Fitting Assistive Devices

As an occupational therapist, it will be part of my job to provide assistive devices and equipment for my clients. It is very important to know how to get the perfect fit for each client.
One reason is to ensure the client's safety and security while using the device for support. There are many different types of devices and it is important to make sure that each client is using the one that is most appropriate for them. Factors such as height, weight, UE strength, ROM, age, endurance, etc., need to be considered when choosing the device that best suits each patient. We want each client to feel comfortable and secure while using his/her device. For example, it would not be safe for a client with weak trunk strength to use crutches or a client with stairs in the home to use a walker.
Another reason is to prevent pain and injury.  If a device does not fit properly, it can cause the client to use bad body mechanics, which would eventually cause pain. It can also result in an injury that otherwise would not have been there. For example, a walker that is positioned too low for a long period of time, could cause kyphosis and pain in the back.


To properly fit a cane, you must make sure that the handle of the cane is in line with the ulnar styloid, wrist crease, or greater trochanter. To adjust the cane to this position, you will release the locking mechanism by pushing the button and moving the cane to the correct height. The client's elbow needs to be relaxed and slightly flexed at 20-30 degrees. Shoulders should be relaxed. Although canes allow environmental freedom, they are the least stable of the assistive devices.


Axillary crutches are the standard type of crutch that is used to restrict weight bearing. To properly fit axillary crutches, you will use the same process as fitting the cane. It is important to note that the correct crutch length should be approximately the same length as the distance from the patient's forearm to the finger tips of the opposite hand. In addition, the axillary rest should be around 5 cm or 2 to 3 finger widths below the floor of the axilla, with shoulders relaxed.

Lofstrand (forearm) crutches are slightly different than axillary because they offer a support on the forearm to reduce strain on the arms.  They will be fit the same way as axillary crutches, with the addition of making sure that the arm band is positioned 2/3 of the way up the forearm.

Platform walkers might be used with patients who cannot bear weight through the wrist or hands or  lack trunk support. The same method will be used to fit the walker as stated above.  In addition, the platform surface needs to be positioned to where it will allow weight bearing though the forearm when the elbow is bent to 90 degrees and the patient is standing tall with the scapula relaxed. TO prevent nerve compression. make sure that the proximal ulna is positioned 1 to 2 inches off the platform surface. The handle fo the platform should be positioned medially to give the patient a comfortable grip when the forearm is at rest on the platform.

Rolling walkers are used by patients who are not able to lift a walker due to upper extremity weakness. To fit rolling walkers, you will follow the instructions as the cane and standard walkers. Due to the rolling wheels, you will need to make sure than the client is able to keep the walker under control.