Physical Access, Seating and Positioning

1. Physical Access, Seating and Positioning Kim Ho, PhD CCC-SLP

2. Overview • Questions about Symbols lecture • Quiz Two • Mobility and Positioning lecture • Wheelchair positioning and handling activity • Lifting and Handling • Transferring activity • Alternative Access Lecture

3. Educational Implications: Mobility & Positioning • Wheelchairs: pads, cushions, straps to keep student in midline position: • Ankles, knees, and hips bent at 90˚ • Supports placed correctly: • Headrest (if needed) • Tray--may restrict movement • Other mobility aids: Walkers, crutches, adapted bicycles, scooters

4. Wheelchair Positioning • Hips and Pelvis: Midline position; hips bent 90˚; Pelvis in back of seat • Trunk: Midline position; maintain normal curve of spine • Shoulders and arms: Shoulders at midline and neutral position; Elbows flexed about 90˚ • Head and Neck: Midline position; face forward • Legs: Thighs and knees slightly apart; knees bent at 90˚; Feet facing forward and directly below or slightly behind knees; ball and heel flat on footrest.

5. Wheelchair Handling • Foot rest removal • Managing curbs • Transferring to and from w/c • Collapsing • Safety – speed, wheelies

6. General Principles of Lifting and Handling • Have child bear weight and assist • Determine how many people needed to lift safely • Provide broad base of support • Never bend at waist to pick child up • Do not bend at the back when placing child in wheelchair • Use arm and leg muscles to lift • Hold child close when carrying to maintain balance • Never twist back when holding child • Never use arms or legs as handles

7. One-Person Lift • Bring wheelchair close to child and lock brakes • Kneel on one leg next to child • Bring child into sitting position • Place one arm under child’s thigh and other around child’s back • Lift child up close to you • Come to standing position • Slowly carry child to wheelchair and lower in • Properly position child and adjust equipment

8. Two-Person Lift: Side-to-Side Method • Bring wheelchair close to child and lock brakes • Two adults kneel on either side of child • Bring child into sitting position • One person brings one arm under thigh and other around back. Second person does same • One person counts 1..2..3 • Lift child straight up (on 3) • Carry child to wheelchair • Lower child into wheelchair • Properly position child and adjust equipment

9. Tow-Person Lift: Top-Bottom Method • Bring wheelchair close to child and lock brakes • One adult kneels at top of child, other at side (near child’s legs) • Bring child into sitting position • Top person brings arms under child’s arms and around to front • Bottom person holds both thighs • One person counts 1..2..3 • Lift child straight up (on 3) • Carry child to wheelchair • Lower child into wheelchair • Properly position child and adjust equipment

10. Transferring Activity • Form groups of 3-5. Each individual in the group will practice being transferred and being the one who transfers at least once. Other group members will observe and assist. • Write names down on a piece of paper • Include comments/questions

11. Weight-Bearing Transfer • Tell individual what you are going to do (each step); provide a touch cue as needed • Lock w/c breaks • Position chair approximately 90 degrees from w/c • Remove/swing away w/c foot rests • Take off safety straps, seat belt, etc

12. Transfer Cont’d • Move individual’s hips forward so that feet are flat on the ground • Keep a wide base of support, bend your knees and keep your back straight, as you hold individual around their chest, under their arms • Encourage weight bearing (if authorized) as you pivot individual to other chair • If the individual is well balanced, place one hand on the chair arm or nearby table before seating her/him

13. Transfer Cont’d • Hold individual around hips, and encourage her/him to bend at the waist and sit down on the chair • Position individual on the chair following positioning guidelines from the lecture. • Include comments/questions to hand in

14. Gross-Motor Terminology • Flexion • Dorsiflexion • Extension • Decubiti – tissue breakdown/death • Contractures – permanent muscular contraction; joints • Tone – tension present in resting muscles – support against gravity • ROM – range of motion

15. Gross-Motor Cont’d • Spasticity – velocity-dependent resistance to passive stretch • Paresis - weakness • Rigidity – consistent resistance to passive ROM • Hypotonicity – too little activity • Tremors – involuntary trembling • Initiation/cerebellar – voluntary movement • Passive/resting – tremor during rest

16. Gross-Motor Cont’d • Apraxia – impairment in executing purposeful movements • Ataxia – inability to coordinate muscles in voluntary movement • Supine – on back • Prone – on stomach • Side-lying

17. Positioning Devices • Devices used during functional or academic activities to promote movement, alignment, and bone growth, and to provide stability: • Wedges • Sidelyer • Corner Chair • Supine/prone standers

18. Placement of Material • Determine optimal placement of materials based on: • Student’s range of motion • Student’s visual field

19. Alternative Access • Selection set • Physical characteristics of displays • Number of items • Determined by number of messages • Symbols • Codes • Commands

20. Size of Display • Individual item and overall display • Visual displays, symbol size depends on: • Visual capabilities • Motor access technique • Type of symbol • Number of items

21. Size of Display Cont’d • Overall size involves compromise: • Number of items • Size of individual items • Spacing of items • Mounting and portability factors • AAC user’s physical capabilities • Auditory displays, depends on: • Memory • Ability to retain the organizational scheme of the display

22. Types of Displays • Fixed – symbols and items fixed • Dynamic – two types • Changes the selection set when activated • Informs the user which items in the selection set are available for activation

23. Selection Technique • Way the AAC user selects items from selection set • Direct Selection • AAC user indicates desired item directly • Typing, natural speech, gestures, finger pointing/touching • Light pointer, headstick, eye gaze • Scanning • Choose items indirectly from selection set

24. Direct Selection • Physical pressure/depression • Physical contact • Pointing (no contact) • Voice recognition

25. Scanning • Lack of motor control • Scanning Patterns • Circular Scanning • Linear Scanning • Group-item Scanning

26. Selection Control Techniques • Directed (Inverse) Scanning • Indicator/cursor begins with activation • Selection is made when switch is released • Automatic (Regular or Interrupted) Scanning • Movement of cursor is automatic and continuous • Make a selection by closing the switch • Step Scanning • Cursor moves one step at a time per activation • Make a selection by pausing or second switch

27. Feedback • Activation Feedback • Lets user know that an item has been selected • Not what symbol/message has been selected • Message Feedback • Tells user what symbol/message has been formulated • May be useful to communication partner

28. Message Output • Synthesized Speech • Rule-generated speech using complex algorithms • Digitized Speech • Natural speech recorded, stored and reproduced