Locomotion and Adaptive Devices
There are a few reason's a patient may need to be fitted for an assistive device, and each patient should be individually assessed for their capabilities and ambulation goals so that they may be given the most appropriate device. Falls are a huge risk and preventing them should always be kept in mind for every patient, an ambulation aid is a great device to help with this. An aid may be required to help them improve balance, strength, and stability. By assisting with these skills, an aid is also improving the safety and security of the patient so that they may ambulate more confidently and with less risk of falls. If a patient has just had an injury or surgery they may require a fitting for an assistive device temporarily for these same reasons. The main goal of occupational therapy is always to increase the occupational performance of our clients and ambulation is an ADL directly related to many occupations. The proper assistive device will be the one that allows them to be the safest, most independent, greatest mobility, and directly related to the client's goals.
A cane may be chosen because it is inexpensive, can fit in small spaces, allows for the most freedom to move about, allows for weight distribution, and will widen the base of support for the client. This device is the least stable of the devices so it should be used with clients who already have adequate balance and do not need much weight bearing support. For fitting, the hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter. The elbow will be relaxed and flexed to 20-30 degrees. Shoulders should also be relaxed.
The fitting for crutches follows the same as listed above for the cane, but should also have an axillary rest about 5cm below the floor of the axilla with shoulders relaxed. Loftstrand crutches have an arm-cuff that wrap around the proximal forearm for more stability than a cane. Loftstrand cutches are good for long-term use as they reduce strain on the arms, permit the use of the hands, and allow for more dynamic movement. Axillary crutches are situated in the axillary region and are lightweight and durable. Axillary crutches are even more stable/supportive that the loftstrand. Crutches increase the variability of gait patterns and speed, while also restricting weight-bearing. However, they are still not the most stable option and require a fair amount of trunk and arm strength.
Walkers are the most stable of all the options, with the largest base of support. However, they are difficult to navigate and alter the gait pattern. The fitting for a walker is the same as for the cane. The rolling walker is for patients that cannot lift a walker. A platform walker is appropriate for patients who do not have the trunk support for a front wheeled walker and cannot bear weight in the wrists or hands.
A cane may be chosen because it is inexpensive, can fit in small spaces, allows for the most freedom to move about, allows for weight distribution, and will widen the base of support for the client. This device is the least stable of the devices so it should be used with clients who already have adequate balance and do not need much weight bearing support. For fitting, the hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter. The elbow will be relaxed and flexed to 20-30 degrees. Shoulders should also be relaxed.
The fitting for crutches follows the same as listed above for the cane, but should also have an axillary rest about 5cm below the floor of the axilla with shoulders relaxed. Loftstrand crutches have an arm-cuff that wrap around the proximal forearm for more stability than a cane. Loftstrand cutches are good for long-term use as they reduce strain on the arms, permit the use of the hands, and allow for more dynamic movement. Axillary crutches are situated in the axillary region and are lightweight and durable. Axillary crutches are even more stable/supportive that the loftstrand. Crutches increase the variability of gait patterns and speed, while also restricting weight-bearing. However, they are still not the most stable option and require a fair amount of trunk and arm strength.
Walkers are the most stable of all the options, with the largest base of support. However, they are difficult to navigate and alter the gait pattern. The fitting for a walker is the same as for the cane. The rolling walker is for patients that cannot lift a walker. A platform walker is appropriate for patients who do not have the trunk support for a front wheeled walker and cannot bear weight in the wrists or hands.
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