Locomotion and Assistive Devices

Assistive devices are universal equipment that can be used by clients for various reasons including decreasing pain after a surgery, fracture, and/or amputation, increasing strength, balance, stability, and safety. Some assistive devices clients can use to help these reasons are canes, walkers, and crutches. These devices must be fitted properly to prevent injuries and provide stability. Each client has their own needs and their assistive devices must be fit correctly so the clients can have the best occupational performance and functional mobility.  

Crutches: Loftstrand & Axillary Crutches 

Axillary crutches are the typical type of crutches that are placed under the armpit or axilla. For fitting this device you want the crutches to be about the same height as the client and make sure the client is standing properly. The hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter. The pads of the axillary crutches should be about 4 finger widths (~5cm) under the axilla when the shoulders are relaxed. Loftstrand crutches have a cuff that fits around the upper 2/3 of the forearm. The handles should be set at the same level as the greater trochanter. 

When moving from a seated to standing position if the client is non-weight bearing, the involved leg should be extended in front of the client and off the ground. If the client is allowed to bear weight, keep both feet on the ground with toes under knees. The client will scoot to the edge of the seat and place both crutches on the involved side and hold the handgrips with one hand while the other hand will be placed on the armrest or seat surface. The client will then lean forward and push ip to stand using arms and uninvolved leg. Once the client is stable, they will move one crutch under arm of opposite side and place the other crutch on the involved side. 

When the client wants to sit down from standing, they will approach the seat, turn, and back up until the backs of their legs touch the seat. The client will place both crutches on the involved side holding the handgrips, then reach back with opposite hand for armrest or seat surface. It is important to make sure the client sits down slowly, NO plopping! 

You can use the same techniques for using the Loftstrand crutches, but the forearm should be placed into the cuff after standing and removed before sitting. 

When using the crutches, they should be placed with the tips in a tripod position and the weight should be shifted through the handgrips, not the axilla pads, and swing through. For Loftstrand crutches the pattern is the same as axillary crutches, but the handgrip should face forward during ambulation. 

When using these crutches it is important to not have the crutches too close or too far apart because that can lead to falls. There should be an equal weight distribution and equal distance of the crutches to prevent nerve damage to the axilla. It is important to also not have the cuffs too high on the forearm when using a Loftstrand crutch. 

Walker: Rolling & Platform 

When fitting for a walker, the client should stand and look straight ahead with their arms relaxed. This position ensures that we are using the correct position for measuring the height of the client for the walker to fit appropriately. The handgrips should be in line with the ulnar styloid, wrist crease, or greater trochanter when hands are resting at their sides. The elbow should be slightly flexed around 20-30 degrees. A client will use a Platform walker when they cannot bear weight through their wrist or hand. When fitting for a Platform walker, the platform surface should be positioned to allow weight-bearing through the forearm when the elbow is flexed to 90 degrees. The handgrip should be positioned so the client has a comfortable grip and is preventing nerve compression. To prevent nerve compression, the proximal ulna should be positioned one to two inches off the platform surface and have the handgrips positioned slightly medially when the forearm is resting. 

When moving from a seated to standing position, the client will place the walker in front of them and scoot to the edge of the seat. The client will place their hands on the armrest or seat surface while leaning  forward and pushing up to stand using their arms and uninvolved leg. Once the client is standing they will place their hands on the walker. Remember, if the client is non-weight bearing, the involved leg will be extended off the ground. If the client is able to bear weight, both feet will be on the ground with their toes under their knees. 

When moving from a standing to seated position, the client will approach the seat and back up until the back of their legs touch the seat. The client will reach back with their hands, one at a time, for the armrests or seat surface. The client will sit down slowly and not plop in the seat. If the client is non-weight bearing, the involved leg will be extended in front of them and off the ground. 

When using a Platform walker, clients can use the same technique for sitting to standing and vise versa, but there are some precautions to know. The client should not push up from the seat with the involved arm. Once the client is standing and stable they can place their forearm(s) on the platform(s). The client should remember to remove their forearm(s) from the platform(s) before sitting down. 

When your client is walking, make sure they push the walker forward no more than arm's length. When they push the walker forward the involved leg moves forward first followed by the swing of the uninvolved leg with equal weight distribution in their hands. If a client has to turn they will take multiple controlled steps. 

To ensure safety, it is important to not have the walker too close or too far when walking because it can lead to falls. It is also important to make sure the walker is at an appropriate height to prevent poor posture. When using Platform walkers, it is important to teach the clients that they cannot bear weight on their affected side to prevent further injuries. Typically clients use walkers due to upper extremity weakness, so it is important to ALWAYS use a gait belt when learning how to use a walker to prevent falls or instability with a client. 

Cane: Standard & Quad 

When fitting for a cane, the client should stand straight and look straight ahead with their shoulder and arms relaxed at their sides. The handle of the cane should be in line with the wrist crease, ulnar styloid, or greater trochanter. When the client is holding the cane, their elbow should be flexed approximately 20-30 degrees. When fitting for a quad cane, the wider legs have to point away from the client. 

When moving from a seated to standing position the client should scoot to the edge of the seat and have feet flat on the ground with their toes under their knees. The cane should be placed in the uninvolved side while holding the handle loosely. The client will reach back and place their hands on the armrest or seat surface. Once the client is in this position, they should lean forward and push up to stand using their arms and legs. 

When moving from a standing to seated position the client will back up to the seat until the backs of their legs touch the seat. While holding the cane handle loosely, reach back and hold armrest or seat surface. The client will sit down slowly and not plop into the seat.  Since the quad cane can balance on its own, there is no need for the client to hold it while standing up or sitting down. 

When the client is walking the client should advance the cane and the involved leg at the same time and then step through with the uninvolved leg. The uninvolved leg should step beyond the involved leg when swinging through. 

It is important to never have the cane on the involved side! The client should never lean on the cane because the cane could fall out from under them and cause further injuries. Like using a walker, it is important for a client to always wear a gait belt when learning how to use a walker! 

Reference: 

Giles, A.K. & Kraft, S. (2019). MOBI - Mobility Aids. Available from https://apps.apple.com/us/app/mobi-mobility-aids/id205309397