It's All About The Fit

In a recent TNOTA seminar about the basics of seating and positioning a quote was shared that stated, "The body will always win. Assistive devices are an extension of the human body." Assistive devices are meant to promote function, independence, and protect body shape. Some assistive devices that a client may use are a cane, axillary crutches, lofstrand crutches, platform walkers, and rolling walkers. In order for these devices to properly assist in the needs of a specific client, the therapist must make sure that the positioning demand of the client and the specifications of the assistive device match up. There are many reasons for the importance of appropriately fitting a client for use of an assistive device. Correct fitting of assistive devices ultimately aids in proper positioning that assures maximum mobility, function, and control. Appropriate fitting can also increase safety and security of a client. The therapist needs to guarantee that the device will not injury or cause further harm for the client. To begin fitting a client, the therapist needs to start by conducting individualized, holistic evaluations to determine client factors, performance skills, and patterns of daily living.

 Proper fitting for assistive devices are as followed:

Canes: Will be used on the opposite side of the affected extremity. Hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter and facing backward. The elbow should be relaxed, flexed 20-30 degrees. Shoulders should be relaxed and not elevated. To adjust the cane, release the locking mechanism. Push the button and move the cane base to the correct height. After the button clicks in place, secure the locking mechanism.

Crutches: Axillary crutches provide the most support/stability of any other crutch. The hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter. The elbow should be relaxed, flexed 20-30 degrees. Axillary rest should be -5 cm below floor of the axilla with shoulders relaxed. The crutch length should be approximately the same length as the distance from the patient's forearm to the finger-tips of the opposite hand. To adjust the handgrips, unscrew the wing nut and remove the bolt. Move the handgrip up or down. Replace the bolt and then replace the wing nut. Loftstrand crutches are used for long term disabilities are provide more support/stability than a cane but less than axillary crutches. For loftstrand crutches, the arm band should be positioned 2/3 of the way up the forearm. 

Walkers: Rolling walkers are used for clients that can not lift a walker due to UE weakness. Start by estimating the appropriate height of the walker based on the patients height. The patient should stand and look straight ahead with arms relaxed. To adjust the walker, push the button and move the legs to the correct height. Be sure that the buttons click back into place when finished. Adjust all legs to the same height. The hand grips should be in line with the wrist crease, ulnar styloid, or greater trochanter. The elbows should be slightly flexed, 20-30 degrees. For a platform walkers, the platform surface should be positioned to allow weight-bearing through the forearm when the elbow is bent to 90 degrees. To avoid nerve compression, the proximal ulna should be positioned 1 to 2 inches off the platform surface. The hand of the platform should be positioned slightly medially to allow for a comfortable grip when forearm is resting on the platform.