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Physiotherapy: Crutches, Strapping and Collars

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Nicole Burdfield

on 14 March 2014

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Transcript of Physiotherapy: Crutches, Strapping and Collars

BEST
PRACTICE
WHEN TO REFER BACK
Other health professionals should refer their patients to physiotherapists when their patient with crutches is using incorrect technique, or if their crutches need to be fitted appropriately.

PATIENT
SAFETY
ADVISING CLIENTS
Best Practice
When to Refer Back
Patient Safety
Advising Clients
When to Refer Back
For sub-acute and chronic conditions referral may be necessary for pressure care, for resizing if swelling or weight loss has occurred of if the condition has changed in anyway.

Patient Safety
Advising Clients
-Cervical collars/neck braces are used to give support to the neck.
-Acute or chronic head, neck or spinal trauma or post surgery.
-Soft collars provide less support, are more comfortable and are for long term use
-Hard collars provide more support, have reduced comfort and more suited to acute trauma.
-Collars do not completely immobilise the area.

Physiotherapy: How to use
Crutches, Strapping and
Collars

CRUTCHES
STRAPPING
COLLARS
Fitting
2 to 3 finger widths should be present between the patients arm pit and the top of the crutch
The heel of the hand should rest on the hand piece of the crutch with the elbow flexed slightly
Walking
To initiate walking the unaffected leg remains standing while the crutches are positioned around a step length in front.
The patient then hops through with the unaffected leg.

Stairs
When ascending stairs, the unaffected leg is put up onto the step first before the crutches are raised to the same step.
When descending stairs, the crutches are lowered to the step below before stepping down to the same step with the unaffected leg.

Stairs (cont..)
Remember - ‘Good leg goes to heaven, bad leg goes to hell.’

Sitting
Patient must back into the chair so that it can be felt at the back of the legs.
Crutches are both held by the hand of the affected side while the hand of the unaffected side reaches for the chair before sitting down.

Standing
When standing up from a chair, the hand of the affected side again holds both crutches, while the hand of the unaffected side assists to push up from the chair.

Respect the rights and
autonomy of the individual.
Cause no harm
Advance the common good
Act fairly

Appropriate strapping tape
Restrict motion
Non-irritant
Shave body hair (8-12 hours prior)
Clean patient skin

To apply rigid strapping tape:
Use anchors
Unroll tape before application for correct tension
Apply even pressure
Overlap tape by 1/3 to 1/2
Re-anchor/lock-in tape
Smooth out folds and creases to prevent blisters and lacerations
Ax circulation/colour and neurological signs numbness/tingling

Remove tape with tape cutters/scissors (not torn off)

Adhesive skin spray (if on sports field) to increases adhesiveness if sweaty

Ligament in shortened position (if injured) or in joint resting position

Cover any wounds or broken skin

Patient and therapist in comfortable/ergonomic position for tape application

Reduced circulation, compartment syndrome or neural compromise
Allergic reaction to the tape
Skin irritation or open wounds (blisters or lacerations)
Inadequate support for injury sustained (such as fracture)
Reduced effectiveness with time or tape failure (further injury)

Advance the Common Good
Should accompany a full PT Ax and rehabilitation program (not used as the sole intervention).
PT responsibility in achieving optimal health outcomes for the sustained injury.

WHAT WAS LEARNT
ETHICAL BOUNDARIES
Best
Practice
Sizing
-Place your small finger on the trapezium and count how many fingers there are up to the jaw line.
-Match this on the collar between the marker pin and the bottom edge of the collar.
-If the jaw support on a hard collar protrudes past the chin the collar is too big
-If the chin sits over the jaw support the collar is too small.

Fitting
-Someone must support the head while the collar is being fitted!
-Explain steps to the patient
-If possible remove clothing from the patients neck
-Slide the back of the collar under the patients neck if the patient supine.
-Wrap it around the neck if patient is sitting.
-Join the collar fasteners/Velcro.

-Ensure the collar is not causing excessive traction to the cervical spine
-The head must continue to be stabilised once the collar is fitted until the patient is secured on a spine board or by a cervical extrication device.

-Airway restriction-the collar is firmly closing the jaw
-Compressed jaw: risk of aspiration is high
-Incorrect sizing: compressed trachea
-Tissue ischemia
-Collars do not provide complete immobilisation to any part of the spine so further spinal damage is possible
-Poor fitting collars: pressure on the back of the neck
Financial burden
-Reduced airway access for other interventions

A soft collar reduced movement on average by 17.4% and the cervical brace by 62.9%

Preventative taping reduced the incidence of ankle sprains by 71% with rigid taping in previously uninjured athletes

Compression
Hold a dressing in place
Immobilisation or restriction potentially adverse joint while still allowing the necessary movement for the activity

-Injury to a leg that requires a non-weight
bearing or partial weight-bearing gait.

-Fitting of the crutches and the amount of weight to be put on an injured lower limb needs to be determined by a health care professional, usually a physiotherapist
-Correct technique needs to be demonstrated to the patient by the physiotherapist or other health professional

-The patient must then display safe, correct use of these walking aids to be deemed
independent.

The patient should inspect the crutches regularly to ensure:
All screws a securely tightened.
Rubber tips are clean and the tread has not worn out.
While using crutches, supportive, non-slip shoes should be worn.
Slippery or very smooth surfaces should be avoided.

Instructions re removal following training/game
Referral after 1-2 days or when needed for re-strapping
Referral back to PT if patient having adverse reaction or re-injured joint
State Government of Victoria (2010)
State Government of Victoria (2010)
State Government of Victoria (2010)
State Government of Victoria (2010)
Princess Alexandra Hospital (2008)

Princess Alexandra Hospital (2008)
Princess Alexandra Hospital (2008)
Princess Alexandra Hospital (2008)
Princess Alexandra Hospital (2008)
McDonald (2004, p.4)

Beam (2011, p.5), Brukner & Khan (2012, p.122) & McDonald (2004, p.5)
Beam (2011, p.5), Brukner & Khan (2012, p.122) & McDonald (2004, p.5)
Beam (2011, p.5), Brukner & Khan (2012, p.122) & McDonald (2004, p.5)
Beam (2011, p.5), Brukner & Khan (2012, p.122) & McDonald (2004, p.5)
Beam (2011, p.5), Brukner & Khan (2012, p.122) & McDonald (2004, p.5)
Beam (2011, p.5), Brukner & Khan (2012, p.122) & McDonald (2004, p.5)
Beam (2011, p.5), Brukner & Khan (2012, p.122) & McDonald (2004, p.5)
State Government of Victoria (2010)
Schur (2007, p.34)

Wittcroft (2011)
Dizon (2010)
References
Aker, P. D., Gross, A. R., Goldsmith, C. H. & Peloso, P. 1996. Conservative management of mechanical neck pain: systematic overview and meta-analysis.
BMJ
, 313, 1291-6.

Aoi, Y., Inagawa, G., Hasimoto, K., Tashima, H., Tsuboi, S., Takahata, T., Nakamra, K. & Goto, T. 2011. Airway scope laryngoscopy under manual inline stabilization and cervical collar immobilization: a crossover in vivo cinefluoroscopic study
. J Trauma,
71, 32-6.

Australian Physiotherapy Association. 2008.
APA Code of Conduct
: September 2008. Retrieved 05/03/2014 from http://www.physiotherapy.asn.au/DocumentsFolder/The_APA_Governance_Code_of_Conduct_2008.pdf

Beam, J. W. 2011.
Orthopedic Taping, Wrapping, Bracing, and Padding
, F a Davis Company.

Bragg, R. W., Macmahon, J. M., Overom, E. K., Yerby, S. A., Matheson, G. O., Carter, D. R. & Andriacchi, T. P. 2002. Failure and fatigue characteristics of adhesive athletic tape.
Med Sci Sports Exerc
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Brukner, P. 2012.
Brukner & Khan's clinical sports medicine, 4th ed
, McGraw-Hill Australia, North Ryde, N.S.W

Dizon, J. M. & Reyes, J. J. 2010. A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players.
J Sci Med Sport,
13, 309-17.

Kanji, H. D., Neitzel, A., Sekhon, M., Mccallum, J. & Griesdale, D. E. 2014. Sixty-four-slice computed tomographic scanner to clear traumatic cervical spine injury: Systematic review of the literature.
J Crit Care
, 29, 314 e9-314 e13.

Macdonald, R. 1994.
Taping techniques: principles and practice,
Butterworth-Heinemann.

Muzin, S., Isaac, Z., Walker, J., Abd, O. & Baima, J. 2008. When should a cervical collar be used to treat neck pain?
Current Reviews in Musculoskeletal Medicine
, 1, 114-119.

Princess Alexandra Hospital: Physiotherapy department. 2008.
Walking safely with crutches
. Retrieved 05/03/2014 from
http://www.health.qld.gov.au/pahospital/services/docs/crutches.pdf

Schur, A. 2007.
Sports Taping
, Meyer & Meyer Sport, Limited.

State Government of Victoria: Department of Health. 2010.
Using Crutches
. Retrieved 05/03/2014 from http://health.vic.gov.au/edfactsheets/downloads/using-crutches.pdf

Verhagen, E., Van Der Beek, A., Twisk, J., Bouter, L., Bahr, R. & Van Mechelen, W. 2004. The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial.
Am J Sports Med
, 32, 1385-93.

Whitcroft, K. L., Massouh, L., Amirfeyz, R. & Bannister, G. C. 2011. A comparison of neck movement in the soft cervical collar and rigid cervical brace in healthy subjects.
J Manipulative Physiol Ther
, 34, 119-22.


Images
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<http://blogs.independent.co.uk/wp-content/uploads/2011/09/crutches.jpg>
<http://kidshealth.schn.health.nsw.gov.au/sites/kidshealth.schn.health.nsw.gov.au/files/fact-sheets/images/509/crutch_stairs.gif>
<http://www.rch.org.au/uploadedImages/Main/Content/kidsinfo/crutches02_finger_depthKHI-RCH.gif>
<https://i.chzbgr.com/maxW500/3590947328/h2E1C560A/>
<http://4.bp.blogspot.com/_1nOiIPDvfr0/TNhCMstJYjI/AAAAAAAADUA/aH5CjH1U7Lg/s1600/DRunk+Crutches.jpg>
<http://orthoinfo.aaos.org/figures/A00181F01.jpg>


<http://www.freakingnews.com/pictures/38000/Machine-Gun-Crutches--38466.jpg>
<http://www.rch.org.au/uploadedImages/Main/Content/kidsinfo/CRUTCHES03.jpg>
<http://www.upmc.com/patients-visitors/education/PublishingImages/P-S/crutchsit3.jpg>
<http://www.upmc.com/patients-visitors/education/PublishingImages/P-S/crutchsit2.jpg>
<http://www.menshealthpro.org/wp-content/uploads/health-professional.jpg>
<http://www.whitecardinfo.com.au/wp-content/uploads/2013/06/Safety-on-crutches.png>
<http://rlv.zcache.com/cute_mummy_kid_cartoon_character_full_color_flyer-r9d5241a4406f4b268a437c6736c43a2d_vgvyf_8byvr_512.jpg>
<http://www.packaging-b2b.com/b2b/pics/PP_Strapping_Tape__PP_Strapping_Band.jpg>
<http://www.medicalequipmentnz.co.nz/ic/712328146/3MNEXxx.jpg>
<http://massageschools.com.au/images/strapping.jpg>
<http://www.bsnmedical.com/typo3temp/pics/e843af2edb.jpg>
<http://resources3.news.com.au/images/2011/04/01/1226031/936367-steven-salopek.jpg>
<http://i1.ytimg.com/vi/okk-rKzTlJ4/0.jpg>
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Crutches Mower Picture
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Crutches Prints Picture
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Crutches Walking Picture
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Crutches Down Stairs Picture
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Crutches Up Stairs Picture
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Ankle Strapping Tape Picture
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Tensospray Picture
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Ankle Strapping Anchors
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Cervical Collar Types Picture
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3 Finger Measurement Picture
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Cervical Collar Fitting Picture,
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Network Picture
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Misused Cervical Brace Picture, 2011, digital image viewed 12 March,
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Soft Collar Picture
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Purple Ankle Strape
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e,
Muzin et al (2008) & Whitcroft et al (2011)
Aker et al (1996) & Muzin et al (2008)
Aker et al (1996) & Muzin et al (2008)
Aker et al (1996), Aoi et al (2011) & Muzin et al (2008)
APA Code of Conduct: September 2008
Full transcript