BKA Rehabilitation: Crutch Walking Preparation and Training

Posted on Nov 20, 2025 in Physical Education

Preparing a BKA for Crutch Walking

Preparing a Below-Knee Amputee (BKA) for crutch walking requires a structured, step-by-step approach focusing on safety, balance, strength, and coordination. This comprehensive outline details the necessary steps for successful rehabilitation and mobility.

1. Medical Clearance and Initial Assessment

Ensure the patient is medically stable before initiating training.

Assessment Criteria:

  • Wound healing status
  • Pain level management
  • Strength and range of motion (ROM)
  • Balance and coordination abilities
  • Upper limb and sound leg function
  • Cognitive ability and understanding of instructions

2. Patient Education and Safety

  • Explain the purpose and proper use of crutches.
  • Discuss the prescribed weight-bearing status: whether it is Non-Weight Bearing (NWB), Partial Weight Bearing (PWB), or Full Weight Bearing (FWB).
  • Instruct thoroughly on safety precautions, emphasizing fall prevention techniques.

3. Strengthening and Conditioning

Before crutch training begins, emphasize exercises to improve:

  • Upper Limb Strength: Focus on triceps, shoulders, and grip strength, which are crucial for weight-bearing through the crutches.
  • Core Stability: Essential for maintaining overall balance and posture.
  • Residual Limb Care: Including Range of Motion (ROM) exercises and desensitization techniques.
  • Sound Limb Strength: Necessary for support, push-off, and overall mobility.

4. Proper Crutch Fitting

Use axillary (underarm) or forearm (Lofstrand) crutches depending on the patient’s ability, strength, and specific needs.

Fitting Guidelines:

  • Axillary Crutches:
    • The top pad should be 2–3 finger-widths below the axilla (armpit).
    • Hand grips must be level with the wrist crease when the arms hang naturally.
  • Forearm Crutches (Lofstrand):
    • Cuffs should be positioned about 1–2 inches below the elbow joint.
    • The handle should be set at wrist level.

Important: Ensure crutches have non-slip tips and are adjusted to the correct height.

5. Step-by-Step Gait Training

A. Pre-Gait Activities:

  • Practice within parallel bars (if available).
  • Static and dynamic standing balance exercises.
  • Weight shifting drills (side-to-side and front-to-back).
  • Single-leg standing practice (on the sound limb).

B. Progressing to Crutch Walking:

The appropriate gait pattern depends heavily on the prescribed weight-bearing status and the patient’s balance level.

I. Non-Weight Bearing (NWB) or Early Training
Three-Point Gait:

This gait pattern requires the patient to bear weight only on the sound limb.

  1. Move both crutches forward simultaneously.
  2. Move the residual limb (or prosthetic side) forward, keeping it off the ground.
  3. Step through with the sound leg.
II. Partial Weight Bearing (PWB)
Modified Three-Point Gait:

Similar to the three-point gait, but the patient is permitted to place partial weight on the prosthetic side or residual limb, as instructed by the therapist.

III. Full Weight Bearing (FWB) / Advanced
Four-Point or Two-Point Gaits:

These gaits are used for improved balance and efficiency once full weight bearing is achieved or when using a prosthesis.

  • Four-Point Gait: Right crutch → Left foot → Left crutch → Right foot (slowest, most stable).
  • Two-Point Gait: Right crutch + Left foot move together → Left crutch + Right foot move together (faster, requires more coordination).

6. Stairs and Curbs Training

A simple mnemonic for safety: “Up with the good, down with the bad.”

  • Going Up Stairs: Sound leg steps up first → Crutches and prosthetic side follow.
  • Going Down Stairs: Crutches and prosthetic side move down first → Sound leg follows.
  • Safety Note: Always use a handrail if one is available for added support.

7. Monitoring Progress and Adjustments

  • Monitor the patient closely for signs of fatigue, increased pain, or improper technique.
  • Watch for potential skin issues on the residual limb (especially when using a shrinker or early prosthesis).
  • Adjust the gait pattern and training intensity as the patient demonstrates improvement and confidence.

8. Psychosocial Support and Encouragement

  • Encourage independence, self-efficacy, and confidence throughout the process.
  • Address the emotional impact of amputation, body image concerns, and motivation levels.
  • Involve family members or caregivers in the training process as appropriate.

Key Training Tips

  • Short, frequent training sessions are often more effective early in rehabilitation.
  • Utilize a mirror to provide visual feedback on posture and technique.
  • While progression to using a prosthesis is the goal, safe and proficient crutch ambulation remains an essential foundational skill.