Locomotion and Adaptive Devices
As future occupational therapists, we will have to fit our client for assistive devices very frequently. Being a client-centered practice does not only include the interventions that we use to treat our clients, but also in the assistive devices that we provide our clients with. Just as all of our clients come to us with their own unique abilities ad disabilities, assistive devices come in all shapes and sizes. In order to provide our clients with the utmost safety and comfort, we need to provide them with an assistive device that is best suited for their unique needs. Safety and comfort is essential for someone to be able to participate in the activities that are most meaningful and purposeful to them. If a client feels unsafe and/or uncomfortable with their assistive device, then that will put them at risk for even greater injury and ultimately hinder their ability to participate in their ADLs.
Assistive devices can include canes, axillary crutches, lofstrand crutches, platform walkers, and rolling walkers. Appropriately fitting these devices to our clients is essential. When deciding which assistive device to provide, an OT should be sure to assess the client's physical condition, including their disability, weight-bearing status, strength, ROM, and balance. In addition to checking the physical capabilities of the client, the OT should also assess the client's confidence in using an assistive device, their fear, and their cognitive status. This is extremely important because we do not want to provide a client with an assistive device that they are too afraid to use. If a client is not confident in their ability to use their assistive device, they might choose to not use it at all and risk the possibility of further injury.
A cane is the least stable of all of the assistive devices. Because of this instability, the client should have enough strength, balance, and weight-bearing capacity to use a cane safely. To fit a cane to a client, the hand grip should be positioned in line with the ulnar styloid, wrist crease, or greater trochanter. When fitting, the client's elbow should be relaxed, flexed 20-30°, and the shoulders should be relaxed.
The same method should be used to fit axillary crutches. In addition to fitting the hand grips, the axillary rest also needs to be adjusted to the client. The axillary rest should be 5 cm below the floor of the client's armpit, with their shoulders relaxed. Axillary rests that are too high or too low can cause significant pain and discomfort for the client.
Lofstrand crutches provide more stability than a cane, but less stability than axillary crutches. These crutches are commonly provided to clients who possess long-term disabilities. Fitting these crutches requires the same steps of fitting a cane, with the addition of ensuring that the arm cuff is positioned 2/3 of the way up the forearm.
Platform walkers are used for clients who can't bear weight through their wrists or hands. With this type of walker, the client's forearms and hands are neutral and supported by a trough/platform. The same method of fitting that was used for the cane will also be used here, with the addition of ensuring the proper height for the platform attachments. To do this, the client's forearms need to be flexed at 90° and in neutral position.
Finally, there is the rolling walker. This walker is for clients who do not have enough strength to lift a standard walker. While this walker is easier to move, it does not provide much stability as a result of its mobility. In addition to fitting the client to the walker (the same method that you would use to fit a cane), the OT would want to make sure that the client possesses the necessary balance and stability to keep this walker under control.
Assistive devices can include canes, axillary crutches, lofstrand crutches, platform walkers, and rolling walkers. Appropriately fitting these devices to our clients is essential. When deciding which assistive device to provide, an OT should be sure to assess the client's physical condition, including their disability, weight-bearing status, strength, ROM, and balance. In addition to checking the physical capabilities of the client, the OT should also assess the client's confidence in using an assistive device, their fear, and their cognitive status. This is extremely important because we do not want to provide a client with an assistive device that they are too afraid to use. If a client is not confident in their ability to use their assistive device, they might choose to not use it at all and risk the possibility of further injury.
A cane is the least stable of all of the assistive devices. Because of this instability, the client should have enough strength, balance, and weight-bearing capacity to use a cane safely. To fit a cane to a client, the hand grip should be positioned in line with the ulnar styloid, wrist crease, or greater trochanter. When fitting, the client's elbow should be relaxed, flexed 20-30°, and the shoulders should be relaxed.
The same method should be used to fit axillary crutches. In addition to fitting the hand grips, the axillary rest also needs to be adjusted to the client. The axillary rest should be 5 cm below the floor of the client's armpit, with their shoulders relaxed. Axillary rests that are too high or too low can cause significant pain and discomfort for the client.
Lofstrand crutches provide more stability than a cane, but less stability than axillary crutches. These crutches are commonly provided to clients who possess long-term disabilities. Fitting these crutches requires the same steps of fitting a cane, with the addition of ensuring that the arm cuff is positioned 2/3 of the way up the forearm.
Platform walkers are used for clients who can't bear weight through their wrists or hands. With this type of walker, the client's forearms and hands are neutral and supported by a trough/platform. The same method of fitting that was used for the cane will also be used here, with the addition of ensuring the proper height for the platform attachments. To do this, the client's forearms need to be flexed at 90° and in neutral position.
Finally, there is the rolling walker. This walker is for clients who do not have enough strength to lift a standard walker. While this walker is easier to move, it does not provide much stability as a result of its mobility. In addition to fitting the client to the walker (the same method that you would use to fit a cane), the OT would want to make sure that the client possesses the necessary balance and stability to keep this walker under control.
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