Restoring confidence in mobility

The hierarchy of mobility skills begins with bed mobility then goes to mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADL, toilet and tub transfer, car transfer, functional ambulation for community mobility, and finally community mobility and driving.  This is very close to what I expected the "stages" of mobility skills to be like because each one builds on the other. I have seen this used when working with clients and I agree that it is the correct way to work with individuals on mobility.
From class and labs, I have learned that you start working with clients on tasks that are not as complex and then grade the individual up or down based on their performance.  This is why the hierarchy of mobility skills is in the correct order in my eyes because each one builds up to being able to perform the next. 

Fitting Assistive Devices

Fitting assistive devices to clients is very important and specialized to each person.  It is crucial to fit the device to the person so that they are able to use it for a long period of time.  As discussed in class, insurance companies expect a device to be used for a certain length of time before they will pay for another.  This is especially for children who may outgrow the device.  Another reason it is important to appropriately fit assistive devices is so that the client can use it safely. If a walker is too low when a person is using it, it could cause them to be flexed at their back and cause additional injuries to that person.  Another example would be a cane being too short cause the person to lean further to one side and could also cause them to fall when supporting themselves on it.

To fit an individual for a cane, they should be wearing shoes and the cane should be adjusted to the height of their greater trochanter.  They should use the cane on their uninvolved side as well.  To fit a person for axillary crutches, the axilla rest should be approximately 5 cm below the person's axilla. The handgrips also need to be adjusted to the height of the greater trochanter of the person with their shoes on.  The lofstrand crutches should attach the arm band approximately 2/3 up the forearm with the handgrips at the height of the greater trochanter and facing forward. 
A platform walker should have the handgrips adjusted to the height of the greater trochanter of the individual with shoes on. The platform should be set with the individual's elbow flexed at 90 degrees to allow weight bearing through their forearms.  The proximal forearm should be 1-2 inches off the platform to avoid compressing nerves.  The handgrip of the platform should be slightly medial for comfort of the individual.  Finally, a rolling walker should have the height adjusted to the person's greater trochanter while wearing shoes.  The front and back legs should be at the same height allowing the handgrips to be level as well.