Locomotion & Adaptive Devices

     Our clients will put their trust in us as OT's to do what is best for them in order to help reach their goals. So, when adaptive devices are needed, it is imperative to make sure that we know how to properly fit them for many reasons. First, each client will have unique body mechanics and measurements and the adaptive device needs to be specific to them to ensure safety at all times. Second, correct measurements will not allow additional pain or injury to prevent conditions such as pressure ulcers. Knowing the client's limitations and capabilities including their physical conditions, age, endurance and psychological condition will allow us to make the safest and most appropriate adaptive device decision.
     If the client is stable on their own but needs occasional assistance with balance, a cane would be appropriate because it provides the least stability of all the ambulation assistive devices. Different variations of canes include standard, with one leg, and wide or narrow base quad canes which provide four prongs for increased balance compared to just the one on a standard cane. To properly fit a client for a cane, the hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter. The client's elbow should be relaxed, flexed 20-30 degrees and shoulders should be relaxed and not elevated in order to grip the cane easily and most comfortably.
     Another device that a client could need to provide more stability than a cane are crutches. One of the types of crutches are Axillary crutches and, to properly fit the client, all of the same criteria of the cane are used with addition to the axillary rest being 5 cm below the floor of the axilla when the shoulders are relaxed. This is important to note because contact with the axilla area can result in increased pressure and potential damage to the Brachial Plexus. Another type of crutches are the Loftstrand crutches. These are used for clients that have long term disabilities and need more support than a cane provides, but less support than the previously mentioned axillary crutches. These crutches require the correct fit of the cuff around the proximal forearm along with the correct hand grip fit, which is the same qualifications of the cane and axially crutches.
     As the client's need for stability increases and canes and crutches are no longer provide enough, walkers are the best option. The same criteria is used when fitting walkers as it is used for canes. Walkers provide three or four contacts with the ground and vary in amount of stability based on the different types. One type of a walker is the platform walker which is used for a client that is unable to bear weight though wrist or hand because of a fracture or other injury. It is important to correctly fit where the trough or platform supports the forearm to ensure comfort and no further damage or injury to the forearm. Another type of walker that can be used is the rolling walker. Rolling walkers are the same as standard walkers however, they add wheels.The addition of wheels is ideal for a client who is lacking the UE strength to lift a standard walker but still needs multiple contact points for support.