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!