TERAPIA FAMILIAR Y TRABAJO SOCIAL

A good cushion

Provides enough support over the bony prominences Creates a stable sitting base

Durable Light

Usable in hot seasons

Add foam tubing to the handle to build up the grip or bend the utensil to improve the angle to bring the food to the mouth easily.

The famous scientist Stephen Hawking wrote his world famous books using such an alternative communication device. From: S. Hawking: The Universe in a Nutshell. Photo: S. Cohen

An advanced communication board produces sounds when the picture is touched. Attach a headrest to the wheelchair

or stroller to provide head support.

Cushions and positioning components

Various cushions are manufactured to provide an even distribution of body weight and to prevent pressure sores [A]. They contain either foam, water, air or a gel-like substance. Light cushions are advised if the child is independent in transfers.

Adding certain positioning pieces to the seating system provides better trunk alignment in the wheelchair dependent child. Side supports keep the body in the center while chest belts support the front. A pelvic band at 45o to the seating surface positions the pelvis. Use abduction pillows and wedges to prevent excessive adduction of the hips. Footrests are helpful to position the feet correctly.

The position of the head is important for many reasons including visual perception, control of muscle tone, feeding and swallowing. Posterior and lateral head rests provide support and increase transport safety in children who do not have head control because of low muscle tone [B].

A child sitting in a properly fitted wheelchair with the right seating and positioning devices has more opportunity to explore and experience the world. Social integration and involvement in school activities increases greatly.

Assistive aids

There are a variety of assistive devices used in children with CP to gain function. These devices aim to decrease the caregiver’s burden and to increase the child’s independence in activities of daily living, communication, education, recreation and vocation.

Feeding aids

Various knives and forks have been devised to enable independent feeding [C]. The shape, thickness and angle of these knives, forks and spoons are modified according to the child’s joint range of motion, strength and coordination. These kitchen utensils may be bought or modified from standard knives and forks at home. Mechanical and electronic feeding devices have also been invented for children who do not have sufficient hand control but they are very expensive and not available worldwide.

Aids for communication

Communication is among the most important priorities of children with CP. Communication impairment has two components, dysarthria and dysphasia. Problems of speech and articulation are called dysarthria and problems of language are named dysphasia. Dysarthria occurs because of involvement of the oropharyngeal or laryngeal muscles. Dysphasia occurs because of mental problems secondary to global developmental delays or because of a lesion in the language centers of the brain.

Various devices exist to improve both speech and language impairments and increase communication. They range from very simple picture sets of symbols to high technology equipment such as computerized systems. The simplest is a communication symbol set used to understand the child’s wishes. It can be made at home from simple pictures. The child learns the meanings of these symbols in activities of daily living. Speech therapists teach the child how to express his thoughts, needs and feelings using communication boards, notebooks and devices producing simple every day talk. Communication boards are a set of symbols and pictures that the child sees and knows from everyday life [D]. He simply points at the picture or nods when the picture is pointed at. More complex systems produce sounds when the picture is pushed.

Computerized systems [E] developed after 1980s produce age and gender appropriate speech in different languages. A

E

E

D

D

A

A

C

C

B

B

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Mobility Aids & Assistive Devices

personal computer or portable notebook computer working with mouse, keyboard, joystick, eye gaze, touchscreen or breath supplied with the appropriate software is necessary for speech production. The speech impaired child can communicate with his family and friends in this manner but the language impaired child will still need picture boards and symbol sets.

A computer is an asset for the child who cannot speak but can write. Dyskinetic and total body involved children who cannot speak but have sufficient mental function can use it with an appropriate mouse or trackball to write and express themselves. All children who have problems with fine motor control benefit from having a computer at school for education.

Recreational equipment

Games are the primary means of any child to discover the world and learn. The child with CP needs to join the community life, playing games with peers and friends. There are many simple and relatively cheap options to increase the child’s opportunity to play. The three-wheeled bike can be modified for the disabled child with hand propulsion, wide seats, seat belts, trunk supports and chest straps [A]. Children with trunk extensor spasticity can pedal special bicycles in the upright position [B]. Battery powered cars can easily be adapted with joysticks or special switches.

References

2004 Pennington L, Goldbart J, Marshall J Speech and language therapy to improve the communication skills of children with cerebral palsy. Cochrane Database Syst Rev. 2:CD003466

2002 Sussman M ‘Adaptive Equipment For Children With Spastic Diplegia’ Turk J Phys Med Rehabil 48 (2):12-13

1998 Deitz Curry JE ‘Promoting functional mobility’ In Caring for Children with Cer- ebral Palsy A Team Approach 283-322 Dormans JP, Pellegrino L Paul H Brookes Co Baltimore

1993 Greiner BM, Czerniecki JM, Deitz JC ‘Gait parameters of children with spastic diplegia a comparison of the effects of posterior and anterior walkers’ Archives Phys Med Rehabil 74 381-384

1991 Butler C ‘Augmentative mobility, why do it?’ Phys Med Rehabil Clin N Am 2(4): 801-815

A

A

B

B

Special tricycle with modifi ed handles, head rest and restraints for the body.