NON AND PARTIAL WEIGHT BEARING WALKING AFTER

FRACTURES OF LOWER LIMB

WHY EARLY MOBILITY OF PATIENT IS TO BE ENCOURAGED?

- TO AVOID COMPLICATIONS OF PROLONGED BED REST

- TO PROMOTE HEALING- TO LESSEN THE NEED FOR HOSPITAL STAY

COMPLICATIONS OF PROLONGED BED REST

EFFECTS ON VARIOUS SYSTEMS1) MUSCULO SKELETAL2) CARDIO VASCULAR3) RESPIRATORY4) SKIN5) EXCRETORY6) METABOLIC7) PSYCHO SOMATIC

MUSCULO SKELETAL SYSTEM

- DISUSE MUSCLE ATROPHY & DECREASED ENDURANCE OF MUSCLES.

- SOFT TISSUE CHANGES, TIGHTNESS AND CONTRACTURES.

- DISUSE OSTEOPOROSIS.- GENERALIZED MUSCLE WEAKNESS.

CARDIO VASCULAR

- INCREASED HEART RATE.- DECREASED CARDIAC RESERVE.- ORTHOSTATIC HYPOTENSION.- VENOUS THROMBOEMBOLISM.

RESPIRATORY SYSTEM

- DECREASED VENTILATION- COLLECTION OF SECRETIONS- ATELECTASIS- DECREASED AEROBIC FITNESS

EXCRETORY SYSTEM

- RETENTION OF URINE- INFECTIONS- RISK OF KIDNY AND BLADDER CALCULI- CONSTIPATION

METABOLISM

- LOSS OF APPATITE- DECREASED LEAN MASS TO BODY WEIGHT- INCREASED CHANCES OF DEVELOPING

DIABETES

SKIN

- PRESSURE SORES

PSYCHO SOMATIC

- SLEEP DISTURBANCE- ANXIETY- DEPRESSION- IRRITABILITY- APATHY- INCREASED DEPENDANCY ON CARE GIVER

MEASUREMENT OF CRUTCHES• CRUTCH PAD DISTANCE FROM ARMPITS: THE CRUTCH PADS (TOPS OF CRUTCHES) SHOULD BE 1½" TO 2" (ABOUT TWO FINGER WIDTHS) BELOW THE ARMPITS, WITH THE SHOULDERS RELAXED.• HANDGRIP: PLACE IT SO THAT THE ELBOW IS SLIGHTLY BENT – ENOUGH SO ONE CAN FULLY EXTEND THE ELBOW WHEN TAKING A STEP.• CRUTCH LENGTH (TOP TO BOTTOM): THE TOTAL CRUTCH LENGTH SHOULD EQUAL THE DISTANCE FROM THE ARMPIT TO ABOUT 6" IN FRONT OF THE SHOE.

TYPES OF CRUTCH WALKING

• NWB - NON WEIGHT BEARING• TDWB (OR) TTWB - TOUCH DOWN WEIGHT

BEARING (OR) TOE TOUCH WEIGHT BEARING

• PWB - PARTIAL WEIGHT BEARING

• WBTT - WEIGHT BEARING TO (OR) TOLERENCE

• FWB - FULL WEIGHT BEARING

NON WEIGHT BEARING WALKINGINSTRUCTIONS

• PLACE NO WEIGHT ON THE AFFECTED LIMB• DO NOT TOUCH THE GROUND WITH THE

AFFECTED LIMB WHILE STANDING OR WALKING

• BEAR THE FULL WEIGHT THROUGH THE NORMAL LIMB AND CRUTCHES WHILE STANDING AND WALKING

TO START WALKINGBALENCED STANDING (TRIPOD POSISTION)

• USE THIS POSITION WHEN AT START OR END A GAIT OR WHEN STANDING FOR ANY LENGTH OF TIME.

• MOVE CRUTCHES TO THE FRONT ABOUT 12 INCHES. FIND THE BALANCE.

• DON'T REST THE ARMPITS ON THE CRUTCH PADS.

• BEAR WEIGHT THROUGH NORMAL LIMB AND THE HAND GRIPS OF THE CRUTCHES

TRIPOD POSITION

NON WEIGHT BEARING

1. STAND ON UNAFFECTED LEG, LIFT BOTH CRUTCHES AT THE SAME TIME AND PLACE THE CRUTCHES ONE STEP’S LENGTH IN THE FRONT

2. PUSH DOWN ON THE HANDGRIPS WITH HANDS WHILE SQUEEZING THE TOP OF THE CRUTCHES BETWEEN THE CHEST AND UPPER ARMS.

3. PUTTING THE WEIGHT THROUGH THE HANDGRIPS, HOP FORWARD WITH THE UNAFFECTED LEG TO MEET THE CRUTCHES.

- REPEAT THE ABOVE 3 STEPS.

TDWB (OR) TTWB TOUCH DOWN WEIGHT BEARING (OR)

TOE TOUCH WEIGHT BEARING WALKING

INSTRUCTIONLIGHTLY TOUCH THE AFFECTED LIMB’S FOOT TO THE FLOOR, AND LET THE CRUTCHES BEAR MOST OF THE WEIGHT. IMAGINE AS IF STEPPING ON A RIPE TOMATO: STEP LIGHTLY, SO IT WON’T BE SQUASHED.

1. STANDING ON THE UNAFFECTED LEG, LIFT BOTH CRUTCHES AT THE SAME TIME AND PLACE THE CRUTCHES ONE STEP’S LENGTH IN FRONT2. BRING THE AFFECTED LEG FORWARD SO THAT IT IS IN LINE WITH THE CRUTCHES. ONLY PUT TOES DOWN ON THE GROUND UP TO A MAXIMUM OF 4 Kg OF PRESSURE.

3. PUSH DOWN ON THE HANDGRIPS WITH HANDS WHILE SQUEEZING THE TOP OF THE CRUTCHES BETWEEN CHEST AND UPPER ARMS.4. PUTTING WEIGHT THROUGH THE HANDGRIPS, HOP FORWARD WITH UNAFFECTED LEG TO MEET THE CRUTCHES, OR SLIGHTLY AHEAD OF THE CRUTCHES, MAKING SURE THAT ONLY 4 Kg OF PRESSURE IS PUT THROUGH THE AFFECTED LEG.- REPEAT THE ABOVE 4 STEPS.

PARTIAL WEIGHT BEARING WALKING

INSTRUCTIONS BEAR SOME WEIGHT ABOUT 50 PER CENT ON AFFECTED LIMB AS ONEWALKS

1. STANDING ON UNAFFECTED LEG, LIFT BOTH CRUTCHES AT THE SAME TIME AND PLACE THE CRUTCHES ONE STEP’S LENGTH IN FRONT2. BRING THE AFFECTED LEG FORWARD SO THAT IT IS IN LINE WITH THE CRUTCHES. ONLY PUT UP TO 50% OF BODY WEIGHT ON THIS LEG AS PLACE IT ON THE GROUND.

3. PUSH DOWN ON THE HANDGRIPS WITH HANDS WHILE SQUEEZING THE TOP OF THE CRUTCHES BETWEEN YOUR CHEST AND UPPER ARMS.

4. PUTTING YOUR WEIGHT THROUGH THE HANDGRIPS, HOP FORWARD WITH UNAFFECTED LEG TO MEET THE CRUTCHES, OR SLIGHTLY AHEAD OF THE CRUTCHES, MAKING SURE THAT ONLY 50% OF BODY WEIGHT IS PUT THROUGH THE AFFECTED LEG.

- REPEAT THE ABOVE STEPS.

FULL WEIGHT BEARING WALKING

INSTRUCTIONBEAR MOST OF TH WEIGHT ON AFFECTED LIMB AS TOLERAED. PLACE ONLY A LITTLE REMAINING WEIGHT ON CRUTCHES.

• STANDING ON BOTH LEGS WITH CRUTCHES AT THE SIDE FOR SUPPORT, LIFT BOTH CRUTCHES AT THE SAME TIME AND PLACE THE CRUTCHES ONE STEP’S LENGTH IN FRONT

• BRING THE AFFECTED LEG FORWARD SO THAT IT IS IN LINE WITH THE CRUTCHES.

• PUSH DOWN ON THE HANDGRIPS WITH HANDS WHILE SQUEEZING THE TOP OF THE CRUTCHES BETWEEN CHEST AND UPPER ARMS.

• PUTTING SOME WEIGHT THROUGH HANDGRIPS AND AS MUCH WEIGHT AS ONE CAN THROUGH THE AFFECTED LEG, STEP FORWARD WITH UNAFFECTED LEG.

• REPEAT THE ABOVE STEPS.

ASCENDING THE STAIRS• FACE THE STAIRS HOLDING ONTO

CRUTCHES AND STANDING ON AFFECTED LEG. ONLY PUT AS MUCH WEIGHT AS ALLOWED AS PER ORDERS ON THE AFFECTED LEG. IF NON WEIGHT-BEARING – ONE CAN CHOSE TO KEEP KNEE IN BENT POSITION AS SHOWN IN THE DIAGRAM IF POSSIBLE.

• PUT PRESSURE THROUGH CRUTCH HANDGRIPS AS HOP UP WITH YOUR UNAFFECTED LEG ONTO THE NEXT STEP.

• THEN BRING AFFECTED LEG AND CRUTCH UP TO THAT STEP.

• REPEAT THE ABOVE STEPS UNTIL ONE GETS TO THE TOP OF THE STAIRS.

DESCENDING STAIRS• STAND AT THE TOP OF THE STAIRS WITH

THE TOES OF UNAFFECTED LEG CLOSE TO THE EDGE OF THE STEP AND HOLDING ONTO TWO CRUTCHES, ONE ON EITHER SIDE.

• PLACE CRUTCHES ONTO THE LOWER STEP, BRINGING AFFECTED LEG FORWARD AT THE SAME TIME. ONLY PUT AFFECTED LEG DOWN ON THE STEP IF ALLOWED

• PUTTING WEIGHT THROUGH YOUR CRUTCHES, SLOWLY LOWER UNAFFECTED LEG ONTO THE LOWER STEP, REMEMBERING TO ONLY PUT WEIGHT THROUGH AFFECTED LEG IF ALLOWED AS PER DOCTOR’S ORDERS.

• REPEAT THE ABOVE STEPS UNTIL YOU GET TO THE BOTTOM OF THE STAIRS.

GENERAL INSTRUCTIONS AND PRECAUTIONS IN CRUTCH WALKING

• Take care on slick or wet surfaces (for example, the kitchen and bathroom).

• Be careful of throw rugs; they should be taken up.• Never hop around holding on to furniture; it may slide or fall.• Keep the crutches near you so they are always in reach.• Wear low-heeled shoes that will not slip off (for example,

sneakers).• For the first few days, a strong belt may be worn to allow

someone to assist• Be careful of ramps or slopes, as it is a little harder to walk.

THANK YOU