Fitting Assistive Devices

   Assistive devices are used for many reasons, and it is important to know your client’s limitations and capabilities when considering a good fit for them. Many factors must be considered when selecting an assistive device for your client. Some of these factors are age, physical condition (disability, weight-bearing status, upper and lower body strength, ROM and balance/ coordination), endurance and psychological condition (degree of confidence, fear or apprehension as well as cognitive status). Two main reasons for properly fitting an assistive device to your client is for stability and safety. When choosing an assistive device for your client, it is also important to not only focus on their present abilities, but to consider how they will progress in the following months.

   To appropriately fit a cane to your client, you need to adjust the hand grip to the level of the ulnar styloid, wrist crease or greater trochanter of the femur on the non-affected side of the body. When fitting your client to the height of their cane, it is important that their shoulders are relaxed and not elevated, as well as their elbow relaxed and flexed to 20-30 degrees. In order to use a cane, your client must have good stability and balance, as this is the least stable assistive device for walking.

   To fit axillary crutches, there are two areas that must be fitted to your client. First, like the cane, the hand grip should be fitted at the ulnar styloid, wrist crease or greater trochanter of the femur. The elbows should be relaxed and flexed to 20-30 degrees. In addition, the axillary rest at the top of the crutch should rest about 5 cm (or four finger length) below the floor of the axilla, or armpit. When fitting, the shoulders should remain relaxed and not elevated. Axillary rests that are too high can cause increased pressure on the axilla and could cause damage to the brachial plexus.

   Loftstrand crutches are crutches that are attached to the forearm and provide more stability/support than a cane, but less stability than axillary crutches. However, they are fitted similar to axillary crutches. The hand grip needs to be at the level of the ulnar styloid, wrist crease or greater trochanter of the femur. Elbows should be relaxed and slightly flexed 20-30 degrees, and shoulders should also be relaxed and not elevated. Loftstrand crutches have arm cuffs that wrap around the forearm about 1-2 inches below the elbow. These crutches are ideal for individuals with long-term disabilities.

   Platform attachments can be added to crutches or walkers and are a good choice for clients who are unable to bear weight through their wrist and/or hand. For fitting a platform walker, the forearms should be supported in a neutral position. The platforms are attached down the sides of the walker and can be placed on the inside or outside depending on comfort. It is imperative that the attachments are at the appropriate height so that the elbows are flexed to 90 degrees, weight is distributed properly and the client remains in an upright posture.

   As for rolling walkers, they are fitted the same as canes and standard walkers. Adjust the hand grip height to the level of the ulnar styloid, wrist crease or greater trochanter of the femur. Make sure the elbows are relaxed and flexed to 20-30 degrees, while the shoulders are also relaxed and not elevated. Rolling walkers are ideal for individuals who have UE weakness and are unable to lift a standard walker from the floor in order to walk.