By: Rachel Luzer and Aiyannah Wilson
What is an assisted device and who may benefit from having one?
Assisted devices can come in a range of sizes, shapes and stability. A few common devices are canes, walkers, and crutches. Although they may seem similar to one another, they can all fall in different parts of the stability vs mobility spectrum. Assisted devices are used to compensate for many deficits such as, balance impairment, decreased strength or range of motion, pain, and many other ailments. While commonly seen in older individuals, assisted devices do not discriminate based on age. Devices are chosen based on various client-specific factors including weight bearing status, surgical precautions, functional ability, cognitive ability and goals. These factors can significantly impact a physical therapist’s decision in prescribing a device that is right for the client.
Assisted Devices- Type, Fitting, & Use:
While we mentioned previously that common devices are canes, walkers, and crutches; there are plenty more! Some other assisted devices are tilt tables and parallel bars, often used in physical therapy clinics for standing and gait training. Additionally there are various kinds of walkers, crutches, and canes. Each device has their own benefits, risk factors, and proper use and fitting criteria.
A rolling or wheeled walker is the most common walker prescribed to patients. While it is less stable because of its wheels than a standard walker, it is actually faster and more functional. An individual can simply push it along while walking rather than lifting and advancing with each movement. A walker can be a great option for those needing a large base of support and assistance with endurance. A downfall to walker use is that it can not be used functionally while stair climbing, only, if necessary, as support.
Fitting: The height of the walker arms should be aligned to the client’s wrist crease when standing upright.
Firmly grip walker utilizing only the hand grips
Remain inside of walker at all times (even while moving)
Make sure all four legs of walker remains firm on the group
There are two main kinds of crutches; Lofstrand/forearm and axillary crutches. Lofstrand crutches are more often preferred for long-term use for chronic conditions due to comfort. Axillary crutches are most commonly prescribed for an injured lower extremity1. Crutches are a great option for an individual with upper extremity strength and endurance, as they are not the most stable option for assisted devices. Crutches can additionally be used while stair climbing if skilled and careful.
Fitting (Axillary): With the client standing upright with a normal foot stance, allow the cutch legs to be about 6 inches in front of the feet. The client’s wrists should be aligned with the wrist crease. It is important to ensure that there is at least 2 finger widths between the client’s axilla (armpit) and the top of the crutch. This will ensure that there is enough room for safe movement without damaging internal structures.
Fitting (Loftstrand): With the client standing upright with arms laying neutral by the client’s sides, the top of the cuff should be about an inch below the elbow joint and the hand piece should be aligned at the wrist crease.
Slightly bend elbow while gripping crutches
Allow the arms to accept the weight
Two crutches are used for non-weight bearing, One crutch is utilize when progressing to normal gait training
For single crutch, place on opposite side of injury
Canes have a wide range of designs that differ in stability and mobility. Some examples of different types are the wide-based quad cane, narrow-based quad cane, orthotic cane, and standard cane. Can you guess which ones are the most stable? The quad canes! They allow for a wider base of support for balance assistance and can help to reduce pain. Clinically, a single point cane is more common with a decreased risk of tripping over the cane’s legs and increased mobility. A downside to canes is that an individual cannot use a cane as an assisted device if they are not able to bear weight in both legs.
Fitting: With the client standing upright, the hand grip should be aligned with the client’s wrist crease and the tip of the cane aligned with the heel of the shoe.
Use arm to help take load off leg
Place cane slightly in front and slightly to side to avoid falls
When stepping forward with injured leg, move cane forward
When stepping forward with “healthy” leg, use cane to help put weight through injured leg