Assistive Devices and Locomotion

    When your client needs assistive devices it is important to fit your client appropriately to ensure safety and proper use of the device. Devices are not usually a universal fit to everyone, so it is important to fit the equipment to your client's height and size to ensure safety. If it is not ft properly it will decrease the stability of the assistive device. It is also important to fit your client appropriately so that the device is at its maximum potential for function and performance. You don't want your client's device to not work properly because it is not fitted to your client correctly. 

    There are two types of canes a client could use: straight cane and quad canes. For both canes, you want to adjust the hand grips to be at the level of the ulnar styloid process, wrist crease, or greater trochanter. When making this adjustment, you want to make sure your clients elbows are relaxed, flexed at 20-30 degrees with shoulder relaxed and not elevated. The handle should be pointing backwards with both types of canes. With a quad cane, the wider legs need to be on the outside to ensure the client does not trip over them. When walking with a cane, the client should hold the cane in the arm of the non-affected side. When walking, the cane should come forward when the affected side takes a step forward. This is so the client can use the can for stability. When transferring from sitting to standing the client should not hold on the cane. The client should push off from the surface they are sitting on with both hands and then grab on to the cane once they are fully standing. When transferring from standing to sitting, the client should never hold on the cane. The client should have their legs backed up to the surface they are trying to sit on and bring their hands behind them to help brace themselves to sit down slowly. 

    When fitting a client for axillary crutches, the handle placement should be at the level of the ulnar styloid process, wrist crease, or greater trochanter. When making this adjustment, you want to make sure your client's elbows are relaxed, flexed at 20-30 degrees with shoulder relaxed and not elevated. The axillary rests should be about 4 fingers below the armpit (~5 cm) with shoulders relaxed. When ambulating with axillary crutches, the client wants to position the crutches at a slight angle for the hips to be able to pass through. The client should not lean on to the crutches, instead they should stand up straight. If the client is non-weight bearing, they should not put any weight on the affected leg. To ambulate the client would move the bottom tips of the crutches about a step forward and then place the weight through your hands as you hop forward on the weight bearing leg. Make sure the client gains good balance before repeating this process. When transferring from standing to sitting, the client should back the legs up to the surface, set the crutches to the side, and reach back with both hands to help you slowly sit down. When transferring from sitting to standing, the client should push off the surface with both hands and then grab their crutches. The client should refrain from pulling their self up by holding on to the crutches to ensure safety. 

    To fit your client with Lofstrand crutches, the hand grips should be at the level of the ulnar styloid process, wrist crease, or greater trochanter. When making this adjustment, you want to make sure your clients elbows are relaxed, flexed at 20-30 degrees with shoulder relaxed and not elevated. The armcuffs should be placed about 2/3rds of the way up the forearm. The hand grips should always be pointing forward. The same as when using axillary crutches when ambulating, the client should not lean on to the crutches, instead they should stand up straight. If the client is non-weight bearing, they should not put any weight on the affected leg. To ambulate the client would move the bottom tips of the crutches about a step forward and then place the weight through your hands as you hop forward on the weight bearing leg. Make sure the client gains good balance before repeating this process. When transferring from sitting to standing, the client should push off the surface with both hands and then grab their crutches. The client should refrain from pulling their self up by holding on to the crutches to ensure safety. When transferring from standing to sitting, the client should back the legs up to the surface, set the crutches to the side, and reach back with both hands to help you slowly sit down.

    To fit your client to a rolling walker, the client should be standing up straight inside the walker. The hand grips should be at the level of the ulnar styloid process, wrist crease, or greater trochanter. When making this adjustment, you want to make sure your clients elbows are relaxed, flexed at 20-30 degrees with shoulder relaxed and not elevated. Walkers can also have platforms put on them if the client needs some more stability.When fitting your client with platforms on their walker, make sure the platforms are placed on the inside of the walker so they can get through doorways. When a walker has platforms on it, the platforms should be fitted by having the client flex their elbow to 90 degrees and the platforms should be raised to meet their forearms. The client should be standing up straight when making this measurement. It is important that the client is not leaning on the walker at any time. When ambulating with both of these types of walkers, the client should not be leaning forward on to the walker or be pushing the walker forward with their hips. The client should be standing up straight within the walker and walking normally. The client does not need to pick up the walker if using a rolling walker. The client should push the walker with both hands and do not push the walker too far in front of them. To go from standing to sitting when using a walker is similar to the other devices. The client should back up to the surface they are trying to sit on and have the back of their legs touching the surface, reach back to help guide themselves down. To transfer from sitting to standing, the client should get to the edge of the chair, lean forward, and use their hands to push off the seat. The client should never hold on to the walker or put their weight on to the walker when trying to sit down or stand up. 

Key considerations to ensure safety when using an assistive device:

- Be aware of the surface you are walking on. Take smaller steps if necessary, keep assistive device close to body, and pick up feet when walking (don't shuffle feet). Be aware of rugs, cords, and other objects that may be on the ground.

- The use of a gait belt may be needed if working with new devices to ensure safety. The therapist or caregiver would be able to have a hand on the client when using the device to help catch them if they were to fall. 

- The caregiver or therapist needs to be aware of the client's ability and disabilities to be able to give them the appropriate device to use. 

- The caregiver/therapist must provide safety for the client through proper guarding and instructions when activities include the use of the assistive device. 

References:

mmLearn.org. (n.d.). Aging with ease: Understanding assistive devices. Aging with Ease: Understanding Assistive Devices. https://training.mmlearn.org/caregiver-training-videos/understanding-assisted-devices

YouTube. (2015, January 27). How to adjust a platform Walker (tips from physical therapy). YouTube. https://www.youtube.com/watch?app=desktop&v=aWwNWjwTcrE