It is important to fit a client with the right assistive device to improve the safety of the client and to increase the client’s mobility, while still being stable. When fitting a client with an assistive device, it is important to look at their physical condition, endurance, confidence, strength, balance, age. For example, if someone had poor endurance, the client might need a device with a seat in order to take a break when becoming fatigued. An assistive device can also be used to decrease pain, sometimes after a procedure. When fitting a client, it is important to look at how much weight a person can put on their affected extremity. Evaluating a client’s balance and cognition are also important to help guide the decision for the right assistive device. Parallel bars are the most stable, then standard walker, wheeled walker, axillary crutches, forearm crutches, and the least stable is a cane.
When fitting someone with a cane, the hand grip needs to be at the level of the ulnar styloid process, wrist crease, or greater trochanter. The elbow should be flexed to 20-30 degrees with the shoulders relaxed. A wide based quad cane increases stability and a narrow based quad cane could be used for someone who doesn’t need as much support. The side of the quad cane where the legs stick out a little farther, should be on the outside of the client. It is important to educate the client on putting the cane on the side of the uninvolved extremity.
The handgrip for a rolling walker should be at the ulnar styloid, wrist crease, or greater trochanter. The elbow should be relaxed and flexed at about 20-30 degrees and the shoulders shouldn’t be elevated, but relaxed. A rolling walker can be used for clients who have upper extremity weakness or a problem with balance.
A platform walker could be fitted for clients who are unable to bear weight through the wrist or hand. They weight bear through elbow and forearm, when the elbow is flexed at 90 degrees and the shoulders are relaxed. The forearm should be positioned about 1-2 inches off the platform, so there isn’t nerve compression.
The axillary crutch hand grip should be the same as a cane or walker: ulnar styloid, wrist crease, or greater trochanter, with elbow flexed at 20-30 degrees and shoulders relaxed. The axillary rest should be about five centimeters below the floor of the axillary with the shoulders relaxed. This helps prevent rubbing or injury.
Loftstrand crutches have an arm cuff that should be about 2/3 up the forearm. Loftstrand crutches are typically fitting for clients who have long term disabilities. The hand grips should be facing forward.
Great job! :-)
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