The Perfect Fit

    In the therapeutic world, assistive devices are often used to aid clients in their occupational performance and participation. So what are assistive devices? Canes, crutches and walkers are prime examples and they are made or adapted to assist a person in order to perform a specific task. These devices can be instrumental in helping a client regain independence. What is also instrumental is making sure that these devices are properly fitted to your client. An inaccurately fitted device can not only be ineffective, but it can actually strain a client's muscle or ligament and cause additional injuries. It can also cause instability and affect a client's gait which can cause more pain.   

    Some common assistive devices include canes, axillary crutches, Lofstrand crutches, platform walker, and rolling walker. I will now explain how to properly fit each device. 

- Canes: the client's elbow should be relaxed and flexed 20-30 degrees and the hand grip should be at he level of the greater trochanter, ulnar styloid process, or the wrist crease. The height of the cane is therefore adjusted to the client's height. You can also determine whether the client needs a wide based or narrow based cane depending on their balance and it is important to explain to the client that the cane should be used on the unaffected side.  

- Axillary crutches: the length can be determined by having the client stand tall and relax and placing the arm pad 5 centimeters beneath the axillary floor. The hand grips should be in line with the greater trochanter ulnar styloid process or wrist crease. 

- Lofstrand crutches: should be sized in the same way the axillary crutches are, with the arm cuff or arm band wrapped around the proximal forearm, about 2/3 of the way up the forearm.

- Platform walker: the platform surface should be positioned below the forearm with the elbow bent to 90 degrees while the client is standing tall with relaxed shoulders. The ulna should be 1-2 inches off the surface of the platform to avoid nerve compression. In addition, the handle of the platform should be positioned slightly medially to allow for a more comfortable grip when the client's forearm is resting on the platform.

- Rolling walker: the hand grips should be in line with the greater trochanter, ulnar styloid or wrist crease while the arms are resting at the client's side. Elbows should be flexed approximately 20-30 degrees when gripping the handgrips.