Alternative Mobility Aids

In Motion – Accessibility and Mobility Issue ~ Originally for May/June 2009

Everyone who has been confronted with a lower extremity amputation has had to make decisions regarding his or her mobility options. Many amputees opt for a prosthesis as their primary mode, wearing it (or them) full-time. Some prefer wearing their prosthesis part time or for specific activities. In either scenario, the ‘must have’ equipment, the most important aid that a single leg amputee could ever invest in, is a pair of appropriate crutches.

The absolute necessity for crutches, especially for a single leg amputee and for any length of time, is because they provide the most efficient means of transportation. Aside from the axilla crutches, which fit under the arm, the forearm or ‘Canadian’ crutches have been most commonly used and are the most ergonomic in design. From amongst that general field of devices, many niche market products like ‘Ed’s Legs’®, One Crutch®, Easy Walk®…, etc. have entered the consumer arena and in some cases have already disappeared.

CRUTCHES HAVE EVOLVED !

Let me try and guide you through the crutch maze. Aside from the drug store variety of crutches, typically made by Guardian® or Lumex® in North America, over the years vast arrays of European designed crutches have appeared on the scene. They vary in style and size with open or hinged cuffs, shock absorbers, anatomically shaped hand grips and wide based tips and pads. Today’s crutches are lighter in weight and free from the traditional ‘shake and rattle’ alerting everyone of your arrival. They also have a fantastic variety of colors available. I will go into this in more detail a little later on in this article.

Just imagine the convenience during those ‘off’’ times when you are not wearing a prosthesis. When you are travelling with the folding crutches in your suitcase, carry-on bag, back-pack or even strapped to your bicycle it can be a real life-saver! Hopping is not safe, especially when you are older and for some it is not even possible. Basic actions like having to go to the bathroom at night, walking around the pool or beach tells us that having a comfortable, reliable pair of crutches can make or break the trip. Even being able to walk in the sand with a prosthesis can be challenging at times. So, instead of having your prosthesis act as a liability or ‘limbibility’, a leg amputee’s best ally is their crutches. Being on holidays or vacation sometimes presents difficulties an amputee doesn’t often encounter when they are ‘at home’. We frequently ‘over-do’ it physically, going the extra mile, ‘so to speak’ & find out (often too late) that: “Oops, “I shouldn’t have done that!” This might necessitate a ‘rest’ from their prosthesis and the possibility of missing out on a portion of their trip because they have no alternative means of mobility with them.

This is just another reason on the plus side of the column to have a pair of travel crutches close at hand. In that way, participation is still possible! The investment in a good pair of crutches will pay itself in dividends for many years and in many cases, the purchase would be covered by insurance.

WHEELY ?

A wheelchair, whether powered or manual, a motorized scooter or other powered mobility devices are most often chosen by older amputees who neither have the stamina, endurance or coordination to seriously consider crutches. These types of solutions are great for some but, again, have their limitations. As with electric vehicles on the highway, long distances are a limiting factor. Also, many types of public transportation are incapable of handling powered chairs/scooters. Those are just a couple of hurdles one might find to be a challenge and an impediment – negating the very thing that you are trying to overcome!

If this is your choice of mobility, check into the styles available, stability, distances they can cover with the capacity of the batteries, where you can plug-in, etc. Comfort, style, durability, warranties are all considerations in making your decision. Give them a test drive & see for yourself if they are an appropriate choice. And, even though this may be your primary mobility choice, a decent pair of crutches is still a good plan to have around! Despite signs, symbols and advertising, not all ‘Accessible’ facilities are actually accessible!

PITFALLS !

Not all crutches are created equal! The quality, design, materials and workmanship vary as widely as in any other manufacturing industry. Generally speaking, “you get what you pay for”! Price is a good ‘measuring stick’ to give an indication of quality. ‘Standard’ crutches that some people buy at garage sales or thrift stores are definitely a cheap alternative, but most certainly do not have the features that customized crutches have. When you are an amputee, the requirements for crutches is vastly different than if you have a sprained ankle and only need ‘sticks’ for a week or so. There are many examples of both on the market and an educated, discerning consumer will quickly recognize the critical elements prior to making a decision to purchase. When in doubt, ask questions about materials, specifications
and references.

The primary ‘pitfalls’ of using under-arm crutches for long periods of time are many. No matter how conscientious one is, leaning with your whole weight on the crutch tops will result in peripheral nerve damage (numbness-cutting off the circulation from the under arm to the finger tips). They are also harder on the shoulders, inclined to make you ‘hunch over’ creating bad posture, which often leads to sore backs. The type of grips on that style of crutch can eventually produce carpal tunnel syndrome. Sometimes this damage will not show up till years later, when it is too late! In general they are also much more awkward to use when navigating stairs or walking over uneven terrain.
The fore-arm style of crutch enables the user to more easily go up and down stairs, curbs, logs, rocks, etc. Some examples are:

Straps – Just a Sample!

In my opinion, the positive aspects greatly outweigh the negative when it comes to this
choice. Now…

WHY GO CUSTOM ?

Why is a custom fitted crutch important especially for a full time crutch user? In many cases they are the only means of mobility and by that very definition must provide an energy savings means to walk. Proper sizing of the over-all length and proportions above and below the handle grips are critical. Accessories are important, too.

ANATOMIC STYLE GRIPS

Especially after prolonged use, many individuals experience carpal tunnel syndrome in their palms, tendonitis in their elbows and bursitis in their shoulders. All of these conditions eventually turn into early osteo-arthritis or a variety of other bone or tendon ailments. Prevention is the key goal here! Some amputees who have been long-term (25+ years) crutch users and slated for carpal tunnel surgery, and yet they were able to post-pone or cancel their operations! What was the secret? They were able to transfer their weight differently via an ‘anatomically correct’ handgrip, having a built-in shock-absorber and cushioning wide base tips!

This situation is somewhat comparable to wearing a custom fitted foot orthosis. The additional stresses and strains isolated on a single foot are multiplied exponentially as is the case on arms while using crutches.

ALTERNATIVES ?

The unfortunate aspects of the crutch alternatives have been: expensive, weight issues, bulky, noisy, difficult to use, etc. Is there ‘room’ to introduce an alternative to traditional crutches? YES, there is! Several Universities have attempted to create new products made from Carbon Composites like we have used in prosthetic feet, pylons, struts, orthotic frames, etc. In most cases these were monolithic devices where, aside from cutting them shorter at the bottom end, no other adjustments were possible.

The expense involved in creating such designs became prohibitive and therefore they are currently not commercially available. Crutches made from titanium tubing, however, have made some impact for the serious heavy duty crutch user. Companies like Enabling Technologies and Thomas Fetterman produce several models of them. Currently, the international price of raw titanium has driven the price up significantly. These also are only available in custom sizes, cut and/or welded to a specific user. However, they are extremely durable and with the right combination of cuffs, grips and tips, they are the ‘Rolls Royce’ of crutches.

CRUTCH TIPS

In the ‘tip’ category, the choices are virtually limitless! Round, square, big, small, flat, wide, narrow, cushioned, articulated, ice worthy and so on. Then there is the further choice of colors! Wow, has this industry come a long way! The primary thing to remember is: “Will my tubes fit the inside of the tips I have chosen?” Tube diameters come in inch sizes from ½” to 1” (metric equivalent – 20 mm-40 mm). Sometimes a filler sleeve is required to match these properly. Winter tips, beach tips, suction tips are specialty items that also merit consideration depending on your local environment or your destination when on vacation.

Tornado Crutch Tips

Sherpa Crutch Tips

Winter (Receding) Ice Tips

The ‘BOTTOM LINE’

If you are in the market for mobility products, there is no ‘one type fits all’ solution. Check out the Internet and, if you can, find a local facility to view & test some products prior to making your purchase. If this is not possible, ask around, check references, communicate with satisfied customers. An informed consumer is a wise purchaser! Try to select a provider or manufacturer that has been around for a while. Make sure that you can get expert advice from a professional, not just a sales person. Keep in mind that although the cost of mobility aids is often lower than a leg prosthesis, the importance of what it means to you as the end consumer is no less important!

Once you have made your decision on which crutches to purchase, you can consider ‘crutch clothes’ for those special occasions like weddings. You can also use them to spruce up an older pair of crutches to hide imperfections or to coordinate with your wardrobe, giving the impression that you have many pairs of crutches, like the shoes in your closet!

The main goal here is to be kind to your body! Whatever your choice, make sure you are aware of the consequences of your decision and enjoy your particular mobility aid!

Submitted by: Madeleine Anderson

About the author:

Madeleine Anderson has been an above knee amputee since 1967. This was as result of a motorcycle accident on a Memorial Day trip to the New Jersey beaches. Since that time she has gone on to ski and play golf competitively and volunteers in many capacities primarily in Canada. Currently she is the President of the Amputee Coalition of British Columbia Society (ACBC), Chair of the B.C. Disability Games Society, co- founder of the End the Pain Project.Org and Western Vice-President of the Canadian Amputee Sports Association. Madeleine is also a registered Peer Visitor with the Amputee Coalition of Canada.

References:

• Jothy Rosenberg, PhD., ACA May 2008 article in Motion
  Barbara E. Potter, MCSP, and W. Angus Wallace, FRCSED ~ British Medical Journal Vol. 301
• Archives of Physical Medicine and Rehabilitation, Vol. 83 R. Gailey
  “Living With Amputation” by National Amputee Centre, The War Amps
• Journal of Prosthetics and Orthotics by Maurice A. LeBlanc, MSME, CP, Lawrence E. Carlson, Deng. And Teresa Nauenberg – Volume 5, Number 1
• American Orthopedic Association