Locomotion and Adaptive Devices

As life progresses or after a traumatic event, you or someone you know will need an assistive device. It is very important to make sure that you are properly fitted for your assistive device. Say you were playing basketball with some friends and you sprained your ankle. You go to the nurse, the ankle gets wrapped up and you leave with axillary crutches. This is just your standard crutch that goes under the armpit and has one surface toughing the floor. You want to make sure that it is not too close under your armpit because this will increase the amount of pressure there and possibly damage your brachial plexus. Then you really will have a much bigger problem than a sprained ankle. So preventing other possible injuries is one reason. Another reason would be to prevent fatigue, this device is supposed to assist, not make the client's life a little harder. Say for example grandpa is having leg pain. His therapist orders him a cane but doesn't measure everything correctly and the cane comes in a little too short. The therapist blows this off and says eh you'll be fine. Well as grandpa is using the cane he is hunched over to one side and not standing up tall with good posture. Over time grandpa's back is going to start to hurt and he is probably not going to want to walk much since it causes him pain. A few inches off could really make or break an assistive device. You want to carefully measure everything because again, these devices are to "assist" and make life a little easier/ mobile not cause other problems and make you become more sedentary. Life is too short to watch it blow by from sitting on the couch.

In the following sentences I will explain how to measure and fit a client for a cane, axillary crutches, Lofstrand crutches, platform walker and a rolling walker.

• A cane you want the hand grip to be at the level of the ulnar styloid process, wrist crease, or greater trochanter so that the elbow is flexed at a 20-30°. Also decide which type of cane the client wants. There is a standard cane and also a wide based quad cane (WBQC) with 4 prongs touching the floor. The 4 prongs increases the stability for clients with a decrease in balance. There is also a narrow based quad cane that is the same as the WBQC but the 4 prongs are just closer together.

• Axillary crutches are the normal standard crutch that goes under your armpit. You want the axillary rest (the top) to be about 5 centimeters (or about 4 finger widths) below the floor of the axilla (armpit) with shoulders relaxed, so that there is no increased pressure on the axilla.

• Lofstrand crutches are the type of crutches you would see used by someone with Cerebral Palsy (think of the son from Breaking Bad). There is an arm cuff that wraps around the proximal arm (about 2/3 up the forearm) and hand grips for the client to hold onto. You want the hand grips close for a resting neutral position.

• Platform walker is a standard walker with a platform to support a forearm. You want the walker hand grips to be level with the ulnar styloid process, wrist crease, or greater trochanter and the elbows flexed at 20-30° like for a cane.

• Rolling walker is a walker with 4 wheels and the hand grips have brake pulls to help with stopping. These are for clients that can't lift a walker so you can just push them. Normally they come with a basket and also a place to sit in case client becomes fatigued while walking. Keep in mind that this is the least stable assistive device.