Disabled Village Children
A guide for community health workers,
rehabilitation workers, and families

PART 1
WORKING WITH THE CHILD AND FAMILY:
Information on different Disabilities
E. Exercises and Techniques

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CHAPTER 43

Crutch Use, Cane Use, and Wheelchair Transfers

USE OF CRUTCHES

MAKING SURE THE CRUTCH FITS THE CHILD

IMPORTANT Teach the child not to 'hang' on the crutches with her weight on her armpits. WRONG In time, pressure on the nerves under the arm can cause paralysis of the hands. Using elbow crutches is a good way to keep her from hanging on her armpits. (However, these are more difficult to use for some children.) RIGHT

For designs and measurements of different crutches, see Page 584 to 586.

Walking with crutches

TAKING STEPS

Some children walk best by taking steps, one foot at a time.

For better balance and position, move the right crutch forward together with the left leg, and then the left crutch together with the right leg.

Her 'tracks' should look like this.

'SWING TO' WALKING

Many children who have difficulty taking steps use crutches by pulling or swinging both feet forward to the level of the crutch tips. Then they advance the crutches and pull themselves forward again.

This way is slow but sure.

'SWING THROUGH' WALKING

Although at first they may be afraid to try it, many of these children can learn to 'swing through' between their crutches, like this.

This way is fast and fun.

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USE OF A CANE

It usually works best to hold the cane on the side opposite the weaker leg.

Move forward and put down the weaker leg and the cane together.

For different crutch and cane designs, see Chapter 63.

His 'tracks' should look like this.

WHEELCHAIR TRANSFERS

Persons who use wheelchairs become much more independent if they can learn to transfer (get in and out of their wheelchairs) by themselves, or with limited help. For those who need some help, it is important to find ways to transfer that make it easiest both for the disabled person and the helper.

Too often, as disabled children get bigger and heavier, mothers and fathers hurt their own backs.

Different persons will discover their own 'best way' to transfer with or without help, depending on their own combination of strengths and weaknesses.

Here we give some suggestions of ways to transfer that many people have found to work well.

Notice that it is often easier to transfer sideways out of a chair, and also back into it. To transfer sideways, however, a wheelchair without armrests, or with at least one removable armrest, is needed. Therefore, for many disabled children, make an effort to get or make wheelchairs without armrests or with removable armrests. Unfortunately, most wheelchairs in many countries have fixed, often very high, armrests. We therefore will give examples of transfers both with and without armrests.

A good way to transfer the child who needs help is like this.

Put the child's feet on the floor and lean her forward against your body. Have her hold on as best she can.

Lift her like this and swing her onto the bed.

Ideas for wheelchair design, adaptation, and use are in Chapters 64, 65, and 66.

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Transfer from cot or bed to wheelchair without armrests

To transfer from the wheelchair to the cot, follow the same steps in reverse.

Transfer from cot or bed to wheelchair with armrests

Transfer forward from wheelchair to cot or bed (often works well for children)

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Transfer with sliding board -without help

For getting into and out of bed, a car, etc.

Transfer with sliding board -with help

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Transfer from floor to wheelchair - with help of a low seat

Transfer from wheelchair to floor -and back again -without help of a stool

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Disabled Village Children
A guide for community health workers,
rehabilitation workers, and families
by David Werner

Published by
The Hesperian Foundation
P.O. Box 11577
Berkeley, CA 94712-2577