Assistive Devices and their Fit
Often when I think of assistive devices, I think of my late grandmother. She was a wonderful but stubborn woman who nearing the end of her life, would have benefitted greatly from a walker or even a cane to be more mobile and steady on her feet. Her major issue was balance and stability. But the thought of using any long-term AE was, I think, a reason for her to feel embarrassed. I think clients will often feel like this when offered or fitted for assistive equipment. It is important to keep them in mind and how they may feel when exploring options and fitting for AE.
When fitting a client for assistive equipment, it is important to do it properly for comfort. Clients are about to have a change in their life whether they look at it positively or negatively. Regardless of their attitude towards their assistive device, comfort is very important to ease the transition. A client will not want to continue use if they find their device cumbersome or uncomfortable or even painful. Assistive equipment should make an occupation more doable, or possible for a client. If it is not fitted properly to a client, they will not be able to accomplish their daily activities efficiently and safely. Safety is crucial when a person has issues with mobility and it is the therapist's job to not only educate the client but also prepare the client in the best way possible to be safely mobile with properly fitted assistive equipment.
When fitting these assistive devices, it is important that the client is stabilized and kept safe. Safety is highly important and the therapist and the client should not be put at risk in the process.
For a cane, while stabilizing your client, allow for them to stand with their shoulders relaxed and arms at their sides. The hand grip should be level with the wrist crease, ulnar styloid, and the greater trochanter. Their elbow should be relaxed at a 20 to 30 degree angle. It is important that their shoulders be relaxed because their scapulae should not be elevated.
For crutches, they should be about the length of the client's forearm to the tips of the fingers on the opposite hand. The hand grip should be at the level of the wrist crease, ulnar styloid, and the greater trochanter while the arms are resting. The elbow should be relaxed at a 20 to 30 degree angle. Shoulders should also be relaxed and not elevated when fitting. For axillary crutches the axillary rest should be about 5 cm from the armpit. Much is the same for Loftstrand crutches, but for these the cuff of the crutches should be at the proximal forearm.
A rolling walker is necessary for clients who cannot lift a regular walker due to upper extremity weakness. It is important to state that a rolling walker is not a rollater, which is all-wheeled, but only has front wheels. The hand grip should be at the level of the ulnar styloid, wrist crease, and greater trochanter. The elbow should be flexed at 20 to 30 degrees and the shoulders should be relaxed.
A platform walker is best suited for clients who will use this walker long-term because of its utility of being able to stand while doing tasks that would otherwise require them to sit if using a different walker. The platform surface should be positioned for an elbow flexed at 90 degrees. The client should be standing with relaxed shoulders in order to have relaxed scapulae. The platform should be about 1 to 2 inches from the proximal ulna in order to avoid nerve compression. The handle of the platform surface should also be positioned so that it is slightly medially rotated in order to allow for a sustainable long-term grip.
When fitting a client for assistive equipment, it is important to do it properly for comfort. Clients are about to have a change in their life whether they look at it positively or negatively. Regardless of their attitude towards their assistive device, comfort is very important to ease the transition. A client will not want to continue use if they find their device cumbersome or uncomfortable or even painful. Assistive equipment should make an occupation more doable, or possible for a client. If it is not fitted properly to a client, they will not be able to accomplish their daily activities efficiently and safely. Safety is crucial when a person has issues with mobility and it is the therapist's job to not only educate the client but also prepare the client in the best way possible to be safely mobile with properly fitted assistive equipment.
When fitting these assistive devices, it is important that the client is stabilized and kept safe. Safety is highly important and the therapist and the client should not be put at risk in the process.
For a cane, while stabilizing your client, allow for them to stand with their shoulders relaxed and arms at their sides. The hand grip should be level with the wrist crease, ulnar styloid, and the greater trochanter. Their elbow should be relaxed at a 20 to 30 degree angle. It is important that their shoulders be relaxed because their scapulae should not be elevated.
For crutches, they should be about the length of the client's forearm to the tips of the fingers on the opposite hand. The hand grip should be at the level of the wrist crease, ulnar styloid, and the greater trochanter while the arms are resting. The elbow should be relaxed at a 20 to 30 degree angle. Shoulders should also be relaxed and not elevated when fitting. For axillary crutches the axillary rest should be about 5 cm from the armpit. Much is the same for Loftstrand crutches, but for these the cuff of the crutches should be at the proximal forearm.
A rolling walker is necessary for clients who cannot lift a regular walker due to upper extremity weakness. It is important to state that a rolling walker is not a rollater, which is all-wheeled, but only has front wheels. The hand grip should be at the level of the ulnar styloid, wrist crease, and greater trochanter. The elbow should be flexed at 20 to 30 degrees and the shoulders should be relaxed.
A platform walker is best suited for clients who will use this walker long-term because of its utility of being able to stand while doing tasks that would otherwise require them to sit if using a different walker. The platform surface should be positioned for an elbow flexed at 90 degrees. The client should be standing with relaxed shoulders in order to have relaxed scapulae. The platform should be about 1 to 2 inches from the proximal ulna in order to avoid nerve compression. The handle of the platform surface should also be positioned so that it is slightly medially rotated in order to allow for a sustainable long-term grip.
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