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!