Fittiing Assistive Devices

Appropriately fitting an individual for an assistive device requires careful attention, consideration, and knowing the needs and abilities of each person. It is important to ensure the most practical fit for individuals because a device is an extension of the person. Choosing an poor fit could lead to a lack of stability and increase the risk for fall or injury. It is also important to choose appropriate devices by considering a client's capabilities, environment, and roles. Based on the client's abilities, you want to offer the support needed without hindering the client from doing what they are capable of doing.

When fitting a person that is going to use a cane, it is important to begin with the client standing straight, looking ahead, with arms relaxed by their side. You should palpate the ulnar styloid, wrist crease, or greater trochanter to determine the placement of the hand grip. The elbow should be slightly flexed. It is important to explain to the client that the cane should be used on the unaffected side. A standard cane allows the most freedom to move and a quad cane has four points, providing more stability.

Axillary crutches are a better choice for an individual with restricted lower extremity weight bearing and the ability to bear weight through hands and wrists. The length can be determined be having the client stand tall and placing the arm pad 5 finger width beneath the axillary floor. Again, the hand grips should be in line with the ulnar styloid, greater trochanter or wrist crease.

Lofstrand crutches reduce the strain in the arms and allows the client to use hands without dropping crutches. The lofstrand or forearm crutches should be sized in the same way that I described axillary crutches to be fitted. In addition, the the arm band of the forearm crutches hsould be positions 2/3 of the way up the forearm.

A platform walker is device that is appropriate for those that cannot bear weight through hands or wrists. It is a good alternative for patients that do not have the trunk support to control a rolling walker. The platform surface should be positions below forearm when the patient is standing tall with the elbow bent to 90 degrees. The ulna should be 1-2 inches off of the surface of the platform. The hand grip should stand upright and be placed slightly medially.

A rolling walker allows for a normal gait pattern and could be an appropriate option for client's with low endurance. The client should stand tall looking ahead and the handgrips should be in line with the wrist crease, ulnar styloid, or greater trochanter while the arms are resting at the client's side. When gripping the hand grips, the client's elbows should be slightly flexed.