Locomotion and Adaptive Equipment
It's important first to consider the individual's physical condition, age, endurance, and psychological condition in order to choose the most beneficial assistive device for a client & their needs. After assessing someone's mobility needs and environment they will be using it in, you can determine if they need to be fit for a cane, axillary crutches, loftstrand crutches, platform walker, or rolling walker. For safety reasons, it is important to customize the assistive device to the client's unique height and posture. Educating the clients and fitting them accurately will prevent injuries as well as increase efficiency of the assistive device. The whole purpose of an assistive device is to help the client move more efficiently despite their mobility limitations. Let's look at the specific mobility aids available and how to appropriately customize them for clients.
For someone who needs the least amount of stability support, they should be fit for a cane. To do this, the therapist should measure the height of a client's ulnar styloid process, wrist crease, or greater trochanter in a relaxed standing position, with the elbow in a relaxed, flexed 20 -30 degrees. This allows the client to maintain the most natural posture when using this assistive device.
For someone who needs a little more stability support, they should be fit for axillary crutches. The hand grip of the crutches should be measured in the same way you would measure that of a cane. Axillary crutches extend all the way to the armpit or axillary region, so the therapist should also measure the height from the ground to this region with the client in a relaxed standing position with an emphasis on relaxed shoulders. To prevent discomfort and potential brachial plexus injuries in the axillary region, the therapist should subtract about 5 cm from the height measured.
For someone who has a chronic disability, they should be fit for loftstrand crutches. This provides more stability support than a cane, but less than axillary crutches because they are shorter and don't extend all the way to the axillary region. To fit a client for these, the therapist should measure the client in the same way they would for a cane. This differs from a cane because there is an arm cuff that wraps around the promixal forearm to provide slightly more support.
Going down the hierarchy of stability support, if a client needs more support than a cane or crutches can provide, they should be fit for a walker. For those who cannot bear weight through their wrist or hand should consider a platform walker. Since these devices are individual to each client, the therapist should measure the height of the client in a relaxed standing position, with their shoulders relaxed and their elbow flexed to 90 degrees. The height of the elbow should be measured because a trough or platform will be attached to a standard walker at this height in order for the client to comfortably bear the weight of his body through his forearms.
Additionally, for those who do not have enough upper body strength to lift a walker should consider a rolling walker. This still provides the client with a substantial amount of stability support, but the ability to move forward more smoothly and easily. The therapist should measure the client in the same manner they would for a cane.
For someone who needs the least amount of stability support, they should be fit for a cane. To do this, the therapist should measure the height of a client's ulnar styloid process, wrist crease, or greater trochanter in a relaxed standing position, with the elbow in a relaxed, flexed 20 -30 degrees. This allows the client to maintain the most natural posture when using this assistive device.
For someone who needs a little more stability support, they should be fit for axillary crutches. The hand grip of the crutches should be measured in the same way you would measure that of a cane. Axillary crutches extend all the way to the armpit or axillary region, so the therapist should also measure the height from the ground to this region with the client in a relaxed standing position with an emphasis on relaxed shoulders. To prevent discomfort and potential brachial plexus injuries in the axillary region, the therapist should subtract about 5 cm from the height measured.
For someone who has a chronic disability, they should be fit for loftstrand crutches. This provides more stability support than a cane, but less than axillary crutches because they are shorter and don't extend all the way to the axillary region. To fit a client for these, the therapist should measure the client in the same way they would for a cane. This differs from a cane because there is an arm cuff that wraps around the promixal forearm to provide slightly more support.
Going down the hierarchy of stability support, if a client needs more support than a cane or crutches can provide, they should be fit for a walker. For those who cannot bear weight through their wrist or hand should consider a platform walker. Since these devices are individual to each client, the therapist should measure the height of the client in a relaxed standing position, with their shoulders relaxed and their elbow flexed to 90 degrees. The height of the elbow should be measured because a trough or platform will be attached to a standard walker at this height in order for the client to comfortably bear the weight of his body through his forearms.
Additionally, for those who do not have enough upper body strength to lift a walker should consider a rolling walker. This still provides the client with a substantial amount of stability support, but the ability to move forward more smoothly and easily. The therapist should measure the client in the same manner they would for a cane.
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