The Perfect Fit - Choosing the Best Adaptive Device

When helping a client select an adaptive device, it is important to find the best “fit” for them in order to promote comfort and function. Comfort is achieved by ordering adaptive devices, such as crutches or canes, that are measured to accurately suit the client. If axillary crutches are too tall, the patient could experience uncomfortable scapular elevation and pressure beneath the axilla. If a cane is too short, the client will have to hunch over with poor posture to grip its handle. Discomfort would discourage the use of each of these improperly fitted devices, ultimately defeating the purpose of the mobility aid. Another important reason to correctly match clients with their adaptive device is to promote functional mobility and activity. If a client is paired with a standard walker, but they do not have the upper extremity strength necessary for lifting the device, then functional mobility is not possible. We also would not want to limit the mobility of a client by fitting them for a highly stable device, when they have the capacity to maneuver a wheeled device, crutches, or canes. In any case, the purpose of OT is to promote function through the performance of activity, and an adaptive device should be a tool that the client can utilize to actively “move” toward their goals!

There are steps an OT can take to appropriately fit various adaptive devices like canes, axillary crutches, Lofstrand crutches, platform walkers, and rolling walkers. To fit a cane, we must first consider the stability of the client, as a cane trades stability for greater freedom. We must ask ourselves if the client will benefit most from a standard one leg cane, a narrow based Quad Cane, or a Wide Based quad cane. When the client is standing with shoulders relaxed and elbows naturally flexed to 20-30°, the hand grip of the cane should be at the level of the ulnar styloid, wrist crease, or greater trochanter. The same is true for the hand grip of axillary and Lofstrand crutches. However, we must also consider the axillary rest of axillary crutches, which should be approximately 5 cm below the floor of the axilla when the shoulders are relaxed. For Lofstrand crutches, the arm band should be positioned 2/3 of the way up the forearm. When choosing between axillary or Lofstrand crutches, we should consider if the patient’s disability is acute or chronic. Lofstrand crutches are better suited for people with long-term mobility challenges because they reduce the strain on the arms. However, more trunk stability is necessary for this option. When choosing between a standard and rolling walker, we must consider the balance and upper extremity strength of the client. Both of these factors are needed for maneuvering a standard walker, so the rolling walker is the best option for clients with UE weakness. Rolling walkers can be very unstable and require good trunk control, so this must also be considered.  The handgrips of each walker should be fitted in the same manner as with a cane and crutches. During the measurement, the client should be standing, looking straight ahead, with arms relaxed. For a platform walker, the platform surface should be positioned to allow weight-bearing through the forearm when the elbow is bent to 90°, and the patient should be standing up tall with the scapula relaxed. To avoid nerve compression, the proximal ulna should be positioned 1-2 inches off the platform surface posteriorly. The handle should be positioned slightly medially to allow for a comfortable grip when the forearm is resting on the platform. This device is a good fit for clients who cannot bear weight through the wrists and hands or who do not have the trunk control needed for using a wheeled walker.