Locomotion & Adaptive Devices

Occupational therapists provide their clients with adaptive equipment and assistive devices to allow them to be more functional and independent. It is extremely important that these devices are fitted appropriately for many different reasons. First, you need to make sure the clients are fitted appropriately to prevent pain and injury. For example, if your client has a walker, you need to make sure its positioned correctly to prevent them from bending over, which could cause lower back pain. If the client’s crutches are not fitted appropriately, pressure can be placed on the axillary artery and radial nerve, which will cause pain and injury to the upper extremity. Second, you need to make sure the device is fitted appropriately to ensure that the client is safe, stable, and can effectively use the device. Every client is different in their own unique way and what works for one person, won’t necessarily work for someone else.  You need to make sure the device is appropriate and most effective for each specific clients use. . When it comes to safety, you may realize that the client doesn’t have enough functional mobility or balance to use a specific device. If they are not stable, the device is not safe and will not be effective for the client to use and you should consider other options.

When fitting a client for a cane, you need to decide if a standard cane or quad cane is appropriate. A standard care allows for the most freedom but is the least stable device. A quad cane provides more stability, because it has a wide base of support. When the client is standing straight up, the handle should be in line with the wrist crease, ulnar styloid, or greater trochanter. Adjust the cane in order to make sure it is at the appropriate level. When holding the cane, the client’s elbow should be slightly flexed at approximately 20-30°. When using the quad cane, the wider legs should be pointing away from the client.

There are three different types of crutches that can be used, an axillary crutch, lofstrand crutch, and a platform crutch. For an axillary crutch, the crutch length should be approximately the same length as the distance from the client’s forearm to the finger tips to the opposite hand. Adjust the crutch based on the client’s height. The client should stand straight up, with their arms to the side. The arm pad should be 1 to 1.5 inches or 2 to 3 fingers widths under the axilla. Just like the cane, the handgrips should be in line with the wrist crease, ulnar styloid, or greater trochanter. Handgrips can be adjusted by unscrewing the wing nut and removing the bolt. For the lofstrand  and platform crutch, the cuff should be placed around the client’s proximal forearm. The hand grip should be at an appropriate distance that allows it to be fully grasped. As I previously stated, these fittings are extremely important in order to prevent damage to the brachial plexus and allow the client to be stable.

There are many different styles of walkers that can be used. A rolling walker is used when a client cannot lift a walker due to weakness in the upper extremities. The height of the walker should be based off the client’s height when they are standing straight up. Adjust the walker to appropriately fit the client’s height by pushing and moving the legs. All legs should be adjusted to the same height. Just like the cane and crutch, the handgrips on the rolling walker should also be in line with the wrist crease, ulnar styloid, or greater trochanter. The clients elbow should be flexed at approximately 20-30°. As I previously stated, if the height of the walker is too high or too low, it could cause the client to hunch over which can potentially lead to back pain or a spinal injury.