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.