How do I use an assistive device?
When patient first begins Physical Therapy they often arrive with the use of an assistive device. An assistive device is a supportive device that is used by a patient to assist in balance, relieve weight-bearing or pressure on a lower extremity, or to help correct postural deficits or gait (walking) impairments. Common assistive devices include crutches, canes, walkers, and wheelchairs. When choosing the appropriate devise to use, you must consider what the intended purpose of the devices is. If a patient has recently had a surgery or injury to the leg and the goal is to keep weight off the limb, we may choose to use axillary crutches or perhaps a walker. In addition to considering the injury, we must also think of the patient. If the patient is a young healthy person crutches may be the best choice. However if the patient is elderly with a history of falls, a safer choice may be a wheelchair.
The bottom line when choosing the correct assistive device it that it should be the least cumbersome device that offers the best support for the intended purpose, i.e. reducing weight-bearing on a limb or helping to improve balance.
How to fit crutches properly?
One common problem we see in Physical Therapy are patients who arrive using crutches that are set either too big or too small for the patient. A simple but effective method of determining the proper height of the crutches can be learned by following these simple steps:
- Have the person stand erect with feet shoulder width apart and arms at their sides
- Place the base of the crutches approximately 4 inches forward and 2 inches out from the front of the toes
- Place the top of the crutches, also known as axillary pads, under the axilla (armpit). Properly adjusted crutches should be approximately 2 finger widths below the axilla. You can usually adjust the height by depressing a small bottom on the tube of the crutch, then either raise or lower to meet desired height
- The next step is to adjust the height of the hand grips. With the crutches placed under the armpits and the bases 4 inches forward and 2 inches lateral to the toes, allow the arm to hang at the sides of the body naturally. The hand grip should be positioned so it is level with the crease of your wrist. To adjust these, there is usually a small wing-nut that must be spun loose allowing a pin to be pulled out from the handle. You can then adjust to desired height, place sliding pin back in and firmly tighten the wing-nut
How do I fit a cane properly?
Regardless of the type of cane that is being used, i.e. straight cane or quad cane, the height should be adjusted using the same method from the crutches set-up.
- Have patient stand tall with arms at their sides and the cane placed on the side of desired use (see below for how to determine which side)
- Place the cane 4 inches forward and 2 inches out from the front of the foot
- The handle of the cane should align with the crease of your wrist. Some straight canes are made from solid wood, metal, or plastics and the height cannot be adjusted. If the handle does not align with the wrist, you may need to consider purchasing an adjustable height cane. These can usually be found at a medical supply store or second-hand store and are relatively inexpensive
- To adjust the height there is usually a small button that must be pressed in. Some canes also have a small collar between the telescoping shafts of the cane that must be loosened to adjust the height, and then retightened for stability.
When using a quad cane, the legs that form a straight line should face the foot. The picture below highlights the proper side of the cane that should face the foot.
One common misconception is that the cane is used on the side of the body that has the injury. This is actually incorrect! The cane should be used on the side opposite the body to promote the person shifting their weight AWAY from the injured leg.
How do I fit a walker properly?
When adjusting a walker to proper height, we must first consider it intended use. If the walker is being used to aide in balance we may choose to have the height set higher compared to if the walker is being used to reduce weight-bearing on a leg.
- Standing tall with feet shoulder width apart, place the walker around the person so they are standing within the base of support.
- The height is adjusted by the same procedure of either raising or lowering until the handles are aligned with the wrist creases. This is done by depressing a button on each leg of the walker and then making your adjustment. Make sure the button fully reengages the hole before using the walker.
- If using the walker only for balance assistance, you may choose to raise the walker higher as you are not using your arms to support the weight of your body.