Mobility Aids and Rehabilitation: Crutches, Splints, PMR

Crutches: Mobility, Types, and Safe Use

Crutches are mobility aids designed to help individuals walk when they cannot use one or both legs effectively. They transfer weight from the legs to the upper body, allowing a person with an injury, surgery, weakness, or disability in the lower extremities to move around safely and independently. Crutches are commonly prescribed after fractures, ligament injuries, joint replacements, or neurological conditions that impair balance or strength.

Purpose and Function of Crutches

The main function of crutches is to provide support, balance, and mobility. They relieve pressure from an injured leg or foot by shifting body weight to the arms and shoulders. Crutches also help maintain independence during recovery, preventing muscle stiffness and allowing gradual weight-bearing as recommended by healthcare professionals.

Types of Crutches

1. Axillary (Underarm) Crutches
   • The most common type.
   • Placed under the armpits with hand grips for support.
   • Suitable for short-term use after fractures, sprains, or post-surgery.
   • Advantages: Simple, inexpensive, and easy to use.
   • Disadvantages: Risk of nerve compression in the armpit if used incorrectly.
2. Forearm (Lofstrand or Elbow) Crutches
   • Feature a cuff around the forearm and a hand grip.
   • Provide better mobility and are preferred for long-term use.
   • Commonly used by people with permanent disabilities or chronic conditions.
   • Advantages: Allow greater freedom of movement and pose less risk of nerve injury.
   • Disadvantages: Require more upper body strength and coordination.
3. Platform Crutches
   • Have a platform where the forearm rests, secured with straps.
   • Used by individuals who cannot bear weight on their hands or wrists (e.g., due to arthritis or cerebral palsy).
   • Provide stability but are bulkier.
4. Hands-free Crutches
   • A newer design that straps around the thigh and calf, leaving hands free.
   • Helpful for active individuals with temporary lower limb injuries.

Crutch Fitting and Proper Use

Proper fitting is essential to avoid complications. For axillary crutches, the top should be about 2–3 finger widths below the armpit, and hand grips should allow the elbow to bend slightly (around 20–30 degrees). The user must bear weight through the hands, not the armpits. Incorrect use can cause nerve damage, shoulder pain, or falls.

Gait patterns with crutches include:

• Non-weight bearing: Keeping one leg completely off the ground.
• Partial weight bearing: Placing some weight on the injured leg.
• Four-point, three-point, two-point gaits: Used depending on the balance and stability required.

Advantages of Using Crutches

• Promote mobility and independence.
• Prevent muscle atrophy by encouraging movement.
• Aid in rehabilitation and weight-bearing progression.

Disadvantages and Risks

• Require significant upper body strength and coordination.
• May cause fatigue, hand or wrist pain, or axillary nerve compression.
• Not suitable for long distances without training.

Crutch Care and Maintenance

• Regularly check rubber tips for wear to prevent slipping.
• Ensure hand grips and cuffs are secure.
• Keep crutches clean and dry to avoid damage.

Conclusion on Crutches

Crutches remain one of the most effective, affordable, and widely used mobility aids. Proper selection, fitting, and training are crucial for safe use. Whether temporary or long-term, crutches play a vital role in restoring independence and improving the quality of life for individuals with lower limb impairments.

Splints: Immobilization and Injury Protection

A splint is a supportive medical device used to immobilize, protect, and support an injured body part, usually bones, joints, or soft tissues. Unlike casts, splints are non-circumferential, meaning they do not completely encircle the limb. They are typically made from rigid or semi-rigid materials and secured with bandages, straps, or Velcro. Splints are widely used in orthopedic care, rehabilitation, and emergency medicine.

Purpose of Splints

Splints serve several important functions:

• Immobilization: Prevents movement at the injured site to allow healing.
• Protection: Shields fractures, sprains, or surgical sites from further injury.
• Pain relief: Reduces discomfort by stabilizing the area.
• Support during healing: Provides alignment and positioning.
• Emergency management: Used as a temporary measure before definitive treatment like casting or surgery.

Indications for Splint Use

Splints are used in conditions such as:

• Fractures (before swelling subsides or surgical fixation).
• Severe sprains or ligament injuries.
• Post-operative immobilization.
• Nerve injuries requiring rest of the limb.
• Congenital or developmental deformities (e.g., clubfoot correction).

Types of Splints

1. Upper Limb Splints
   • Finger splints: Protect and immobilize fractured or dislocated fingers.
   • Thumb spica splints: For thumb fractures, ligament injuries, or arthritis.
   • Wrist splints: Used in carpal tunnel syndrome, sprains, or fractures.
   • Forearm splints: Stabilize radius or ulna fractures.
   • Sugar-tong splints: Immobilize the forearm and wrist, preventing rotation.
2. Lower Limb Splints
   • Posterior splints: Provide support for ankle, foot, or tibial injuries.
   • Stirrup splints: Commonly used for ankle fractures and sprains.
   • Long leg splints: Immobilize knee and tibia/fibula injuries.
3. Spinal and Orthopedic Splints
   • Cervical collars: Support the neck in cases of trauma or whiplash.
   • Back splints/braces: Used in spinal injuries, deformities, or postoperative care.
4. Functional Splints
   • Allow partial movement while still providing support.
   • Used in rehabilitation, for example, in wrist drop or foot drop.

Materials Used in Splinting

• Plaster of Paris (POP): Moldable and inexpensive, but heavy and not water-resistant.
• Fiberglass: Lightweight, strong, and durable.
• Thermoplastic materials: Common in custom-made splints, especially for hand therapy.
• Metal, wood, or padded boards: Often used in emergency first aid.

Advantages of Splints

• Easy to apply and remove.
• Allow swelling to expand, unlike rigid casts.
• Provide access for wound care and monitoring.
• Lightweight and adaptable to different situations.

Disadvantages of Splints

• Provide less rigid immobilization compared to casts.
• Can become loose as swelling decreases.
• Require regular adjustment and monitoring.
• If poorly fitted, may cause pressure sores or skin irritation.

Splint Care and Maintenance

• Keep the splint dry and clean.
• Regularly check for skin redness, swelling, numbness, or pain.
• Adjust straps if too tight or loose.
• Follow medical advice regarding duration of use and exercises.

Conclusion on Splints

Splints are essential medical devices in orthopedics, rehabilitation, and emergency care. Their flexibility, ease of application, and ability to accommodate swelling make them highly effective for both temporary and long-term management of injuries. Proper use, patient education, and regular follow-up are crucial for ensuring safety, comfort, and effective healing.

Physical Medicine and Rehabilitation (PMR)

Physical Medicine and Rehabilitation (PMR), also known as physiatry, is a branch of medicine that focuses on restoring and enhancing functional ability, independence, and quality of life in individuals with physical impairments, disabilities, or injuries. Unlike specialties that concentrate mainly on curing disease, PMR emphasizes improving function and maximizing patient potential through medical, physical, and rehabilitative approaches.

Objectives of PMR

The primary goals of PMR are:

• Restoration of function: Helping patients regain independence in mobility, self-care, communication, and daily living.
• Pain management: Reducing acute or chronic pain to enhance recovery.
• Improvement of quality of life: Promoting psychological, vocational, and social well-being.
• Prevention of complications: Such as contractures, pressure sores, and secondary disabilities.
• Holistic rehabilitation: Addressing physical, mental, and social aspects of disability.

Scope of PMR Conditions

PMR covers a wide range of conditions, including:

1. Musculoskeletal disorders: Back pain, arthritis, sports injuries, and fractures.
2. Neurological conditions: Stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, and cerebral palsy.
3. Amputations: Prosthetic fitting, gait training, and adaptation.
4. Cardiac and pulmonary rehabilitation: Improving endurance and function after heart attack, surgery, or chronic lung disease.
5. Pediatric rehabilitation: Managing congenital or developmental disorders like spina bifida or clubfoot.
6. Geriatric rehabilitation: Helping elderly patients maintain independence and prevent falls.

The PMR Multidisciplinary Team Approach

Rehabilitation is not the work of one specialist but a multidisciplinary team effort. The team may include:

• Physiatrist (rehabilitation physician).
• Physical therapist (focus on mobility, strength, and balance).
• Occupational therapist (focus on activities of daily living and adaptive skills).
• Speech-language therapist (manages speech, swallowing, and communication).
• Orthotist and prosthetist (provide supportive devices and artificial limbs).
• Rehabilitation nurse (coordinates care and patient education).
• Psychologist and social worker (address emotional and social needs).

Treatment Modalities in PMR

• Physical therapy: Exercises, stretching, gait training, and modalities like ultrasound or electrical stimulation.
• Occupational therapy: Training in daily activities, hand function, and adaptive devices.
• Orthotics and prosthetics: External supports (braces, splints) and artificial limbs.
• Medications: For pain relief, spasticity, or inflammation.
• Interventional procedures: Injections for pain management.
• Assistive technology: Wheelchairs, walkers, and communication aids.

Importance of PMR

PMR is essential because it focuses on what a person can do, not just on their disease. It helps individuals reintegrate into society, return to work or school, and live more independently. In countries with rising rates of trauma, chronic disease, and aging populations, the demand for PMR services is rapidly increasing.

Conclusion on PMR

Physical Medicine and Rehabilitation is a vital medical specialty that bridges the gap between medical treatment and functional recovery. Through a holistic and patient-centered approach, PMR empowers individuals with disabilities to achieve their highest possible level of independence, improve their quality of life, and participate fully in society.