Transcript Advances in Pediatric Rehabilitation: Wii

Advances in Pediatric Rehabilitation:
Wii-Hab and Other Modalities to
Engage Children in Rehabilitation
JULIE GIBNEY, PT
REINA MIRANDA, OTR/L
MELISSA WORSDALE, MA CCC-SLP
Physical Therapy
Julie Gibney, PT
Staff Physical Therapist
Broward Health –
Coral Springs
Objectives:
1. Review of Wii-hab and how it is used in the
pediatric physical therapy and occupational
therapy settings.
2. Current technologies used in the outpatient
physical therapy and occupational therapy
settings.
3. Use of Ipad in rehabilitation.
4. Other current technologies and AAC used in
speech therapy setting.
Assistive Technology:
• Assistive technology is an umbrella term that includes
assistive, adaptive, and rehabilitative devices.
• And also includes the process used in evaluating patients for
devices.
• Promotes greater independence.
• Keeps clients motivated.
Physical Therapy
• Physical therapists (PTs) are licensed health care professionals who
can help patients reduce pain and improve or restore mobility - in
many cases without expensive surgery and often reducing the need
for long-term use of prescription medications and their side effects.
• Physical therapists can teach patients how to prevent or manage
their condition so that they will achieve long-term health benefits.
PTs examine each individual and develop a plan, using treatment
techniques to promote the ability to move, reduce pain, restore
function, and prevent disability. In addition, PTs work with
individuals to prevent the loss of mobility before it occurs by
developing fitness- and wellness-oriented programs for healthier
and more active lifestyles.
What is Wii-Hab? And who uses it?
• The use of the Nintendo Wii to assist rehab
clients with improving functional mobility.
• Use of the Wii can be used for clients with
gross motor and fine motor deficits.
• Many different types of clients from those
with orthopedic surgery to clients with
cerebral palsy. The Wii can also be used with
clients in many different age groups.
Requirements for use of Wii:
• Clients must be able to follow at least one step
commands to participate in Wii-hab.
• To use the Wii clients must be able to see the
television from 3-4 feet away.
• To use the Wii balance board clients must be
able to stand with moderate assistance.
Using the Wii:
• The Wii has a hand controller and a balance
board each of which can be used for different
games and purposes.
• Both parts of the Wii are a fun way to exercise
along with building balance and coordination.
• Clients enjoy trying to beat their last score and
will sometimes compete with their therapist.
• The balance board allows us to measure
differences in weight bearing from right to left
allowing the client to work on static and dynamic
balance.
Goals for therapy:
• Inpatients vs. Outpatient setting goals.
• All goals need to bring the clients to more
functional level and need to be measurable to
show that progress is being made.
Home Exercise Program:
• Many families have access to a Wii and can follow
through with activities done during therapy.
• If the family does not have access to Wii then the
home exercise are incorporated into their
activities of daily living.
• Hopefully of all clients with or without access to
the Wii will complete their HEP with their family
to increase family time by competing with family
members.
Other Technologies:
• Walk-aide uses a cuff that goes around a
clients calf to deliver functional electrical
stimulation to assist clients with foot drop.
• There have been many advances in
positioning devices for clients such as
standers, wheelchairs, and gait trainers.
• Wheelchairs can now be driven by the user
with almost any part of their body or with
vision or voice commands.
Occupational Therapy
Reina Miranda, OTL/R
Staff Occupational
Therapist
Broward Health –
Coral Springs
Occupational Therapy
• Living Life to the Fullest
• Independence
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Activities of daily living
Instrumental activities of daily living
Participation in school/work
Social participation
• Services include:
• Evaluation in the home or other environment
• Recommendation for adaptive equipment
• Caregiver/family education
• Holistic perspective
• Adaptive environment to fit the person
• Client-centered practice
Occupational Performance
• Person factors
– Physical
– Cognitive
– Social/Emotional
• Environmental factors
– Context
• Physical (school, home, hospital)
• Social (family support)
• Temporal (weather, time, etc)
• Occupation factor
– Activity analysis
– Individual tasks of each activity
Occupational Therapy
Pediatrics
• Developmental delay
• Prematurity
• Cerebral Palsy
• Downs syndrome
• Autism
• Sensory Processing Disorder
• Fine motor delay
• Visual motor delay
• Stroke / TBI / SCI
• Brachial plexus injury
Adults
• Stroke
• Traumatic brain injury
• Spinal cord injury
• Joint replacement
• Generalized weakness
• General post-operative
• Upper extremity injury
– Hand therapy
• Alzheimer’s / Dementia
• MS, Parkinson’s, ALS, etc.
Examples of Goals
Inpatient setting
• ADLs
– Client will don shirt with min
assist.
• Transfers
– Client will demonstrate
commode transfer with safe
hand placement with min
verbal cues.
• Cognitive retraining
– Client will follow 2-step
command 75% of the time.
Outpatient setting
• ADLs
– Client will complete 3 of 4
buttons on self
independently.
– Client will tie shoe laces with
supervision in 2 of 3 trials.
• Hand therapy
– Client will gain 70 degrees of
wrist supination to brush hair.
– Client will reach over head
with 145 degrees of shoulder
flexion to place item on shelf.
Uses of Apps in
Occupational Therapy
• Fine Motor
– Pincher Peeps
– ABC Alphabet (handwriting)
– Maze (index finger isolation)
– Dexteria (to improve dexterity)
• Visual Motor / Visual Perceptual Skills
– Visual Attention Therapy app
– Labyrinth
– Puzzle app
Uses of Apps in
Occupational Therapy
• Cognition
– Mazes, puzzles, memory games
• Balance and Core Strengthening
– Yoga apps
• Sensory
– Visual, auditory, and tactile stimulation apps
• Other
– Making Change app (money management)
– Visual schedule (routines)
Other Assistive Aides
• Activities of Daily Living
– Sock aide
– Long handled shoe horn
– Reacher
• In the home
– 3-in-1 commode
– Shower chair / tub bench
– Grab bars
• In the classroom
– Pencil gripper, slant board, weighted pencil, self-opening scissors,
raised-lined paper
– TheraBand, seat cushion, fidget toy, chewy necklace
Speech Language Therapy
Melissa Worsdale, MA
CCC/SLP
Staff Speech Language
Therapist
Broward Health –
Coral Springs
What is Speech and Language?
• Speech- a means of
communicating
verbally.
• Components of speech
– Articulation
– Fluency
– Voice
• Language- rules agreed
upon by a society of
what words mean and
how they go together.
• Components of
language
– Receptive Language
– Expressive Language
Components of Speech
• Articulation- how sounds are produced (i.e.
can they make the /p/ or /m/ sound
correctly).
• Fluency- the actual rhythm and flow of
speech.
• Voice- the quality, pitch, loudness level, and
resonance needed to produce sounds.
Components of Language
• Receptive Language- the ability to understand
the spoken word.
• Expressive Language- the ability to express
one’s wants, needs, ideas.
Speech/Language Disorders
• Children with speech/language disorders benefit from
technology such as the Ipad.
• Increases motivation and facilitates engagement in session.
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Speech Apps
ArtikPix
Mouthworks
Turtle Talk for Fluency
Voice apps
Language Apps
• Sounding Board
• Word Sampler
• Sight Words by Photo Touch
Speech/Language Disorders
• Depending on level and needs of clients’
different assistive technology can be used.
• Goal of assistive technology when working
with clients with language disorders is to act
as a bridge for communication.
Augmentative and Alternative
Communication (AAC) systems
• Unaided communication- rely on client’s body
to convey messages.
• Aided communication- rely on client’s body
and equipment to convey messages.
AAC
• Low tech- these devices generally contain no
electrical component.
• Mid tech- these devices often have prerecorded
words and keyboard with voice output although
limited in what can be programmed.
• High tech- these devices contain array of
software where individual would select button
and choices will then present for individual will
select.
AAC
• Picture Exchange
System
• Novachat
• IPAD
Clients that have benefitted from
Technology in Outpatient Rehab
setting…
• Client 1: AA
– 10 year old female with cerebral palsy
– Received PT, OT, and ST
Clients…
• Client 2: CH
– 16 year old female with AVM and multiple strokes
– Currently receives PT and OT and previously
received ST
Clients…
• Client 3: AA
– 8 year old male with autism and apraxia of speech
– Receives OT and ST and previously received PT
References:
• www.apta.org
• www.asha.org
• www.aota.org
Questions/Comments
• Thank you for allowing us to come speak with
you.
• Rehab Department phone number– 954-344-3180
• [email protected]
• [email protected]
• [email protected]