Rubber Band Pinball Game

 

https://youtu.be/s9G50-M7VPs

My client’s name is Harris. He is a 22-year-old who has a T3-level spinal cord injury (SCI), as a result of an auto accident. One of Harris’s meaningful occupations is social participation with his fiancé, Marsha, and entertaining his friends. Harris does not have active range of motion (AROM) in his lower extremities (LEs), but he does has normal motion in his left upper extremity (UE). Also, his right UE strength can’t be fully accessed because of a cast, but he does have normal motion in his right fingers. With the consideration of cultural contexts, a few of Harris’s goals include graduating on time (in 4 months) and to move on with his life. In addition, Harris also works full-time as a bookkeeper for his brother’s plumbing business, which involves typing on a computer. Harris’s family has been very supportive throughout his rehabilitation process, but Harris just desires to regain his independence, so he can resume his normal obligations. 

I created a homemade, rubber band pinball game to address some of Harris’s goals and meaningful occupations. My assigned media materials were rubber bands. I used rubber bands as the boundaries for the game, and for the marble shooter. The pinball game is client-centered because it allows Harris to entertain his friends and engage in the meaningful occupation of social participation. In this way, the game can be used as a modified adaptive equipment device to engage in social participation with friends and his fiancé. Harris can also use the pinball game as a therapeutic activity to increase speed for typing, bookkeeping, and school-related activities on his computer. In this way, the game is used as a restorative therapeutic activity. Additionally, Harris may increase the incline of the pinball board, which would increase the difficulty of the game. Overall, the completion of this assignment has impacted my work in other assignments by teaching me to consider all aspects of the client’s goals. I have learned to focus on what the client finds meaningful first. I have changed as a result from this project by thinking more creatively for client intervention. Now, I feel confident in exploring various, creative options for clients, in order to address what is meaningful to them. After gaining knowledge in the completion of this assignment, I feel better prepared and more confident for future assignments related to client intervention. The most significant thing that I discovered from this assignment was that even simple materials can be used to make a positive difference. 

Brain on Fire

I watched a Netflix film titled, “Brain on Fire.” The film is based on a true story about a young woman named Susannah Cahalan. Susannah was a 24-year-old, who had just landed her dream job as a reporter for the New York Post. Unexpectedly, Susannah began experiencing strange symptoms that ultimately lead to the diagnosis of the rare autoimmune disease, anti-NMDA receptor encephalitis. The movie described Susannah’s symptoms, as well as her diagnostic process and prognosis. To further my learning on this disease, I researched other cases online. After learning that Susannah was the 217th person diagnosed with this disease, I continued to investigate other research studies. Since Susannah was diagnosed, thousands of other people have also been diagnosed with anti-NMDA receptor encephalitis. After conducting research, I learned than more women are affected by this disease than men. Additionally, I learned that this disease is still the subject on ongoing research. 

At the beginning on the film, Susannah experienced flu-like symptoms. These symptoms included headaches, numbness in her left arm and leg, dizziness, and hallucinations, which interfered with her job. Considering these symptoms, Susannah made an appointment with a neurologist. The neurologist conducted a neurological exam, blood work, EEG, and a MRI, which eliminated the possibility of a stroke or blood clot. Later, he met with Susannah and her parents to tell them that the results were clear, and that Susannah’s symptoms were from alcohol withdraw. Since Susannah had been staying at her mother’s home, her mother knew that she had not been drinking alcohol. Therefore, alcoholism could not be the correct diagnosis. Shortly after this, Susannah began experiencing symptoms of forgetfulness, depression, hallucinations, and paranoia. Her boss began to notice Susannah’s inappropriate behavior at work, and her inability to control her emotions. Thus, her boss asked her to work at home and to leave the office. 

As her symptoms persisted, she began to have seizures and started hallucinating more frequently. For example, during the film, Susannah was unable to see her own reflection in a mirror. Her parents began feeling that Susannah was not acting like herself and began to get very worried. They urged Susannah to gain other professional opinions, in which, she did. One psychiatrist prescribed her an anti-psychotic to treat mood and thought disorders. However, this medication failed to show success, and Susannah slowly began to “disappear.” Likewise, she began to lose herself in her own mind. 

Next, Susannah’s parents checked her into a hospital because her symptoms had escalated so quickly. Here, she was misdiagnosed with mania and was given anti-psychotics. One of the psychiatrists from the hospital contacted Dr. Souhel Najjar, a neurologist that agreed to meet with Susannah. When Dr. Najjar first met with Susannah, he tried to test her cognitive impairment by her orientation levels. However, Susannah did not respond. Dr. Najjar had Susannah draw a clock, which indicated that she had left neglect and that her right hemisphere was inflamed. Dr. Najjar explained that the visual world becomes distorted when one hemisphere of the brain is impaired. Thus, he ruled out bipolar disorder and schizophrenia. After this finding, he did a brain biopsy. In this biopsy he found that Susannah’s brain was on fire. Dr. Najjar stated that he found it early, and that it was treatable. He estimated that she would gain at least 90% of her cognitive abilities back. 

Dr. Najjar discovered that anti-NMDA receptor encephalitis was a neurological cause, not a psychological cause. After watching this movie, I learned that this disease had been mistaken for psychological disorders and that people had been misdiagnosed before Susannah’s case.  It was thought provoking to imagine all of the people that had been diagnosed with bipolar disorder or schizophrenia, when it was anti-NMDA receptor encephalitis. To think, so many people were left to be lost and forgotten. Something that really stood out to me in this film was when Dr. Najjar told Susannah that he would find her. He knew that Susannah was lost, but he was determined to find her and help her regain her abilities. After finding Susannah, he continued to practice medicine, and he opened one of the first clinics devoted to treating complex autoimmune disorders.

At the end of the movie, Susannah said that she had to learn everything from scratch, how to walk, talk, write, and love. She found a new appreciation for the mundane, everyday tasks that are so easily taken for granted. Since her recovery, she has helped people all over the world find autoimmune diagnoses and proper treatment. She also continues to raise awareness about autoimmune diseases as a journalist. After watching this movie, I gained imperative knowledge on this disease. I learned that my future career will also involve “finding people” and helping them regain “lost” functions. I will be able to help people reach their goals, regardless of the diagnosis. I chose this film as a part of my assignment because it provided insight to a rare autoimmune disorder, anti-NMDA receptor encephalitis and the symptoms associated. I also chose this movie because I wanted to learn more about inflammation and what it can do to the brain. 

I highly recommend this movie to anyone who would like to learn more about anti-NMDA receptor encephalitis, and Susannah’s story. 

Barrett, G. (2018, June 22). Brain on Fire. Netflix. 

What You Can Do to Prevent Alzheimer’s

I listened to a TED talk titled, “What You Can Do to Prevent Alzheimer’s.” In this video, Lisa Genova, author of Still Alice, discussed the causes and factors of the development of Alzheimer’s Disease (AD). Genova also used research to reinforce her claims on the preventative methods of AD.

At the beginning of the video, Genova discussed how people fear AD because there is no disease-modifying treatment or cure. Then, she began to discuss the disease development. The synapse is where two neurons connect, neurotransmitters are released, signals are transmitted, and communication happens. I learned that AD takes place in the synapse. Furthermore, I learned that neurons not only release neurotransmitters in the synapses, but they also release a small peptide called amyloid beta. Microglia, the brain’s janitor cells, metabolize the amyloid beta. Many neuroscientists believe that AD begins when amyloid beta accumulates in the synapses, causing a binding mechanism. The binding in the synapse forms sticky aggregates called amyloid plaques. Next, I thought that it was interesting to learn that people around the age of forty may not show any impairments in memory, language, or cognition. In this case, PET scans are used to detect amyloid plaques. Then, I learned that it takes at least 15 to 20 years of amyloid plaque accumulation before it reaches a tipping point. Prior to the tipping point, people may notice lapses in memory.

I thought that it was helpful that Genova gave examples of questions that would be associated with memory lapses. In one example, she stated, “Where did I put my keys?” The example of forgetting the location of the keys may happen to someone who was not paying attention. The important point to this disease is understanding that after the tipping point, glitches in memory are very different. Instead of someone finding the keys in a coat pocket, the keys are in the refrigerator. Likewise, another sign of AD would be finding the keys and thinking, “What are these for?” When amyloid plaques accumulate to the tipping point, the microglia janitor cells become hyper-activated. They release chemicals that cause inflammation and cellular damage. Then, the transport protein, tau, becomes twisted and tangled. This twisting chokes off the neurons from the inside. Someone who has mid-stage AD, has massive inflammation, tangles, and cell death. 

Genova stated that the cure for AD will likely be a preventative medicine to reduce the accumulations of the plaque. However, the pill would have to be taken before reaching the tipping point. I learned that the probable reason that past clinical trials have not been successful in finding a cure is because the people in the clinical trials were already symptomatic. Also, I learned that DNA alone does not determine if people get AD. Many scientists believe that poor sleep hygiene, might be a predictor of AD. It was surprising to learn that a single night of sleep deprivation leads to an increase in amyloid beta. Amyloid accumulation has been shown to disrupt sleep, which causes more amyloid to accumulate. Thus, this process causes a positive feedback loop that accelerates the tipping scale. Other factors leading to AD are poor cardiovascular health, high blood pressure, diabetes, obesity, smoking, and high cholesterol. Likewise, some autopsy studies have shown that 80% of people with AD also had cardiovascular disease. 

Aerobic exercise has been shown to decrease amyloid beta. Another important factor in decreasing the likelihood of AD is neuroplasticity and cognitive reserve. Hence, someone with more years of formal education, a high degree of literacy who engages regularly in mentally stimulating activities, would have more functional synapses. AD is the result of losing synapses. Through neuroplasticity, people gain and lose synapses all the time. With cognitive reserve, one will have backup connections even with the presence of AD. Cognitive reserve is built by learning new things, such as, learning to speak a different language, making new friends, or watching a TED talk. 

To further my learning, I explored cognitive reserve research studies and other preventable measures against AD. I chose this TED talk as part of my assignment because Genova thoroughly described the disease development, while using research to back up her statements. Additionally, I chose this video because this video provided information on AD risk factors and proactive preventative measures against the disease. After watching this video, I learned that people with AD do not lose their emotional memory and that they can still understand love. It really stood out to me that Genova said, “Alzheimer’s disease does not mean you’re dying tomorrow; keep living.” I think that this is very important to understand. Each day is a gift, and one has the choice to make a positive difference in the world or to stop trying. In relation to occupational therapy, clients may not remember what was said, but they will remember how the therapist made them feel. As a future occupational therapist, I will encourage my clients to reach their full potential and to always keep trying. 

I recommend this video to anyone who would like to learn more about Alzheimer’s disease and ways to prevent it. 

Genova, L. (2017, April). What you can do to prevent alzheimer’s [Video]. TED Conferences. https://www.ted.com/talks/lisa_genova_what_you_can_do_to_prevent_alzheimer_s?language=en

My Love Affair with the Brain

I watched the award-winning, PBS documentary, “My Love Affair with the Brain: The Life and Science of Dr. Marian Diamond.” In this film, Dr. Marian Diamond, one of the founders of modern neuroscience, discussed her research on neuroplasticity in the brain. Dr. Diamond was the second most popular college professor in the world in 2010 with over 4.6 million views on YouTube from her anatomy lectures. Dr. Diamond has spent more than 60 years studying the brain and is the author of the first study ever published about the brain of Albert Einstein. To further my learning on neuroplasticity, I explored Dr. Diamond's research studies online and searched for several other research studies on neuroplasticity. 

In the 1960s, it was believed that the brain’s potential was unchangeable and determined at birth. At age thirty-one, Dr. Diamond joined a team of University of California, Berkeley researchers to investigate neuroplasticity. Dr. Diamond and her team wanted to explore the brain and how it could be affected by the environment, not predetermined by genetics. For this research study, they tested rats. Some rats were put into an enriched environment; living together with novelty stimulus objects. Another group of rats were put into a standard colony, and the last group of rats were put in an impoverished condition. In this impoverished condition, the rats were separated and each rat was alone without any stimulus objects. After eighty days, Dr. Diamond compared the rats’ brains. Dr. Diamond found that a rat’s brain increased in dimension with an enriched environment, and a rat’s brain decreased in dimension in the impoverished environment. The conclusions in this study showed that the brain is able to reorganize itself by forming new neural connections throughout life; another name for this finding is called neuroplasticity. Dr. Diamond had proven that the brain’s structure changes based on the environment. 

Each day one has the opportunity to build and challenge the brain. Dr. Diamond stated, “you use it, or you lose it.” She understood that one must create an enriched environment in order to have a healthy brain. A few research study topics that supported Dr. Diamond’s findings on neuroplasticity included exercise, travel, running, reading aloud to children, bilingualism, playing a musical instrument, and staying socially connected. Research studies conducted that impaired the brain included childhood poverty, fear, trauma, isolation, sleep deprivation, and protein deficiency. Thus, Dr. Diamond discovered the five items that are essential for a better brain: diet, exercise, challenge, newness, and love. Dr. Diamond also conducted research on how love affects the brain. She showed affection to rats in an enriched environment. Neuroplasticity was shown in this study because the rats that received affection lived longer than rats that did not receive affection in enriched environments. 

For me, the most inspiring part of this documentary was when Dr. Diamond took her findings of neuroplasticity to help impoverished orphans in Cambodia. She developed the Enrichment in Action Project, which continued for over ten years. She decided to conduct research on children in Cambodia because they were only fed once a day and did not have shelter. She created an enriched environment for these children that included the five items that are essential for a better brain. She applied scientific knowledge to practical problems. After some time, five of her students finished college and many more benefitted from the enriched environment by gaining many skills. 

I chose this documentary as part of my assignment because I think that Dr. Diamond’s work positively changed science and proved that the brain is affected by the environment. I was also interested in learning about the origin of neuroplasticity and the research behind it.  This assignment helped me understand and learn about the endless potential that each person has when pursuing goals and gaining independence. I think that it is important for each person to understand the benefits of Dr. Diamond’s research; neuroplasticity shows that each person has an equal opportunity to reach goals. From my past assignments, I have learned about neuroplasticity and how the brain rewires itself to adapt and succeed in the environment. Thus, this assignment helped me understand in more detail about neuroplasticity. Overall, I highly recommend this documentary to anyone that would like to learn more about neuroplasticity and Dr. Diamond’s research. 

Luna Productions. (2016). My love affair with the brain: The life and science of Dr. Marian Diamond. https://lunaproductions.com/my-love-affair-with-the-brain-streaming-ica-special-offer/

Thriving in the Face of Adversity

I watched an empowering TED talk titled, “Thriving in the Face of Adversity | Stephanie Buxhoeveden | TEDxHerndon.” The video described Stephanie’s experience with multiple sclerosis (MS), along with her interpretation on life challenges, overcoming adversity, and choosing strength over denial. Stephanie also discussed various symptoms of MS, along with relapsing-remitting MS. After listening to Stephanie’s story, I researched and learned about the different types of MS. Also, I compared Stephanie’s symptoms and prognosis with online research studies to recognize variability. 

At the beginning of the Ted talk, Stephanie presented three different pathways to choose between, when faced with a difficult situation; deny, cope, or thrive. Stephanie chose to thrive because she understood that some things in life can be challenging. At some point, life might give you something unfair, take something from you, or interfere with your plans. After watching this video, I understand that no matter what one’s challenge is, one can choose to thrive and find purpose in the challenge. Moreover, a challenge that might seem difficult at first, could be used as a gift to help make the world a better place. 

Stephanie was diagnosed with MS at the age of 25. She was a neurosurgical intensive care nurse and a graduate student. In her free time, she loved to workout. One day when she was working out, her right foot fell asleep and never woke back up. Within the next week, the numbness that began in her foot, began to travel up her legs. At first, she thought that it was a sports injury and disregarded the symptoms. Soon after, the day arrived that she was to put her student skills to the test and administer anesthesia to a patient. She was getting dressed in the hospital locker room and fumbled, while putting on surgical scrubs. At this point, Stephanie knew that her legs were numb, she had no feeling from the waist down or her right arm, and her vision was a blur of bright florescent lights. Next, she called her teacher, who instructed her to go to the ER. Stephanie quickly realized that she couldn’t even make it to the elevator. Upon arrival to the ER, she had spinal taps, MRI scans, and IV infusions. Stephanie was then diagnosed with MS; she was one of 2.3 million people living with MS. At my surprise, I learned that MS most commonly begins to effect people 20-30 years of age. 

After watching this Ted talk, I learned that there is no cure for MS and the cause is unknown. I learned about the variety of symptoms that include vision and hearing problems, cognitive decline, tremors, pain, bowel and bladder problems, numbness and tingling, and difficulty walking. Furthermore, I learned that there are some treatments for MS, but they are not guaranteed to work and could come along with serious, sometimes deadly, side effects. MS is an autoimmune disease of the brain and spinal cord; one’s immune system attacks the nerves. During the Ted talk, I thought that Stephanie did a great job of comparing a TV wire to the human nerve fiber. A TV wire needs insulation to conduct electricity, and nerves need insulation in order to conduct signals in the human body. For nerves, the insulation is called myelin. In reference to the TV wire, if it is damaged or cut, the HD picture would become unreliable. Likewise, immune cells target and destroy the myelin around nerves, leaving the inner wiring of the nerve exposed and causing the nerves to be unreliable. Overtime, scar tissue forms around these nerves, creating permanent lesions that can be seen on MRI scans. 

Stephanie specifically discussed her diagnosis of relapsing-remitting MS: periods of sudden attacks or new lesions formed, followed by dormancy. Relapsing-remitting MS is the most common form of MS, and it is the only type that is somewhat treatable. Progressive forms of MS do not have a treatment, and those with relapsing-remitting MS can move to progressive MS at any time. Stephanie said that she has had hundreds of injections, thousands of pills, and monthly IV infusions for MS. These treatments help suppress her immune system and keep her symptoms somewhat controlled. 

Something that really stood out to me is that Stephanie’s doctor wrote, “Advise patient to pursue new career options, prognosis poor.” As a future occupational therapist, I understand that nothing is impossible with determination and perseverance. I am inspired by Stephanie’s idea to create a website for those who have questions about MS. On this website, Stephanie helps people understand MS and promotes active participation in their own care. Stephanie used her determination and became a board-certified MS nurse, just six months after being diagnosed with MS. Also, Stephanie took an active role in research and participated in clinical studies to further understanding of MS. I chose this TED talk as part of my assignment because I am inspired that Stephanie did not allow her challenge to halt her ambitions. Moreover, Stephanie stated that her experience made her a better nurse, a better person, and gave her a better purpose for life. Also, I chose this TED talk because I was interested in learning more about MS, and I thought that Stephanie’s story was an empowering and educational opportunity to learn more about it. 

I think that Stephanie’s experience was a great example of overcoming barriers in life to reach one's full potential. After watching this video, I am even more motivated to practice empathy, encouragement, and comfort when interacting with clients. This assignment and video helped me understand that no two people are alike with the diagnosis of MS. Each person is unique and deserves respect and understanding. Overall, I recommend this video to anyone who would like to learn more about MS and gain insight from someone with this disease. 

TED. (2015, April 3). Thriving in the Face of Adversity | Stephanie Buxhoeveden | TEDxHerndon. [Video]. https://www.youtube.com/watch?v=zuLOT6GsAxw

Andrew's Story: Guillain-Barré Syndrome

I watched a YouTube video titled, “Andrew’s Story: Guillain-Barré Syndrome.” The video describes Andrew’s story of Guillain-Barré Syndrome (GBS), along with mentioning Andrew’s symptoms, prognosis, and diagnostic process. To further my learning on GBS, I researched other cases and experiences. Also, I compared Andrew’s story with other evidence online to gain a better understanding of the diagnosis.

To begin, Andrew enjoyed playing his guitar, working out, outdoor activities, and spending time with his girlfriend. He went to EMT school and became a firefighter. Shortly after this, he experienced symptoms of severe weakness and numbness in his feet, which led to no longer being able to walk normally. To confirm the GBS diagnosis, he had a spinal tap at Saint Thomas Rutherford Hospital. Within four days, he could no longer walk. Then, he began treatments of intravenous immunoglobulin (IVIG) and plasmapheresis, which are special blood treatments. Soon after this, he was placed in ICU and experienced symptoms of pain, blurred vision, facial paralysis, numbness in the arms, and continued weakness in breathing and swallowing. Next, he had a femoral catheter placed and was sent to the ER. Then, he lost his ability to swallow and had a nasogastric intubation (NG) tube inserted. Next, he realized that it became difficult for him to digest his new liquid diet. The drugs given to stimulate his digestive system caused major abdominal pain, and he had to constantly use a suction cup to breathe.

It was difficult and exhausting for Andrew to sleep. One night, he began aspirating and suffocating. He was placed on a Bilevel Positive Airway Pressure (BiPAP) machine and put back in ICU. Soon after, he decided to be intubated and to be on life support. During intubation, he went into cardiac arrest after being given succinylcholine; this medication is contraindicated for GBS patients. He was in cardiac arrest for seven minutes, and he was shocked three times before returning to a life supporting heart rhythm. At this point, he was paralyzed from the neck down and experienced migraines, blurred vision, and a burning sensation in his bones. For communication, he used a communication board, since he was unable to speak at the time. After being intubated for 10 days, he decided to have a tracheostomy and peg tube placed. He declared that the trach tube malfunctioned sometimes and was very uncomfortable. Next, he used a Passy-Muir valve (PMV) and received speech therapy, which allowed him to smile again. At this time, he experienced painful wound care. He needed help repositioning and constant mouth and bathroom care. 

After being weaned off of the ventilator, he began breathing on his own, and his arm movement began to come back. About 10 days after his first signs of recovery, he was throwing a football from his hospital bed. Soon after that, he was feeding himself with little assistance, playing the guitar again, and was reunited with his girlfriend. Next, he went to Shepard Center; one of the top ten best rehabilitation hospitals in the nation ranked by U.S. News & World Report. Here, he worked with parallel bars, tilt tables, and participated in five hours a day of intense therapy; Andrew began to gain his independence back. After he was fully recovered, he did outpatient therapy for two months and resumed his job as a firefighter. 

Throughout this video, I noticed that Andrew had a great support system: his family, friends, girlfriend, and healthcare staff. Whether it is a family, a friend, or a healthcare provider, I think that it is important to have support during a situation like this. I chose this video as part of my assignment because I think that Andrew’s story was a great example of never losing hope when faced with a difficult situation. Also, I was interested in learning more about GBS, and I thought that Andrew’s story was an informative and inspiring chance to learn more about it. 

As a future occupational therapist, I think that it is important to remember that one has the opportunity to positively change many lives, and to always go the extra mile to help someone reach independence. After viewing this video, I learned about the value and importance of one’s independence in everyday life. Andrew said, “It felt like I was trapped in my own body.” This statement really stood out to me. Occupational therapists have the ability to help others regain lost abilities and reach their goals. Thus, this assignment and video helped me gain imperative insight on the lasting, positive impacts therapy can have on an individual. In addition to the positivity of therapy for GBS, I gained knowledge on the different types of interventions and treatments used during Andrew’s therapy sessions. Overall, I highly recommend this video to anyone that would like to learn more about GBS and Andrew’s story.

Franek, A. J. (2017, August 1). Andrew’s Story: Guillain-Barré Syndrome. YouTube. https://www.youtube.com/watch?v=VWvrHhs2jps

Locomotion and Adaptive Devices

In order to appropriately fit a patient for the use of an assistive device, it is important to look at the whole person, while keeping safety as the primary concern. Proper measurements for the assistive device are important to ensure safety and stability. From a physical standpoint, consider the patient’s weight bearing status, and if they have any limitations on fully putting weight on both upper and lower extremities. Also, consider if the patient has any weight bearing restrictions that can occur after a surgery or a fracture. Additionally, think about the client’s endurance, speed of fatigue, and the number of breaks needed. Next, age is an important factor when fitting client’s because different recommendations will be given for a younger client compared to an older client. From a psychological standpoint, it is important to consider the client’s degree of confidence, fear, or apprehension. If a client is nervous about using a device, they are more likely to get injured. Also, look at the client’s cognitive status, and if they understand the safety features of the device.

For fitting a cane, the hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter of the femur. The elbow will be relaxed and slightly flexed to 20-30 degrees. The shoulders should be relaxed and not elevated. The cane is the least stable assistive device because it only has one point of contact with the ground. Thus, in order to use the cane, the client must have good stability. I would inform the client that the cane will be used on the opposite side of their weak leg. When walking, the cane will move in sync with their weak leg. There are different types of canes to consider for clients. For example, the standard cane allows the most freedom of movement, and the quad cane provides additional stability with four points of contact.

For fitting axillary crutches, the hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter of the femur. The elbow should be relaxed and flexed to 20-30 degrees. The axillary rest should be about 4 fingers width or 5 centimeters below the floor of the axilla. The shoulders should be relaxed, not elevated, to prevent increased pressure, which would lead to damage of the brachial plexus.

The Lofstrand crutches are fit similar to the axillary crutches. The hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter of the femur. The shoulder should be relaxed, not elevated, and the elbow should be flexed to 20-30 degrees. Lofstrand crutches offer more stability than canes, but less stability than axillary crutches. Also, Lofstrand crutches are for clients with long-term disabilities. These crutches have an arm cuff that wraps around the client’s proximal forearm. Lastly, these crutches allow for more dynamic movement and control in small spaces.

The same measurements should be taken when fitting a client to a walker, just as when fitting a client to a cane. For fitting a platform walker, the forearms should be supported and in a neutral position. In order to prevent falls, it is important for the platform walker to be fitted correctly to the client. Likewise, the client’s height should be measured appropriately to ensure proper weight distribution. The platform itself is the steering device and is used for people with fractures of the upper extremities, wrists, or those who can’t grip onto the handles.

For fitting a rolling walker, it is still measured the same as fitting canes and standard walkers. This walker should be measured appropriately by the client’s height (while standing) to ensure adequate weight distribution for their arms. This walker is for individuals who can’t lift a walker due to upper extremity weakness or individuals who have impaired balance.