Adaptive Equipment Heidi Sanders, OTR/L University of New Mexico Health Sciences Center, Los Pasos Program Amy Shuckra, MPT Shriners Hospitals for Children Salt Lake City, Utah What is Adaptive Equipment? Taber’s Medical Dictionary: Any device specifically designed and fabricated with the purpose of permitting or assisting persons with disabilities to perform life tasks independently (Thomas, 1993) Advantages of Adaptive Equipment • Increased independence • Improved safety • Prevention of secondary complications • Physiological benefits Types of Adaptive Equipment • • • • Walking Aids Wheelchairs Self Care Aids Developmental Aids Walking Aids Types of walking aids in order of most to least stable and supportive: 1. Parallel bars 2. Walker 3. Axillary Crutches 4. Forearm (Lofstrand) crutches 5. Two canes 6. One cane Walking Aids Parallel Bars • Most stable • Height and width adjustable Walking Aids Forward Walker • Very stable and easy to use • Used with generalized weakness, need to reduce lower extremity weight bearing, poor balance and coordination • With or without wheels Walking Aids Reverse Walker • Encourages erect posture, more energyefficient (Tecklin, 1994) • With or without wheels • Pelvic stabilizers and forearm supports available Walking Aids Rifton Pacer Gait Trainer • Increased support Walking Aids Lite-Gait Trainer (Walkable) • Partial weight bearing Walking Aids Axillary Crutches • Moderate degree of stability • Requires good strength of upper extremity Walking Aids Forearm (Lofstrand) Crutches • Moderate degree of stability • Provides more ease of movement • Chosen for those requiring the use of crutches for long periods Walking Aids Canes • Provide limited stability • Quad canes and poles are used for those who have lateral but not backward balance Wheelchairs Goal: Provide optimal sitting position to allow the child the greatest degree of function Wheelchairs Optimal and functional seating: • • • • Neutral pelvis Hips and knees flexed to 90 degrees Head aligned over the trunk Trunk at midline over pelvis providing equal weight on ischial tuberosities • Feet resting on support surface • Upper extremities kept free for function (Tecklin, 1994) Wheelchairs Types of wheelchairs Manual Tilt in space Adaptations to the Wheelchair • • • • • Solid Seat Solid Back Head Support Tilt in Space Lateral Trunk Supports • Lateral Hip Supports • Hip Abductors • Seatbelt • Chest Support • Trays Self Care Aids • Toileting Aids • Bathing Aids • Feeding Aids Self Care Aids Toileting • • • • • • Modular Toileting System Bedside Commode Safety Rails Potty Chair Ring Reducer Steps Self Care Aids Toileting • Modular Toileting System • Deflector and pan • Hip and chest straps • Anterior support and armrests • Abductor • Headblocks • Reclining Low or high back • Footboard Self Care Aids Toileting • Bedside Commode • Useful when bathroom is not accessible • Decreases amount of transfers • Requires good head control and fair trunk control • Stable or drop arm rests available • Frames may fit over standard commode when needed for increased stability Self Care Aids Toileting • Safety Rails • Assist with transfers/balance • Allows free use of hands • Potty Chair • For smaller children • Allows feet to rest on floor • Also accessible via crawling Self Care Aids Toileting • Ring Reducer • Decreases width of seat • Provides increased stability • Steps • Assist smaller children with transfer • Supports feet • Assists in pushing Self Care Aids Bathing • Modular Bathing System • Wrap-around Support Systems • Shower Chairs Self Care Aids Bathing • Modular Bathing Systems • Secure positioning • Seat and back adjustable • Chest, hip and thigh straps • Head Blocks • Tub stand for convenient transfers • Rolling Shower stand • Adaptable as a lounge chair Self Care Aids Bathing • Wrap-Around Bath Supports • Requires good head control • Provides adjustable trunk support • Increases sitting tolerance • Frees hands for washing • Adductor and pelvic support available Self Care Aids Bathing • Shower Chairs • Requires good head and trunk control • Seated position • • • • Independence Stability Safety Endurance • Arm rail for support while transferring and bathing Self Care Aids Feeding • Optimal and Safe Positioning • • • • • • Neutral pelvis Hips and knees flexed to 90 degrees Head in slight flexion or neutral over the trunk Shoulders depressed and neutral Chin tucked Feet on support surface Self Care Aids Feeding • Foam Filled Feeder Seats • • • • • • Full head and trunk support Curved sides promote midline Promotes shoulder protraction Reclines for optimal head positioning Chest and hip straps available Easy clean-up Self Care Aids Feeding • Corner Chair • • • • • • Allows for hip and knee flexion Back support promotes midline Inhibits shoulder retraction Does not recline – good head control is needed Tray surface to assist self feeding Good for playtime, too! Self Care Aids Feeding • Adaptive Feeding Equipment • Utensils • • • • Built up handles for easier grasp Universal cuff to secure handle to hand Weighted handles to assist in control Curved handles for limited range Self Care Aids Feeding • Suction cups/dycem • Secure dish to surface for stability • Scoop Dish • Raised/curved side for increased success • Cups/Straws • Straws – promotes chin tuck, eliminates lifting • Lids – decrease spilling Developmental Aids Standers: Benefits • Elongates hip and knee flexors and ankle plantarflexors • Allows active antigravity use of neck, trunk and upper extremities • Prevention of positional contractures • Normalizes postural tone throughout body and stimulates antigravity muscles of hip and knee Developmental Aids Standers: Benefits • • • • Increase bone mineral density Decrease risk of fractures Helps develop a more normal acetabulum Improvement in function (transfers, upper extremity strength, fine motor skills) • Provides new visual perspective of environment (Campbell, 1995 and Tecklin, 1994) Developmental Aids Standing Program: • Often started at 1 year of age for children unable to bear weight on their own • Duration of Program: • Improving lower extremity flexor contractures: 45 minutes, 2-3 times a day • Facilitating Bone Development: 60 minutes 4-5 times per week (Stuberg, 1992) Developmental Aids Supine Standers • Posterior surface of body leans against equipment • Used when child has limited head control • Involves activation of abdominal muscles, especially when upper extremities are active Developmental Aids Prone Standers • Anterior surface of body leans against equipment • Allows movement of head and trunk Developmental Aids Vertical Stander • Child is in upright position, increased amount of weight bearing • Activates the head, trunk and upper extremities Developmental Aids Mobile Stander • Mobile prone stander • Provides opportunity for independent mobility Developmental Aids Wedges • Improve hip and knee extension • Improve head/neck and upper extremity strength Developmental Aids Tricycles • Adaptive tricycles that provide stability and ease of pedaling • Benefits: strength, range of motion, weight bearing, mobility Things to Consider Accessibility • Ramps: 8.3-10% grade (1:12-1:10 inches) • Doorway width: 32 inches Things to Consider Precautions • Skin Integrity (pressure sores) • Safety • Appropriate and functional positioning Things to Consider Transfers • Dependent • Three-person carry • Hydraulic lift • Assisted • Two-person lift • Sliding board • Standing pivot References • Campbell SK. Physical Therapy for Children. Philadelphia: W.B. Saunders Company, 1995, pp. 117, 122. • Stuberg WA. Considerations related to weightbearing programs in children with developmental disabilities. Physical Therapy, 72:35-40. 1992. • Thomas, CL. Taber’s Cyclopedic Medical Dictionary. Philadelphia: F.A. Davis Company, 1993, pp. 38. • Tecklin JS. Pediatric Physical Therapy. Philadelphia: J.B. Lippincott Company, 1994, pp. 114-119. THANK YOU!!!