Locomotion & Assistive Devices

     Assistive devices are wonderful tools that allow people to move who would otherwise not be able to. Reasons for needing an assistive device could be recovering from a procedure, lacking muscle tone, and more. Ensuring the device properly fits the client is of most importance. A device that does not properly fit a client will cause discomfort and may lead to further injury. 

    When sizing a client for a cane, the client should stand tall, look straight ahead, and have their arms relaxed at either side. To adjust the height of the cane, push the button to release the lock. Make sure the lock clicks once the desired height is reached. To determine the proper height, the handle of the cane should align with the client's wrist crease, styloid process of the ulna, or the greater trochanter of the femur. All three points of contact should be about the same height. It is also important to note that the cane should be fitted for the side of the body in which it will be used. If an injury or weakness occurs on the left side of the body, the cane should be fitted for the right and vice versa. If the client is using a quad cane, the longer two legs should be pointing away from the client to avoid tripping. 

    Just as it is important to properly fit your client for a device, it is equally important to teach them how to use it. When a client is moving from sit to stand using a cane, they should begin by scooting toward the edge of their sitting surface. Their cane should be held in their side. While coming to stand, the client should avoid bearing weight on their cane. Once they are standing and stable, they can apply force using the cane. While using a cane, the client should move both the cane and affected limb simultaneously. Next, the client should step through with their unaffected limb, and their stride should exceed the affected limb. Lastly, when the client returns to sitting, they should not bear weight on the cane. The client should approach the sitting surface until the backs of their knees touch the surface. Then, they should find the surface by reaching back with their arms and slowly lower themselves. 

    Crutches are another device commonly used to aid in ambulation. determining the proper size of axillary crutches is similar to the process of sizing for a cane. The client should stand tall and look straight ahead. Both arms should be relaxed at their sides. The top of the axillary pad should be 1-1.5 inches under the armpit. You can estimate by using 2-3 fingers width. The handgrips should align with the client's wrist crease/ greater trochanter. The height of the crutches can be adjusted using a button-lock mechanism. The handgrips can be adjusted by unscrewing the wing nuts. For Loftstrand crutches, the arm band should be placed in the proximal 2/3 of the forearm. The handle should align with the greater trochanter. 

    When teaching a client to stand with crutches, it is important for them to begin by scooting to the edge of their seat. Holding the handgrips, both crutches should be held by the client's affected side. The other hand should support their body by placing it on the sitting surface. Next, the client should lean forward and push up using their unaffected limbs. Once they are standing and stable, the client can adjust the crutches under their arms. to return to sitting, the client should get close enough to the surface so that their knees touch the edge of the surface. The client should slowly lower their body by bearing weight on the unaffected limbs. These considerations for axillary crutches can be applied to forearm crutches as well. However, it is important to note that the forearm cuffs should be placed around the arm after standing and should be removed before sitting. The handgrips should always face forward during ambulation. During ambulation, it is important to apply most of the weight over the handgrips. Bearing weight through the armpits will lead to major discomfort. 

    Sizing a client for a walker begins the same as sizing for other devices. The client should stand tall, face forward, and keep their arms relaxed at their sides. The legs of the walker can be adjusted using the button-lock mechanism. Make sure all legs are the same height. Uneven legs can lead to fall and/or injury. The handgrips of the walker should align with the client's wrist crease, ulna styloid, or greater trochanter. If fitting for a platform walker, the forearms surfaces should be measured while the elbows are flexed to 90 degrees, and the scapulae are relaxed. To avoid nerve compression, the forearms should not fit tight against the platforms. Lastly, the handgrips should be positioned slightly medially to provide a long-term, comfortable grip. 

    When informing a client on how to use their walker, it is important to address proper technique. Under no circumstances should a client use their walker to bear weight while coming to sit or stand. While going to sit, the client should be close enough to the surface so that the backs of their knees touch the surface. their hands should find the surface, and the client should lower themselves slowly. Plopping onto the surface can lead to loss of balance and injury. The client should also use their upper limbs when coming to a stand. The client can grab onto the walker only after they are standing and balanced. While the client is moving with their walker, it is important that they keep an appropriate distance from the handles. They should stand no farther than an arm's length away. Standing too close or too far from the walker can lead to tripping and poor posture. 

    In conclusion, clients should always be properly fitted and properly informed for using their devices. If these steps are not completely appropriately, the devices can cause more harm than good. 

Weisser-Pike, O. (2023, June). Lecture 12: Gait & Locomotion. OT 430 Biomechanics, University of Tennessee Health Science Center

Giles, A.K. & Kraft, S. (2019). MOBI- Mobility Aids. Available from https://apps.apple.com/us/app/mobi-mobility-aids/id1205309397