Locomotion & Adaptive Devices

Assistive devices allow a person to be more mobile and independent. Selecting an assistive device involves looking at the whole person. Factors such as physical condition, age, endurance, and psychological condition need to be considered. This allows the OT to understand the patient’s limitations and capabilities. The selected assistive device should increase the patient’s occupational engagement. Appropriately fitting the patient to their device is important for their safety, comfort, and proper body mechanics. 

A cane is the least stable assistive device but allows for increased freedom of movement. A cane is beneficial for someone who needs little stability assistance. The patient’s stability needs should be considered when deciding what type of cane is necessary: standard cane, narrow based quad cane or wide based quad cane. While the patient is standing with arms and shoulders relaxed by their side, I would fit the cane to their unaffected side. The height should be adjusted so the handle is in line with their wrist crease, ulnar styloid, or greater trochanter of the femur. Their elbow is relaxed and slightly flexed to 20-30°. The patient holds the cane on the unaffected side and moves it simultaneously with the affected side. 

Axillary crutches are more stable than a cane and are beneficial for patients who need to restrict or reduce weight bearing. To fit axillary crutches, the height of the axillary rest should be about 5 cm or 4 fingers below the axilla while the patient’s shoulders are relaxed. This prevents increased pressure in the axilla and damage to the brachial plexus. The hand grips should be at the height of their wrist crease, ulnar styloid, or greater trochanter. Both elbows are slightly flexed to 20-30°. 

Lofstrand crutches have an arm cuff that wraps around the proximal forearm. They are more stable than a cane but less stable than axillary crutches due to a shorter height. Lofstrand crutches enable use of the hands as well as allow for more movement and control. These crutches are suitable for long-term use. To fit Lofstrand crutches, the arm cuff should be positioned 2/3 of the way up the forearm. The hand grips are in line with their wrist crease, ulnar styloid, or greater trochanter. Both elbows are slightly flexed to 20-30°.

Platform walkers are stable devices with a platform attachment to strap in forearms. A platform walker is appropriate for someone who has a fractured upper extremity or wrist and cannot bear weight though their wrist or hand. The platforms support forearms in a neutral position. To fit a platform walker, the platform surface is raised so the elbow is at 90° to allow weightbearing through the forearm. The proximal ulna should be 1-2 inches off the platform to prevent nerve compression. The handle on the platform is positioned slightly medially for comfortable grip. 

Rolling walkers are a stable assistive device and have 4 points of contact with the ground. A rolling walker is appropriate for someone who does not have enough upper body strength to lift a standard walker. There are two front wheels that make it easier to push the walker forward. To fit a rolling walker to the patient, the hand grips should be in line with the wrist crease, ulnar styloid or greater trochanter enabling 20-30° of elbow flexion.