Occupational Therapy and Assistive Devices

Assistive devices help clients with decreased balance, strength, and stability. Properly fitting assistive devices to each client is important for proper body mechanics and for safety and stability. Proper body mechanics is important so the client does not further enjoy himself/herself. For example, if a client is using a walker, the handles should be fitted properly so that the client does not hutch over or walk with elevated shoulders. Improper body mechanics can cause compensation and pain in areas that was not originally present. Assistive devices provide safety and security when fitted properly. If they are not fitted properly, the client may become less stable, weight bear when not allowed, or injure other body parts that was not originally present. For example, if a client is using axillary crutches and the handles are too high, the armpit area, which includes the brachial plexus, may become compressed. The brachial plexus contains many vital nerves, so if those nerves become compressed, new problems may arise.

When fitting clients for assistive devices, it is important to take into account the client's physical condition, age, endurance, and psychological condition. Physical conditions include the diagnosis, weight bearing status, strength, range of motion, and balance/coordination. Psychological conditions include individual degree of confidence, degree of fear/apprehension, and cognitive status.

One of the most stable assistive devices is the walker. A rolling walker, or front wheeled walker, allows for a somewhat normal gait pattern, but takes a decent amount of balance and stability. Unlike a standard walker, the client does not need to continually pick up the walker, but he/she must be stable enough to control the walker. To fit a client to a front wheeled walker, the handgrips should be in line with the wrist crease, ulnar styloid process, or the greater trochanter when the hands are resting at the side. The client's elbows should be slightly flexed 20-30 degrees. Shoulders should be relaxed and not elevated.

A platform walker can be used with clients who cannot bear weight through their wrists or hands. It can also be beneficial for clients who have a weak trunk and cannot support themselves with a front wheeled walker. To fit a platform walker, the platform surface surface should be positioned to allow weightbearing through the forearm when the elbow is flexed 90 degrees. The patient should stand tall with the scapula relaxed. The proximal ulna should be 1-2 inches off the platform surface to avoid nerve compression.

Crutches are less stable than walkers, but allows for increased variability of gait patterns and speed. Crutches require relatively good trunk and arm strength. The axillary crutch length should be approximately the same length as the distance from the patient's forearm to the finger tips of the opposite hand when the arms are open wide. To fit axillary crutches, the arm pad should be ~5 cm below the floor of the axilla with the shoulders relaxed. The hand grips should be in line with the wrist crease, ulnar styloid process, or the greater trochanter when the hands are resting at the side. Elbow should be flexed 20-30 degrees.

Lofstrand crutches have an arm cuff that wraps around the proximal arm. They allow more dynamic movement and control in small spaces. They allow the client to use their hands without dropping the crutch. Lofstrand crutches are more appropriate for long-term use since they reduce strain on the arms. However, they require more stability than axillary crutches. To fit lofstrand crutches, the arm band should be positioned 2/3 of the way up the forearm.

Canes are the least stable assistive devices. They allow the most environment freedom. Canes widen the base of support for increased balance when compared to not using any assistive devices. However, canes cannot resist weight bearing like walkers and crutches. To fit a cane, the handle should be in line with the wrist crease, ulnar styloid process, or the greater trochanter when the hands are relaxed. When holding the cane, the elbow should be flexed 20-30 degrees. Canes should be placed in the opposite hand of the injury. For example, if the client had a right total knee arthroplasty, the client should hold the cane in the left hand.