equipment part ii: developmental motor, adl, and communication
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
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
Crawl, creep Scooter board Crawlabout
Early mobility
Spatial Perception Normal limit setting Seated mobility not “normal” but so what?
Caster cart and variants
Standers
Upright Prone Supine Adjustable Mobile Dynamic vs Static Weightbearing Need trays or use at tables
Prone standers
Facilitate trunk extension Require good head control
Upright standers
“Normal” position Commonly used for
people with spina bifida Simpler design, lighter,
less space needed
Supine standers
Maximum support, variable angle
Tilt table
Adjustable designs
Easy Stand Magician
Options for independent or powered lift Options for conversion to mobile Pediatric to Adult sizes
Standing wheelchairs Power or manual
http://www.usatechguide.org/itemreview.php?itemid=131
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
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
!!!!
Rifton style
Uses “prompts” MOVE/conductive
education philosophy
Cricket/Pony style (prone support)
Walking means… Community* Household* Exercise only Assisted only
Device vs helper
* RLA “Functional” classification
ARJO
Early rehab With enough help,
anyone can “walk” at least a little
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 (?)
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
T.L.C. style
Many options
Overhead track lifts desired but rarely funded (CMS, Waiver)
Will it fit?
See also the Slider: http://www.adaptivemall.com/slidbatchair.html
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
ADLs - Eating
Ataxia – bigger, heavier utensils Reduced dexterity – swivel and/or bent spoon
Winsford feeders
Cheek switch to scoop and present food
Need some head control
Hands-free
Food preparation
Cultural relevance
Dressing, doors, reaching
Miscellaneous gadgets
Writing and typing
Writing bird, typing stick (or use pencil eraser end down in cuff)
Don’t underestimate two or even single finger typing
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
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
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
The Strawberry Shake Story
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!