Adaptive Equipment Flashcards
what are the goals for the use of AE?
1- improve function
2- ease caregiver burden in ADLs
3- prevent secondary impairments in the child
how is AE needed differently throughout the lifespan?
infancy?
preschool?
school aged?
adolescent?
a child’s needs change with growth and development
infancy- social interaction and development of early concepts
preschool- learn to self initiate movement and control his/her environment and indicate needs and make choices
school aged- postural support and comfort to enable learning and adaptive function
adolescent- need to keep up with peers and be accepted socially
what are some general comments on equipment?
no way can receive constant handling
cost of direct care
daily management at home
accomplish the family’s goals
need exploration, not just static environment
how long?
multidisciplinary approach:
users?
team?
community?
school/work?
funding?
medical/health?
Users:
-client/family
Assistive technology team:
- PT/OT/ST
- rehab engineer
- rehab technology supplier
Community:
- family members
- transportation (school and/or public)
- architecture
- other
School/work:
- teacher
- supervisor
- vocational counselor
- primary PT, OT, ST
- psychologist
- administrators
Funding:
- funding specialist
- social worker
- advocacy attorney
- insurance companies
- charitable organizations
Medical/health:
- family physician
- medial specialists
- nursing specialists
- psychologist
what is RESNA?
“Rehab Engineering & Assistive Technology Society of North America”
est. in 1995
interdisciplinary association
credentialing
ATP (assistive technology practitioner)
what needs to be evaluated before getting equipment?
- ROM
- muscle tone, control, strength
- reflexes
- sensation
- social-emotional
- functional needs
- home set up
- community
- school
- financial considerations
what are basic seating concepts?
pelvis is key!
neutral pelvic alignment
symmetrical alignment of the trunk/neck
neutral head position over the pelvis
maintenance of a horizontal gaze
90-90-90 when possible and appropriate for the individual
maintenance of thighs in neutral ABD
neutral shoulder positioning
maximize weight distribution
why is the pelvis key?
neutral- pressure is on the ischial bones
APT- pressure is on the ischial bones
- often leads to arms to assist with support in sitting
- increases the likelihood of lordotic sitting
PPT- pressure is on the sacrum
- increases sliding in the seat
- increases the likelihood of kyphotic spine
pressure relief:
what are options with a seating system?
pressure sores typically occur at bony prominences
decrease risk if WB force is on WB bones
Options w/ a seating system:
- Arm rests
- tilt in space
- recline
- lumbar roll
- cushion selection/contoured
- cushion cover
- foot rest
- trunk support
why is UE control and fine motor function important?
stabilization proximally allows for distal movement
improve accuracy
improve the quality of movement
isolation of muscles vs. synergistic movement patterns
improved coordination of reach
better acquisition of fine motor skills
how does speech, communication and oral motor relate to AE?
“stabilize the hips, free up the lips”
- increase in the type of sounds
- increased lung capacity
Communication
-improved fine motor control to activate switches/communication board
Oral motor:
-improved eating and drinking skills
what are the benefits of a standing program?
“a child who stands is more independent, function, productive and easier to care for”
- WBing through the LE
- improved trunk/head control
- decreased muscle spasms and muscle tone
- maintain/improve joint ROM in the LEs
- decrease muscle atrophy/strengthen the LE
- decrease effects of osteoporosis
- improved development of the hip joints
- improve physiological- circulation, CV
- improved bowel/bladder
- psychological benefits- improves eye contact, confidence, peer interaction, and independence
- brain works best when upright
what are different types of standers?
free standers
prone standers
supine standers
what are free standers? what children are they good for?
use for children with good head control
increased weight through the LEs
orienting to upright position
what are prone standers? what children are they used for?
promote gradual acceptance to WBing
mild to more severe levels of physical involvement
be cautious of children with compromised respiratory function
what are supine standers? what children are they used for?
gradual acceptance to WBing
increased east in positioning child. able to position and strap in supine and then bring upright
great for post op children or children who need gradual orientation to upright
what are different types of walkers?
posterior walkers anterior walkers gait trainers kid walk hart walker up n free lite gait
what is a kid walk? who is it good for ?
single adjustment bilateral pelvic pad
quick exacting hip position
mid wheel location for better control and small turning radius
dynamic vertical movement allows for stepping phase
dynamic lateral movement allows for weight shift
mechanism aids in development of ambulation and gait
open front design
children with increased tone may not do as well as those with low tone
what is a hart walker? who is it good for?
2 components; bracing system and wheeled base
holds LEs in symmetrical alignment
free motion joints at hip and knees
variable motion joint at ankles
spring suspension mechanism
swivel front wheels
reciprocal cables enhance reciprocal gait
adjustability and growth
increased difficulty donning and doffing as child grows
child doesn’t wear AFOs in walker
child must be able to initiate reciprocal stepping
What is the up n free?
seating system stabilizes pelvis and maintains center of gravity
gas piston provides support
support remains constant during walking and transitions
allows for natural up and down movement of trunk during ambulation
4 levels of support (% of BW supported)
child can sit when tired by locking seat
can perform therapeutic activities in walker
can be hands free
handles available
can be too light, child isn’t able to lock/unlock walker independently
what is the lite gait? who is it good for?
manual and remote BWS adjustment
can be used over ground or treadmill
walking over treadmill allows for increased speed to work on cardiovascular fitness
used mostly as a therapeutic tool
difficult to access treadmill controls
can be used for support for sitting and crawling with same harness
transportation safety?
best practice- when at all possible, wheelchair users should transfer out of their wheelchair and into age/weight appropriate vehicle seat and occupant restraint system that meets federal safety standards
suggestions for insurance issues?
go to manufacturer’s website
demo equipment
video and pics
research articles
access primary and secondary insurances when available
what should the letter of medical necessity include?
dx
PMH
current MH
home environment
current equipment
specific equipment requested
rationale for this vs. others
justification for ALL components
summary and contact info
physician’s signature
