Assistive devices

For clients who are new to a certain assistive device, it can be an overwhelming process to learn how to ambulate correctly. It is the job of the therapist to be able to fit the device properly to the patient so that ambulation isn’t any more difficult than it needs to be.Fitting the device properly will be necessary for maximal function depending on whether the client is using the device to decrease pain, increase balance, or support joint stability. If a walker, cane, or crutches is placed too low the client will experience excessive weight bearing on their upper extremities. If the opposite occurs and the device is placed too high, the client will put too much strain on the shoulder and experience discomfort. If the client must use a platform surface on a walker, they may be at risk for nerve compression near the elbow. It is important that the therapist verifies that the client positions ulna 1 to 2 inches off the platform surface.

For each type of assistive device, there are necessary guidelines to follow to ensure the client is able to have optimal function with the device. For a cane, the handle should be in line with the wrist crease or greater trochanter with a slight elbow flexion. The cane should be held in the hand of the unaffected side. It is also crucial to be sure that the wider legs are pointing away from the patient when using quadcanes so the client does not trip. For axillary crutches, the arm pad should be 1 to 1.5 inches under the axilla or 2 to 3 finger widths. The handgrips should be in line with the wrist crease. When using loftstrand crutches the arm band should be about 2/3 of the way up the forearm, with the handgrips facing forward. To determine the proper height of a platform walker, the handgrips should be positioned in line with the greater trochanter. The platform surface should be positioned so that the elbow is bent at a 90-degree angle. Be sure to avoid nerve compression by positioning the ulna 1 to 2 inches off the platform. Like the platform walker, the rolling walker will also have the hand grips placed at the greater trochanter.