Locomotion and Assistive Devices

Assistive Device Fitting

 Assistive devices are used to increase the client's function and ability to move around safely. Some common devices include crutches, canes and walkers. It is important to appropriately fit your clients for their device to ensure it is functional for them. If the device is too short it could cause the client to slouch causing posture problems. If the device is too high it could cause them to lose balance or experience uncomfortability. When fitting a client for their device, it is important to consider their physical condition. If a patient cannot bear weight on their arm, you may consider platform crutches over axillary. If a patient has limited balance a standard walker might be a better fit than a cane because it is the most stable.

Cane

    A cane is the most unstable assistive device. When fitting for a standard cane, it is important to adjust the size of it. You want to make sure the handle of the cane is the same height as the client's greater trochanter. When gripping, the client's elbows should be flexed 20-30 degrees. This also applies to a quad cane. From a sit to stand position, I would have my client scoot to the edge of their seat and make sure their feet  are flat on the ground with toes under knees. Next, I would instruct the client to loosely grab the handle of the cane on the non-injured side and use the armrest or seat surface to lean forward and push up to stand using both arms and legs. If a patient was going from standing to sitting, I would have them go up to the seat, turn around, and back up until their legs came in contact with the seat. I would instruct the client to loosely hold the cane in one hand and reach back with both hands for the armrest or seat. I would tell them to sit down slowly, avoiding plopping as it could cause injury. During ambulation, I would instruct them to advance cane and the involved leg at the same time. If balance was impaired, I would have them advance the cane first before the leg. I would make sure they stepped through with the uninvolved leg making sure to go further in front of the other leg. For the client to make a turn, I would have them take multiple control steps. It is important to consider safety when using a cane. When using a quad cane, make sure the wider base is away from the client to keep them from tripping. When going up stairs, you should go up with the good leg and down with the bad leg. If you are training a client on using a cane, make sure they are wearing a gait belt. 

Axillary Crutches and Lofstrand Crutches

    When fitting a client with axillary crutches, you will have to make two adjustments. The height of the crutches should be three fingers below the armpit. The hand grips should be aligned with the greater trochanter. Client's wrist crease and ulnar styloid appropriate when at rest. The elbows should be slightly flexed. When fitting a client for lofstrand crutches, you will make two adjustments. The cuff should be 2/3 up forearm. The hand grip should be aligned with the greater trochanter. Client's wrist crease and ulnar styloid appropriate when at rest. Elbows should be slightly flexed. When teaching your client how to go from sit to stand and vice versa, it is almost the same for axillary and lofstrand crutches. When going from sit to stand, I would instruct my client to scoot to the edge of their seat. I have them place both crutches on the involved side and hold hand grips while placing the other hand on the armrest or seat. I would have them lean forward and push up to stand. When the client gets to standing, I would have them place one crutch under one side and then the other. When teaching the client to go from standing to sitting, I would have them go their seat, turn around, and back up until your legs touch the seat. I would have them place both crutches in one hand while holding the hand grips and reach back with the other hand to come in contact with the armrest or seat. I would instruct them to sit down slowly and not plop down to avoid injury. During ambulation, I would have them place crutches with tips in a tripod position. I would have them transfer weight onto hand grips while not putting pressure on the axilla. The client would then swing through the crutches and continue this pattern. I would have them take multiple controlled steps to make a turn. A few differences to note with the lofstrand crutches. While using the lofstrand crutches, the forearm should be placed into the cuff after standing and removed before sitting. The handgrip should face forward during ambulation. A few safety considerations when using crutches. You do not want to position the crutches too close together, too far apart, or in front or back when walking. To avoid compressing a nerve, make sure to not position the crutches too close to the axilla and make sure the cuff is not too far up the forearm. When training a client to use these devices, always make them wear a gait belt. 

Platform Walker and Rolling Walker

    When fitting a client for a platform and rolling walker, adjust the height of hand grips to the greater trochanter. Their wrist crease and ulnar styloid should be appropriate when relaxed and elbows flexed approximately 20-30 degrees. A platform walker is great for a client who cannot weight bear or does not have enough trunk support to use a rolling walker. A rolling walker is great for a client who fatigues easily. The same applies for platform and rolling walker during sit to stand and vice versa and ambulation. When teaching the client to go from sitting to standing, I would have them place the walker in front of them. If the client can weight bear, keep both feet on the ground, toes under knees. If they can not, extend injured leg off the ground. I would have them scoot to the edge of their seat and place hands on the armrest or seat. Client should then lean forward and push up using both arms and legs. Once standing, have them place hands on walker. When instructing the client on how to sit down, I would have them go to their seat, turn around, and have them backup until their legs touch the seat. If the client cannot weight bear, have them extend the injured leg in front and off the ground. I would have them reach back and place hands on the armrest or seat. While leaning forward, use the armrest or seat to slowly sit down and avoid plopping down to avoid injury. During ambulation, have the client push walker forward no more than arm's length. I would have them place the involved leg forward (keep this leg off the ground if no weight bearing is allowed) and transfer weight onto hands. The client should swing through with uninvolved legs and continue this pattern. The client should take multiple controlled steps to complete a turn. For safety, a client should not sit down until their legs touch the back of their seat. Always use a gait belt when teaching your client to use these devices.