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Equipment Part II: Developmental Motor, ADL, and Communication

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

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Equipment Part II: Developmental Motor, ADL, and Communication

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  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

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

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

  5. Prone standers • Facilitate trunk extension • Require good head control

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

  7. Supine standers • Maximum support, variable angle

  8. Tilt table

  9. Adjustable designs

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

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

  12. 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

  13. 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

  14. !!!!

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

  16. Cricket/Pony style (prone support)

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

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

  19. 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 (?)

  20. 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

  21. T.L.C. style

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

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

  24. 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

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

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

  27. Food preparation

  28. Cultural relevance

  29. Dressing, doors, reaching

  30. Miscellaneous gadgets

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

  32. 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

  33. 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

  34. 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

  35. The Strawberry Shake Story

  36. 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! THE TOP TEN ADAPTED SLOGANS

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