Locomotion and Adaptive Devices

In the therapeutic world, some clients may need "assistive devices" to aid them in occupational participation and performance. Some of these devices may include canes, walkers, and crutches. It is incredibly important to correctly fit your client to his or her assistive device. One reason is because inaccurate fitting can cause the device to be completely ineffective; another reason is that inaccurate fitting can actually strain another muscle or ligament, thus creating an additional injury. When it comes to canes, the client's elbow should be relaxed and flexed 20-30°, and the cane's hand grip should be at the client's ulnar styloid, wrist crease, or greater trochanter. Therefore, the height of the cane must be adjusted to fit the client's height. Whether the cane is wide based or narrow based depends on the client's balance. For axillary crutches, the axillary rest of the crutch should be around five centimeters below the client's axilla with his or her shoulders relaxed. The handgrips should be in line with the client's wrist crease, ulnar styloid, or greater trochanter when the client's hands are resting at his or her side. With loftstrand crutches, the arm cuff or arm band must wrap around the proximal forearm, about 2/3 of the way up the forearm. Moving on, with platform walkers, the platform surface should be positioned to allow weight bearing through the client's forearm when the elbow is bent to 90° and the client is standing tall with the scapula relaxed. In order to avoid nerve compression, the proximal ulna should be positioned one to two inches off the platform surface. In addition, the handle of the platform should be positioned slightly medially to allow for a more comfortable grip when the client's forearm is resting on the platform. Finally, with a rolling walker, the handgrips should be in line with the client's wrist crease, ulnar styloid, or greater trochanter when his or her hands are resting at his or her side. Again, like the cane, the client's elbows should be flexed approximately 20-30°. If the occupational therapy practitioner follows these guidelines in fitting his or her client, success with the assistive device is far more likely.