Assistive Devices

It is very important to properly fit your clients for their assistive device(s). Not only is it implementing client centered practice by taking in the client’s physical condition, age, endurance, and psychological condition in to account to ensure that they get the most out of their device.  Proper and accurate measures are also crucial to ensure that these devices be fit properly to the individual client because they will most likely need them for 5 or more years due to insurance purposes. Assistive devices provide clients with the stability, strength, and balance they will need to actively engage in their daily occupations so ensuring that the client can use them to reach their maximum independence is very important. 

Fitting for these devices is very important to be done as accurately as possible to ensure proper body mechanics. If the device is too low, it will cause poor body mechanics and cause more problems than they began with.  Furthermore, a walker being too low for the client would cause them to compensate with other muscles and this is not the proper way to be used and can cause safety issues as well as putting the client at a higher risk for injury. 

The most stable device is a walker. There are many different types of walkers. A rolling walker, platform walker, a rollator, are just a few examples. These all require a different amount of balance, strength, and stability to be able to use. 

The most stable of them all is the standard walker. It has many positives to it. For one, it’s light-weight, easy to fold, but it does require the upper body strength to lift it up during walking. It also requires endurance because there are not seats on these requiring someone to have to stand during breaks if needed. To fit for a standard walker the handgrips should be in line with the wrist crease, ulnar styloid process, or the greater trochanter when the hands are resting at the side. The client's elbows should be slightly flexed 20-30 degrees. Shoulders should be relaxed. It is important that the walker has all four legs at the same level to prevent compensation and other issues. It is the same method to measure for front wheeled walkers or (FWW) sound like what they are. They have 2 wheels at the front of the walker. This walker is less stable because of the wheels. Rolling walkers are designed for individuals who cannot lift a standard walker due to upper extremity weakness or balance and stability issues during lifting the walker. 

A platform walker is for a client who is unable to weight bear through their hands or wrist. The platform part is their to support the forearm and this device can be attached to a walker or crutches. The proper way to measure for a platform walker: the platform surface should be positioned to allow weightbearing through the forearm when the elbow is flexed 90 degrees. The patient should stand tall with the scapula relaxed. The proximal ulna should be 1-2 inches off the platform surface to avoid nerve compression.

Crutches are less stable than walkers but still provide the patient with some stability when ambulating. There are many types of crutches as well. Standard crutches, which are situated in the person axillary region. Lofstrand that have an arm cuff that wraps around the proximal arm and are used mainly for individuals with long term disabilities because they provide more stability than a can but less than axillary crutches. And as talked about above, platform crutches which keep the forearm and hand in neutral and supported. 

When fitting axillary crutches there are 2 landmarks. Axillary rest should be 5cm (width of the palm) under the axilla, the hand grip should be measured at the greater trochanter. There are some positives to axillary crutches: can be used on stairs, allow for more of a gait pattern, easy to store. however, they are NOT to be used on wet or slick surface, they also require a good amount of balance so they would not be ideal for a client who is unstable when ambulating. 

Lofstrand crutches AKA Forearm crutches are mainly used with individuals with long-term disabilities. They allow you to use your hands to maximize independence. When measuring for these the handgrips should be pointing forward and the cuffs should be 2/3rds proximal to the wrist. 

Lastly, a cane which is less stable than a walker. Canes should be placed on the opposite of the involved side. For example, if a patient has weakness on the left leg, the cane would be positioned on the right side of their body. Canes are easy to store, light weigh, and promote asymmetry with weight bearing.  There are several different types of canes. A quad cane, which has 4 bases of support. The bases of support needs to be facing away from the inside so the patient does not trip over them. Wide based Quad Cane (WBQC) which has one shaft connected to a wide base with 4 prongs to increase stability when a person has decreased balance using a standard cane. 

To fit a cane, the handle should be in line with the wrist crease, ulnar styloid process, or the greater trochanter when the hands are relaxed. When holding the cane, the elbow should be flexed 20-30 degrees. 

These devices allow our clients to be as independent as possible and it is crucial that they be measured accurately to promote proper gait patterns, proper body mechanics, and client SAFETY!!