When deciding what assistive device is best for each client, there are many factors that need to be considered in order to have the best "fit." It is important to consider the physical condition of the client, including their disability, weight bearing status, strength, and balance. For example, if the client is not allowed to put any weight through one leg, you would not want to suggest they receive a cane. Additionally, it is important to fit the assistive device to your client to ensure safety and proper body mechanics. If the client's crutches are too short and not adjusted to match their landmarks we use to fit, then they will likely have poor body mechanics. If these factors are not considered, it can be detrimental to your client and cause an increase in risk for falls or further injury.
To properly fit a cane or rolling walker to your client, the hand grip should be at the level of their greater trochanter to allow their elbow to be flexed 20-30 degrees. Also, we need educate the client to use the cane in the hand opposite of the involved leg. The same landmark of the greater trochanter applies when fitting the hand grips for axillary crutches. The axillary rest should be 5 centimeters below the floor of the axilla to not cause harm to all the vital structures that are in that area. For Lofstrand crutches, the hand grip location is the same as the previous, with the grips facing forward. The arm cuff should be approximately two-thirds up the forearm. For clients who need a platform walker to weightbear through their forearm, the platform should allow the elbow to be bent to 90 degrees when the client is standing. The platform handle should be places slightly medially to allow for comfort. Additionally, the ulna should be positioned 1-2 inches off the platform to avoid nerve compression.
Nice and succinct!
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