Many patients buy or borrow devices without advice from a professional. It is usual for these devices to fit poorly, be unsafe, or be used improperly. In one study, only 15 of 60 canes were the correct length. This Division will describe how to evaluate a device for safety and evaluate a device for proper fit.
Physicians should also consider referring patients to a physical or occupational therapist when recommending a device (or when they discover a patient is using one) to ensure fit and training in safe use.
Over 20,000 accidents requiring treatment in an emergency room involved, or were associated with, crutches, canes, or walkers in 1987 (Commission). During an emergency maneuver, such as a "stumble" or a "slip," the degree of support the device needs to provide may double. Therefore, it is important that the device be sturdy. However, the device also needs to be lightweight enough that the patient with poor strength can use it.
Assessing Fit of a Device
The following are rules of thumb for fit in an office. Because of severe kyphosis, loss of height, and/or contractures around joints, the actual height and fit may at times "break the rules." When in doubt, refer to physical therapist for fitting and training.
Are designed to support up to 20% of the person's body weight. With the arm resting comfortably at one's side, the hand grip should reach either the wrist's proximal crease, the styloid process, or the greater trochanter.
In general the elbow should be held in an approximate 20- to 30-degree angle when holding the device. This optimizes strength while protecting wrist and shoulder joints. If the cane is used for unloading a joint, it is placed closer to the body and should, therefore, be shorter than one used for improving balance (broadens the base of support).
Quad-canes and tri-canes provide a broader base of support, but they are more awkward to use on stairs. Unless all four (or three) legs of the quad (tri) cane are in contact with the ground, the cane will wobble and will not be stable or able to hold maximal load.
Canes are used on the "good" side. This provides the most stability, unloads the joint (hip, knee, or ankle), and provides the lowest energy cost gait. (Patients who self-prescribe commonly use the cane in the hand of the affected side.)
Crutches are designed to support up to 50% of the person's body weight.
Axillary crutches should place the hand according to the above rules. However, the top of the device should be 1 to 2 inches below the axilla to avoid brachial plexus nerve injury.
Forearm crutches should be adjusted not only for length as above but also for the handle and the elbow. The cuff should be within the proximal third of the forearm.
Provide the most stability and are designed to support up to 50% of the person's body weight. Length should be similar to that of a cane. Clearly walkers are more difficult to maneuver in small spaces. In general, they do not perform well outside on uneven surfaces.
Wheelchairs need to be fitted by width and height. The desired height of a wheelchair depends on whether the patients will propel themselves with their hands or their feet. If the patient is propelling by hand, the height should keep the feet off the floor. If the patient is propelling with the feet, at least one foot needs to reach the floor comfortably.
Common sense dictates that the width of the wheelchair should not cause pressure sores to develop. However, the wheelchair can also be adjusted to improve positioning of the body or extremities. A professional fit by a physical or occupational therapist is strongly recommended.
Companies Providing Equipment
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