-
American Family Physician Jun 2021Many individuals need a mobility assistive device as they age. These devices include canes, crutches, walkers, and wheelchairs. Clinicians should understand how to... (Review)
Review
Many individuals need a mobility assistive device as they age. These devices include canes, crutches, walkers, and wheelchairs. Clinicians should understand how to select the appropriate device and size for individual patients (or work with a physical therapist) and prescribe the device using the patient's health insurance plan. Canes can improve standing tolerance and gait by off-loading a weak or painful limb; however, they are the least stable of all assistive devices, and patients must have sufficient balance, upper body strength, and dexterity to use them safely. Older adults rarely use crutches because of the amount of upper body strength that is needed. Walkers provide a large base of support for patients who have poor balance or who have bilateral lower limb weakness and thus cannot always bear full weight on their legs. A two-wheel rolling walker is more functional and easier to maneuver than a standard walker with no wheels. A four-wheel rolling walker (rollator) can be used by higher-functioning individuals who do not need to fully off-load a lower limb and who need rest breaks for cardiopulmonary endurance reasons, but this is the least stable type of walker. Wheelchairs should be considered for patients who lack the lower body strength, balance, or endurance for ambulation. Proper sizing and patient education are essential to avoid skin breakdown. To use manual wheelchairs, patients must have sufficient upper body strength and coordination. Power chairs may be considered for patients who cannot operate a manual wheelchair or if they need the features of a power wheelchair.
Topics: Aged; Canes; Crutches; Female; Humans; Male; Mobility Limitation; Self-Help Devices; Walkers
PubMed: 34128609
DOI: No ID Found -
American Family Physician Jan 2011Stress fractures are common injuries in athletes and military recruits. These injuries occur more commonly in lower extremities than in upper extremities. Stress... (Review)
Review
Stress fractures are common injuries in athletes and military recruits. These injuries occur more commonly in lower extremities than in upper extremities. Stress fractures should be considered in patients who present with tenderness or edema after a recent increase in activity or repeated activity with limited rest. The differential diagnosis varies based on location, but commonly includes tendinopathy, compartment syndrome, and nerve or artery entrapment syndrome. Medial tibial stress syndrome (shin splints) can be distinguished from tibial stress fractures by diffuse tenderness along the length of the posteromedial tibial shaft and a lack of edema. When stress fracture is suspected, plain radiography should be obtained initially and, if negative, may be repeated after two to three weeks for greater accuracy. If an urgent diagnosis is needed, triple-phase bone scintigraphy or magnetic resonance imaging should be considered. Both modalities have a similar sensitivity, but magnetic resonance imaging has greater specificity. Treatment of stress fractures consists of activity modification, including the use of nonweight-bearing crutches if needed for pain relief. Analgesics are appropriate to relieve pain, and pneumatic bracing can be used to facilitate healing. After the pain is resolved and the examination shows improvement, patients may gradually increase their level of activity. Surgical consultation may be appropriate for patients with stress fractures in high-risk locations, nonunion, or recurrent stress fractures. Prevention of stress fractures has been studied in military personnel, but more research is needed in other populations.
Topics: Algorithms; Anti-Inflammatory Agents, Non-Steroidal; Bone Density Conservation Agents; Calcium, Dietary; Crutches; Diagnosis, Differential; Diagnostic Imaging; Electric Stimulation Therapy; Etidronic Acid; Fracture Healing; Fractures, Stress; Humans; Orthotic Devices; Pain; Risedronic Acid; Risk Factors; Ultrasonic Therapy; Vitamin D
PubMed: 21888126
DOI: No ID Found -
European Journal of Trauma and... Feb 2020The goal of this study was to assess if unprotected weight-bearing as tolerated is superior to protected weight-bearing and unprotected non-weight-bearing in terms of... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
The goal of this study was to assess if unprotected weight-bearing as tolerated is superior to protected weight-bearing and unprotected non-weight-bearing in terms of functional outcome and complications after surgical fixation of Lauge-Hansen supination external rotation stage 2-4 ankle fractures.
METHODS
A multicentered randomized controlled trial was conducted in patients ranging from 18 to 65 years of age without severe comorbidities. Patients were randomized to unprotected non-weight-bearing, protected weight-bearing, and unprotected weight-bearing as tolerated. The primary endpoint of the study was the Olerud Molander Ankle Score (OMAS) 12 weeks after randomization. The secondary endpoints were health-related quality of life using the SF-36v2, time to return to work, time to return to sports, and the number of complications.
RESULTS
The trial was terminated early as advised by the Data and Safety Monitoring Board after interim analysis. A total of 115 patients were randomized. The O'Brien-Fleming threshold for statistical significance for this interim analysis was 0.008 at 12 weeks. The OMAS was higher in the unprotected weight-bearing group after 6 weeks c(61.2 ± 19.0) compared to the protected weight-bearing (51.8 ± 20.4) and unprotected non-weight-bearing groups (45.8 ± 22.4) (p = 0.011). All other follow-up time points did not show significant differences between the groups. Unprotected weight-bearing showed a significant earlier return to work (p = 0.028) and earlier return to sports (p = 0.005). There were no differences in the quality of life scores or number of complications.
CONCLUSIONS
Unprotected weight-bearing and mobilization as tolerated as postoperative care regimen improved short-term functional outcomes and led to earlier return to work and sports, yet did not result in an increase of complications.
Topics: Adolescent; Adult; Aged; Ankle Fractures; Casts, Surgical; Crutches; Early Ambulation; Female; Fracture Fixation, Internal; Humans; Male; Middle Aged; Postoperative Care; Postoperative Complications; Quality of Life; Range of Motion, Articular; Return to Sport; Return to Work; Time Factors; Treatment Outcome; Weight-Bearing; Young Adult
PubMed: 30251154
DOI: 10.1007/s00068-018-1016-6 -
Continuum (Minneapolis, Minn.) Feb 2019This article presents an overview of the clinical syndrome of posterior cortical atrophy (PCA), including its pathologic underpinnings, clinical presentation,... (Review)
Review
PURPOSE OF REVIEW
This article presents an overview of the clinical syndrome of posterior cortical atrophy (PCA), including its pathologic underpinnings, clinical presentation, investigation findings, diagnostic criteria, and management.
RECENT FINDINGS
PCA is usually an atypical form of Alzheimer disease with relatively young age at onset. New diagnostic criteria allow patients to be diagnosed on a syndromic basis as having a primary visual (pure) form or more complex (plus) form of PCA and, when possible, on a disease-specific basis using biomarkers or underlying pathology. Imaging techniques have demonstrated that some pathologic processes are concordant (atrophy, hypometabolism, tau deposition) with clinical symptoms and some are discordant (widespread amyloid deposition). International efforts are under way to establish the genetic underpinnings of this typically sporadic form of Alzheimer disease. In the absence of specific disease-modifying therapies, a number of practical suggestions can be offered to patients and their families to facilitate reading and activities of daily living, promote independence, and improve quality of life SUMMARY: While rare, PCA is an important diagnostic entity for neurologists, ophthalmologists, and optometrists to recognize to allow for early accurate diagnosis and appropriate patient management. PCA provides an important opportunity to investigate the causes of selective vulnerability in Alzheimer disease.
Topics: Alzheimer Disease; Atrophy; Brain; Humans; Neuroimaging; Quality of Life; Vision Disorders
PubMed: 30707187
DOI: 10.1212/CON.0000000000000696 -
International Journal of Sports... 2021Instead of using axillary crutches, using a hands-free crutch (HFC) has been associated with higher functional outcome scores. However, hip and back pain have been...
BACKGROUND
Instead of using axillary crutches, using a hands-free crutch (HFC) has been associated with higher functional outcome scores. However, hip and back pain have been reported as side effects.
PURPOSE/HYPOTHESIS
The purpose of this study was to compare range of motion and joint reaction forces at the hip and low back between HFC walking, normal walking, and standard crutch walking. It was hypothesized that hip joint reaction forces and low back joint reaction forces would be higher with HFC walking compared with normal walking and axillary crutch walking.
STUDY DESIGN
Controlled Laboratory Study.
METHODS
Using 3D motion analysis and force plates, kinematics and ground reaction forces were measured in 12 healthy subjects during gait, crutch ambulation and HFC walking. Gait speed, hip and trunk range of motion, and hip and low back reaction forces, were compared using repeated-measures ANOVA.
RESULTS
Gait speed during HFC ambulation was reduced 33% compared to crutch ambulation (P<0.001) and 44% compared to normal gait (p<0.001). Hip range of motion was reduced during both crutch conditions compared to gait (p<0.001). Trunk range of motion was greatest during HFC walking compared to both gait and crutch ambulation (p<0.001). Peak hip joint reaction force during HFC walking was 11% lower than during gait (p=0.026) and 30% lower than during crutch walking (p<0.001). Peak low back reaction force during HFC walking was 18% higher than during gait (p=0.032) but not different than during crutch walking.
CONCLUSION
Hip joint reaction forces during HFC walking did not exceed those during gait or axillary crutch ambulation. However, a reduction in hip motion using the HFC was associated with increases in trunk motion and low-back loading. These could be a cause for reports of low-back pain accompanying HFC usage.
LEVEL OF EVIDENCE
Level 3.
PubMed: 34909252
DOI: 10.26603/001c.29517 -
Sensors (Basel, Switzerland) Jul 2019In rehabilitation procedures related to the lower limbs, gait monitoring is an important source of information for the therapist. However, many of the approaches...
In rehabilitation procedures related to the lower limbs, gait monitoring is an important source of information for the therapist. However, many of the approaches proposed in the literature require the use of uncomfortable and invasive devices. In this work, an instrumented tip is developed and detailed, which can be connected to any crutch. The instrumented tip provides objective data of the crutch motion, which, combined with patient movement data, might be used to monitor the daily activities or assess the recovery status of the patient. For that purpose, the tip integrates a two-axis inclinometer, a tri-axial gyroscope, and a force sensor to measure the force exerted on the crutch. In addition, a novel algorithm to estimate the pitch angle of the crutch is developed. The proposed approach is tested experimentally, obtaining acceptable accuracies and demonstrating the validity of the proposed lightweight, portable solution for gait monitoring.
PubMed: 31277380
DOI: 10.3390/s19132944 -
American Family Physician Aug 2011Disability and mobility problems increase with age. Assistive devices such as canes, crutches, and walkers can be used to increase a patient's base of support, improve... (Review)
Review
Disability and mobility problems increase with age. Assistive devices such as canes, crutches, and walkers can be used to increase a patient's base of support, improve balance, and increase activity and independence, but they are not without significant musculoskeletal and metabolic demands. Most patients with assistive devices have never been instructed on the proper use and often have devices that are inappropriate, damaged, or are of the incorrect height. Selection of a suitable device depends on the patient's strength, endurance, balance, cognitive function, and environmental demands. Canes can help redistribute weight from a lower extremity that is weak or painful, improve stability by increasing the base of support, and provide tactile information about the ground to improve balance. Crutches are useful for patients who need to use their arms for weight bearing and propulsion and not just for balance. Walkers improve stability in those with lower extremity weakness or poor balance and facilitate improved mobility by increasing the patient's base of support and supporting the patient's weight. Walkers require greater attentional demands than canes and make using stairs difficult. The top of a cane or walker should be the same height as the wrist crease when the patient is standing upright with arms relaxed at his or her sides. A cane should be held contralateral to a weak or painful lower extremity and advanced simultaneously with the contralateral leg. Clinicians should routinely evaluate their patients' assistive devices to ensure proper height, fit, and maintenance, and also counsel patients on correct use of the device.
Topics: Aged; Canes; Crutches; Decision Support Techniques; Dependent Ambulation; Directive Counseling; Health Services for the Aged; Humans; Orthopedic Equipment; Self-Help Devices; Walkers
PubMed: 21842786
DOI: No ID Found