Positioning and Adaptive Equipment

Question 1

Why do pediatric PTs position a child?

Answer 1

 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!!

Question 2

When might you use positioning as an intervention strategy

Answer 2

• Neuro: break up tone, CP/stroke
• Position of relief

Question 3

What types of patients benefit the most from positioning

Answer 3

non-ambulatory

Question 4

Common positions for children with motor dysfunction

Answer 4

 Supine
 Side lying
 Prone
 Standing
 Sitting
 Kneeling

Question 5

Supine advantages

Answer 5

 Stable
 Early wt. bearing exp. For feet
 Good for visual focus and tracking

Question 6

Supine disadvantages

Answer 6

 Promotes whole-body extension
 Difficult to get hands to midline
 Promotes “frog-leg” position in low-tone child
 Aspiration
 Reflux- GERD

Question 7

Prone advantages

Answer 7

 Promote active, isolated head and trunk extension
 Promotes trunk control
 Develop UE strength and stability
 Increase range of motion in hip and knee extension

Question 8

Prone Disadvantages

Answer 8

 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

Question 9

Sidelying Advantages

Answer 9

 Midline orientation
 Bilateral hand activity
 Neutral tone position – decreases extensor or flexor hypertonicity
 Promotes lateral neck and trunk flexion

Question 10

Sidelying Disadvantages

Answer 10

 LE position – may promote subluxation/dislocation
 Places pressure on lower arm
 Head is not in midline

Question 11

Sitting Advantages

Answer 11

 Orientation in space
 Pulmonary function
 Functional position
 Socialization

Question 12

Sitting Disadvantages

Answer 12

 Gravity influences on posture – poor alignment
 Inappropriate/ inadequate support surface

Question 13

Prone Standers Advantages

Answer 13

• Develop active trunk, neck, hip extension
• Opportunity for UE WB’ing
• Physiological effects of standing
• Social and cognitive function

Question 14

Prone Standers Disadvantages

Answer 14

• Neck hyperextension
• Shoulder girdle retraction
• Weight bearing through ball of foot

Question 15

Supine Standers Advantages

Answer 15

• Develop active trunk neck flexion
• WB’ing though heels
• Physiological effects of standing
• Social and cognitive

Question 16

Supine Standers Disadvantages

Answer 16

• Promote kyphosis/forward head
• Increase extensor tone
• Poor opportunity for UE WB’ing

Question 17

Vertical Standers Advantages

Answer 17

• Upright position
• LE WB’ing position

Question 18

Vertical Standers Disadvantages

Answer 18

Require adequate trunk control

Question 19

Can kids with atypical tone use true vertical standers?

Answer 19

No
- Typically used more for SB, DMD if they have total flexibility and can get into good position

Question 20

How can we make changes in standers?

Answer 20

• 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

Question 21

Eval of child for adaptive equipment

Answer 21

 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?

Question 22

Obtaining equipment

Answer 22

• resources: who will pay?
• ordering special positioning equipment
• Fabricating positioning equipment (materials, liability)

Question 23

what do you need to order special positioning equipment

Answer 23

 Prescription
 Letter of Justification (Letter of Medical Necessity)
 Products – where can you find this information
 Documentation of trial
 Appeal process