Assistive devices

There are many reasons as to why it's important that a client's assistive device is individually and appropriately fitted for them. One of the reasons is to ensure the safety, stability, and mobility of the client. For example, in order for a client to have a standard walker they must have fair balance and somewhat good upper extremity strength in order to life the walker with each step. In addition, there must also be good cognition to know and understand when to lift the walker. Another important reason is to prevent injury to the client. For example, when appropriately fitting standard crutches to a client it is important to measure 5cm below the axilla region. Failure to do so will result in injury to the brachial plexus. 

When choosing the appropriate cane to a client you must first select which cane is most suitable for them. There are two types of canes - a standard cane (one point of contact) or a quad cane (four points of contact, additional stability). Then the handle of the cane should be in line with either the wrist crease, ulnar styloid, or the greater trochanter of the client. It is also important to make sure the client knows to use the cane on the non-affected side. For example, if the client had surgery on their right leg then the cane should be used on their left side to help shift the weight. As a therapist, it's also important to inform your client to make sure the points of contact (the legs) of the cane are pointed away from the foot so it doesn't get in the way of walking.

The arm pads of the axillary crutches should be measured 5cm below the axilla so it doesn't add pressure to the brachial plexus and cause more injury. The handgrips of the axillary crutches should be in line with the wrist crease, ulnar styloid, or greater trochanter.

Lofstrand crutches handgrips should be at the same height as the handgrips of axillary crutches which is at the greater trochanter, ulnar styloid process, or the wrist crease. The arm band of this crutch should be placed at approximately 2/3 of the forearm of the client. It is also important that the therapist ensures the grips of the crutches are facing forward during use in order to provide the most stability and safety of the client. 

The platform walker should be chosen if the client cannot bear weight through their wrists or hands. The handgrips should be fitted to the greater trochanter, ulnar styloid, or wrist crease of the client. For the handle of the platform the therapist should ensure that it is positioned to allow weight bearing through the client's arms when elbow is flexed at 90 degrees. It is important to make sure the client is also standing tall. Also, to avoid nerve compression the proximal ulna should be positioned a couple inches of the platform surface and the handle should be slightly medially to allow for a comfortable grip when the forearm is resting on the platform.

The rolling walker should be chosen for clients who may fatigue easily since there will be a seat available for them to rest when needed. As well as brakes on the walker to ensure no movement while sitting. The handgrips of the walker should be in line with the greater trochanter, ulnar styloid, or wrist crease. 

While appropriately fitting the client to their assistive device it is important to make sure the client is standing tall, shoulders relaxed, and with shoes on. By following these steps and considering other factors that may be important to the client - coordination, balance, strength - the client should have an assistive device that will help and not hurt them.