Heidi Sanders, OTR/L. Amy Shuckra, MPT

Transcription

1 Adaptive Equipment

2 Heidi Sanders, OTR/L University of New Mexico Health Sciences Center, Los Pasos Program Amy Shuckra, MPT Shriners Hospitals for Children Salt Lake City, Utah

3 What is Adaptive Equipment? Taber s Medical Dictionary: Any device specifically designed and fabricated with the purpose of permitting or assisting persons with disabilities to perform life tasks independently (Thomas, 1993)

4 Advantages of Adaptive Equipment Increased independence Improved safety Prevention of secondary complications Physiological benefits

5 Types of Adaptive Equipment Walking Aids Wheelchairs Self Care Aids Developmental Aids

6 Walking Aids Types of walking aids in order of most to least stable and supportive: 1. Parallel bars 2. Walker 3. Axillary Crutches 4. Forearm (Lofstrand) crutches 5. Two canes 6. One cane

7 Walking Aids Parallel Bars Most stable Height and width adjustable

8 Walking Aids Forward Walker Very stable and easy to use Used with generalized weakness, need to reduce lower extremity weight bearing, poor balance and coordination With or without wheels

9 Walking Aids Reverse Walker Encourages erect posture, more energyefficient (Tecklin, 1994) With or without wheels Pelvic stabilizers and forearm supports available

10 Walking Aids Rifton Pacer Gait Trainer Increased support

11 Walking Aids Lite-Gait Trainer (Walkable) Partial weight bearing

12 Walking Aids Axillary Crutches Moderate degree of stability Requires good strength of upper extremity

13 Walking Aids Forearm (Lofstrand) Crutches Moderate degree of stability Provides more ease of movement Chosen for those requiring the use of crutches for long periods

14 Walking Aids Canes Provide limited stability Quad canes and poles are used for those who have lateral but not backward balance

15 Wheelchairs Goal: Provide optimal sitting position to allow the child the greatest degree of function

16 Wheelchairs Optimal and functional seating: Neutral pelvis Hips and knees flexed to 90 degrees Head aligned over the trunk Trunk at midline over pelvis providing equal weight on ischial tuberosities Feet resting on support surface Upper extremities kept free for function (Tecklin, 1994)

17 Wheelchairs Types of wheelchairs Manual Tilt in space

18 Adaptations to the Wheelchair Solid Seat Solid Back Head Support Tilt in Space Lateral Trunk Supports Lateral Hip Supports Hip Abductors Seatbelt Chest Support Trays

19 Self Care Aids Toileting Aids Bathing Aids Feeding Aids

20 Self Care Aids Toileting Modular Toileting System Bedside Commode Safety Rails Potty Chair Ring Reducer Steps

21 Self Care Aids Toileting Modular Toileting System Deflector and pan Hip and chest straps Anterior support and armrests Abductor Headblocks Reclining Low or high back Footboard

22 Self Care Aids Toileting Bedside Commode Useful when bathroom is not accessible Decreases amount of transfers Requires good head control and fair trunk control Stable or drop arm rests available Frames may fit over standard commode when needed for increased stability

23 Self Care Aids Toileting Safety Rails Assist with transfers/balance Allows free use of hands Potty Chair For smaller children Allows feet to rest on floor Also accessible via crawling

24 Self Care Aids Toileting Ring Reducer Decreases width of seat Provides increased stability Steps Assist smaller children with transfer Supports feet Assists in pushing

25 Self Care Aids Bathing Modular Bathing System Wrap-around Support Systems Shower Chairs

26 Self Care Aids Bathing Modular Bathing Systems Secure positioning Seat and back adjustable Chest, hip and thigh straps Head Blocks Tub stand for convenient transfers Rolling Shower stand Adaptable as a lounge chair

27 Self Care Aids Bathing Wrap-Around Bath Supports Requires good head control Provides adjustable trunk support Increases sitting tolerance Frees hands for washing Adductor and pelvic support available

28 Self Care Aids Bathing Shower Chairs Requires good head and trunk control Seated position Independence Stability Safety Endurance Arm rail for support while transferring and bathing

29 Self Care Aids Feeding Optimal and Safe Positioning Neutral pelvis Hips and knees flexed to 90 degrees Head in slight flexion or neutral over the trunk Shoulders depressed and neutral Chin tucked Feet on support surface

30 Self Care Aids Feeding Foam Filled Feeder Seats Full head and trunk support Curved sides promote midline Promotes shoulder protraction Reclines for optimal head positioning Chest and hip straps available Easy clean-up

31 Self Care Aids Feeding Corner Chair Allows for hip and knee flexion Back support promotes midline Inhibits shoulder retraction Does not recline good head control is needed Tray surface to assist self feeding Good for playtime, too!

32 Self Care Aids Feeding Adaptive Feeding Equipment Utensils Built up handles for easier grasp Universal cuff to secure handle to hand Weighted handles to assist in control Curved handles for limited range

33 Self Care Aids Feeding Suction cups/dycem Secure dish to surface for stability Scoop Dish Raised/curved side for increased success Cups/Straws Straws promotes chin tuck, eliminates lifting Lids decrease spilling

34 Developmental Aids Standers: Benefits Elongates hip and knee flexors and ankle plantarflexors Allows active antigravity use of neck, trunk and upper extremities Prevention of positional contractures Normalizes postural tone throughout body and stimulates antigravity muscles of hip and knee

35 Developmental Aids Standers: Benefits Increase bone mineral density Decrease risk of fractures Helps develop a more normal acetabulum Improvement in function (transfers, upper extremity strength, fine motor skills) Provides new visual perspective of environment (Campbell, 1995 and Tecklin, 1994)

36 Developmental Aids Standing Program: Often started at 1 year of age for children unable to bear weight on their own Duration of Program: Improving lower extremity flexor contractures: 45 minutes, 2-3 times a day Facilitating Bone Development: 60 minutes 4-5 times per week (Stuberg, 1992)

37 Developmental Aids Supine Standers Posterior surface of body leans against equipment Used when child has limited head control Involves activation of abdominal muscles, especially when upper extremities are active

38 Developmental Aids Prone Standers Anterior surface of body leans against equipment Allows movement of head and trunk

39 Developmental Aids Vertical Stander Child is in upright position, increased amount of weight bearing Activates the head, trunk and upper extremities

40 Developmental Aids Mobile Stander Mobile prone stander Provides opportunity for independent mobility

41 Developmental Aids Wedges Improve hip and knee extension Improve head/neck and upper extremity strength

42 Developmental Aids Tricycles Adaptive tricycles that provide stability and ease of pedaling Benefits: strength, range of motion, weight bearing, mobility

43 Things to Consider Accessibility Ramps: % grade (1:12-1:10 inches) Doorway width: 32 inches

44 Things to Consider Precautions Skin Integrity (pressure sores) Safety Appropriate and functional positioning

45 Things to Consider Transfers Dependent Three-person carry Hydraulic lift Assisted Two-person lift Sliding board Standing pivot

46 References Campbell SK. Physical Therapy for Children. Philadelphia: W.B. Saunders Company, 1995, pp. 117, 122. Stuberg WA. Considerations related to weightbearing programs in children with developmental disabilities. Physical Therapy, 72: Thomas, CL. Taber s Cyclopedic Medical Dictionary. Philadelphia: F.A. Davis Company, 1993, pp. 38. Tecklin JS. Pediatric Physical Therapy. Philadelphia: J.B. Lippincott Company, 1994, pp

47 THANK YOU!!!