PEDs - Adaptive equipment QUICK AF

What are some of the goals of positioning?

- minimize/prevent deformity

- promote function

- keep head in midline

What assistive device encourages head and trunk control/posture in sitting and in prone, and can be used to decrease kyphotic postures by improving pelvic tilt?

Wedges, baby

What assistive device increases sitting balance, and can be straddled to increase LE ABD/ER by developing the glute med?

Bolsters

What MUST be avoided with side-layer positioners?

- neck hyperextension

- shoulder flexion/retraction on NWB side

WHY must shoulder abd/retraction on NWB side and neck hyperextension be avoided with side-layer positioners?

can cause airway obstruction in children with neck extension tone or tracheostomy

What are some things should you primarily know about activity chairs/adaptations?

- most changes can be made for the cheap by a parent or by a PT (pool noodles, books in seat, seat belt, etc.)

- can use things like diaper/shoe box or laundry basket in the home

- keep it simple and address those adaptations... don't go and try to justify a $5k chair that they'll grow out of in a year

What angle of hip ABD in a supine stander begins to encourage bone loading?

30 degrees

What pediatric population best fits the need for a SUPINE stander?

- excessive extensor tone in prone

- decreased cervical extensor endurance (can't hold head up)

- Unanticipated seizures or related disorders

- Super dependent children

Which stander should a child use in the case that they have 45 degree flexion contractures at the hip and knee as well as a 30 degree PF contracture at their ankle?

This child is NOT appropriate for the use of a stander because their contractures would restrict them from fitting into the assistive device.

What pediatric population best fits the need for a PRONE stander?

- prevention/management of hip/knee flexion and PF contractures

- In need of bone development, blood flow, bowel and bladder regulation, and body image (participation)

What does research say about the dosage of a standing program in children with CP?

60 mins, 4-5 days a week to maintain bone density

What do recent studies say about the best way to build/maintain bone density?

Bone loading methods that incorporate twisting/torsional movements while in loading is BEST

What are the benefits of a standing program that occurs 5 days a week (around 60 mins)?

- increased bone mineral density

- increased hip stability

- improved hip, knee, ankle ROM

- Decreased spasticity

Which assistive device encourages strengthening of the hamstrings, quads, trunk, and UEs in sitting (and is really fun for kids)?

scooter board

T/F: Axillary Crutches are recommended for children with CP because they can use the increased UE stability to focus more on their LE use.

Incorrect, they have an over reliance on their UEs to compensate for their LE deficits.

If you knew nothing about a child and had to choose between an anterior and posterior rolling walker, which would you choose and why?

Choose the posterior 9 times out of 10 because it decreases a crouched position, encourages more independence/participation, and is great to allow a child to fall forward if needed.

Which assistive device allows WB on LEs, allows for greater independent mobility/participation, helps burn calories, and can be gradually decreased in terms of support so as to continue to challenge the child's functional independence?

gait trainer

Which assistive device is GREAT for children with CP because it encourages participation, improves control on the hemi side, and promotes active hip ABD/ER?

Training bikes! Fun for the whole family.

Why might an early prescription of a power wheelchair be appropriate in children who will not be able to ambulate independently in the future?

being able to explore your environment at a young age increases cognitive, scholastic, and neuropsychosocial test performances at 11y/o

T/F: Readiness for the use of a power wheelchair is dependent on how high you score on the Intellectual Quotient test.

Incorrect, it is more based on cognitive abilities.

T/F: BWSTT is a decent choice for children with down syndrome and CP so long as you can keep them engaged and safe.

True, children with CP even saw a decrease in scissoring, and an increase in BOS, stride, and speed during ambulation

A 30 month old non-ambulatory toddler is getting ready to transition into a typical pre-school program when she turns 3 yrs old. She is currently using a manual wheelchair independently for mobility. In order to minimize hip and knee flexor shortening and to facilitate participation with her classroom peers during recess, which of the following is the BEST recommendation as an alternative to the wheelchair?

Mobile Prone Stander

The following patient's mother is asking about getting her 3 y/o son with spastic quadriplegia a stander. What would be the BEST recommendation for him based on the following information:

He has good head control, is able to roll independently, and is able to maintain prone on forearms. He uses combat crawling/belly crawling as his primary mode of mobility. Currently he does not use a gait trainer but recently exhibits holding supported standing in a crouched LE posture for up to 1-minute at a time with moderate assistance.

Prone stander based on emerging standing control, but lack of ambulation. Get this child some bone loading going so we can get up and moving!