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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!