1. Equipment Part II: Developmental Motor, ADL, and Communication Spring Break, March 28, 2006 (GRAT and Cases NEXT week!)

2. 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

4. Early mobility Spatial Perception Normal limit setting Seated mobility not “normal” but so what? Caster cart and variants

6. Standers Upright Prone Supine Adjustable Mobile Dynamic vs Static Weightbearing Need trays or use at tables

8. Prone standers Facilitate trunk extension Require good head control

10. Upright standers “Normal” position Commonly used for people with spina bifida Simpler design, lighter, less space needed

12. Supine standers Maximum support, variable angle

13. Tilt table

14. Adjustable designs

15. Easy Stand Magician Options for independent or powered lift Options for conversion to mobile Pediatric to Adult sizes

16. Standing wheelchairs Power or manual http://www.usatechguide.org/itemreview.php?itemid=131

17. 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

18. 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

20. !!!!

21. Rifton style Uses “prompts” MOVE/conductive education philosophy

22. Cricket/Pony style (prone support)

24. Walking means… Community* Household* Exercise only Assisted only Device vs helper * RLA “Functional” classification

25. ARJO Early rehab With enough help, anyone can “walk” at least a little

26. 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 (?)

27. 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

29. T.L.C. style

30. Many options Overhead track lifts desired but rarely funded (CMS, Waiver)

31. Will it fit? See also the Slider: http://www.adaptivemall.com/slidbatchair.html

33. 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

34. ADLs - Eating Ataxia – bigger, heavier utensils Reduced dexterity – swivel and/or bent spoon

36. Winsford feeders Cheek switch to scoop and present food Need some head control Hands-free

37. Food preparation

38. Cultural relevance

39. Dressing, doors, reaching

40. Miscellaneous gadgets

41. Writing and typing Writing bird, typing stick (or use pencil eraser end down in cuff) Don’t underestimate two or even single finger typing

42. 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

43. 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

45. 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

46. The Strawberry Shake Story

47. 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!