Appropriately Fitting Assistive Devices

There are many reasons why an assistive device should be individually adjusted to each client that an occupational therapist sees. One reason to appropriately fit clients for their assistive devices is to prevent injury from the use of the devices. For instance, if someone’s crutches are too tall for them, this could place significant pressure on their axilla – which could damage, or compress, nerves and blood vessels. Another reason why fitting assistive devices is so important is to provide the client with the appropriate amount of stability and mobility considering their given condition and prescribed assistive device.

To appropriately fit a client for a cane the therapist should adjust the height to the client’s greater trochanter with them standing with shoes on(or ulnar styloid process, or wrist with the elbow flexed around 20 degrees and to the side). The therapist should also ensure that the client is using the cane on the uninvolved side. In addition to this, they should ensure that the cane’s wider feet (if more than one – like a quad cane) are angled out away from the client’s center.

For axillary crutches therapists need to adjust the height and the hand grips in the appropriate place. For the height of the crutches, the arm pads of the crutches should be approximately five centimeters below the client’s axilla. Once that is done, the therapist should adjust the crutches’ handgrips to the height of the client’s greater trochanter with their shoes on and standing (or the ulnar styloid process, or wrist crease with the elbow bent at 20 degrees and arms to the side).

Lofstrand crutches, or forearm crutches, should be adjusted so that the height of the grip is at the same place for axillary crutches hand grip placement – which is to the height of the client’s greater trochanter with shoes on and standing (or their ulnar styloid process, or wrist crease with the elbow bent at 20 degrees and arms to the side). The arm band of the Lofstrand crutches should be placed two-thirds up the forearm of the client. The therapist should also ensure that the client has the grips of the crutches facing forward when in use.

To appropriately fit a client for platform walker the therapist should  first adjust the height of the walker’s hand grips, especially if only one platform is attached. For this, the therapist should fit the walker so that the hand grips are at the same height as the client’s greater trochanter with shoes on and standing (or their ulnar styloid process, or wrist crease with the elbow bent at 20 degrees and arms to the side). To appropriately fit the handle of the platform, the therapist should have it positioned to allow weight-bearing through the forearm(s) when the client’s elbow is flexed at 90 degrees, is standing tall and has their shoulders relaxed. The therapist should adjust if needed and/or inform the client that their proximal ulna, or forearm, should be one to two inches off of the platform surface to avoid nerve compression. Finally, the handle of the platform should be adjusted slightly medially in order to allow the client to have a comfortable grip.

For a rolling walker the height of the walker should be positioned so that the handgrips are at the client’s greater trochanter with shoes on standing straight ahead with their arms relaxed (or their ulnar styloid process, or wrist crease with the elbow bent at 20 degrees and arms to the side). The therapist should ensure that the adjustment buttons are clicked back into place for the rolling walker and all of the other assistive device adjustments listed above.

Following these steps and considering other factors – like a client’s strength, balance, motor coordination and endurance should ensure that they are getting the most appropriate assistive device and that it’s fitted correctly to them.