Assistive Devices

When it comes to assistive devices, i.e. a wheelchair, cane, or a crutch, a proper fitting of these devices for your client is imperative. If a proper fit is not made with an assistive device an indiviudal could end up in a danger while undergoing ambulation. A proper fit will prevent these falls from occuring. Another consideration that needs to be taken when fitting a client is which assistive device is the best "fit" for the individual. This means that you should factor in your patient's environment, functional capability and personal preferences when making an assistive device selection. 

Each assistive device has its own fit and considerations for a client.

Cane: For proper cane sizing you should have your client stand and look straight ahead wiht their arms relaxed at the side. The cane's handle should be in line with either the ulnar styloid or greater trochanter. To adujust your client's cane release the locking mechanism and push the button and move the cane base to the correct height. After this step is completed ensure that the locking mechanism is in place. A cane is inexpensive and allows your client the most environmental freedom. However, a cane is the leaset stable device and cannot restrict weight bearing. If a proper fit is not given and the cane is not properly used asymmetry in gait can occur. It should also be noted that wooden canes cannot be adjusted. 

Axillary Crutches: Axillary crutches are "standard" crutches and are lightweight and durable. For proper fitting, the crutch length should be the same length as the distance from the client's forearm to the fingertips of the opposite hand. This crutch length should go off of your client's height and during the fitting the client should stand and look straight ahead with their arms relaxed. The arm pads of the crutches should be 1-1.5 inches under the axilla. The handgrips of the crutches should be in line with the ulnar styloid or greater trochanter when the hands are resting at the side. A benefit of the axillary crutches are contoured handgrips and are more comfortable than rounded handgrips. A platform attachement can be added to the axillary crutches to promote NWB in the upper limb. Crutches in general are also beneficial because they can increase the variablit of gait patterns and your speed.

Lofstrand Crutches: Lofstrand crutches are beneficial because they allow more movement and control in small spaces. They are more appropriate for long-term usage and they reduce strain on the arms. Lofstrand crutches would be a good choice for an individual who wishes to use their hands a lot while still using the crutch as you would be able to use your hands without getting out of the crutches. Loftstrand crutches do implement the use of an arm band, so for these crutches the arm band should be positioned 2/3 of the way up the forearm. This is alongside all of the other aformentioned crutches sizing instructions above.

Platform Walker: When fitting a walker, the fit goes off the client's height. To adjust the walker, push the button and move the legs to the correct height. Handgrips of the walker should be in line with the ulnar styloid or greater trochanter when the hands are resting at the side. For a platform walker, special considerations should be made and the platform surface should be positioned to allow WB through the frearm when the elbow is bent to 90 degrees. The client should also be standing up straight with their scapula relaxed. The handle of the platform should also be positioned to allow for a comfortable grip when the forearm is resting on the platform. A platform is best used for client's who cannot bear weight through their wrists or hands. It can also be beneficial to clients who do not have the trunk support to use a front wheeled walker.

Rolling Walker: All of the standard fittings of a walker is the same as what is aformentioned for the platform walker. A rolling walker has a seat attached and is beneficial for those who fatigue easily. Rolling walkers are also easy to maneuver in small spaces. However, the rolling walker is the least stable and most difficult walker to transport.