Assistive Devices

    It is important to properly fit clients with assistive devices so it does not inflict more harm. If crutches are too tall, it could cause skin irritation, injury to axilla artery, and soreness. Another importance of properly fitting devices is to ensure the client feels comfortable and supported. If the client does not feel confident or comfortable, they are more likely to lose their balance and fall. 

When determining what type of device will be used, the therapist needs to assess the client’s physical conditions, endurance, age, and psychological conditions. Standard walkers require the person to have a fair balance and upper extremity strength to lift the device, but rolling walkers can be used in this instance if a client has weaker upper extremities. Platform attachments can be put on walkers, and these can help clients that are unable to bear weight through wrists or hands. These platforms support the forearm and can be attached to walkers or crutches. The side-steppers allow for clients with an impairment to one side of the upper extremities to use it with one hand. The next step from a walker is a cane. Canes are less stable, and can be changed to a wide or narrow base depending on how much support is needed. The Loftstrand crutches provide more support than a cane but less than axillary crutches.

 

When fitting a client with a cane or rolling walker, we want to ensure the client’s shoulders are relaxed with no elevation. The elbows are in a relaxing position but flexed at 20º to 30º. The hand grips should be at the level of the ulnar styloid, wrist crease, or greater trochanter. When discussing a platform walker, the clients shoulders should be relaxed and the elbows are normally flexed at a 90º angle. This allows the client to be weight bearing through their arms and forearms.

 

In order to fit crutches to a client, the shoulders should be relaxed and not elevated. The axillary rest should be 5 centimeters below the axilla. This will prevent injury to the artery while using crutches for an extended period of time. With Loftstrand crutches, arm cuffs wrap around the proximal arm and under the joint of the elbow. Again, we want to ensure that the shoulders are relaxed. The elbows will be slightly flexed, and the hand grips will need to be around the wrist creases. 

Any of these devices can give a client the confidence they need to get back to their daily activities. It may not be normal to everyone else, but we are not all meant to be the same. These assistive devices can change a client's life. I am forever grateful for choosing this occupation and learning so much from my education. I cannot wait for the opportunity to help a client get back to doing what they love most.  

@blushing.ginger