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Orthotic Devices

Orthotic devices provide support for damaged joints, ligaments, tendons, and muscles. Although some orthotic devices are standard items, most are made to fit the needs and anatomy of individual patients.

Shoes

For safe ambulation, a physically disabled person needs well-constructed orthopedic shoes, which may have steel shanks and low rubber heels shaped to increase ankle or foot stability. The height of the shoes (oxford or high top) and closing system (shoelace, strap, buckle, or Velcro) may be modified to meet the patient's needs. If one leg is shorter than the other, a lift made of light material, such as cork, may be needed.

Walkers, Crutches, and Canes

These devices can aid ambulation in persons with chronic disability and those who have suffered an injury or undergone surgery. Walkers provide a movable, stable platform that protects the patient from falls, but they are not constructed to support weight. Walkers also slow gait and make climbing stairs and crossing thresholds difficult.

Ordinary crutches are usually inappropriate for the elderly, who often lack the upper-body strength and motor coordination to use them. Canadian crutches, which have forearm supports and hand grips, require less upper-body strength and are useful for the chronically disabled.

Canes help with balance and reduce the weight-bearing forces across the hip. Several types of canes are available, including some with four legs (called quad canes) that offer considerably more stability but, like walkers, slow gait. The height of a cane must be adjusted so that the patient's elbow is bent at slightly less than 45° when maximum force is applied. The head of the cane should provide a secure grip.

Fig. SG1. Proper cane height. The patient's elbow should be bent at slightly less than a 45° angle when maximum force is applied.

Leg Braces

A short leg brace, which stops just below the knee, is used for ankle disabilities. A knee brace, which extends from midthigh to midcalf, may be used for disabilities confined to the knee (eg, an inability to lock the knee caused by extensor weakness). A long leg brace, which reaches midthigh, is indicated for disabilities in both the ankle and knee. A long leg brace with a pelvic band and hip joint is used for disabilities of the ankle, knee, and hip. However, such a brace is seldom practical for a geriatric patient because it greatly increases the energy demands of walking.

A weight-bearing brace, with which the weight is borne at the tibial condyle or ischial tuberosity, may be prescribed for a patient with a nonunited fracture who cannot bear body weight on the affected leg.

Neck Braces

A neck brace is used to immobilize the head or to minimize weight bearing of the head. It can be attached to a rigid corset; usually it is not worn in bed. Soft neck braces are generally preferred because they are more comfortable and are less likely to injure the skin. Fitting a neck brace properly is essential to obtaining benefit.

Corsets

A corset is used to immobilize the thoracic or lumbar spine. Prolonged use may result in weakening of the abdominal and spinal muscles; corsets should not be used for vague reasons or in an attempt to improve a person's figure.

Arm Splints

The static splint maintains the range of motion of wrist and finger joints and prevents contractures. It should be ordered whenever contracture is likely, such as after a stroke. The dynamic splint allows wrist and fingers to perform such tasks as pinching and grasping and is often used with quadriplegic patients.

Wheelchairs

Two types of wheelchairs are available: indoor (large wheels in the rear) and outdoor (large wheels in the front). Most geriatric patients use the indoor model. Persons maneuvering in tight quarters may find a smaller model useful. A one-arm-drive wheelchair may be suitable for a hemiplegic patient with good coordination. A motorized wheelchair, which requires little strength, is prescribed for a patient who has little or no arm function. Because the wheelchair can go up to 5 mph, the user should have good coordination, vision, and judgment.

SELF-HELP DEVICES

Kitchen and Bathroom Aids

Many kitchen activities require considerable strength, coordination, and stamina, and certain devices can help impaired elders prepare meals. A high stool with a backrest provides comfort while a person works on a countertop. A rolling cart can transport heavy or cumbersome articles and decrease the number of trips between the kitchen and dining table. If the oven is too low to use comfortably, a tabletop electric broiler oven may be used. Heavy pots can be replaced with lighter aluminum ones, and unbreakable plastic dishes can be used rather than breakable china.

Tools with long handles such as a dustpan and duster can help avoid the need to stoop. Using a long-handled reacher for retrieving items from high shelves can avoid the need to climb on a ladder or step stool. Other useful items include an electric can opener, a jar opener installed on the wall, and a rubber cover that can be slipped over the door knob to provide a better grip. Occupational therapists can evaluate cooking skills and often can recommend creative and useful devices to improve a person's ability to function in the kitchen.

The bathroom is a particularly dangerous place for impaired elders. Space is tight, and surfaces are often slippery. Blood pressure may fall after micturition, defecation, or showering, causing a person to feel faint or lose balance. Assistive devices are often needed in the bathroom to ensure safety and improve function. Again, an occupational therapist can evaluate the person's needs. A hand-held shower head with an extension hose may be easier to use than a regular shower, particularly with a shower chair. Guardrails enable a person to get in and out of the tub more easily and safely. A bar of soap on a piece of rope can be hung from the neck to prevent losing the soap or slipping on it while bathing or showering. Instead of buying such soap, a person can place a regular bar of soap in a small bag made from a dishcloth with a loop of soft string attached, or a person can use a mitten with a pocket for soap. A shower caddy may be used to store necessary articles for bathing. Alternatively, a child's pool raft or a small air mattress can be floated in the tub with the necessary items on it. A raised toilet seat, available in medical and surgical supply stores, can make standing easier after using the toilet. Bathroom storage shelves should be adjusted to a convenient height.

Dressing Aids

Devices such as a long-handled shoehorn, hairbrush, comb, and toothbrush can help an impaired elder dress independently. A ring or an 18-in. cord with a metal hook at the end can be attached to a zipper, enabling women to close zippers in the back of their dresses. Other useful items for patients with limited range of motion of the hand or arm joints include a bootjack, elastic shoelaces, front-closure brassieres, and button hooks.

Aids for Low Vision

Many devices can help persons with poor eyesight. In addition, a number of support groups are available to offer advice and recommendations.

Hand-held magnifiers, with or without a light attachment, are often used by persons whose vision is mildly or moderately impaired. A concave magnifying mirror may help with grooming. Eyeglasses and telescopic lenses that can be permanently attached to the upper part of eyeglasses are available to supplement poor vision. Large-print editions of newspapers, magazines, and books are also available. Public libraries and bookstores have books available on audiotapes, and radio reading services are available.

Although moderate illumination is helpful for low vision, too much causes a whiteout effect, and too little causes a blackout effect. Reflected lighting is often better than direct lighting. A strong contrast of light and dark on a flat floor, as in a hospital corridor, may create the illusion of a step. Colors of hospital or other institutional interiors should be selected with the low-vision population in mind; pastels may please the medical staff but may be invisible to those with low vision. A door or the protruding corner of a wall should be painted with a high-contrast color.