Locomotion and Adaptive Devices

Assistive devices can be necessary for many reasons so it is important that a therapist look at all contributing factors from a holistic approach with the client so they can come up with a plan together.  Assistive devices help a person perform their daily activities and occupations so they must be suited to match a person’s client factors and performance skills. The therapist must know the client’s limitations and capabilities in order to choose and fit a device correctly.  It is important to fit a device to a client’s environment for safety.  It is also important to fit it to ensure comfort and provide stability.  

To fit a cane to a client I would start with having the client stand straight up with arms relaxed looking forward.  I would measure the handle to be in line with the wrist crease, ulnar styloid, or greater trochanter.  Then I would have the client hold the cane on the uninvolved side and adjust it until the client’s elbow was relaxed and slightly flexed to about 20-30°.  The shoulders should not be elevated.

To fit axillary crutches, I would start by measuring the length of the crutch relative to the distance from the client’s forearm to the finger-tips of the opposite hand.  Then I would have the client stand straight up with arms relaxed and measure it to the height of the client.  We would then look at the axillary rests while standing and adjust them until they are about 5 cm under the axilla with shoulders relaxed.  I would measure the handgrips to be in line with the wrist crease, ulnar styloid, or greater trochanter. The elbows should be relaxed and slightly flexed to 20-30° with shoulders relaxed and not elevated.

Fitting Lofstrand crutches are slightly different because they have an arm band around the forearm and a hand grip that should face forward during ambulation.  They reduce strain on the arm and are more fitting for long-term use.  The arm band should be located 2/3 of the way up the forearm.  The hand grip should be in line with the wrist crease, ulnar styloid, or greater trochanter.  The elbows should be relaxed and slightly flexed to 20-30° with shoulders relaxed and not elevated.

A platform walker is used for clients who cannot bear weight through wrists or hands.  It has a platform that supports the forearms.  When fitting the walker, the client should stand and look straight ahead and the height should be adjusted based off of the clients height.  The proximal ulna should be positioned 1 to 2 inches off of the platform surface.  The platform surface should also be positioned to allow weightbearing through the forearm when the elbow is bent to 90° with the scapula being relaxed. The handle of the platform walker should be set slightly medially for the forearm to rest comfortably.  

Finally, a rolling walker should also be adjusted based on the clients height while he or she stands straight up with arms relaxed. The hand grips should be in line with the wrist crease, ulnar styloid, or greater trochanter.  The elbows should be relaxed and slightly flexed to 20-30° with shoulders relaxed and not elevated.