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.

Social Determinants of Health

Social determinants of health (SDoH) are factors that include socioeconomic status, money, employment, education, social support, physical environment, and access to healthcare. SDoH are influenced by where people are born, live, and work. Some people are born into situations at a disadvantage and don’t have access to these factors. When these factors are linked to a lack of opportunity, health risks can occur. SDoH affects the nervous system by development and the ability to function. When a person has stress, they experience allostasis; a process of adapting to stress. As the body adapts, one may experience an increase of blood pressure, headaches, and GI problems. Additionally, the allostatic load influences the nervous system, which influences biobehavioral factors. Next, behavioral factors include things like physical activity, diet, and alcohol use. For example, a poor diet leads to the development of blood pressure problems, which leads to long-term consequences and an increased risk of stroke. Lastly, a social factor is no access to the gym, which leads to risky behaviors.

When someone is stressed, their adrenal glands produce high levels of cortisol, which leads to health issues. These health issues could include high blood pressure, obesity, or diabetes. Specifically, high levels of cortisol diminishes the function of the PFC and reduces the number of connections in the hippocampus, causes memory problems. UTHSC’s OT program requires students to complete service and professional development hours, which serves to facilitate career preparedness. UTHSC prepares students to think from an upstream approach, one that considers a client’s living and working conditions, instead of just the diagnosis. Moreover, students learn how to ask important questions, break barriers, work together, and contribute to building health in the community. Now, I understand the importance of the context of a client’s life and can provide the best standard of care.

Transfers

The hierarchy of mobility skills goes in the following order: bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADLs, toilet and tub transfer, car transfer, functional ambulation for community mobility, and community mobility and driving. I think that this hierarchy is in this particular sequence because skills are built sequentially. Moreover, it is important that the client is able to perform the steps that are at the bottom of the hierarchy and then progress to the more challenging skills at the next level. The order of the hierarchy is mostly what I would expect because of my observations at Covington Care Nursing and Rehabilitation. Here at this skilled nursing facility, I observed occupational therapists help clients move up the hierarchy order from wheelchair transfers to bed transfers. I agree to the order of this hierarchy, but I do think that all clients are unique. Thus, not all clients progress at the same rate or order. I believe that occupational therapists are great at adapting to the situation and should encourage clients based on their unique improvements. Furthermore, I believe that safety should be of the highest importance at all times, especially if the client is progressing in a different order.