Locomotion and Assistive Devices

     Appropriately fitting a patient for an assistive device is important that it can prevent many issues. As a future practitioner, It's important that I help patients get appropriate assistive devices to first prevent injuries like falls. If the assistive device isn't an appropriate fit, the client can end up slipping and fall, when the device is appropriately fitted, the client is secure and can move in stable manner without anything slipping.  Another importance of appropriate fitting is the comfort of the client. Clients need to be comfortable and feel okay with the device. The device is there to help and not stop them from moving comfortably or causing any pain while they use it. So making sure the device is fitted in all important place.

Fitting for a cane:

When it comes to canes, there are two kinds which are the standard and the quad cane. The standard cane gives more freedom of movement and the quad cane is known for more stability with its four points of contact and it has a wide base, and during the use of this quad cane, there's a longer feet which when client is using should point away from them and for the smaller  part, it should point  towards the client. To make sure the cane is fitted, the client should stand and therapist must make sure the handle stays on line with the ulnar styloid or greater trochanter. To correct the height of the an, there are buttons on the cane that the therapist must push on for the height to be adjusted perfectly for the client, then they hold the button till there's a click showing its securely at the right height to avoid any moving. When the clients holds the handgrips of the cane, their elbows must be flexed approximately 20-30 degrees. Again for the quad canes, the wider legs should always be pointed away from the patient.

Stand to sit and sit to stand: To move from a standing to sit position, the client has to get close to the seat, turn and move back till the back part of their legs touches the seat. When they feel that, they have to hold the cane loosely in one hand and slowly reach back for the armrest of the chair or surface of seat and sit in it slowly, and not just plop in the seat. Moving from sitting to standing is the opposite way. The client has to scoot to the edge of seat, with their feet flat on the ground and their toes more under their knees. The client then has to place the cane vertically on uninvolved side and hold on to handle loosely with hands placed on the seat surface or arm rest then they lean forward and push up to stand using their arms and legs.

Ambulation: In ambulation, advance the cane and involved leg simultaneously  and step through with uninvolved leg and step beyond the involved leg and you repeat this pattern till you're at a place of comfort. When there's a need for a turn, the client just needs to take multiple controlled steps.

Safety: It's important to always consider some safety precautions when a client uses an assistive device. When using cane its important to make sure the client knows to hold it on the opposite side of the involved side, never place the can too far in front, not lean onto the cane and always stand straight. Next, the handle of the can should face backwards, the long feet should be away from the body, never skip steps and always use handrails when available. The therapist has to also make sure the client has on a gait belt when gait training.

Fitting for crutches:

There are two types of crutches, the axillary crutches, which is known as the standard crutches and the forearm crutches also known as either Lofstrand or Canadian crutches which are more dynamic in movement and reduce strain on arms. To appropriately fit this for a client, the therapist should make sure the length of the crutch should be approximately be the same as the distance from the patients forearm to the the finger tips of the opposite hand, To appropriately estimate, the client should stand and have arms relaxed. The arm pad on the crutch must be 1 to 1.5 inches under the axilla and 2 to 3 fingers width. With arms resting on side, the handgrips also have to be in line with the client's ulnar styloid or greater trochanter. To adjust these handgrips the therapist needs to open the wings at sides of the handgrip and remove the bolt to move the handgrip up or down to the appropriate fitting  and replace the bold  and the wing nut. With the forearm crutches, the armband should be positing 2/3 of the way up the forearm.

Stand to sit and sit to stand:

To move from a stand to sit position, the client must approach the seat and turn back and move back till the back of their legs touch the seat. They have to place both crutches on involved side while holding the handgrips. The client must reach back for the armrest of the chair or surface of seat and sit in it slowly, and not just plop in the seat. From sitting to standing, the client must scoot to the edge of the seat and place both crutches on involved side and hold the handgrips while placing the other hand on the armrest or seat surface. The client then needs to lean forward and push up to stand using their arms and uninvolved legs. Once they are standing and able to balance, they can move one crutch under arm to the opposite side and place other crutch under arm of the involved side.

Ambulation: In ambulation, the tips of the crutches must be places in a tripod position and if its non-weight bearing, client's leg must be extended and off the ground. The client then has to transfer weight on handgrips and swing through the crutches and repeat this pattern continuously till at the needed place. In terms of turning, the client must take multiple controlled steps.

Safety: It's important to always consider some safety precautions when a client uses an assistive device. For safety, crutches should not be positioned too close together or too far apart, the crutches should not be positioned too far behind or too far in front of the client, the crutches do not need to be positioned too close to the client's axilla, the cuff of a forearm crutch should not be too high up, clients should always use handrails if available, and the therapist should always use a gait belt when gait training with the client. 

Fitting for a walker: 

When using a walker, there are different kinds like the standard walker which is known to provide great stability, the front wheeled walker which allows for more normal gait pattern, the rollator, which is easier to move around small spaces and the platform walker which helps patients who cant bear weight through their writs or hands. To appropriately fit this for a client, the height of the walker must. be base on clients height with the client standing straight and arms relaxed. To fit the walker appropriately for the client, the therapist  must push the buttons on each leg to the correct height to the client's greater trochanter and make sure all legs are adjusted at the same height. The handgrips should be in line with the ulnar styloid or greater trochanter. The elbow of the client must flexed approximately 20 to 30 degrees. With a platform walker, its surface must be positioned to allow weight bearing through the forearm when elbow is bent at 90 degrees with patient is standing tall with scapula relaxed and the proximal ulna should be positioned 1-2 inches off the platform surface to avoid compression. For comfortable grip when forearm is resting on the platform, the handle of the platform should be positioned medially.

Stand to sit and sit to stand: To move from a standing to sitting position, the client must approach the seat, turn and move back till they are able to feel the seat with the back of their legs, if its non-weight bearing, the client must extend their legs in front and off the ground. They then have to reach back with their hands one at a time from the handgrips of the walker to the armrests or seat surface then sit down slowly without plopping into the seat. To move from sitting to standing position, the client must place the walker  in front of them while sitting. If its non-weight bearing, client must extend leg off ground but if weight bearing, client must have feet flat on ground with toes under knees then scoot to the edge of the seat and place their hands on the armrest or the seat surface. The client will then lead forward and push up to stand using the arms and uninvolved legs and place both of their hands on the walker.

Ambulation: In ambulation, the client must push forward no loner than the length of their arms and place involved leg forward, Next, they transfer weight onto hands and swing through with uninvolved leg and continue in the pattern. When it comes to completing a turn, client must take multiple controlled steps.

Safety: For safety with the walker, it  should not be sized too low or too high, the client should not position the walker too close or too far away from them, and the client does not need to sit down until the back of their legs is touching the seat, and lastly, the therapist should always use a gait belt when gait training with the client. 

 

References:

Giles, A. K. & Kraft, S. (2019). MOBI– Mobility Aids. Available from https://itunes.apple.com/us/app/mobi-mobility-       aids-id1205309397

Weisser-Pike, O. (2023, June). Lecture 12: Gait & Locomotion. OT 430 Biomechanics, University of Tennessee               Health Science Center