If the Assistive Device Fits

When fitting a client for assistive devices, it is important that the equipment allows the client to have the most stability and functionality needed depending on their physical condition (ROM, balance/coordination, strength, etc) to be able to carry out ADL's as independent as possible in the safest manner. For example, if a client does not have very much strength in their upper extremities, then a standard walker would not be the best option, because there is lifting needed to be done to maneuver the walker. However, in this case the best option would be a rolling walker because there are wheels and the arms do not have to lift the device. Something else to consider when fitting assistive devices, is the cognitive status of the client. If the client does not understand how to use the device, then this will be difficult for the client to use the device confidently and without problems. Also, if the client does not comprehend how to use the device, like locking the brakes when needed or keeping the device close to the body when in motion, then there can be an increased risk of a fall or something happening that is not in the best interest of the client.

As for actually fitting these devices, for a cane and walker, the hand grip should be placed at the bony landmarks of the ulnar styloid, wrist crease, and greater trochanter. In addition, the elbow should be relaxed and flexed 20-30 degrees, as well as the shoulders not elevated, but relaxed. Furthermore, for a cane, depending on the physical and psychological status of the patient, this will determine if a wide based quad cane or a narrow based quad cane will need to be used. As for a rolling walker, a client with impaired balance or upper extremity weakness, this would be best suited for them. For a platform walker, these are used if the person cannot weight bear through the wrist and hand. The platform needs to support the forearm and that it is in neutral. Fitting for crutches, the bony landmarks are the same as the walker and cane. In addition, the armpit region rest should be about 5 centimeters below the floor of the armpit (axilla) with the shoulders relaxed. In more detail, for Lofstrand crutches the cuffs are wrapped around the proximal arm and are for people with long term disabilities and who are not as stable for use of axillary crutches. Axillary crutches are situated in the client's axillary region and less stable than other types of crutches.

As you can see, it is important that these devices are appropriately fitted to the client and that it meets the needs of the client, so if the assistive device fits, there is likely a higher chance of there being a happily ever after!

Proper Posture and Body Mechanics

Having the proper posture and body mechanics can help prevent and protect the body from resulting in pain and injury. Also, it can help to efficiently and effectively carry out functional tasks in daily activities without having problems. Some things to take into consideration with having good posture and body mechanics is having a good base of support which contributes to stability and balance and allows the body to stay in equilibrium. In addition, if a client has poor posture it can cause tightening and loosening in muscles and cause the spine to become kyphotic or lordotic. Educating a client who has faulty posture and body mechanics can help with restoring or help with injury or pain from reoccurring or happening in the first place. Simply by letting them know the correct way to sit, stand, bend/lift, reach, turning, pushing/pulling and even modifications that could be done.

An intervention example I would use for my client in order for them to have the right body mechanics and posture, is to work on trunk and core exercises to strengthen these areas. Having a strong and stable trunk and core can take a lot of stress and load off the body. Another intervention I would teach is to make sure when the client is performing tasks, especially when repeating a motion, that they are not overworking or fatigued when doing an activity, as this increases the risk of pain and injury. Furthermore, this would include taking rest breaks when needed and not doing an activity that is strenuous to the body.

"Man from the South"

If the soldier were to lose the bet, an occupation that could be impacted is his ability to get dressed and put his uniform and shoes on everyday for duty. This occupation would be greatly affected because the pinky deals a lot with grip, function, power, and opposability, so upper and lower body dressing would be more difficult to perform. Getting dressed requires having to grasp the clothing to put on bilaterally. Also, if there are buttons, zippers, or shoelaces then pinching and gripping could be hard to do. A strategy that I would recommend to help with putting his shirt on in particularly, is for the man to sit down and have the shirt in his lap with the collar facing away from him, then he would thread his bad hand first through the sleeve using his good hand to help and bring it up to his shoulder. Next, he would thread his good hand through the other sleeve and pull it up to his shoulder, then take the opening for the head with his good hand and pull it over his head. If it were a jacket he was wearing, then the same steps would occur except for bringing the head opening over the head, the back of the jacket would go around to the other side and thread that way. In addition, if the jacket had buttons, then the soldier could put an elastic band and loop it through the where the button hole is and then around the button to bring it together. The strategy and modification described would help the soldier be more independent in this specific ADL.