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Equipment Part II: Developmental Motor, ADL, and Communication Spring Break, March 28, 2006 (GRAT and Cases NEXT week!)

Crawl, Sit, Stand, Make Your Parents Childproof Your House  Head up in prone

– 3 months 

Wedge

 Sitting and

postural reflexes – 6 months  

Bolster Corner Chair

 Crawl, creep  Scooter board  Crawlabout

Early mobility  Spatial Perception  Normal limit setting  Seated mobility not “normal” but so what? 

Caster cart and variants

Standers

 Upright

 Prone  Supine  Adjustable

 Mobile  Dynamic vs Static Weightbearing  Need trays or use at tables

Prone standers  Facilitate trunk extension  Require good head control

Upright standers  “Normal” position  Commonly used for

people with spina bifida  Simpler design, lighter, less space needed

Supine standers  Maximum support, variable angle

Tilt table

Adjustable designs

Easy Stand Magician  Options for independent or powered lift  Options for conversion to mobile  Pediatric to Adult sizes

Standing wheelchairs  Power or manual 

http://www.usatechguide.org/itemreview.php?itemid=131

Walkers and Gait Trainers  Wider base of support  May have added supports and modifications

for gripping ability  Gait trainer implies more supports  Weight, freedom of movement can vary  Face front or reverse  Should NOT be usable like baby walkers (slump and kick method)  TRY out in therapy first whenever possible

Designs  Forward facing – visual support, folding  Reverse – better LE extension, avoid LOL mode  Add-on supports – abductor, pelvic stabilizer,

arm troughs for poor grip or protecting joints

!!!!

Rifton style

 Uses “prompts”

 MOVE/conductive

education philosophy

Cricket/Pony style (prone support)

Walking means…  Community*  Household*  Exercise only  Assisted only 

Device vs helper

* RLA “Functional” classification

ARJO  Early rehab  With enough help,

anyone can “walk” at least a little

Bone and joint development  Limited evidence in PT literature for efficacy of

static standing  “Ballistic” weightbearing believed necessary for normal stimulus to bone mineralization / ossification  Boys with Duchenne start losing bone before sitting down, documented in pre-steroid era  No real evidence for bowel, bladder, respiratory benefits  Prevent contracture, coxa valga, acetablular dysplasia (?)

Bath equipment and lifts  Car and bath transfers most difficult  Weightbearing transfers ideal when feasible  Assisted standing and walking get easier as child gets taller, not harder (vs. total lift)  Lift equipment better strategy than chronic undernutrition  Decide how much support needed in bath,

recline vs back support  Waiver may help with roll-in shower, use different equipment than regular tub/shower

T.L.C. style

Many options  Overhead track lifts desired but

rarely funded (CMS, Waiver)

Will it fit?  See also the Slider:

http://www.adaptivemall.com/slidbatchair.html

Going potty  Not necessary to wait for

walking and talking  Support feet, trunk if needed, reduce size of hole to reduce fear of falling in

ADLs - Eating  Ataxia – bigger, heavier utensils  Reduced dexterity – swivel and/or bent spoon

Winsford feeders  Cheek switch

to scoop and present food  Need some head control  Hands-free

Food preparation

Cultural relevance

Dressing, doors, reaching

Miscellaneous gadgets

Writing and typing  Writing bird, typing stick (or use pencil eraser

end down in cuff)  Don’t underestimate two or even single finger typing

Computer access  Simple handwriting replacement – consider

portable keyboard instead  

AlphaSmart QuickPad

 Voice recognition still improving  Slower, hands free use possible  Adaptive keyboards  Smaller for weaker, less mobile hand use  Larger for less accurate hand use  Special ergonomic  One-handed (software vs hardware)  Alternative mouse access

Motor, sensory, or cognitive issues  Trackball or Mouse Keys for mouse if can see it  Tactile mouse for blind person experimental 

Need keystroke navigation

 Screen reader – text to speech  Magnification software, large monitors  Voice rec. – speech to text 

Different correction strategy

 Scanning access – severe motor issues  

Low efficiency Compensate with word prediction

AAC (Alternative – Augementative)  Prerequisites vs Participation  Interdisciplinary evaluation mandatory  May Rx “therapy units as needed”  Different choices for ambulatory vs not  Verbal communication may increase  Communicate more than basic needs to familiar

caregivers  May interface with computer  Training and programming issues 

Literate English vs special language vs pictures

 Need for support

The Strawberry Shake Story

THE TOP TEN ADAPTED SLOGANS  10.OT- Function, Folks,  





and Fun 9. OT- You got the right one baby, uh-huh! 8. OT- When you care enough to have the very best 7. A.O.T.A.Membership has its privileges. 6. Male OTs- You've come a long way, baby.

 5. _T- "I'd like to buy a

vowel, Pat."  4. OT- Built for the human race.  3. OT- Real Therapy for Real People  2. OT- it does a body good.

 1. OT- JUST DO IT!