Biomechanics Blog 8: Locomotion and Assistive Devices

Retrieved from: Assistive Devices Stock Illustrations – 68 Assistive Devices Stock Illustrations, Vectors & Clipart - Dreamstime 

As a future practitioner, I am most likely going to have a client that uses an assistive device. When using an assistive device, it's important to appropriately fit the client. Fitting the client for the use of an assistive device allows safety and ensures the proper use of the device. If used correctly and properly fitted, it reduces the risk of injuries and falls while allowing the client to have optimal function. When it comes to assistive devices, one size does not fit all! It's important to consider the client's personal needs. Below I have included how to properly fit a client for a device, instructions during ambulation, standing to sitting, sitting to standing, and key safety considerations when using the device.

Canes: Standard & Quad

 Before using a cane, the client must be properly fitted for it. The handle should be in line with the wrist crease, ulnar styloid, or the greater trochanter. When the client holds the cane, their elbow should be slightly flexed 20-30 degrees and should be held on the non-affective side. In terms of the quad can, the wider part of the base should be pointed away from the client, while the narrow part is towards the client. When using the cane during ambulation, the client should advance the cane and the involved leg simultaneously if their balance is impaired. The client should make sure that they step through with the uninvolved leg beyond the involved leg. If the client needs to turn, they need to make sure to take multiple controlled steps. When using a cane from standing to sitting, the client should first approach the seat, turn, and slowly back up until the back of their legs touches the seat. Next, they should hold the straight can loosely in their hand then slowly reach back with both hands to the armrest or seat surface. Lastly, they sit down slowly, and don't just plop down in the seat! The same technique and steps are followed when using a quad cane except they do not hold the quad cane when standing up or sitting down. When using a cane from sitting to standing, the client should first scoot to the edge of the sit. This allows a smaller base of support and greater mobility. The next thing they should do is position their feet on the ground with their toes under their knees. Next place the straight cane on the uninvolved side and hold it loosely. Next place your hands on the armrest or seat surface. Lastly, they need to lean forward and push up to stand using their arm and leg muscles!

Safety Precautions: The cane should not be positioned on the involved side, the cane should not be placed too far in the front, the size of the cane does not need to be too tall or too short for the client, the cane's handle should be facing forward when going downstairs the client needs to lead with the involved leg and lead with the uninvolved leg going upstairs, the client should not lean onto the cane, and lastly the practitioner should always use a gait belt when gait training with the client.

Crutches: Axillary (standard) & Forearm (lofstrand)

When fitting standard crutches, the crutch length should be around the same length as the distance from the client's forearm to the fingertips of the opposite hand. The arm pad should also be 1- 1.5 inches under the axilla or 2 to 3 finger widths. The handgrips should be in line with the wrist crease, ulnar styloid, or greater trochanter. Regarding the forearm crutches, the armband should be positioned 2/3 of the way up the forearm. During ambulation, the crutches tips should be placed in a tripod position. if non-weight bearing, the involved leg should be extended and kept off the ground. The client should transfer weight onto the handgrips while not putting pressure on the axilla. The client should then swing the crutches and continue that pattern. When using crutches from sitting to standing, the client should first scoot to the edge of the sit, this allows for a smaller base of support and more mobility. The client should then place both crutches on the involved side and hold handgrips. Next, the client needs to place the other hand on the armrest or seat surface. The client then leans forward and pushes up to stand using their arms and the uninvolved leg. Lastly, once standing and balanced the client needs to move one crutch under the arm of the opposite side and place the other crutch under arm of the involved side. The same technique is followed when using forearm crutches except, the forearm should be placed into the cuff after standing and removed before sitting. When using crutches from standing to sitting, the client should approach the seat, turn and back up slowly until their legs are touching the seat. The client then needs to place both crutches on the involved side while holding the hand grips. Next, the client needs to slowly reach back with the opposite hand for the armrest or seat surface. Lastly, the client slowly sits down, they do not need to just plop down!

Safety Precautions: The 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 practitioner should always use a gait belt when gait training with the client.

Walker: Platform & Rolling

When fitting a walker, the handgrips need to be in line with the wrist crease, ulnar styloid, or greater trochanter when the hands are resting at the side. Their elbow should also be slightly flexed 20-30 degrees. For a platform walker, the surface should be positioned to allow the client to apply weight through the forearm while the elbow is bent 90 degrees, and the scapula relaxed. The proximal ulna should also be positioned 1-2 inches off the platform surface to avoid nerve compression. Lastly, the handle of the platform should be positioned medially to allow the client to grip it comfortably when their forearm is resting on the platform. During ambulation, the client should push the walker forward no more than arm's length. They should place the involved leg forward. They should also transfer the weight onto the hands while swinging through with the uninvolved leg. The client should continue these steps during ambulation. Lastly, if the client needs to turn, they need to take multiple controlled steps. When using a walker from sitting to standing, the client should first place the walker in front of them, then scoot to the edge of the chair to create a smaller base of support. This allows for more mobility. The client should then place their hands on the armrest or the seat surface. Lastly, lean forward and push up to stand using the arms and the uninvolved leg. The client should then be standing with both hands on the walker. When using a walker from standing to sitting, the client should approach the seat, turn, and slowly back up until the back of their legs touches the seat. Next, they should reach back with their hands, one at a time for the armrest or seat surface. Lastly, the client should slowly sit down, and make sure not to just plop in the seat!

Safety Precautions: The walker 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 practitioner 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