Prescription of Adaptive Equipment in Children with CP

Question 1

What is adaptive equipment

Answer 1

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

Question 2

What position does the equipment place students in?

Answer 2

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

Question 3

Equipment designed to help students how?

Answer 3

Improve the bone and joint health of the students and to increase the muscle strength of the extensor musculature of the body

Question 4

Primary use of AD

Answer 4

Sitting
Standing
Walking

Question 6

Activities of CPi

Answer 6

Communication
Self care
Mobility (getting in and out of car/couch, car transfers, bed mobility, toilet and tub transfers, indoor and outdoor locomotion, stairs)

Question 6

Body structure of CP

Answer 6

Muscle tone and extensibility
Muscle strength
Skeletal structure
Selective control
Postural control
Pain
Fatigue
Gait

Question 7

Participation of CP

Answer 7

Communication
Play
Community setting like park, mall, beaches
Competitive sports
Going to a party

Question 8

Env’t factors of CP

Answer 8

School/home/play area adaptations
Accessibility
Social support
Caregiver assistance
Health and education services and policies

Question 9

Personal factors of CP

Answer 9

Age
Gender
Education
Motivation/confidence
GMFCS level
Personal goals

Question 10

ROM

Answer 10

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

Question 11

Muscle tone, motor control and strength

Answer 11

UE/trunk/LE
Decisions regarding manual/motorized w/c
Control mechanism for motorized w/c
Tone changes in response to position/support changes

Question 12

Skin and sensation assessment

Answer 12

Areas of increased pressure
Areas of reduced sensations
Bony prominence

Question 13

Cognitive, sensorimotor and social/emotional skills

Answer 13

Perceptual function
Motor planning
Reaction time
Cognitive skills

Question 14

Cognitive, sensorimotor and social/emotional skills
- cognitive

Answer 14

Judgment
Problem-solving
Ability to understand cause and effect
Direction and spatial relationships
Motivation

Question 15

Family/Home/School Assessment

Answer 15

Physical layout of the house
Community factors
Socioeconomic factors
Cultural factors

Question 16

Equipment selection

Answer 16

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

Question 17

Purchasing equipment

Answer 17

Apparatus dimensions
Optional adaptation
Manufacturer reputation
Delivery promptness
Cost
Availability of genetic models
Aesthetics
Weight, size and manageability

Question 18

Funding

Answer 18

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

Question 19

Types of adaptive equipment

Answer 19

Seating systems
Standers
Hygiene and toileting system
Tricycle
Gait transfers (pacers)
Walkers (anterior/posterior)

Question 20

Types of adaptive equipment
- Seating systems

Answer 20

Activity chairs
Wheelchairs (lecture assessment form)
Strollers
W/C for children on ventilators

Question 21

Types of adaptive equipment
- Standers

Answer 21

Supine
Prone
Sit to Stand
Segmental trunk support standards

Question 22

Standers and Gait trainers

Answer 22

Supine stander
Prone stander

Question 23

Standers and Gait Trainers
- supine

Answer 23

For children with limited/poor head/trunk control

Question 24

Standers and Gait Trainers - prone

Answer 24

For children with improved head control and allow for weight shift

Question 25

Standing guidelines

Answer 25

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

Question 26

Standing guidelines - Dosage

Answer 26

30 mins 5x/week for most outcomes 60 min/day for BMD

Question 27

Standing guidelines - Position

Answer 27

Hip ABDuction 30-60º

Question 28

Standing guidelines - Limited evidence

Answer 28

Regarding ability to reduce/prevent hip dysplasia, improve bowel/bladder function, improve self-esteem, or improve communication

Question 29

Dosage recommendations for standing - Non ambulatory children

Answer 29

60 minutes a day 4-5 days a week Promote bone development and prevent contractures Intermittent loading as compared to continuous loading

Question 30

Dosage recommendations for standing - Prone vs supine standing

Answer 30

Wt bearing adjustability Forearm support Variability in the level of the trunk support Mobility features

Question 31

ADLs: feeding, bathing, and toileting - Feeding

Answer 31

Optimal alignment assists with suck/swallow, chew/swallow, coordinated respiration and possibly self feed

Question 32

ADLs: feeding, bathing, toileting - Bathing

Answer 32

Focus is on caregiver: are they able to position the child safely with ease and accomplish what they need to do?

Question 33

ADLs: feeding, bathing, toileting - Toileting

Answer 33

Single most important task for this population: caregiver ease, safety as affording the child some independence in self care