equipment prescription for pediatric mobility this series will empower you to:
TRANSCRIPT
Equipment Prescription for Pediatric Mobility
This series will empower you to:
Objectives Explain what is the same and what is different about
pediatric seating and mobility Set pediatric mobility goals and choose the best equipment
to achieve them Overcome "Phony Prerequisites" and otherwise justify use of
specialized equipment to families and third party payors (OK, maybe 70% of the time anyway)
Troubleshoot problems with equipment (As long as it is brought in to clinic or you at least have a photo)
So What's the Difference?
(What are you going to tell us that Dr. Smelz didn't, big shot pediatric
person, huh?)
Growth and Development Adults - Focus on Function
Children Also Grow and Develop Size concerns Orthopedic concerns Developmental milestones
Age appropriate expectations Equipment helps recreate or simulate usual sequence
Growth adjustability and replacement Orthotics every 6 months Wheelchair-Equivalent every 3 years Less well defined for other items
Correct Sizing Seat depth and slump Seat width and reaching
wheels, using trunk supports and/or hip guides
Footrest length, distal thigh support
Back height and chest harness
Troubleshooting 101 "Start at the pelvis“ Seat to back angles Pelvic tilt Pelvic obliquity 90 recline tilt reverse
Orthopedic Issues Bad seating aggravates But - “You can’t do orthopedic
surgery with a wheelchair!” - - Dr. Richard McCarthy
Custom Molded Seating
WARNING – WARNING – “HISTORICAL PERSPECTIVE” ALERT!!
Limit use appropriately Asymmetrical fixed deformity AND poor postural control Possibly in movement disorder for extra stability Pressure relief vs. stability can be an issue
The Roseanne Rosannadanna Syndrome(-or- Welcome to Trade Off City)
some chairs don't fold some chairs don't fold easily no tilt chairs good for pushing
(will a fixed tilt or more trunk support do?)
power chairs break down more often adaptive car seats comfy, supportive
but take up half the back seat! and weigh a ton!
Sliders and Easy Stand Magician are great but you can't make it up on volume if you're LOSING money (Why "Allowable" is a four-letter word.)
More examples
LIbre tilt – “yeah sure, it folds!” above
Nexus Roho-Jay hybrid cushion right
It “counts” as a wheelchair…
About powered mobility Minimum Age = About 18 months
Medicaid won’t get any chairs until age 2 anyways
Hooray for parent support groups! Perfect vision, DL not required Some need training Some don’t!
DEVELOPMENT – Milestones Sit 6 months* Floor mobility shortly thereafter (varies)*
*DDS may fund, may need loan closet, school help
Stand 10-12 months Walk 10-14 months Drive 15-16 years Drive parents crazy 2 years and again at 13 years Get own health insurance 26 years
GOALSFunctional and Developmental
Independent Sitting Crawling and Creeping
getting into stuff and making the grownups childproof the house Supported Sitting
enable UE function Independent walking Assisted walking Exercise walking Weightbearing - static vs dynamic Total lift versus weightbearing transfers Driving
supporting the auto insurance and body shop industries Being safe while driving or being driven
staying off the inpatient unit
How to Help - Sitting Corner Chair Floor Sitter Bumbo Seat – less support
http://www.brighthub.com/education/early-childhood/reviews/36686.aspx
Tumbleform feeder seat – more support Wedge – head/trunk control
How to Help – Early Mobility Crawlabout, Crawligator, Prone scooter Caster cart, big wheels up front 1st chairs
How to Help - Standing Prone, upright, supine Research lacking vs
“ballistic” weightbearing No “bad girl, go stand in
the corner!” syndrome
More standers
Mobile Standers Parapodium Swivel Walker
Bridge to Parawalker?
Batmobile (“Dynamic Stander”)
Standing chimney with orthotics
Walking Walkers Forward or reverse Walker add-ons
Weighted Arm supports, troughs, “prompts” Pelvic stabilizer Abductor bar
Gait Trainers Treadmill/weight relief systems Crutches, canes, hemiwalkers
age/coordination issues
Can’t hold on? So what?
Baby walker style
Sit-slump-kick syndrome
Delays normal walking ~ 1 mo
Injury risks for typical age use
Lite Gait Not generally
suited for home use
Pool therapy alternative
Transfer Aids - How ToAvoid the Ashley Treatment Passive or max assist transfers may be
necessary (try to avoid if possible) MDA, quadriplegia 2 SCI, low cognitive function
Bath options Full support shower chairs Roll-in shower Bath bench with hand held
shower Specify back support,
padding if needed
Access and safety on the road
Forward facing essentialSecure to frame of chairOUT of chair would be better!
What's a Waiver and what can we get on it?
Still medical model, you will be asked for prescriptions
But medical profession less in control Focus on staying out of institution Less tainted with the idea that it must be
undesirable for use in the absence of disability Capped amount of funding per year Regular Medicaid must reject Aka Katie Beckett – most states under DDS
Waiver Haiku (yes, this lecture could have been far,far worse…)
Still no van or lift Though we're off the
waiting list... Bad case manager?
On waiver whole year But still giving daily bed
baths... Needed the ramp first!