Mobility

The goal for mobility should be to use as little adaptive equipment as possible, in order to promote maximal unaided functional independence.

Goals of Mobility 1.Typical 2.Purposeful 3.Functional

Mobility Considerations Readiness to perform the mobility skill Goal-oriented and functionally based Interesting and successful experiences Practice Prompt use Across environments Energy use

Equipment for Mobility Scooters Walkers

Crutches and canes Wheelchairs Tilt Switch pneumatic Other mobility devices Mobile stander

Other assistive technology for mobility Weighted vests/cuffs Splints and braces Transfer boards Protective head gear

Assistive Strategies Rolling Crawling Creeping Scooting Cruising Walking Wheeling

Instructional Strategies Include in Individual Health Plan and IEP Choice making Fade prompts Use task analysis Data collection on student performance of mobility skills

Positioning and Handling

Common Characteristics with physical impairments contractures lack of normal motor patterns lack of proper positioning

Initial Procedure in Positioning and Handling Determine muscle tone (postural tone): the state of tension that the central nervous system (CNS), comprised of the brain and spinal cord, continuously exerts on all muscles of the body The level of muscle tone involvement will depend on the extent of the damage within the sensorimotor system.

Muscle Tone Hypertonia (also known as spasticity)Hypertonia Hypotonia Fluctuating and Mixed Tone (athetosis)athetosis Primitive Reflexes

Factors which effect muscle tone physical health mood level of fatigue medications environmental factors such as temperature and noise level activity level in the room

Main Goals of Positioning and Handling To bring muscle tone as close to normal as possible To minimize the occurrence of primitive reflexes To facilitate active movement in typical patterns within the normal developmental sequence

Handling Guidelines 1.Techniques which alter muscle tone are usually used to prepare the child ’ s body before requiring active participation 2.A child ’ s body is usually handled at the head, shoulders, trunk, or hips 3.The facilitator should try to guide the child ’ s body in typical patterns of movement as the child ’ s muscle tone changes 4.Handling techniques should not be overused

Assistive Strategies for Therapeutic Handling Inhibition Techniques Gentle shaking or rocking Relaxation in side-lying Relaxation in supine Slow rolling Deep pressure Neutral warmth Sensory Stimuli

Assistive Strategies for Therapeutic Handling Stimulation Techniques: Rapid, irregularly timed rolling, shaking, rocking and bouncing Joint compression quick stretch to a muscle Resistance to a desired movement Tapping Vestibular stimulation Sensory stimulation

Rules for Positioning Frequent Changes Symmetrical/ Resting Comfortable Adequate Support Gradual

Therapeutic positioning without systematic instruction is insufficient to meet the educational needs of students with physical impairments. Positioning should be viewed as a facilitator to maximum participation in educational tasks.

Precautions Medical Considerations Sense of Security Slow Reassess Position Multiple Positions

Reasons for Positioning Normal Tone Stability Respiration Prevent Congestion Prevent Pressures Prevent Deformities and Contractures Comfort Normal Posture Body Alignment Midline Orientation Motor Skill Maintenance Motor Skill Improvement Environmental Interaction

Equipment for positioning sitting adult ’ s body pillow-like rings (baby boppies) swim rings rolls bolsters and bolster chairs Therapy balls Benches Tumble-form floor sitters trays

Sitting Positions Pretzel or tailor sitting Ring sitting Long sitting Side sitting Heel sitting W-sitting

Equipment for Standing lower extremity orthoses (braces)

standing frames prone standers

supine standers mobile standers

Assistive Strategies for Standing 1.Determine if standing positioning is appropriate for the student 2.Obtain instruction in positioning from the PT (should include body alignment and frequency of positioning) 3.Learn the proper set up of activities and materials Child ’ s time in standing device should be built up gradually (no more than 30 mins)

Proper Positioning of Instructional Materials Factors which may contribute to determining functional positioning of materials in the classroom will depend upon: Physical positioning and postural skills Range of motion Object manipulation skill and accuracy Visual skills Fatigue level of the child

Range Of Motion Considerations Determine material placement- within active ROM When a student is learning or being assessed, it is important that the material be placed within an easy active range of motion for that student If the student is working on a task that is already mastered, the material may be placed within areas that are in the outer ranges of the student ’ s range of motion

Object Manipulation Requirements Examine what is required in order for the child to manipulate the material of the task Possible positions for the required materials Type of positioning usually used in activity Placement of the materials

Visual Skills Visual position may compete with manipulation position By modifying how the activity may be completed the child is able to participate in the academic learning experience with independence

Fatigue and Endurance Level Sometimes it takes a lot of energy for a child to access material, even when he is positioned optimally, the material is within his range of motion, and he has sufficient manipulation skills. As the student fatigues, he is less accurate and less able to continue with the activity Alternate positioning of the material which requires a different movement pattern may be helpful

Equipment and Adaptive Equipment for Positioning Material Work surface modification Positioning Devices Object modifications and low tech devices High tech devices Word processors Modified computers Calculators

Assistive Strategies for Positioning Materials Place items in good visual position Position items which facilitate good midline alignment Position items that allow for the greatest ease of movement of extremities

Lifting, Carrying, and Transferring

Lifting refers to the act of picking up the child Transferring refers to moving the child from one place to another

Equipment Mechanical Lifts hydraulic lift simple mechanical lift Assistive Transfer Devices transfer board transfer disc belts and straps

Transfer/ Lifting Basics Transfer considerations wheelchair transfers toilet transfers bathtub transfers Types of Lifting one, two, three person lift

Handling Considerations 1.Student Preparation 2.Key points 3.Functional Movement

Lifting Considerations 1.Weight/ load 2.Planning 3.Environmental arrangement

Strategies Body Mechanics and Proper Lifting the student ’ s arms and legs should never be used as handles never lift a child under the armpits…instead, the sides never twist your back, rotate your entire body never move a student by yourself when 2 or 3 people are needed or a mechanical lift

Lifting Body Mechanics 1.Plan 2.Broad Base 3.Posture 4.Thighs and Legs 5.Straight Back- up 6.Close 7.Key Points 8.Distance 9.Straight Back- down

Instructional Strategies Ecological inventory Task Analysis

Additional Notes Emergencies IHP Planning