How to Properly Fit a Client for an Assistive Device
It is extremely important to properly fit a client for a device. Proper fit increases safety and security as wells as decreases strain on the body. If the equipment was not fit properly, the client may fall or be unable to properly use it. Strain is also decreased as equipment being at the proper height, allows for better mechanics of the body.
Cane
For a cane, the hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter. The elbow should be in a relaxed position where it is flexed 20-30 degrees. The therapist should also ensure that the shoulders are relaxed and not elevated.
For sit to stand, the client should scoot to the edge of the seat with their feet flat on the ground with toes under knees. The cane should be straight on the ground in the hand of the uninvolved side. The client should place their other hand on the armrest or seat. Then, the client should lean forward and push-up to stand using arms and legs.
For stand to sit, the client should approach the seat, turn, and back up until the back of their legs touch the seat. They then should reach back with hand not holding the cane. They should then slowly lower themselves using the cane with one hand, and armrest or seat with the other hand.
When walking with a cane, advance the cane and involved leg simultaneously. Step through with uninvolved leg beyond the involved leg.
Some safety consideration to consider would be to ensure the cane is placed on the correct side. This would be the side of the uninvolved leg. Another consideration would be to not place the cane too far in front of the body, this encourages leaning, which can lead to falling. A few other things to note is the position of the cane faces backwards, the long feet of the quad cane should be positioned away from the body, and the cane should be at the correct height. When using the stairs always use the handrail, lead with the involved leg going down the stairs, and lead with the uninvolved leg going up the stairs.
Axillary Crutches and Lofstrand Crutches
For a axillary crutches, the length should be about the same length as the distance from the patients forearm to the fingertips of the opposite hand. The hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter. The elbow should be in a relaxed position where it is flexed 20-30 degrees. The axillary rest should be about five centimeters or two to three finger widths below the floor of the axilla with shoulders relaxed.
For Lofstrand crutches, the proximal arm will be in an arm-cuff. The arm-cuff should be positioned two-thirds of the way up the forearm. The length should be about the same length as the distance from the patients forearm to the fingertips of the opposite hand.
To go from sitting to standing with axillary crutches the client first needs to extend the involved leg in front and off the ground. If the client is allowed to weight bear, then both feet should be on the ground with toes under knees. The client should scoot to the edge of the seat, place both crutches on involved side, and hold the handgrips. The other hand should be on the armrest or seat. The client should then lean forward, push up, and then place crutches under both arms. To go from standing to sitting, the client should approach the seat, turn, and then back up until their legs touch the seat. They then should place both crutches on the involved side and hold the hand grips. The client should then lean forward and reach back with opposite hand for the seat. If non-weight bearing, make sure the client is extending the involved leg off of the ground. Finally, the client can lower themselves slowly into the seat. For Lofstrand crutches, sit to stand and stand to sit will be the same as the axillary crutches except for one thing: the forearm should be placed into the cuff after standing and removed prior to sitting.
The crutch tips should be arranged in a tripod position with the uninvolved leg. The client should then place weight onto the handgrips, not the axilla, and swing forward. In order to walk the client should repeat this pattern of forming a tripod, placing weight on hands, and swinging through. During ambulation, the Lofstrand crutches will be mostly the same as the axillary crutches. However, the client should ensure the handgrip is facing forward when using. If the handgrip were to be backwards, this would cause an unnatural angle in the forearm, as the crutches are angled to allow for a bent elbow.
Some precautions to consider before using crutches are to not position the crutches too close together, too far apart, too far behind, or too far in front as it could cause the client to trip or slip. Another thing to consider when using axillary crutches is to avoid nerve compression by not positioning the crutch too close to the axilla. For Lofstrand crutches, the cuff does not need to be too high on the forearm. When using the stairs always use the handrail, lead with the involved leg going down the stairs, and lead with the uninvolved leg going up the stairs.
Platform Walker and Rolling Walker
For a walker, the client should stand within the walker and the therapist should adjust it to the correct height. The therapist should also ensure that the shoulders are relaxed and not elevated. For a platform walker, the elbow will be at ninety degrees to allow weight bearing through the forearm. The forearm will be supported in a trough or platform. This if used for individuals that are unable to bear weight through their wrist or hand. To avoid nerve compression, the ulna should be positioned one to two inches off the platform surface. The hand should be medial to allow for a comfortable grip. For a rolling walker, the elbow should be flexed to approximately twenty to thirty degrees. The handgrips should be in line with the wrist crease, ulnar styloid, or greater trochanter when hands are resting at their sides.
For sit to stand, the walker should be placed in front of the client. If non-weight bearing then the involved leg should be extended to keep it off of the ground. The client should then scoot to the edge of their seat, place hands on the armrest or seat surface, lean forward, and push up to standing. After standing, the client can then place their hands on their walker. To go from standing to sitting, the client will approach the seat and then turn, backing up until their legs hit the chair. If non-weight bearing, extend that leg. Reach back with hands, lean forward, and slowly lower yourself. For the platform walker the technique is the same, however, the client should not push up from the seat with a non-weight bearing arm. Once standing, place forearm(s) on the platform(s). Also when sitting, remove arms from platform before sitting down.
When walking, push the walker forward no more than arm's length. Place involved leg forward, unless non-weight bearing. Transfer weight onto hands while standing on involved leg. Then swing through uninvolved leg.
Some precautions that one should consider before using a walker are the walker being to high or to low, or the walker being too close or too far away. A rolling walker has two wheels in the front and is for people who cannot lift a walker due to upper extremity weakness. However, this makes the device less stable. Something to consider when using a platform walker is to make sure the client is not weight bearing on the involved hand as that could cause further injury.
