Assistive Devices

Assistive devices make an enormous impact in establishing or maintaining independence for people with a permanent or temporary disability. In order to properly assist our clients with their devices, we must make sure they are fitted to our client. Properly fitting a client ensures the client has proper body mechanics and posture when using a device like a cane or wheelchair. Properly fitting also decreases compensatory movements that can strain the body over time. Properly fitting a device also decreases the risk of injury or fall. Safety while using a device is top priority.

Another consideration is fitting a client to a device that is most appropriate to meet their needs. These needs include personal and environmental. A client may benefit from a power wheelchair over a standard. Considering their diagnosis, choose their assistive device based on their condition for the next five years, not just their abilities at the present moment. Insurance will only pay for a wheelchair once every five years so as a clinician, it is our responsibility to advocate for the most beneficial device.

When fitting a client to a cane, axillary crutches, Lofstrand crutches, platform walker, or a rolling walker, certain body landmarks are to be used for reliability and comfort. 

For a cane, the handle should be in line with the wrist crease, ulnar styloid or greater trochanter. The cane's height is easily adjustable and can be secured by tightening the locking mechanism. The cane should be held with the elbow slightly flexed. Quad cane's wider legs should be pointing away from the body to avoid a tripping hazard.

Axillary crutches should rest 5 cm below to axilla to avoid compressing nerves in the brachial plexus. The hand grips should be in line with the wrist crease, ulnar styloid and greater trochanter. Lofstrand crutches arm band should be positioned 2/3 of the way up the forearm.

For walkers, the hand grip should be in line with he wrist crease, ulnar styloid and greater trochanter. For a platform walker, the platform surface should be positioned to allow weight bearing through the forearm. The ulna should be 1-2 inches from the platform surface. The handle should be positioned towards the midline for comfort.