information session with G.F. Strong helped identify universal
issues and advantages associated with crutch use, both forearm
and axillary. The professional setting of G.F. Strong offered a
broad range of information that lent itself to universal design
whereas an informal meeting with our co-creator in her home
revealed information of a more personal nature; she commented
on her experience with frequent axillary crutch use, telling us
about the side effects of pain in her shoulders and upper body. She
also expressed her need for collapsibility in a crutch to facilitate
ease of mobility while travelling; something she does on a routine
basis as part of the national Paralympic basketball team. Finally,
the issue of aesthetics came forward. She felt that the current
aesthetic of her standard axillary crutch was not only unattrac-
tive but impersonal. Her desire for a personalized aesthetic
revealed her relationship with her crutches as an extension of
her body (Scarry, 1985). Collaboration with G.F. Strong and our
co-creator helped us to clearly define our project goals: reducing
the potential for stress injuries to the brachial plexus’, increasing
mobility through collapsibility and developing a more personal-
ized aesthetic.

Re-designing the axillary crutch with our co-creator provided an
opportunity to design for her specific needs. The first meetings
revealed her reasons for using the axillary crutch instead of the
forearm crutch. The ability to travel a greater distance without tir-
ing and to transition from crutch to hands-free while performing
daily tasks was of primary importance. Prototyping based on feed-
back from our co-creator allowed us to further refine the concept
and ask more directed questions. What was her natural inclina-
tion when using the axillary crutch, how does this differ when in
a stabile position verses in motion? Would a hybrid between the
forearm and axillary crutch offer further support? Is there a need
for more forearm support?

Research on Axillary Crutches// To further understand the
physiology of the brachial plexus, we contacted a kinesiologist.
This meeting helped us to not only better understand the poten-
tial damage resulting from long term crutch use, but to rethink
ways of lessening risk of injury by facilitating neutral posture. We
learned that the impact of regular misuse of the axillary crutch
affects not only axillary nerves but can also impact the ulnar and
radial nerves (Youdas, Kotajarvi, Padgett, and Kaufman, 2005).
This information led us to explore alternatives for the underarm
piece of the axillary crutch. We also discovered that weight distri-
bution of axillary crutches creates stress on the wrist due to the
angle of the crutch handle. Research revealed that the optimal
angle for stress reduction to be twelve degrees below horizon-
tal. This creates optimal weight redistribution on the wrist and
forearm (Youdas et al.). With this information, we were better pre-
pared to begin the creation of prototypes.

‘ Brachial plexus is an arrangement of nerve fibers, running from the spine, formed
by the ventral rami of the lower four cervical and first thoracic nerve roots (C5-Tr).
wwvwlt proceeds through the neck, the axilla (armpit region), and into the arm.
(http://en.wikipedia.org/wiki/Brachial_plexus)

Figure 1.
Concept drawing

Prototype Testing// We started our ideation process by sketching.
Figure one shows a concept we developed regarding collaps-
ibility and stress injuries. This process of ideating through
sketching created new ideas throughout the project. With a range
of ideations and feedback from our co-creator, we began to con-
nect drawn concepts to physical forms through prototyping.

We began prototyping underarms pieces (Fig. 2) to reduce
impact on the brachial plexus and encourage neutral posture.
These components were designed to be tested with an adjustable
trial prototype (Fig. 3). To further reduce stress, we focused on the
potential for impact on the forearm and wrist.

The adjustable trial prototype (Fig. 3) enabled us to map the
ergonomics of our co-creator’s body while static. To further under-
stand her interaction with a mobility aid, we then mapped the
ergonomics of her body while dynamic. With this information, we
began to build a product prototype (Fig. 4). The process of map-
ping and prototyping with our co-creator narrowed the project's
ergonomic goals (Buchenau, 2000).

After testing underarm pieces with our co-creator, we received
extensive feedback. She stated that none of the prototypes felt
as natural to use as the current underarm piece of her standard
axillary crutch; she highlighted where there may be potential
modification in the design, commenting on the comfort of a more
minimal form. With this feedback we met the physiotherapists at
G.F. Strong. In discussion with our co-creator’s physiotherapist,
we came to understand that we did not need to focus on a re-
design for the underarm piece of the crutch since our co-creator
did not use her underarm crutch in a way related to stress inju-
ries. With this feedback, we were able to narrow the constraints
of the project. Our objectives became clearly defined as working
to increase mobility through collapsibility, and personalizing
the aesthetic.

Testing the product prototype (Fig. 4) based on our previous
ergonomic findings revealed that the addition of the forearm
support meant the crutch was actually less functional. When test-
ing the prototype during construction, we found that we were
more inclined to hold the crutch close to our person in both
a stabile position and while in motion — similar to what a new
crutch user would do. As a result, when this prototype was tested
with our co-creator, she saw very little relevance in the placement

CO-CREATION + CO-DESIGN 37