The Just Right Fit

It is very important that each client be fitted to their assistive devices. An assistive device can be something like a walker, cane, or even crutches. Each client will have different heights, cognition, endurance and stability levels which will determine the effectiveness of each assistive device. If the client does not have very good upper body strength or wrist restrictions  you do not want to fit them with a device that is going to require the majority of upper body strength and make them push weight through their wrist. Another factor that is important when finding the just right fit for assistive devices is the stability and endurance of the client. You want to allow that individual to feel safe at all times and also have a device that correctly matches their endurance levels. An individual that may have really good stability, but tires easily may need a rollator. An individual that has good endurance, but weak stability may need a standard or front wheeled walker. 

To fit a client to a rolling walker the hand grips should either be at the level of the ulnar styloid or wrist crease. The handgrips can also be placed at the same level as the greater trochanter. Make sure that the client also has relaxed shoulders and the elbows flexed about 20-30 degrees.  

For a platform walker the platform should be adjusted so that weightbearing is allow through the forearm when the elbow is flexed at 90 degrees with the scapula relaxed. the proximal surface of the ulna should be positioned 1-2 inches off of the platform to prevent compression of the nerves. The grip on the platform should be slight medial so  there is a comfortable grip when arm is supported on the platform. 

To fit a client for a cane you want to make sure the client is standing straight forward, making sure they are steady and not going to fall. Along with the walker the cane handle should also be at level with the wrist crease, ulnar styloid, or greater trochanter. The cane can be adjusted with the locking mechanism allowing the client to have 20-30 degrees of elbow flexion. If the client needs a quadcane the same rules apply, just remember that the wider legs face away from the patient. If the legs are not facing away you can adjust them. 

When fitting a client for axillary crutches the height should be based on the appropriate  height of the patient. The hand grips should be placed at the level of the greater trochanter, ulnar styloid, or the wrist crease. The axillary rest should be about 5cm below the floor of the axilla with the shoulders relaxed. This is about 2.5 inches or a palm's length distance to fit under the arm. 

To fit a client with lofstrand crutches the arm band should be placed 2/3 of the way up the forearm. An important tip to remember is that the hand grips should always face forward to promote a proper gait.

There are many different types of assistive devices that accommodate for weightbearing status, endurance, stability, and decreasing fall risk of the client. Consider the needs/goals of the client when finding the right fit in assistive devices, and ALWAYS remember to use the gait belt when transferring or walking with a client. 

Body Mechanics

Why is proper body mechanics and posture an important factor? Body mechanics and posture work together to prevent injury and illness. Having poor body mechanics when lifting/moving things increases the risk of back pain. A benefit of having proper posture and body mechanics requires less energy to maintain a state of balance. Proper posture includes keeping your body centered over the base of support in regards to line of gravity when this is disturbed the individual increases risk of falling or injuring ones self. Proper posture and movement helps the body reduce stress applied to the spine and does not strain the body's muscles and ligaments. Posture is also involved in joint function and when the alignment is off it causes stress and the degeneration of different joints. Another factor associated to poor posture is a more difficult time breathing, if the body has proper posture the chest is able to expand. It is important to teach good body mechanics and posture to individuals because they are reducing their risk of injury, illnesses, and joint and muscle damage while increasing the spines stability. 

During an intervention of teaching a client body mechanics and posture the first thing I would do would be to have the client stand against the wall if possible to explain correct body posture. While against the wall the client needs to have their heels to the back of the wall, the shoulders against the wall, with the chin tucked and head down while against the wall as well to demonstrate proper posture. I could even have the client show me what they think correct posture is to them and correct where necessary. Next to assess body mechanics I will get the client to make sure they have their feet placed shoulder width apart or large enough to have a good base of support. Reminding the client that when lowering down to grab something and lift back up to bend at the hips and knees and not at the waist which stresses the back. They also may need to be reminded that when using proper body mechanics the neck pelvis and back should all be aligned remembering not to twist at the waist, which will cause back pain and or injury. Lift with the legs and arm muscles not your back and keep the object close to was it level. The client can practice this while using a stick placed on their back to make sure their alignment is correct or they can perform an activity while the therapist observes and corrects their posture. 

Man From The South

In the story, Man From The South by Roald Dah the soldier made a bet and if he lost this bet he would lose his pinky finger. If the soldier would have lost the bet, his ability to have a strong grip strength in his pinky would not as strong as needed. Upon losing the bet the wife might have to help with taking care of the man. One way that her life may be impacted along with his is going to the restroom. After using the restroom one must be able to wipe and if the grip strength is not present it would be difficult for him to clean himself so his wife may have to help it. They could work on exercises to increase grip strength of the other digits or make adaptions to going to the restroom.  They could also use a type of assistive device to help the man go to the restroom independently. Using a long handle bottom wiper that has a grip that includes only the three jaw-chuck grasp or even the lateral grip could make cleaning the bottom easier. Another way would be to have a device installed on the toilet to clean the soldiers bottom. This type of technology may have been more difficult to come by so using therapeutic exercise along with an assistive device to clean himself may promote more independence  for both the soldier and his spouse.