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!