Biomechanics Blog 7 - Locomotion and Adaptive Devices

There are many situations where a person might need adaptive equipment to help with their ambulation and mobility. When picking what kind of AE the person needs, many factors need to be taken into account to make sure the most efficient and safe option is chosen for the client. Things such as disability, weight bearing status, strength, ROM, balance, and coordination will need to be assessed to make sure the correct assistive device is being chosen and if they need any added on equipment to the device. Other factors should also be looked at like age, endurance, and psychological condition. As an OT, we need to make sure that the device is comfortable for the client and doesn't cause any pain or breakdown of the skin, puts the client in a position to use correct body mechanics, and is practical and usable for the client in their day to day life.

Some devices that can be used to help with ambulation and mobility include canes, crutches (axillary and Lofstrand), and walkers (platform and rolling). A cane would be used when the least amount of stability needs to be added to the client. To fit a cane to the person, we need to make sure that the hand grip is at the level of the client's wrist crease and that their elbow is slightly flexed to hold on to the cane. There are also different types of canes that can be chosen from, for example, a standard or straight cane with one leg or a quad cane that has a wider base and 4 prongs to increase stability (base can be wide or narrow).

Crutches can give more added stability than canes. To fit crutches to a client, we would need to take the same measures as for a cane and add that the crutches, if axillary, should be around 5 cm below the floor of the axilla with the shoulder relaxed. This is for comfort and correct alignment of the shoulders while using the crutches. For Lofstrand crutches, these have an arm cuff that goes around the proximal forearm of the client. We would still need to make sure they are the right height and that the arm cuffs were a correct fit for the client. They provide less stability than axillary crutches, but are for long-term disabilities.

Finally, walkers are more stable than either canes of crutches. The same measures should be taken when fitting a walker to a client as with a cane. A platform or rolling walker will have 4 points of contact to the ground, but the rolling will be less stable than the platform. A platform or standard walker should be given to someone with fair balance that needs a large amount of added stability. A rolling walker is more efficient for a person that cannot lift a walker up to move.