Adaptive Equipment

Heidi Sanders, OTR/L

University of New Mexico Health Sciences

Center, Los Pasos Program

Amy Shuckra, MPT

Shriners Hospitals for Children

Salt Lake City, Utah

What is Adaptive Equipment?

Taber’s Medical Dictionary: Any

device specifically designed and

fabricated with the purpose of

permitting or assisting persons with

disabilities to perform life tasks

independently

(Thomas, 1993)

Advantages of Adaptive

Equipment

• Increased independence

• Improved safety

• Prevention of secondary

complications

• Physiological benefits

Types of Adaptive Equipment

• Walking Aids

• Wheelchairs

• Self Care Aids

• Developmental Aids

Walking Aids

Types of walking aids in order of

most to least stable and supportive:

1. Parallel bars

2. Walker

3. Axillary Crutches

4. Forearm (Lofstrand) crutches

5. Two canes

6. One cane

Walking Aids

Parallel Bars

• Most stable

• Height and width

adjustable

Walking Aids

Forward Walker

• Very stable and easy to

use

• Used with generalized

weakness, need to

reduce lower extremity

weight bearing, poor

balance and coordination

• With or without wheels

Walking Aids

Reverse Walker

• Encourages erect

posture, more energy-

efficient (Tecklin, 1994)

• With or without wheels

• Pelvic stabilizers and

forearm supports

available

Walking Aids

Rifton Pacer Gait

Trainer

• Increased support

Walking Aids

Lite-Gait Trainer

(Walkable)

• Partial weight bearing

Walking Aids

Axillary Crutches

• Moderate degree of

stability

• Requires good

strength of upper

extremity

Walking Aids

Forearm (Lofstrand)

Crutches

• Moderate degree of

stability

• Provides more ease of

movement

• Chosen for those requiring

the use of crutches for long

periods

Walking Aids

Canes

• Provide limited stability

• Quad canes and poles

are used for those who

have lateral but not

backward balance

Wheelchairs

Goal:

Provide optimal sitting

position to allow the

child the greatest

degree of function

Wheelchairs

Optimal and functional seating:

• Neutral pelvis

• Hips and knees flexed to 90 degrees

• Head aligned over the trunk

• Trunk at midline over pelvis providing equal

weight on ischial tuberosities

• Feet resting on support surface

• Upper extremities kept free for function

(Tecklin, 1994)

Wheelchairs

Types of wheelchairs

Manual Tilt in space

Adaptations to the Wheelchair

• Solid Seat

• Solid Back

• Head Support

• Tilt in Space

• Lateral Trunk

Supports

• Lateral Hip

Supports

• Hip Abductors

• Seatbelt

• Chest Support

• Trays

Self Care Aids

• Toileting Aids

• Bathing Aids

• Feeding Aids

Self Care Aids

Toileting

• Modular Toileting System

• Bedside Commode

• Safety Rails

• Potty Chair

• Ring Reducer

• Steps

Self Care Aids

Toileting

• Modular Toileting System

• Deflector and pan

• Hip and chest straps

• Anterior support and

armrests

• Abductor

• Headblocks

• Reclining Low or high back

• Footboard

Self Care Aids

Toileting

• Bedside Commode

• Useful when bathroom is

not accessible

• Decreases amount of transfers

• Requires good head control and fair trunk

control

• Stable or drop arm rests available

• Frames may fit over standard commode

when needed for increased stability

Self Care Aids

Toileting

• Safety Rails

• Assist with transfers/balance

• Allows free use of hands

• Potty Chair

• For smaller children

• Allows feet to rest on floor

• Also accessible via crawling

Self Care Aids

Toileting

• Ring Reducer

• Decreases width of seat

• Provides increased stability

• Steps

• Assist smaller children with transfer

• Supports feet

• Assists in pushing

Self Care Aids

Bathing

• Modular Bathing System

• Wrap-around Support Systems

• Shower Chairs

Self Care Aids

Bathing

• Modular Bathing Systems

• Secure positioning

• Seat and back adjustable

• Chest, hip and thigh straps

• Head Blocks

• Tub stand for convenient transfers

• Rolling Shower stand

• Adaptable as a lounge chair

Self Care Aids

Bathing

• Wrap-Around Bath Supports

• Requires good head control

• Provides adjustable trunk support

• Increases sitting tolerance

• Frees hands for washing

• Adductor and pelvic support available

Self Care Aids

Bathing

• Shower Chairs

• Requires good head and trunk control

• Seated position

• Independence

• Stability

• Safety

• Endurance

• Arm rail for support while transferring

and bathing

Self Care Aids

Feeding

• Optimal and Safe Positioning

• Neutral pelvis

• Hips and knees flexed to 90 degrees

• Head in slight flexion or neutral over the trunk

• Shoulders depressed and neutral

• Chin tucked

• Feet on support surface

Self Care Aids

Feeding

• Foam Filled Feeder Seats

• Full head and trunk support

• Curved sides promote midline

• Promotes shoulder protraction

• Reclines for optimal head positioning

• Chest and hip straps available

• Easy clean-up

Self Care Aids

Feeding

• Corner Chair

• Allows for hip and knee flexion

• Back support promotes midline

• Inhibits shoulder retraction

• Does not recline – good head control is needed

• Tray surface to assist self feeding

• Good for playtime, too!

Self Care Aids

Feeding

• Adaptive Feeding Equipment

• Utensils

• Built up handles for easier grasp

• Universal cuff to secure handle to hand

• Weighted handles to assist in control

• Curved handles for limited range

Self Care Aids

Feeding

• Suction cups/dycem

• Secure dish to surface for stability

• Scoop Dish

• Raised/curved side for increased success

• Cups/Straws

• Straws – promotes chin tuck, eliminates lifting

• Lids – decrease spilling

Developmental Aids

Standers: Benefits

• Elongates hip and knee flexors and ankle

plantarflexors

• Allows active antigravity use of neck, trunk

and upper extremities

• Prevention of positional contractures

• Normalizes postural tone throughout body

and stimulates antigravity muscles of hip

and knee

Developmental Aids

Standers: Benefits

• Increase bone mineral density

• Decrease risk of fractures

• Helps develop a more normal acetabulum

• Improvement in function (transfers, upper

extremity strength, fine motor skills)

• Provides new visual perspective of

environment (Campbell, 1995 and Tecklin, 1994)

Developmental Aids

Standing Program:

• Often started at 1 year of age for children

unable to bear weight on their own

• Duration of Program:

• Improving lower extremity flexor contractures:

45 minutes, 2-3 times a day

• Facilitating Bone Development:

60 minutes 4-5 times per week

(Stuberg, 1992)

Developmental Aids

Supine Standers

• Posterior surface of body

leans against equipment

• Used when child has

limited head control

• Involves activation of

abdominal muscles,

especially when upper

extremities are active

Developmental Aids

Prone Standers

• Anterior surface of body

leans against equipment

• Allows movement of head

and trunk

Developmental Aids

Vertical Stander

• Child is in upright

position, increased

amount of weight bearing

• Activates the head, trunk

and upper extremities

Developmental Aids

Mobile Stander

• Mobile prone stander

• Provides opportunity for

independent mobility

Developmental Aids

Wedges

• Improve hip and knee extension

• Improve head/neck and upper extremity

strength

Developmental Aids

Tricycles

• Adaptive tricycles that

provide stability and ease

of pedaling

• Benefits: strength, range of

motion, weight bearing,

mobility

Things to Consider

Accessibility

• Ramps: 8.3-10% grade (1:12-1:10 inches)

• Doorway width: 32 inches

Things to Consider

Precautions

• Skin Integrity (pressure sores)

• Safety

• Appropriate and functional positioning

Things to Consider

Transfers

• Dependent

• Three-person carry

• Hydraulic lift

• Assisted

• Two-person lift

• Sliding board

• Standing pivot

References

• Campbell SK. Physical Therapy for Children.

Philadelphia: W.B. Saunders Company, 1995, pp.

117, 122.

• Stuberg WA. Considerations related to weight-

bearing programs in children with developmental

disabilities. Physical Therapy, 72:35-40. 1992.

• Thomas, CL. Taber’s Cyclopedic Medical Dictionary.

Philadelphia: F.A. Davis Company, 1993, pp. 38.

• Tecklin JS. Pediatric Physical Therapy. Philadelphia:

J.B. Lippincott Company, 1994, pp. 114-119.

THANK YOU!!!