and copyright restrictions, I can’t post pictures of them all.
The most common type of cane is the standard cane, which is seen above, with only one point at the bottom.
There are more than three types of canes, but these are the most commonly used. I’m not the biggest fan of the quad canes for my patients due to the physics of the gait pattern and the fact that patients can trip over them if not used correctly. These odds are decreased with standard canes.
Now, for the correct pattern: The cane should ALWAYS go in the hand OPPOSITE the side of weakness/imbalance/instability, etc. Unless there is a problem with the hand or arm of the opposite side, the cane needs to go there in order for the base of support to be adequately distributed throughout the body and the cane. Keeping the cane on the same side of the injury actually causes further weakness and a terrible walking pattern that is hard to break after the cane is no longer needed. People don’t like to use the cane in their non-dominant hand, but with practice and advisement from a physical therapist, it usually isn’t a problem.
As for stairs, when using a cane, you go up with the stronger leg, then the injured side, then the cane. So, the cane follows the bum leg on the way up.
When descending stairs, the bum leg goes first because it requires more effort on the part of the leg on the top step to slowly lower your body weight (times the weight of gravity) down a step. Therefore, the bum leg goes first, then the cane, then the good leg. Simple, right?
A popular mistake in TV with this is Gregory House from the show House, M.D. He walks with the cane in the wrong hand, and just take a look at his gait!! It’s completely wonky! If he’d used it in the correct hand, it would have been much smoother and less cumbersome. Our muscles fatigue much quicker when our gait is incorrect. His muscles were working overtime on one side of his body, and the other side was getting nothing.
Huge pet peeve! Ergh!
Here’s a video to help.
The only thing I don’t like about this video is that the cane is actually adjusted too tall for the patient. I won’t get into how to measure them. You can google and YouTube this all day long.
Not to be blunt or rude, but crutches are usually used in the younger population. It is rare to see someone older than 50-55 use crutches simply because the sequencing is too complex, or the patient’s balance isn’t sufficient enough to allow them to use crutches. If they can’t, they must use a walker.
There are different types of crutches.
The ones we all know are called axillary crutches, because they sit in the axillae (armpits) of our shoulder girdle. Those are the ones we see athletes using after a knee, hip, or foot injury.
Other common crutches are Lofstrand crutches, which have a cuff around our forearms and handles for ease of walking. These are commonly used in children with Spina Bifida or Cerebral Palsy. However, they can also be used when someone has weakness in both legs. It helps to even out the gait.
Axillary crutches are most common, and there are many gait patterns available when using them.
If someone has one leg that is unable to bear weight, we put the crutches forward first, then swing the strong through for a step while keeping the injured leg elevated. This is an advanced form of gait that is difficult for people who have balance deficits. Hence, the reason older adults and the elderly cannot use them.
Once someone progresses to the point of putting weight on their leg, the gait pattern turns into something else. The crutches are put forward first, then the injured leg, then the good leg. If done opposite, the patient will almost certainly fall because they don’t have the unweighting affect of the crutches to offset the weakness of the injured leg once it’s trailing behind the body.
Typically when using crutches on the stairs, you put both crutches in one hand and hop up on the good leg. Many people don’t have the lower body strength for this, so they resort to scooting on their butt up and down the stairs. Also effective, but sometimes it’s difficult to achieve an upright posture from the low seated position once they reach the top of the stairs.
You need to remember NOT to lean your armpits against the crutches. You could end up with a brachial plexus palsy, which is permanent nerve damage that will take out all the muscles in your arm, and it will be dead weight. NOT GOOD. DO NOT lean on your crutches. Nerve damage is likely.
Here’s another great video.
This one is for non-weight bearing only, but there are numerous videos out there for other ways to walk with crutches.
Walkers are generally reserved for patients who have poor balance and strength, but are still able to walk. Or, if they don’t/can’t achieve correct gait or balance for crutches, they are given a walker, which is far more stable, but more cumbersome and a bit heavier.
There are multiple types of walker, but the three most common are the standard walker, which has no wheels, the rolling walker, with two wheels in the front, and the Rollator walker, which has four wheels and a seat for when the patient becomes fatigued.
The standard walker is the most stable since it has no wheels, and is used when patients have weakness of one or both lower extremities, or when they have a weight bearing restriction. The gait pattern is similar to crutches. Walker goes first, then the injured leg, then the strong leg. It is very fatiguing to walk this way because of how much energy expenditure is required to continually lift the walker and place it down.
For patients without weight bearing restrictions, who may only need it for balance and shorter walking distances, a rolling walker is sufficient. This allows for a free and smooth gait pattern and allows the patient to walk without fear of falling.
Patients who require a walker for the long-term who are a little more agile and need to walk farther distances, a Rollator walker is perfect, because they can sit on the seat when they get fatigued. However, unlike the other two types of walkers, this one does NOT collapse or fold for easy storage. So, the price for freer movement is a cumbersome storage requirement.
One other type of walker I’ll mention is one that is used often in children that were born with neurological deficits or birth defects. This is called a Kaye Posture Walker and it looks like a backward walker to the rest of us. However, one of the downfalls of walkers is that people don’t stand upright while using them and it promotes poor posture. If walkers are correctly adjusted and instructed on proper use by a physical therapist, this isn’t usually a problem, but in children, poor habits happen very easily and they’re hard to break as they age.
The “backwards walker” requires the children to use an upright posture while still allowing for stability and support during the gait process.
Two more videos, these on walkers.
You HAVE to watch this one! Isn’t she precious? Good for her!
It’s amazing to watch a little girl take steps like that when she probably hasn’t been able to walk for a very long time! Sigh. I love treating kids. It can be heartbreaking, but usually joyful when they’re able to do something that is so easy for the rest of us.
Whew!! You made it!
Sorry for the length of this post, but it’s required. Remember, these are the very BASIC essentials of using assistive devices.
Please make sure to research the use of them if one of your characters finds himself in a sticky situation.
There’s so much I had to leave out of this post, so if you have questions, PLEASE leave a comment and I’ll return it ASAP.