Fitting Assistive Devices
Appropriately fitting a client for an assistive device is an important task for occupational therapists, as it allows clients to have increased strength and stability as they engage in activities of daily living, as well as an increase in safety and stability. This fitting should take into account factors that range from the physical conditions of a client to their psychological conditions. Important components to consider could be the weight bearing status of the client, their strength, balance, endurance, and degree of confidence or fear.
One of the first steps to ensuring that a cane is fitted correctly to a client is to ensure that the device will be used on the opposite side of the affected extremity. For the use of the cane, the elbow should be relaxed, while flexed between 20-30 degrees. The shoulder should also be relaxed, while not elevated. The hand grip of the cane should be placed at the wrist crease, or at the site of the ulnar styloid process. A wide-base cane would be fitted to someone who needs a wider base of support, giving the client more balance and stability for engagement in activities. Axillary crutches, or standard crutches, should be fitted under the same protocol as a cane, with the addition of the axillary rest being approximately 5 centimeters below the floor of the axilla.
Lofstrand crutches differ from axillary crutches, as they have arm cuffs that wrap around the proximal forearm. Fitting should account for grip and upper extremity strength. This type of assistive device is intended for people with long term disabilities, and although it provides more stability than a cane, it also provides less stability than axillary crutches.
With a platform walker, forearms and hands are in a neutral and supported position, which does require clients to have upper extremity strength for use. Grip strength, length of forearm and elbow flexion are factors to take into account before fitting a patient with the device. It is also important to know what type of equipment can be used together, as most platforms do attach to crutches and walkers. A rolling walker is typically fitted to a client who easily fatigues, or who does not have a great deal of strength in the upper extremities. This could be a device fitted to someone who does not have the upper extremity strength to lift a walker or someone with impaired balance.
No matter the selection of assistive devices, it is important to account for all relevant factors, and understand what type of performance and activities the client cares to engage in.
One of the first steps to ensuring that a cane is fitted correctly to a client is to ensure that the device will be used on the opposite side of the affected extremity. For the use of the cane, the elbow should be relaxed, while flexed between 20-30 degrees. The shoulder should also be relaxed, while not elevated. The hand grip of the cane should be placed at the wrist crease, or at the site of the ulnar styloid process. A wide-base cane would be fitted to someone who needs a wider base of support, giving the client more balance and stability for engagement in activities. Axillary crutches, or standard crutches, should be fitted under the same protocol as a cane, with the addition of the axillary rest being approximately 5 centimeters below the floor of the axilla.
Lofstrand crutches differ from axillary crutches, as they have arm cuffs that wrap around the proximal forearm. Fitting should account for grip and upper extremity strength. This type of assistive device is intended for people with long term disabilities, and although it provides more stability than a cane, it also provides less stability than axillary crutches.
With a platform walker, forearms and hands are in a neutral and supported position, which does require clients to have upper extremity strength for use. Grip strength, length of forearm and elbow flexion are factors to take into account before fitting a patient with the device. It is also important to know what type of equipment can be used together, as most platforms do attach to crutches and walkers. A rolling walker is typically fitted to a client who easily fatigues, or who does not have a great deal of strength in the upper extremities. This could be a device fitted to someone who does not have the upper extremity strength to lift a walker or someone with impaired balance.
No matter the selection of assistive devices, it is important to account for all relevant factors, and understand what type of performance and activities the client cares to engage in.
:-)
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