Making it "Fit"

Please give at least two reasons for the importance of appropriately "fitting" your patient for use of an assistive device. Next, please explain how you would accomplish this for a cane, axillary crutches, Lofstrand crutches, platform walker, and a rolling walker.

          Making sure that the patient’s assistive device “fits” properly is imperative; it ensures comfortability, it improves posture, it increases stability and balance, and takes pressure off certain nerves and muscles. Canes and walkers would be an example of devices that should fit properly. As we know, these two devices assist people who may have instability or weakness in certain muscles or bones. A way to guarantee that the devices are customized and comfortable for the person is to make sure that the hand grip is at the level of client’s ulnar styloid, wrist crease, or greater trochanter. If not carefully and properly customized, the hand grip could essentially put pressure on the flexor retinaculum; making the client more susceptible to carpel tunnel syndrome and tendinitis of the wrist.

 Crutches would also be considered an assistive device.  They are used if a client has lost a limb or has a lower extremity impairment. When assigning crutches, the clinician should always make sure that the shoulders are relaxed; then they should measure and reassure that the axillary rest is 5 cm below the floor of the axilla. If not fitted properly, it can cause major discomfort under the arm and also may make the client more prone to pressure sores, due to the constant pressure contact beneath the arm.

Another device that should always be fitted properly are wheelchairs. It is important that the size of the wheelchair be proportional with the person. The seat’s width, length, and height should all be sized for the comfort of the client. When measuring the width and height, the therapist should always add two extra inches just to ensure comfort and room to move. When measuring the height, however, the clinician should subtract two inches. This is done to make sure that the posterior leg is not rubbing against the wheelchair and to allow the leg to swing (if able).