If The Device Fits?

Assistive devices are a large part of Occupational Therapy, and a variety of clients utilize assistive devices for many reasons. In a biomechanical approach, assistive devices help individuals increase their mobility by assisting them while doing any weight-bearing activities like walking or standing. They are beneficial for clients who might have pain when moving, decreased balance, weakness, joint instability, or clients who are experiencing increased fatigue. 

Since there are a variety of uses for these devices, they have to be customizable to best fit each client's needs and abilities. Fitting a client to their assistive device is as important as wearing the correct size shoe. The wrong fit could be painful, decrease their ability to ambulate, or even be dangerous (increased risk of falls). 

Let's go through how to fit some standard devices.

Canes:

There are three different kinds of canes:

1. Standard Straight Canes- These are great for clients who need minimal assistance, and it allows for the most freedom of movement. 

Quad Canes: provides increased stability because there are more contact points, but results in a slower gait pattern. These can be difficult to use on stairs. 

2. Wide Based Quad Canes (WBQC)- for patients with decreased balance

3. Narrow Based Quad Canes (NBQC)- for patients with slightly decreased balance 

To size it correctly, you need to make sure the handle is in line with the wrist breast, ulnar styloid, or greater trochanter of the femur. 

The client should show slight elbow flexion of about 20-30 degrees while using the cane after fitting. 

Axillary Crutches:

Axillary crutches are the type you or your friend have had to use after an ankle sprain. These devices are used to restrict weight-bearing and allow for a relatively large variety of movement, including ambulating on stairs. 

To size these correctly, you will need a couple of measurements. The crutch should be adjusted to be the same length as the patient's forearm when the elbow is flexed and abducted to 90 degrees to the fingertips on a fully abducted and extended opposite hand. The crutch pad should be 1 to 1.5 inches under the axilla or armpit (this is about 2-3 fingers). Handgrips of the crutches should rest in line with the wrist crease, ulnar styloid, or greater trochanter of the femur when the arms are relaxed and the client is standing with the crutches position. 

Lofstrand Crutches:

Sometimes these are also referred to as forearm crutches and allow for more dynamic movement and control in small spaces than axillary crutches. It also allows clients to use their hands while using the device and reduce the strain on the arms. Clients with these devices have to have increased trunk strength. 

These crutches require the armband to be 2/3 of the way up the forearm. 

Platform Walkers:

These walkers are helpful for patients who cannot bear full or partial weight through their wrists and hands.  These clients might have decreased trunk strength compared to clients who use a rollator walker. 

The fitting of the walker is very similar to the rolling walker. The platforms should support the forearm for weight-bearing when the elbow is flexed to 90 degrees and the patient is standing straight. The ulna needs to be a few inches off the surface of the platform to avoid pressing the nerves. 

Rolling Walker

Rolling wakers have a seat, which is helpful for clients with increased fatigue. Because of the wheels, these walkers can be easier to move and have the most minor stability of the different types of walkers. 

The walker's height should be based on the patient's size with the handgrips in line with the wrist crease, ulnar styloid, or greater trochanter when arms and hands are relaxed at the client's side. The elbow should be slightly flexed at about 20-30 degrees when the walker is being used.