Assistive Devices - Biomechanics #6

   There a many reasons why it is important to appropriately fit a client for the use of an assistive device. There are multiple factors in determining the right assistive device for a client. These factors include the client's environment, physical condition, age, psychological condition, safety, and endurance. It's important to account for all of these considerations when determining the right fit for the client. The physical condition plays a big role in choosing an assistive device. Considering if the client can bear weight or if they have the strength to support themselves on the device is very important. The environment also plays a critical role in choosing an assistive device because some spaces may be too small for a certain device or it could cause a safety hazard. Safety is a crucial factor when choosing the right device for a client. 

   To fit a client with a cane, it should be determined if the client needs a quad cane or a standard cane. Canes can be fit for a client who would like the most freedom of movement and who would need to increase the base of support for better balance. For a standard cane, the client should stand up facing forward and relax their arms at their side. The hand grips should be in line with the ulnar styloid, wrist crease, or greater trochanter. If the client is being fitted for a quad cane, the wider legs should be pointed away from the client. 

   Crutches are fit differently than a cane. Crutches are ideal for clients who need to restrict weight bearing. To fit axillary crutches, there should be 5 cm under the armpit with the arm relaxed. With Lofstrand crutches, the client’s forearm should be inside the cuff after standing and removed before sitting. The handgrip should also be facing forward. These are commonly used for clients who have long term disabilities. 

   There are also different kinds of walkers that a client can be fitted for such as a platform walker and a rolling walker. To be fitted for a platform walker the individual must be unable to bear weight through the wrist or hand. The elbow should be flexed at 90º, the client is relaxing their scapula, and the platform surface should bear weight through the forearm. The ulna should be 1-2 in. from the platform surface and the handle should be comfortable to the client and slightly medial so that the arm is resting on the platform. A client should be fitted for a rolling walker if they have upper extremity weakness and cannot lift a walker or if they have impaired balance. These walkers are the most stable.