Transcript Equipment Prescription for Pediatric Mobility

Equipment Prescription
for Pediatric Mobility
This series will empower you to:
Objectives
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Explain what is the same and what is different about
pediatric seating and mobility
Set pediatric mobility goals and choose the best equipment
to achieve them
Overcome "Phony Prerequisites" and otherwise justify use of
specialized equipment to families and third party payors
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(OK, maybe 70% of the time anyway)
Troubleshoot problems with equipment
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(As long as it is brought in to clinic or you at least have a photo)
So What's the
Difference?
(What are you going to tell us that
Dr. Smelz didn't, big shot pediatric
person, huh?)
Growth and Development
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Adults - Focus on Function
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Children Also Grow and Develop
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Size concerns
Orthopedic concerns
Developmental milestones
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Age appropriate expectations
Equipment helps recreate or simulate usual sequence
Growth adjustability and replacement
Orthotics every 6 months
 Wheelchair-Equivalent every 3 years
 Less well defined for other items
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Correct Sizing
Seat depth and slump
 Seat width and reaching
wheels, using trunk supports
and/or hip guides
 Footrest length, distal thigh
support
 Back height and chest
harness
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Troubleshooting 101
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"Start at the pelvis“
Seat to back angles
Pelvic tilt
Pelvic obliquity
90 recline tilt
reverse
Orthopedic Issues
Bad seating aggravates
 But - “You can’t do orthopedic
surgery with a wheelchair!”
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- Dr. Richard McCarthy
Custom Molded Seating
WARNING – WARNING – “HISTORICAL PERSPECTIVE” ALERT!!
Limit use appropriately
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Asymmetrical fixed deformity AND poor postural control
Possibly in movement disorder for extra stability
Pressure relief vs. stability can be an issue
The Roseanne Rosannadanna Syndrome
(-or- Welcome to Trade Off City)
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some chairs don't fold
some chairs don't fold easily
no tilt chairs good for pushing
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power chairs break down more often
adaptive car seats comfy, supportive
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(will a fixed tilt or more trunk support do?)
but take up half the back seat!
and weigh a ton!
Sliders and Easy Stand Magician are great but you can't
make it up on volume if you're LOSING money
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(Why "Allowable" is a four-letter word.)
It “counts” as a wheelchair…
More examples
LIbre tilt – “yeah sure, it folds!” above
Nexus Roho-Jay hybrid cushion right
About powered mobility
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Minimum Age = About 18 months
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Medicaid won’t get any chairs until age 2 anyways
Hooray for parent support groups!
 Perfect vision, DL not required
 Some need training
 Some don’t!
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DEVELOPMENT –
Milestones
Sit 6 months*
 Floor mobility shortly thereafter (varies)*
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*DDS may fund, may need loan closet, school help
Stand 10-12 months
 Walk 10-14 months
 Drive 15-16 years
 Drive parents crazy 2 years and again at 13 years
 Get own health insurance 26 years
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GOALS
Functional and Developmental
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Independent Sitting
Crawling and Creeping
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Supported Sitting
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enable UE function
Independent walking
Assisted walking
Exercise walking
Weightbearing - static vs dynamic
Total lift versus weightbearing transfers
Driving
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getting into stuff and making the grownups childproof the house
supporting the auto insurance and body shop industries
Being safe while driving or being driven
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staying off the inpatient unit
How to Help - Sitting
Corner Chair
 Floor Sitter
 Bumbo Seat – less support
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http://www.brighthub.com/education/early-childhood/reviews/36686.aspx
Tumbleform feeder seat – more support
 Wedge – head/trunk control
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How to Help – Early Mobility
Crawlabout, Crawligator, Prone scooter
 Caster cart, big wheels up front 1st chairs
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How to Help - Standing
Prone, upright, supine
 Research lacking vs
“ballistic” weightbearing
 No “bad girl, go stand in
the corner!” syndrome
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More standers
Mobile Standers
Parapodium
 Swivel Walker
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Bridge to Parawalker?
Batmobile (“Dynamic
Stander”)
 Standing chimney with
orthotics
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Walking
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Walkers
Forward or reverse
Walker add-ons
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Weighted
Arm supports, troughs, “prompts”
Pelvic stabilizer
Abductor bar
Gait Trainers
Treadmill/weight relief systems
Crutches, canes, hemiwalkers
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age/coordination issues
Can’t hold on?
So what?
Baby walker style
Sit-slump-kick
syndrome
 Delays normal
walking ~ 1 mo
 Injury risks for
typical age use
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Lite Gait
Not generally
suited for
home use
 Pool therapy
alternative
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Transfer Aids - How To
Avoid the Ashley Treatment
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Passive or max assist transfers may be
necessary (try to avoid if possible)
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MDA, quadriplegia 2 SCI, low cognitive function
Bath options
Full support shower chairs
 Roll-in shower
 Bath bench with hand held
shower
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Specify back support,
padding if needed
Access and safety on the road
Forward facing essential
Secure to frame of chair
OUT of chair would be better!
What's a Waiver and what can we get
on it?
Still medical model, you will be asked for
prescriptions
 But medical profession less in control
 Focus on staying out of institution
 Less tainted with the idea that it must be
undesirable for use in the absence of disability
 Capped amount of funding per year
 Regular Medicaid must reject
 Aka Katie Beckett – most states under DDS
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Waiver Haiku (yes, this lecture could have been far,far worse…)
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Still no van or lift
Though we're off the
waiting list...
Bad case manager?
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On waiver whole year
But still giving daily bed
baths...
Needed the ramp first!