Prescription of Adaptive Equipment in Children with CP Flashcards
What is adaptive equipment
Any item, piece of equipment, or product system that increase, maintains, or improves an individual’s fxn status
Enables adaptive motor function when skill attainment is unrealistic or impossible
What position does the equipment place students in?
One to allow them to perform functional activities such as moving from one place to another, self-feeding, self-controlled toileting, table work, and leisure activities
Equipment designed to help students how?
Improve the bone and joint health of the students and to increase the muscle strength of the extensor musculature of the body
Primary use of AD
Sitting
Standing
Walking
Activities of CPi
Communication
Self care
Mobility (getting in and out of car/couch, car transfers, bed mobility, toilet and tub transfers, indoor and outdoor locomotion, stairs)
Body structure of CP
Muscle tone and extensibility
Muscle strength
Skeletal structure
Selective control
Postural control
Pain
Fatigue
Gait
Participation of CP
Communication
Play
Community setting like park, mall, beaches
Competitive sports
Going to a party
Env’t factors of CP
School/home/play area adaptations
Accessibility
Social support
Caregiver assistance
Health and education services and policies
Personal factors of CP
Age
Gender
Education
Motivation/confidence
GMFCS level
Personal goals
ROM
Adequate passive head and neck rotation to bring head to midline
Trunk rotation to achieve trunk symmetry
Min 90º of hip and knee flexion and platigrade feet for functional sitting
Identify contractures
Muscle tone, motor control and strength
UE/trunk/LE
Decisions regarding manual/motorized w/c
Control mechanism for motorized w/c
Tone changes in response to position/support changes
Skin and sensation assessment
Areas of increased pressure
Areas of reduced sensations
Bony prominence
Cognitive, sensorimotor and social/emotional skills
Perceptual function
Motor planning
Reaction time
Cognitive skills
Cognitive, sensorimotor and social/emotional skills
- cognitive
Judgment
Problem-solving
Ability to understand cause and effect
Direction and spatial relationships
Motivation
Family/Home/School Assessment
Physical layout of the house
Community factors
Socioeconomic factors
Cultural factors
Equipment selection
Identify areas of deficit that the equipment will help address
Document test and measures used to identify and describe impairments
Describe how impairments affect the activity/participation/quality of life
Describe lack of equipment could potentially worsen fxn status
Describe how the equipment selection will accommodate the growning needs of the child
Include school and house assessment to provide evidence for equipment selection
Purchasing equipment
Apparatus dimensions
Optional adaptation
Manufacturer reputation
Delivery promptness
Cost
Availability of genetic models
Aesthetics
Weight, size and manageability
Funding
Private medical insurance
Individuals with Disability Act Part B and C
Medicaid
Early and periodic screening, diagnosis and treatment program
Children’s Health Insurance Program (CHIP)
State assistive technology loan
Require physician’s prescription and letter of medical necessity
Types of adaptive equipment
Seating systems
Standers
Hygiene and toileting system
Tricycle
Gait transfers (pacers)
Walkers (anterior/posterior)
Types of adaptive equipment
- Seating systems
Activity chairs
Wheelchairs (lecture assessment form)
Strollers
W/C for children on ventilators
Types of adaptive equipment
- Standers
Supine
Prone
Sit to Stand
Segmental trunk support standards
Standers and Gait trainers
Supine stander
Prone stander
Standers and Gait Trainers
- supine
For children with limited/poor head/trunk control
Standers and Gait Trainers
- prone
For children with improved head control and allow for weight shift
Standing guidelines
Positive for preventing contractures
Generally positive for short-term reduction in ankle and hand spasticity
Mildly positive for short-term gait changes
Mixed evidence supporting improvement in bone mineral density
Standing guidelines
- Dosage
30 mins 5x/week for most outcomes
60 min/day for BMD
Standing guidelines
- Position
Hip ABDuction
30-60º
Standing guidelines
- Limited evidence
Regarding ability to reduce/prevent hip dysplasia, improve bowel/bladder function, improve self-esteem, or improve communication
Dosage recommendations for standing
- Non ambulatory children
60 minutes a day
4-5 days a week
Promote bone development and prevent contractures
Intermittent loading as compared to continuous loading
Dosage recommendations for standing
- Prone vs supine standing
Wt bearing adjustability
Forearm support
Variability in the level of the trunk support
Mobility features
ADLs: feeding, bathing, and toileting
- Feeding
Optimal alignment assists with suck/swallow, chew/swallow, coordinated respiration and possibly self feed
ADLs: feeding, bathing, toileting
- Bathing
Focus is on caregiver: are they able to position the child safely with ease and accomplish what they need to do?
ADLs: feeding, bathing, toileting
- Toileting
Single most important task for this population: caregiver ease, safety as affording the child some independence in self care
