Let's Talk About Assistive Devices!
As the name suggests, they are devices in which can aid those with a disability to help perform a task(s) that may be difficult otherwise. When we talk about assistive devices, that can include many different things! Some various examples that helps clients perform locomotion include: canes, axillary crutches, lofstrand crutches, platform walkers, and rolling walkers. These different devices are perscibed based off of the individuals physical and psychological state, age, and endurance. It is very crucial that we make sure the device of choice fits our clients properly to help the client and hurt them. For example, if the walker chosen for the client is below the recommended height, they will spend a lot of time in a slouched back position to reach the hand rest. This example of poor posture can cause the client other painful issues simply brought on by bad body mechanics- and years of that bad positioning could lead to irreversible damage! Not only could this hurt our client's physical abilities but we must think about how it effects their psychological state. Having these assistive devices to successfully participate in occupations should promote self efficacy in individuals, but if they are not comfortable because their device was not fitted correctly it could negatively impact their self belief.
Now that we have defined assistive devices and know why fitting for our client is a necessity, let's take a deeper look into how to fit individuals for the assistive devices listed above.
Height
When fitting canes, axillary crutches, lofstrand crutches, platform walkers, and rolling walkers, we want the hand grip to be at the same level of the individuals ulnar styloid, greater trochanter, or wrist crease. This landmark is important because it allows the shoulder and the elbow to remain relaxed, avoiding any unnecessary extension/flexion at these joints. For axillary crutches the axillary pad, which is under the clients arm, should be roughly 5cm below the floor of the axilla, to prevent damage to the area in which is a major nerve area (the brachial plexus).
Lofstrand Crutches
This type of crutch is commonly used for those with long term disabilities who may need extra upper extremity support. Fitting for this type of crutch it is important to keep in mind the arm cuff wraps around the proximal forearm, about 2/3 of the way up, with the handle facing forward in the direction the individual will be walking.
Platform Walker
The platform is an attachment used for individuals who cannot bear weight through their wrist or hand. The forearm rests on the platform allowing the client to produce about 90 degrees of elbow flexion. The fitting should be appropraite to produce good posture with the shoulders relaxed by the side. The handles are also facing forward for this type of walker.
Rolling Walker
Rolling walkers are great for individuals who do not have the strength to lift a standard walker, therefore they are allowed to push instead. As noted above in the height section, three specific landmarks are recognized to avoid poor postural flexion, overly flexed elbows, or overly extended shoulders.
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