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

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

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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:

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!