Positioning and Adaptive Equipment Flashcards
Why do pediatric PTs position a child?
Promote maintenance of good alignment
Provide a stable base of support for function
Maximize energy efficiency
Promote interaction with the environment
Promote peer interaction
Minimize effects of gravity on posture/abnormal tone
Promote good bone development!!
Allow for pressure relief!!
When might you use positioning as an intervention strategy
- Neuro: break up tone, CP/stroke
- Position of relief
What types of patients benefit the most from positioning
non-ambulatory
Common positions for children with motor dysfunction
Supine
Side lying
Prone
Standing
Sitting
Kneeling
Supine advantages
Stable
Early wt. bearing exp. For feet
Good for visual focus and tracking
Supine disadvantages
Promotes whole-body extension
Difficult to get hands to midline
Promotes “frog-leg” position in low-tone child
Aspiration
Reflux- GERD
Prone advantages
Promote active, isolated head and trunk extension
Promotes trunk control
Develop UE strength and stability
Increase range of motion in hip and knee extension
Prone Disadvantages
UE compensatory patterns develop to lift
head/support on arms
Promotes flexion of arms and neck with gravity influence
May promote full body extension due to effort
LEs may remain in “frog leg” position
Sidelying Advantages
Midline orientation
Bilateral hand activity
Neutral tone position – decreases extensor or flexor hypertonicity
Promotes lateral neck and trunk flexion
Sidelying Disadvantages
LE position – may promote subluxation/dislocation
Places pressure on lower arm
Head is not in midline
Sitting Advantages
Orientation in space
Pulmonary function
Functional position
Socialization
Sitting Disadvantages
Gravity influences on posture – poor alignment
Inappropriate/ inadequate support surface
Prone Standers Advantages
- Develop active trunk, neck, hip extension
- Opportunity for UE WB’ing
- Physiological effects of standing
- Social and cognitive function
Prone Standers Disadvantages
- Neck hyperextension
- Shoulder girdle retraction
- Weight bearing through ball of foot
Supine Standers Advantages
- Develop active trunk neck flexion
- WB’ing though heels
- Physiological effects of standing
- Social and cognitive
Supine Standers Disadvantages
- Promote kyphosis/forward head
- Increase extensor tone
- Poor opportunity for UE WB’ing
Vertical Standers Advantages
- Upright position
- LE WB’ing position
Vertical Standers Disadvantages
Require adequate trunk control
Can kids with atypical tone use true vertical standers?
No
- Typically used more for SB, DMD if they have total flexibility and can get into good position
How can we make changes in standers?
- We can make changes in tone, bone, muscle composition when in there for 60-90 minutes per day, 5x/week
- Typically our role is to train people on how to put them in there correctly and get best alignment
Eval of child for adaptive equipment
Multi-system review – current status of the child?
Goal of equipment?
Impairments that inhibit a child from achieving the goal
When, where, and how will the equipment be used?
Environmental considerations – doorways, ramps, etc.
Who will use the equipment? Is any training needed?
How long will the equipment be used?
How long will the equipment be used?
Prognosis for change
Determination of child/family readiness for equipment – considerations?
Obtaining equipment
- resources: who will pay?
- ordering special positioning equipment
- Fabricating positioning equipment (materials, liability)
what do you need to order special positioning equipment
Prescription
Letter of Justification (Letter of Medical Necessity)
Products – where can you find this information
Documentation of trial
Appeal process
