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Modification of the ambulation aid to suit individual needs is often necessary. Aids that are adjustable in length are useful when a patient is first fitted and for children who require aids that can grow with them. However, nonadjustable aids tend to be slightly lighter and should be considered for the long-term adult user. Handgrips may be modified to reduce the marked radial deviation of the wrist that occurs with standard axillary crutch Tips.12 CUSTOMmolded cane grips can be made for deformed hands. Wrist and triceps pads help prevent wrist and elbow collapse when muscles are weak or joints are painful or deformed.
Although it may seem self-evident that a patient using an ambulation aid would have had it measured properly, this is not always the case. In a study of 60 elderly patients with canes, only 15 canes were of the correct length.14 With most ambulation aids, the elbow should be flexed 15 to 30 degrees while the patient is standing, a rule of thumb that is widely accepted although not well validated. For platform crutches, the elbows are usually flexed 90 degrees.
To achieve 15 to 30 degrees of elbow flexion, the handgrip of the aid should be at about the level of the greater trochanter or at the level of the wrist crease when the arm is hanging at the side. A cane that is too short forces the patient to lean toward the Repl Cane Tips 7/8in during the walking cycle. An aid with a handgrip that is too high may mechanically decrease the tricep's effectiveness. Improper length can therefore cause a poor gait pattern with a resulting increase in discomfort and energy expenditure.
The upper end of an axillary crutch should rest on the ribs approximately 5 cm below the anterior axillary fold. Resting the axillary bar in the axilla can lead to axillary artery thrombosis or compression neuropathy of the radial nerve.
Ambulatory Replacement, Crutch Tips, Repl Cane Tips, Ambulation Aid, Handgrips.