Locomotion & Adaptive Devices
There are various reasons for the use of assistive devices for ambulation with patients, but correctly "fitting" your patient for these devices is of upmost importance. It is important to fit your patient appropriately because it can decrease their risk of further injury by falling. Many patients who use assistive devices have decreased balance, strength, and stability. By appropriately fitting our patient to their assistive device, we can decrease their risk of falling and injuring themselves while increasing their ability to ambulate. By appropriately fitting our patient to their assistive device, we can help to reduce pain. If an assistive device is ill-fitting, the patient will be uncomfortable, and could increase their pain and cause further damage. There are numerous assistive devices that can be fitted to a patient, and I will further explain how to accomplish this.
For a cane, the patient should stand and look straight ahead with their arms and shoulders relaxed at their side. You should then place the hand grip at the level of their wrist crease, ulnar styloid, or greater trochanter. To adjust the height, release the locking mechanism and push the button to move the cane base to the correct height. You should then secure the locking mechanism. When holding the cane, the elbow should be slightly flexed at 20-30 degrees.
For axillary crutches, you should estimate the appropriate length of the crutches based on the patient's height. The patient should stand and look straight ahead with shoulders and arms relaxed. The handgrips should be in line with the wrist crease, ulnar styloid, or greater trochanter when the patient's hand are resting at their side. The elbow should be relaxed and flexed at 20-30 degrees. The axillary rest should be ~5cm below the floor of the axilla or 2-3 finger widths.
For loftstrad crutches, the patient should stand and look straight ahead with shoulder and arms relaxed, follow the above axillary crutch instructions for finding the appropriate handgrip length. The arm band for the loftstrad crutches should be positioned 2/3 of the way up the forearm.
For a rolling walker, estimate the appropriate height of the walker based on patients height when they are standing with their arms and shoulders relaxed and looking straight ahead. The handgrips should be in line with the wrist crease, ulnar styloid, or greater trochanter when hands are resting at side. The elbow should be slightly flexed at 20-30 degrees.
For a platform walker, the platform surface should be positioned to allow weightbearing through the forearm when the elbow is bent at 90 degrees and the patient is standing with the scapula relaxed. To prevent nerve compression, the proximal ulna should be positioned 1-2 inches off the platform surface. The handgrip of the platform should be positioned slightly medially to allow for a comfortable grip when the forearm is resting on the platform.
For a cane, the patient should stand and look straight ahead with their arms and shoulders relaxed at their side. You should then place the hand grip at the level of their wrist crease, ulnar styloid, or greater trochanter. To adjust the height, release the locking mechanism and push the button to move the cane base to the correct height. You should then secure the locking mechanism. When holding the cane, the elbow should be slightly flexed at 20-30 degrees.
For axillary crutches, you should estimate the appropriate length of the crutches based on the patient's height. The patient should stand and look straight ahead with shoulders and arms relaxed. The handgrips should be in line with the wrist crease, ulnar styloid, or greater trochanter when the patient's hand are resting at their side. The elbow should be relaxed and flexed at 20-30 degrees. The axillary rest should be ~5cm below the floor of the axilla or 2-3 finger widths.
For loftstrad crutches, the patient should stand and look straight ahead with shoulder and arms relaxed, follow the above axillary crutch instructions for finding the appropriate handgrip length. The arm band for the loftstrad crutches should be positioned 2/3 of the way up the forearm.
For a rolling walker, estimate the appropriate height of the walker based on patients height when they are standing with their arms and shoulders relaxed and looking straight ahead. The handgrips should be in line with the wrist crease, ulnar styloid, or greater trochanter when hands are resting at side. The elbow should be slightly flexed at 20-30 degrees.
For a platform walker, the platform surface should be positioned to allow weightbearing through the forearm when the elbow is bent at 90 degrees and the patient is standing with the scapula relaxed. To prevent nerve compression, the proximal ulna should be positioned 1-2 inches off the platform surface. The handgrip of the platform should be positioned slightly medially to allow for a comfortable grip when the forearm is resting on the platform.
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