Canes and Crutches - Fundamentals - Episode 58 🩼🩼🩼
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Hey, what's up everyone? Dr. Zeeshan here. I really want to take a moment to thank everyone that listens to our podcast, that subscribes to the podcast, that even shares it amongst other people and your peers. Thank you so much from myself and the team at NCLEX High Yield. It's because of

the audience that we have, the people that follow us on here, on Instagram, on Facebook, on YouTube, and on TikTok, that really keeps us going and motivated to keep bringing you some new content as often as we can. Remember, we do have our free weekly Zoom every single Wednesday that we do a new topic, practice questions as well to try to come to that free weekly Zoom, free education, why not,

And then also right after that, we started doing trivia. It helps the neurons fire. So on test day, you get that association real quick. You're not wasting a lot of that brain power. And lastly, remember, we always have the on-demand going. If you like the podcast, if you like our YouTube channel, imagine having 70 hours of content with notes, with myself lecturing on pretty much every topic and seeing all these people get 85 and out. So again, thank you all so much and good luck.

Let's talk about canes. The different topics that we're going to cover with canes are the different types of canes, their indications for use, proper use of the cane, and then safety and patient education. So there's different levels of exactly what we can ask on the boards regarding canes. The first one is identifying what type of a cane it is.

So we've got what's called a single point cane and we've got a quad cane. And if you just look at exactly what they're saying when they define the type of cane it is, single point is one of those ones that's just a stick. It's only got the one end to it. Whereas the quad cane, it has four little legs, quad being four, and then the cane being the portion of it that holds. So this one offers more stability.

So the single point cane has minimal stability and it's good for balance and support

But if you think about just the actual structure of that cane, a single point is one leg that you're holding on, whereas a quad cane has much more stability than the single point because it's got four legs at the base. When do we use it? Well, we need it for patients that have balance issues.

And when we talk about balance issues or need balance assistance, we're looking at unilateral weakness, unilateral weakness. So in what patients are canes indicated? Think of patients that develop a unilateral weakness. So patients such as strokes,

is a big one. What other balance issues or not, not just balance. How about just unilateral weakness and what other situations do you see? And so when we think about unilateral weakness, we think of different types of populations, populations like stroke patients, patients that have balance issues like vertigo. How about people that have that unilateral weakness with age and degeneration? How about,

arthritis. We don't want to mix up crutch with cane. Now let me explain the difference real quick so that way we understand when we use one over the other. In a cane, we have weakness or balance issues.

Whereas a crutch is going to be for more severe injuries, surgery on the leg or a fracture of the leg. So one is going to be for a more severe injury. The other one is a little bit more milder, mild weakness or balance issues. Crutch, we need to be able to have that support because we have a broken leg. We are unable to use that leg. Whereas a cane, crutches,

offers more stability, whether it be single point or quad cane, it's therefore stability in mild balance issues, mild weakness as well too, such as stroke victims, people that are recovering from strokes and or people that have arthritis, so things of that nature. So that's the difference between crutch and cane. So moving on with cane, we must look at

educating on the proper use of a cane. So the proper use of cane starts with fitting. What are we looking at? What parameters are we looking at when we're dealing with a patient that needs to be fitted for a cane? Well, first and foremost, we've got to look at their height because the length of the cane is going to be dependent on their height because ultimately the cane should align

with the wrist when the patient is standing with their arms down. Standing with arms down. So if I'm fitting a cane, what I'm looking at is the height. So ultimately, how am I going to determine the length of the cane? Well, I want them to stand up and I want them to put their hands by their side. And where the wrist falls next to the side of the body,

is where I want the height of the cane to be. When we talk about technique of canes, we're going to be talking about what hand to hold it in, how we're going to walk with it, and how we're going to take steps moving forward, and then the use of a cane going up the stairs

and also going down. So with technique, we want to start with what hand do we want to hold it in? And the hand that we're going to hold it in is the hand opposite of the affected leg. So with the cane, we hold it

on the hand opposite of the affected side or we hold it on the side of the good leg. Well, we know what hand to hold it in, but how do we walk with it? So let's talk about walking with a cane. First, we want to move the cane forward. We then take the weaker leg and we align it forward

with the cane and then we bring that stronger leg up or forward. So technique, we start with what hand we hold the cane in and it is in fact the hand opposite of the affected leg or the hand that is in fact the stronger leg or the hand that is the same as a stronger leg.

Then we have to learn how to walk with the cane. So when we educate our patients, select all that apply, we're going to move the cane forward, step one. Step two, bring the weaker leg aligned to that cane. And then step three, bring the strong leg forward. So in order, move the cane forward first, then the weaker leg we align to the cane,

and then we bring the stronger leg forward. Now we're going to talk about using a cane going up and down stairs. With stairs, remember the quick tip, we go up with the strong, down with the weak. So what does that mean? When we go up the stairs, we start with the strong leg, and then we bring up the cane, and then we bring up the weak leg.

Whereas when we go down, we go down with the weak. But when we go down with the weak, we start with the cane first, then the weaker leg, then the strong leg. So recap, which stairs...

When we go up the stairs, we go up with the strong, down with the weak. Up with the strong, down with the weak. Go up the stairs with the strong leg first, cane second, weak leg last. When we go down the stairs, we go down with the weaker leg, we start with the cane, then the weaker leg, then the stronger leg. So there's in each one of these, it's a three-step process.

So just remember, up with the stairs, or sorry, up with the strong, down with the weak. Each one is going to have three steps. So when you go up, strong leg, cane, weak leg. When we go down, cane, weak leg, strong leg. Another part of canes that gets overlooked that I think is important that we should know that's very, very fair game for the boards is safety considerations regarding canes.

Because ultimately the problem with patients that have the necessity for canes is that they are a fall risk. That's the biggest thing. A lot of these people, they will end up hurting themselves severely because of a fall. In elderly patients, what are we concerned about? Fall. In patients that have arthritis, in elderly patients, stroke,

We're worried about falls because recovering from a fall, especially as we age, is one of the biggest risk factors for not recovering and actually becoming debilitated is falls. So we must consider the safety precautions when we're dealing with canes. So what is the first thing we're going to look at? Well, it's simple. Inspect the device. So inspect the device. What does that mean? Well, we want to regularly check the cane and look for wear and tear.

We want to make sure that the rubber tips, because on the bottom is a rubber tip, in order to prevent slipping, so we get good traction, make sure that is intact, so that way we're not overlooking something that can be detrimental to their safety. The second is called environment. So safety with a cane, we must look at environment. So again, loose rugs, cords, clutter, clear pathways, nightlights,

fall risks. Make sure there's no leaks or any wet, damp areas, no dusty areas. Anything that can cause slipping or getting in the way or tripping is considered environmental safety. The next two for safety precautions are going to be, are they able to bear the weight on that cane? Is it sturdy enough or is it a little flimsy? Are there any cracks in it?

Are they able to balance on it? So again, we want to just do a little bit more safety precautions when it comes to cane use and cane safety. So for crutches, which obviously can be compared to canes, but the difference being that one is going to be for crutches,

something more severe, like we talked about as far as fractures, as far as post-surgery, things where we need to be able to recover. And these patients, they require non-weight bearing or partial weight bearing on one or both legs. So we really can't use the legs in this situation. In the other situation with Canes, we had weaker legs.

or we had weakness, or we had balance issues. In this situation, we have non-weight-bearing leg or a partial weight-bearing leg or legs. That's when we need crutches. That is going to take the weight off of that leg completely. So what are some parameters that we're going to look at? What are some sections that the boards like to talk about when it comes to crutches? Well, we just talked about the purpose of it, where we have a non-weight-bearing or a partial weight-bearing leg or legs.

Then we're going to talk about the types of crutches. We're going to talk about weight distribution. We'll talk about positioning. We'll talk about gait patterns, which is that 2.3.4 point gait. We'll talk about stability and patient population. So let's talk about the different types of crutches. When we talk about the different types of crutches,

The two that we're going to see for the sake of the boards that I want you to know is an axillary crutch. And where's our axilla? It is our armpit, right? So an axillary crutch and a forearm crutch.

When do we use which and how do we use them? Well, the axillary crutch is the standard crutch that you think about that has the handle and then there's a pad right underneath the armpit and we're able to put pressure on it. Now, the thing about axillary crutches is that it can compress the axillary nerve. So educating them on proper use of a crutch is very important.

then our forearm crutch is going to be used for long-term disabilities. People that have chronic conditions. And these are the ones that you would see that potentially both legs are not able to be used and they're placing their forearms

into that crutch and now they're using that crutch as a means of replacing or stabilizing their leg. And that's what a forearm crutch is. So with crutches, again, we talked about the indications for it, the usage, whether it be non-weight bearing or partial weight bearing situations where you cannot put any type of weight or a little bit of weight on either one or both legs.

So a situation that we'll see that in, things like fractures, sprains, dislocations, surgical recovery, hip or knee surgeries, or severe, severe joint pain, severe joint pain. Then we went into the types of crutches. The two different types of crutches that we're going to see are the axillary crutches, which are, again, underneath the arm in the axillary area or the armpit area. This is good for short-term mobility. Then we've got our

forearm crutches or lobstrand crutches. These are used for long-term mobility in patients with chronic conditions because the cuff fits around the forearm and it gives more freedom of the hands. Whereas under the axillary, we're kind of bound to our hands not being as free. So these are great for things like, or these are great for patients that have potentially cerebral

palsy or other neurological conditions where they're unable to utilize both legs. So now we're going to talk about proper fitting of crutches. So education, education. The reason why we're going to properly fit these is one, so we utilize them properly. Second, so they're comfortable. And third, so we don't obtain any injuries. So with axillary crutches, we're going to adjust the height

so that there's two to three finger widths of space between the top of the crutch and the armpit. So one to two inches or two to three finger widths between the top of the crutch and the actual armpit or the axillary area. So you don't want them resting on it. You want space so that you have that two to three finger widths or one to two inches in between that top and the armpit.

Because again, what are we trying to prevent? Axillary nerve damage. The hand grips should be at the wrist level. The hand grips should be at the wrist level when the patient's arms are hanging naturally. So as they stand, let their hands dangle naturally.

the wrist is where the hand grips should be at. The wrist is where the hand grips should be at. This allows for our elbow to bend, as most literature will say, in that 30 degree angle. So again, hand grips should be positioned where the wrist is hanging naturally, dangling at the side of the body.

This allows for the elbow to bend at that 30 degree angle, which is going to provide control and comfort. Control and comfort. With the forearm crutch, the cuff should fit snugly around the forearm. So about one to two inches below the elbow. And again, the hand grip should be at the wrist level when the arms are hanging naturally. So again, just a little quick point when we're dealing with wear,

we should have the grips at, it should always be for crutches in this situation, axillary forearm, it should always be when you dangle your hands to the side at the level of the wrist. Now we get into arguably the topic with crutches that gets tested the most. In this situation, we're gonna talk about walking with crutches, walking with crutches, which is in fact a two point gait, a three point gait,

and a four-point gait. We'll start with non-weight bearing and then we'll get into partial weight bearing. You've got the option of partial weight bearing and non-weight bearing. With partial weight bearing, you can use a two-point or four-point. With partial weight bearing, you can use a two-point or four-point.

Whereas with non-weight bearing, we're going to use a three-point gait. So what is a three-point gait? First and foremost, we must understand that we're going to use this with non-weight bearing crutches. So three-point gait is non-weight bearing. With this, the patient cannot bear weight with one leg. So what are the steps? Step one, move both crutches forward together. So let's just think about this. If I've got one leg that cannot bear weight,

I've got two crutches and one leg. How many points is that? With non-weight-bearing three-point gait is we've got two crutch legs and one good leg. That is your three points. So now, step by step, what are we going to do? Move both crutches forward together. Then move the injured non-weight-bearing leg forward without placing any weight on it.

and then step forward with the unaffected leg. One more time. Three-point gait, we have a non-weight-bearing leg. So the three points are in fact the crutches and the weight-bearing leg. The steps of moving forward in the three-point gait is move the crutches forward, followed by the non-weight-bearing leg without placing weight on it, and then step forward with the unaffected leg.

That is your three-point gait. Our four-point gait and our two-point gait again are going to be with partial weight bearing. Partial weight bearing. Which means that we can put a little bit of weight on that fourth point or that second point depending on what the situation is. So the four-point gait is with partial weight bearing on both legs. In this situation, we have four steps. Four-point gait, four steps.

If we're able to put partial weight on both the legs, then we're going to move the right crutch forward, then the left leg forward, left crutch forward, right leg forward. Again, four-point gait with partial weight bearing. We're going to move the right crutch forward, left leg forward, left crutch forward, right leg forward. So we alternate.

It's a slow gait, but it's steady and it's stable. So this is great for people that have bilateral weakness. Then the last one is our two-point gait, again, using a partial weight bearing. And in this situation, we have two steps. Move the left crutch and right leg forward together. Step two, move the right crutch and left leg forward together. Two steps, two-point gait.

Again, move the left crutch and right leg forward together. Step two, move the right crutch and the left leg forward together. And that is crutches.