11
- Medically complex
- Significant MSK weakness
- initial standing
- orthostatic hypotension
- lack of head control
- easier transfers
Supine stander
- Vertical posture
- self propelled exploration and freedom
- for social interaction
- for independent mobility
- to improve weight bearing
- to improve weight shifting and postural control
- to improve trunk control
- to improve ROM
Mobile stander
Gait pattern: crutch/cane moves at same time as opposite LE
Two point
Gait pattern: Device and then bilat LE's together
Swing to
What are the (3) diagnosis that have the best chances for independent gait?
1. Spastic hemiplegia
2. Mild to moderate spastic diplegia
3. Mild ataxia ***
- Improved gait efficiency
- normalized stride length
- upright posture during ambulation
- decreased oxygen consumption rate
- improved step length
- increased single limb support time
- flexion angles of the trunk, hip and knee lower using
- energy conservation
Posterior walkers/posture control walkers
Posterior/posture control walkers are best for which diagnosis?
Crouched gait CP patients
Gait pattern: Device then opposite LE then device and opposite LE
Four point
Gait pattern: assistive device - involved side - uninvolved side
Three point
18 months
What is an example of pre-assistive device?
Wagons with handrail
-Added challenge of working trunk and neck muscles against gravity for better postural control
- high ROM
- upright social interaction
- for improving head and trunk control
- minimize extensor tone
- pressure relief
Prone stander
Gait pattern: device and then bilat LE's pass device
Swing through
___: Preferentially affects two-joint muscles
- spasticity contributes to the abnormalities associated with walking
- Loss of ROM creates contracture
- Spasticity imposes loss of ROM in dynamic situations because of resistance to stretch
- effects of inadequate ROM and spasticity can be measured in all three planes of motion
CP **
ROM and spasticity
- Angular repositioning of the seat and back relative to upright
- Changes seat orientation in space
- assist with positioning, pressure relief, and posture
- Tilt at least 45 degrees
- incremental
- manual or electronic
Tilt (whole chair moves back)
Indications:
- do not have functional gait skills or postural control to safely and independently use a standard walker
- not yet able to consistently bear full weight through legs
- Postural control developing
- cognitive skill and motivation to move
- Build postural strength and stability
- alternating/reciprocal leg movements
- improve overall endurance
- promotes social interactions
- NOT TYPICAL GAIT PATTERN
Gait trainers
- Can provide varying levels of support and stability
- Can be used to slowly increase ROM
- can facilitate social interaction
- can have removable tray for activity
- many levels of adjustability
Upright stander
There is good prognosis of independent gait if the child can sit independenly by age ___?
2 yo
- Hip flexion contractures or tightness
- knee flexion contractures or tightness
- Excessive plantar flexor muscle weakness
- impairments in motor control
- combination of above
Increased flexion seen at all joints in sagittal plane
Crouched posture
- Gravity assisted positioning
- accommodate hip extension contracture or cast
- stretching
- minimize risk of contracture or pain
- weight relief/pressure redistribution
- functional tasks without transferring out of their chair (catheterization, toileting, clothing change)
- status post surgery
- spica cast
- halo
- longest wheelbase
- largest overall turning radius
- accessibility and maneuverability challenging
Recline benefits
- Accommodate for muscle weakness
- Accommodate for paralysis
- Accommodate for fatigue of neck and trunk muscles
- provide neutral head/neck position for safe swallowing and saliva control
- Gravity-assisted positioning for rest
- safety for traversing challenging terrain
- minimum 45 degrees tilt for pressure relief/pressure redistribution
- minimize shear forces for recline
Benefits of tilt
- sitting to standing position
- weight
- stand, stretch, reach, and work without needing to transfer
Standing power WC
- four small wheels
- sling seat and back upholstery
- light weight
- easily folded and lifted
- short term use
Transport chairs
- Adjustable seat to back angle
- allows for change in position
- just the back goes back, not the whole chair
- appropriate for short term
Recline
- Pediatric and adult adaptive
- light weight
- minimal support
- folding and ease of transport
- some have positioning features, including tilt, recline, and combination tilt/recline
- many meet transportation crash test standards
- integrated transit option may be required
- client cannot independently propel
Strollers