Energy Consumption of Assisted Walking in Children with Cerebral Palsy / 中国康复理论与实践

Objective To observe the energy consumption of children with cerebral palsy before and after assisted walking. Methods From January, 2014 to October, 2015, 21 children in primary school of Grades 1~5 (control group) and 22 children with cerebral palsy in our hospital (observation group) were enrolled. They were required to walk in the 50 meters trail for six minutes. The resting heart rate, the walking distance and the heart rate after walking were measured, and the walking speed and the physical consumption index (PCI) were cal-culated. The observation group was tested with and without forearm crutches. Results Compared with the control group, the walking dis-tance and speed significantly decreased (t>10.653, P4.207, P2.382, P<0.05) when they walked with forearm crutches. Conclusion Assisted walking can decrease the energy consumption of children with cerebral palsy.

Effects of Forearm Crutches on Motor Function in Children with Cerebral Palsy / 中国康复理论与实践

Objective To observe the effect of forearm crutches on motor function of children with spastic cerebral palsy. Methods 60 children with spastic cerebral palsy were divided into observation group (n=30) and control group (n=30). The control group accepted rou-tine rehabilitation, while the observation group were also trained to use forearm crutches. They were assessed with Gross Motor Function Measure-88 (GMFM-88) and Balancer. The way of item 70 of GMFM-88 was used to assess the mobile capability. Results The scores of GMFM-88 significantly improved in both groups after treatment (t>6.002, P<0.001), and improved more in the observation group than in the control group (t=2.317, P<0.05). The whole path length and the circumference area reduced in both groups after treatment (P<0.05), and reduced more in the observation group with the assist of the forearm crutches (P<0.01). The incidence of walking was more in the observa-tion group with the assistant of the forearm crutches (χ2=25.87, P<0.01). Conclusion Forearm crutches assistant can improve the recovery of motor function, balance and walking ability in children with spastic cerebral palsy.

Crutch-related acute arterial thrombosis in upper limb: case report / Oclusão arterial aguda de membro superior associada à utilização de muleta: relato de caso

Case report of an acute arterial obstruction in the upper limb secondary to thrombosis of the axillary artery caused by chronic use of crutches. The authors make a brief review of the literature and discuss it in relation to the present case.

Relato de caso de obstrução arterial aguda do membro superior por trombose da artéria axilar secundária ao uso crônico de muleta. Os autores fazem uma breve revisão da literatura, discutindo o presente caso.

Biomechanical study on axillary crutches / 医用生物力学

Axillary crutch is one of the common mobility aids, with extensive usage in the given crowd. Due to the lack of adequate theoretical support, the past design of crutches often leads to occurrence of the secondary damage, such as axillary nerve injury, wrist injury and so on. Thus, it is necessary to carry out biomechanical study on axillary crutches. In this paper, the problems related with biomechanics in axillary crutches were reviewed by inquiring and analyzing the relevant references, and discussed from the aspects of human biomechanics, ergonomics, and industrial design. Also in this paper, through man machine interface research, the mechanical analysis on crutches usage, gait analysis and ergonomics design were made to lay a solid foundation for the design and correct use of axillary crutches so as to provide some reference for the option, adaptation and assessment of axillary crutches, which would have great clinical significance.

Bilateral wrist drop complicating axillary crutches mobilization in a young adult / Mano péndula bilateral que complica la movilización con muletas axilares en un adulto joven

OBJECTIVE: Axillary crutches are simple rehabilitative devices that are globally used temporarily or permanently to assist in ambulation of patients and rarely present with complication. This report is about bilateral wrist drop incidentally noticed in a young adult patient mobilized on axillary crutches after internal fixation of a simple right tibia fracture. METHODS: The fracture was fixed by intramedullary nailing and the patient was mobilized on axillary crutches. At six weeks, patient fearfully refused to be commenced on partial weight bearing and at 12 weeks after surgery he was noticed to be totally weightbearing on the bars of the appropriately long axillary crutches and had developed bilateral wrist drop. There was radiological evidence of healing at the fracture sites. Treatment included mobilization on one elbow crutch on the left, physical therapy and nerve stimulation. RESULTS: At six weeks of physiotherapy, the power of the dorsiflexors of the wrists had recovered completely. CONCLUSION: Bilateral posterior cord palsy of brachial plexus could occur even in young healthy patients but total recovery could occur if the diagnosis and treatment are prompt. Patients should be told in unequivocal terms not to weight bear directly on axillary bars.

OBJETIVO: Las muletas axilares son simples dispositivos de rehabilitación que se utilizan en todo el mundo de manera temporal o permanentemente para ayudar a caminar a los pacientes, y raramente presentan complicación. Este trabajo trata de la mano péndula o mano caída, observada incidentalmente en un paciente adulto joven movilizado en muletas axilares, después de la fijación interna de una fractura simple de la tibia derecha. MÉTODOS: La fractura fue fijada mediante clavo intramedular, y el paciente fue movilizado con muletas axilares. A las seis semanas, el paciente se negó temeroso a la iniciación para sostener parcialmente todo su peso con ayuda de muletas, y a las 12 semanas después de la cirugía, se le vio sostener todo su peso sobre las barras de las muletas axilares de longitud adecuada, y había desarrollado mano péndula bilateral. Había evidencia radiológica de curación en los sitios de fractura. El tratamiento incluyó la movilización con una muleta de codo a la izquierda, terapia física, y estimulación nerviosa. RESULTADOS: A las seis semanas de fisioterapia, la capacidad de los dorsiflexores de las muñecas se había recuperado completamente. CONCLUSIÓN: La parálisis del fascículo posterior bilateral del plexo braquial podría ocurrir incluso en pacientes jóvenes sanos, pero la recuperación total podría ocurrir si el diagnóstico y el tratamiento se hacen a tiempo. A los pacientes se les debe decir en términos inequívocos que no deben soportar todo su peso directamente en las barras axilares.

Isquemia arterial aguda del miembro superior por uso de muletas / Isquemia arterial aguda do membro superior por uso de muletas / Crutches induced acute arterial ischemia of the upeer limb

La compresión axilar por el uso de muletas es una causa infrecuente y subdiagnosticada de isquemia arterial aguda del miembro superior. Se presenta el caso de un paciente con isquemia aguda debido a trauma en la confluencia de las arterias axilar y humeral inducido por el uso de muletas. Dicha lesión fue el foco de microembolias que ocluyeron el arco palmar y la arteria humeral. Se diagnosticó con una arteriografía selectiva de la arteria axilar, y se tratómediante un bypass axilo-humeral con prótesis de PTFE anillado de 6 mm, con resultado satisfactorio en el seguimiento clínico a cinco años del postoperatorio.

A compressão axilar devido ao uso de muletas é uma causa pouco frequente e subdiagnosticada de isquemia arterial aguda do membro superior. Apresenta-se o caso de um paciente com isquemia aguda por trauma da confluência das artérias axilar e femoral induzido pormuletas. Esta lesão foi o foco de microembolias que provocaram a oclusão do arco palmar e da artéria femoral. Foi diagnosticado com uma arteriografia seletiva da artéria axilar, e tratado com um bypass axilo-femoral com prótese de capas de PTFE de 6 mm, com resultado satisfatório no seguimento clínico, cinco anos depois do pós operatório.

Crutch induced axillary trauma represents an infrequent but underdiagnosed cause of acuteischemia to the upper limb. We present a case of acute arterial ischemia caused by trauma of the confluence of the axillary and brachial arteries induced by the use of crutches. This lesion was the origin of microembolisms that occluded both the palmar arch and the brachialartery. The diagnosis was made by a selective arteriography of the axillary artery. An axillobrachial bypass with a 6 mm ringed PTFE prosthesis was performed showing satisfactory resultson his 5 year postoperative clinical follow up.