Presentation on theme: "Equipment Prescription for Pediatric Mobility This series will empower you to:"— Presentation 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
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
GOALS Functional 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 1 st chairs
How to Help - Standing Prone, upright, supine Research lacking vs “ballistic” weightbearing No “bad girl, go stand in the corner!” syndrome
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 To Avoid 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 essential Secure to frame of chair OUT 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!