Locomotion and Adaptive Devices

As OTs, we will be fitting clients for assistive devices often. It is important that we make sure these devices fit our clients appropriately because of safety and comfort. In regards to safety, if a device does not fit appropriately, it can be very dangerous for the client and even cause injuries. Next, we want our client to be comfortable in their assistive device. The client could be using the assistive device as much as every day, so it is important it's comfortable for him/her and will not lead to any further injuries.

In order to fit a client for a cane, the hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter. The elbow will be relaxed and flexed 20-30 degrees, and the shoulders will be relaxed with no elevation. Canes are the most unstable of assistive devices, so it is important to know if the client is strong and stable enough to only need a cane. This measurement method is also used for walkers.

For fitting axillary crutches, the same method as fitting a cane will be used. In addition to these steps, the axillary rest should be about 5 cm below the floor of the axilla with the shoulders relaxed. Axillary rests that are too high or too low for the client can be painful.

Lofstrand crutches have arm cuffs that wrap around the client's proximal forearms. These type of crutches are commonly used for those with long term disabilities. Lofstrand crutches are more stable than canes but less stable than axillary crutches. Fitting for these crutches will require following the same steps as that of the cane but with an addition of ensuring the arm cuff is situated 2/3 of the way up the forearm.

Platform walkers are for those who cannot bear any weight in their hands or wrists, so they must rely on their forearms for stability. Once again the same fitting method will be used, as canes and walkers have the same method. Also, the client's forearms need to be in a neutral position flexed at 90 degrees in order to get the proper height measurement for the platform attachments.

Lastly, we have the rolling walker. This is for clients with weak upper extremities, so much so that they would not be able lift a standard walker. We would still use the same measurements as the cane and standard walkers. This device offers very little stability as it is extremely mobile. So, we would need to ensure that the patient has good balance and will be able to keep the rolling walker under control.