Locomotion and Adaptive Devices

As occupational therapist, it is so important for us to know why we need to appropriately fit each client for an assistive device. It is important to make sure each device is fitted for each individual because you want to make sure the device doesn't do more harm than good to the person. Sometimes if they are not fitted correctly it can cause poor or improper body mechanics and cause injury to the client. Assistive devices are prescribed to help client improve their base of support and stability so it is important that you don't do further damage to the client. We also need to make sure each device is comfortable to the client. The clients will be using the assistive device a lot so we need to make sure it fits comfortably so the client does not receive pain from the device.  It is so important to fit each need for the client so that they can be as comfortable as possible in their condition. 

To fit for a cane, you need to make sure that the hand gip is at the level of the ulnar styloid, wrist crease, or greater trochanter for the best support. When testing, the clients elbow should be relaxed and flexed at about 20-30 degrees. Their shoulders should be relaxed and not elevated. A cane does not proved great stability for clients so you need to make sure the client has is stable enough to use it before the fitting process takes place. 

To fit for an axillary crutch, you need to make sure the client is stable enough for the crutches just like the cane. Axillary crutches provide a little more support for the client than a cane, but you need to make sure the client has enough upper body strength to use them. To fit them for a client, you would use the same method as you did for the cane. The handgrip should be level with the ulnar styloid, wrist crease, or greater trochanter. The elbow should be relaxed and flexed 20-30 degrees and shoulders should be relaxed instead of elevated. The difference with the axillary crutches is that the axillary rest should be about 5cm below the floor of the axilla with the shoulders relaxed. It is also important to make sure the hight of the crutches matches the hight of the client. 

To fit for a Loftstrand crutch, you would use the same method as the axillary and cane, but this type has an armcuff that wraps around the proximal forearm. It is important to make sure that the armcuff is about 2/3 of the way up the forearm. This is used with clients that have long term disabilities. It provides more support than a regular cane but less support than the axillary crutches. 

To fit for a platform walker, the client is typically someone who cannot bear weight through their wrists or hands. The platform surface should be positioned to allow weight bearing through the forearm when the elbow is bent to 90 degrees. Make sure that the client is standing tall with the scapula relaxed. The proximal ulna should be positioned 1 to 2 inches off of the platform surface. This helps to prevent nerve compression. Make sure the forearms and hands are in a neutral and supported position. The handle fo the platform should be positioned slightly medially to allow for a comfortable grip for the client. 

To fit for a rolling walker, the client is someone who cannot lift a regular walker due to UE weakness. This assistive device allows for a large base of support for the client. It is important to adjust the walker to the hight of the client to provide the best support and comfort. Again, you would use the same method as the cane when fitting. Make sure the hand grip is level with the ulnar styloid, wrist crease, or greater trochanter when the arms are at the sides. The elbow needs to be relaxed and flexed at 20-30 degrees. Shoulders need to be relaxed and not elevated. 

It is so important that each occupational therapist follows each of these steps for each assistive device so that they can provide the best support for each client.