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
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)
Advantages of Adaptive
Equipment
• Increased independence
• Improved safety
• Prevention of secondary
complications
• Physiological benefits
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
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
Walking Aids
Reverse Walker
• Encourages erect
posture, more energy-
efficient (Tecklin, 1994)
• With or without wheels
• Pelvic stabilizers and
forearm supports
available
Walking Aids
Axillary Crutches
• Moderate degree of
stability
• Requires good
strength of upper
extremity
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
Walking Aids
Canes
• Provide limited stability
• Quad canes and poles
are used for those who
have lateral but not
backward balance
Wheelchairs
Goal:
Provide optimal sitting
position to allow the
child the greatest
degree of function
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)
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
Self Care Aids
Toileting
• Modular Toileting System
• Bedside Commode
• Safety Rails
• Potty Chair
• Ring Reducer
• Steps
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
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
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
Self Care Aids
Toileting
• Ring Reducer
• Decreases width of seat
• Provides increased stability
• Steps
• Assist smaller children with transfer
• Supports feet
• Assists in pushing
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
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
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
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
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
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!
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
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
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
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)
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)
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
Developmental Aids
Prone Standers
• Anterior surface of body
leans against equipment
• Allows movement of head
and trunk
Developmental Aids
Vertical Stander
• Child is in upright
position, increased
amount of weight bearing
• Activates the head, trunk
and upper extremities
Developmental Aids
Mobile Stander
• Mobile prone stander
• Provides opportunity for
independent mobility
Developmental Aids
Wedges
• Improve hip and knee extension
• Improve head/neck and upper extremity
strength
Developmental Aids
Tricycles
• Adaptive tricycles that
provide stability and ease
of pedaling
• Benefits: strength, range of
motion, weight bearing,
mobility
Things to Consider
Accessibility
• Ramps: 8.3-10% grade (1:12-1:10 inches)
• Doorway width: 32 inches
Things to Consider
Precautions
• Skin Integrity (pressure sores)
• Safety
• Appropriate and functional positioning
Things to Consider
Transfers
• Dependent
• Three-person carry
• Hydraulic lift
• Assisted
• Two-person lift
• Sliding board
• Standing pivot
References
• Campbell SK. Physical Therapy for Children.
Philadelphia: W.B. Saunders Company, 1995, pp.
117, 122.
• Stuberg WA. Considerations related to weight-
bearing programs in children with developmental
disabilities. Physical Therapy, 72:35-40. 1992.
• 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. 114-119.