The Importance of Appropriately Fitted Assistive Devices:

     When fitting a client/patient for the use of an assistive device it is important to appropriately fit the device to each individual so that the device does not cause more harm than good, and or potentially pose a safety risk. An improperly fitted device, for example, crutches could cause damage to the brachial plexus if the cradle of the crutch is placed in direct contact with the axilla (arm pit). The purpose of an assistive device is to aid a person with ambulation not cause more problems. While moving with an assistive device it is still important to have proper posture and use proper body mechanics. If the assistive device is not properly fit, it could create poor posture habits and bad body mechanics in order to compensate for the ill fitted device. This could snowball into a whole host of other problems, muscle tightness and or pulling, which would only slow down the healing process for the client. Not to mention the gait of the client would then also be further compromised and potentially cause balance issues that could be a safety hazard.

     To properly fit a client for a cane with the client standing straight ahead and arms relaxed by their sides. The cane should be on the uninjured or unaffected side with the handle lined up with the wrist crease, ulnar styloid, or greater trochanter. When holding the cane, the elbow should be slightly flexed approximately 20-30 degrees with the shoulders relaxed and not elevated. If using a quad cane, make sure the wider legs are pointing away from the client.

     To properly fit a client for axillary crutches, the crutch length should be approximately the same length as the distance from the client’s forearm of one arm to the fingertips of the opposite hand. The arm pad or cradle of the crutch should be about four fingers width or five centimeters below the axilla (arm pit) with shoulders relaxed not elevated. The arm pad should NOT come into direct contact with the arm pit. The hand grips should be in line with the wrist crease, ulnar styloid, or greater trochanter when the hands are wresting at the side.

     To properly fit a client for loftstrand crutches also called forearm crutches. The hand grip should be in line with wrist crease, ulnar styloid, or greater trochanter with the arm band of the crutch positioned about 2/3 of the way up the forearm. Make sure the arm band is not too close to the elbow. There should be about a 20 degree bend in the elbow while in use.

     To properly fit a client for a platform walker you need to estimate the appropriate height of the walker based on the client’s height while client is standing looking straight ahead with arms relaxed at sides. The handgrips should be in line with the wrist crease, ulnar styloid, or greater trochanter. The elbow should be slightly flexed approximately 20-30 degrees with the shoulders relaxed. The platform surface should be positioned to allow weightbearing through the forearm when the elbow is bent 90 degrees and the client is standing tall with shoulders and scapula relaxed. The proximal ulna should be positioned one to two inches off the platform surface so as to avoid compression. The handle of the platform should be placed slightly medially so the client can have a comfortable grip when the forearm is resting on the platform.

     To properly fit a client for a rolling walker you need to estimate the appropriate height of the walker based on the client’s height while the client is standing looking straight ahead with arms relaxed at sides. The handgrips should be in line with the wrist crease, ulnar styloid, or greater trochanter. The elbow should be slightly flexed approximately 20-30 degrees with the shoulders relaxed. You need to make sure the client has enough body control, as well as, is cognitively able to properly operate the hand brakes on the rolling walker. If the client where put in a situation where they were to panic and did not apply the brakes the walker could roll away from them causing them to possible fall and severely injure themselves.