When fitting a client for an adaptive device, it is very important that you fit it to match their body mechanics, mobility, and ambulation. As an OT, we should always consider how the client will progress in the months to come, rather than just focusing on the present.
It is best to make sure the client has the proper measurements, so they are stable and safe while they go about their daily activities. As their OT, it is best to be aware of the client’s limitations and capabilities. The selection of the assistive device may be considered based on the clients age, physical condition (weight bearing status, balance, ROM, etc.), endurance level, and psychological condition (whether they are confident or apprehensive).
When fitting a cane, we want to make sure that it is the right choice for our client. We want to make sure the hand grip is at the level of the ulnar styloid around the wrist or the greater trochanter of the femur. The client’s elbow should be relaxed and flexed in 20-30 degrees. The shoulders should be relaxed and not lifted/elevated. In order to use a cane, the client needs to have good stability, because a cane is the least stable assistive device for walking. It is for those clients who just need minimal assistance for certain tasks. As an OT, we need to make sure to educate our client that the cane is used on the opposite side of the weak leg and that the cane moves with the weaker leg when walking in an upright posture.
When fitting for axillary crutches, we start off by measuring the same as we did for the cane. We want to make sure the hand grip is at the level of the ulnar styloid and the greater trochanter. The elbow should be relaxed and flexed at 20-30 degrees. Shoulders should be relaxed and not elevated. Additionally, the axially rest should be ~5 cm below the floor of the axilla with the shoulders relaxed.
As for Lofstrand crutches, they will be measured similar to the axillary crutches. The hand grip should be level with the ulnar styloid or greater trochanter. Elbows should be relaxed and flexed 20-30 degrees and shoulder should be relaxed and not elevated. In addition to, the Lofstrand crutches consist of an arm cuff that is about 1-2 inches below the elbow, that wraps around the proximal forearm. They are matched with clients who have long-term disabilities and need more support than a cane, but less than the standard axillary crutches. When educating about crutches, we want to make sure when the client steps, they are stepping where their forearms and the crutches are bearing the weight as they swing their body forward.
When fitting a platform walker, we want to start off measuring for the walker where the hand grip should be level with the ulnar styloid or greater trochanter. The elbows will be relaxed and flexed to about 20-30 degrees. Shoulders should be relaxed and not elevated. Now, the most important part is where the platform (trough) attaches on the walker so the forearms and hands are in neutral position and supported properly. The platform itself attaches down the side of the walker. It can be placed on the outside or the inside of the walker. Next, we need to make sure the client has their affected arm(s) bent at a 90-degree angle. At this point, the platform should be level with their forearm(s) and they should still be in an upright posture.This is used for individuals who are unable to bear weight through their wrist or hands.
Lastly, when measuring for a rolling walker, we still measure the same as we did for canes and standard walkers. We start off by making sure the hand grip is level with the ulnar styloid or greater trochanter. The elbows will be relaxed and flexed to about 20-30 degrees. Shoulders should be relaxed and not elevated. A rolling walker is for individuals who cannot lift a walker in order to walk. The 2 wheels are typically on the front 2 legs of the walker and helps you glide easier.
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