Proper Fitting of Assistive Devices

Assistive devices have been around for decades and though new models and versions continue to come out in the health field, the general set up for ADs is relatively the same.  As a therapist who will more than likely be working with clients who will need assistive devices, it is necessary to understand the importance of properly fitting the device to a client.  Though the set up time is short, proper fitting of the device to the client will ensure better results in the healing process down the road.  One of the reasons to appropriately fit a person to an assistive device is compression.  Let's say, for example, a client needs axillary crutches and needs to be fitted for them.  If the crutches are not properly seated underneath the axilla (armpit), it can cause compression in many of the structures in that area (blood vessels, nerves, etc.).  Another reason to proper fit a client to an AD is due prevention of additional injuries.  An example of this is if a client needs platform attachments to crutches to keep weight off of an injured wrist, the platform must be fitted properly so as not to cause compression of the nerves in the elbow.  If not fitted properly, nerve damage can happen, thus prolonging the client's recovery.  So let's look at how to properly, and appropriately, fit a few ADs to clients.

Canes are relatively easy to adjust, as long as they have proper mechanics to do so (wooden canes often to do have the right tools to adjust appropriately).  To adjust a cane to a client, make sure said client is standing and looking straight ahead with arms relaxed at their sides.  The handle of the cane should always be in line with either the wrist crease, ulnar styloid process, or the greater trochanter of the hip.  The height can be adjusted via the locking mechanism and button on the side of the cane.  Once the cane has been properly fixed, when the client is gripping the handle while standing, their elbow should be slightly flexed about 20-30'.

Axillary crutches are very common place and seen pretty much everywhere.  To properly fit this AD to a client, first make sure the crutches are the same length as the distance from client's forearm to the fingertips of their opposite hand.  From there, have the client stand up straight with arms relaxed at their sides.  The arm pad of the crutches should be around 1" to 1.5" under the armpit (or 2 to 3 finger width).  By doing this, the arm pad is not pressed up into the arm, which keep pressure off of the structures underneath the skin.  The hand grips of the crutches should be in line with either the wrist creases, ulnar styloids, or the greater trochanters.  The hand grips can be adjust via the wing nut and bolt on each crutch.  For Lofstrand crutches, the same type of fitting goes for the hand grips, while the arm bands should be positioned roughly 2/3 of the way up the client's forearms.

Walkers have also been around for decades and there are many different versions out there, all with their own unique fitting properties.  For a platform walker, make sure where the platforms attach to the standard walker (or where the hand grips usually are) are level with the greater trochanters of the hip.  The platform surface should be positioned to allow weightbearing through the client's forearms when the elbow is bent at 90'.  The client's elbow should also be positioned roughly 1 to 2" off the platform's surface, and the handles of the platforms should be positioned more medially to allow for a more comfortable grip for the client.  For a rolling walker, have the client stand up straight with their arms relaxed at their sides.  Position the height of the walker to where the hand grips are in line with either the client's wrist creases, ulnar styloids, or greater trochanters.  If properly adjusted, the client's elbows should be slightly flexed to 20-30'. 

Proper Posture and Body Mechanics

Having and maintaining both proper posture and good body mechanics are essential for completing every day activities that ask for some form of increased stress on the body.  If a client has faulty posture and poor body mechanics, there are a number of reasons why fixing both are important.  The first one is linked to posture and that having poor posture can lead to back problems, like injury or pain.  The second one is also linked to posture, and that having poor posture, like having your neck in a forward position, can increase the weight of the head on the cervical vertebrae, thus increasing the stress on certain structures, like the posterior longitudinal ligament and joint capsules.  The third reason is linked to body mechanics, and that poor positioning of the body during the act of lifting heavy objects can increase the strain on the vertebral column, possibly resulting in injury.  Increased flexion of the spine due to poor body mechanics can lead to spinal issues, like bulging, or even herniated, discs. 

In the intervention process with the client, one of the activities I would have them do is focus on core strength during sitting, so as not to develop or continue having a hunched-back while doing repetitive tasks, like typing or writing at a desk.  The other activity I would do is teach them how to properly lift a heavier object from the floor, making sure to tell, and show, them to bend on the hips and knees while keeping the back straight, as well as have the object closer to them and keeping the abdominal muscles firm and tight during the lifting process.