The Hruska Clinic Integrator
Caiti Discusses How "One Size Does Not Fit All" Regarding Assistive Devices (Part 1)
Posted on 04/12/2016
We all know someone who either currently uses or has used an assistive device. Canes, walkers, crutches, wheelchairs to name a few are assistive devices designed to be used in a way that increases both safety and independence with functional mobility (i.e. walking, stair negotiation, transfers sit to stand, balance deficits). Often patients will come to therapy and it is evident the moment they walk through the door whether or not the assistive device FITS them. I always start by asking them how long they've used their device, then follow by where did you get it?, and did someone ever fit that to you or show you how to use it? Answers to these questions are commonly "This was my moms", or "is my uncles", or "my son used these crutches once and we kept them". In the rare chance that this person has the exact anthropometrics and injury as their relative or friend from whom they got the device, the fit may be correct.
More often than not, the device doesn't fit and needs to be measured to the new owner or user of the cane/walker/walking stick/crutches/wheelchair etc. Frequently, patients walk into the clinic using devices too short or too tall for them. Sometimes people use devices that restrict to their freedom of movement without knowing it; a device that is too stable or perhaps lacks sufficient support. In these cases, the device is not actually aiding the individual, but can become a safety hazard or create undue stress on areas of the body that are supposed to be unloaded.
Following the issue of "fit" is the ability to correctly use a device. Patients need to learn how to position, advance, and use their device to shift their center of mass optimally throughout the gait cycle. Improper use or placement of a device during functional mobility can lead to other issues, aches and pain throughout the body as we compensate to move.
For instance, if your Right leg hurts, you may grab a cane or crutch and use it on the right side to support that Right painful or sore leg. Contrary to popular belief, the laws of physics actually demonstrate that with this approach, your body's center of mass and weight is actually increased on the Right side of the body rather than unloading the sore leg. This also limits the individual to shift their weight and utilize the left side of the body in a balanced and proper way to move forward.
This unloading and balance of forces around the painful side is not the only element to thing we consider here at the Hruska Clinic. We also look at the asymmetries in quality of motion between right and left sides of the body. For instance, we may instruct a patient who has a painful Left side to actually hold their device in the Left hand. To find out more about if an assistive device is right for you, what type, what fit, and for training on how to use the device properly for optimal mobility, come and see us (402)467-4545.