Hesperian Health Guides
Carefully Evaluate What Kinds of Support Each Child Needs
Maria’s legs straighten, press together, and turn inward. Her whole body position is affected.
|A hip strap holds her hips back some but does not help her overall position much.||However, a backboard that bends her hips more, plus a knee post, help improve her whole body position —without straps!|
Pedro is a heavy child whose body stiffens and his knees push open.
|A combination of a backboard with guides, a special cushion and a knee block does not help him.||However, a hip strap together with blocks outside his knees gives him a much better position. (He may also need foot straps.)|
|Pablito’s spastic muscles pull his shoulders back and make it hard for him to bring his hands together in front of him. The village team had an idea.|
|They put ‘wings’ behind his shoulder blades, like this, to help keep his shoulders forward.||
Now Pablito can bring his hands together and play more easily.
These can be made from thin wood, plywood, or fiberboard. They should be easy to take off, but grip firmly when in place.
|You can make a simple instrument out of cardboard or stiff paper to measure the child’s body for cutting out the lap board.|
|Extra holes for changing peg position.|
|Raised edges help keep toys from falling.|
|Two pegs to hold onto may help him sit, or move into a better position. They also help him develop hand control (games with rings, etc.)|
|A lap board can help keep shoulders, arms, and body in a better position, especially if it has a part cut out measured to fit around the child.|
|Velcro (stick-to-itself tape) can be used to fix the board to the chair for easy removal — and to adjust it forward or backward.|
|Height of the lapboard is usually the same as for armrests. Experiment to find out what works best.|
|If needed, arm guides can be used with a lap board to keep a child’s shoulders forward and his arms in a better position to use his hands.|
|Be sure to put the softer part of the Velcro on the chair arms. The rough parts could scratch the child when the board is not used.|
DESIGN FOR A WHEELCHAIR INSERT
This insert, from Positioning the Client with Central Nervous System Deficits, provides a lot of control, and is especially useful for some children with spasticity. Although it was designed as an insert for a wheelchair, you can use it as the frame of a wooden wheelchair, or chair without wheels built for a specific child.
Measurements are given in centimeters (cm.). To change to inches, divide by 2.5.
DESIGN FOR A STRAIGHT-LEG SITTING FRAME
(mostly for very young children)
shoulder blade wings
straps for holding legs apart
To seat the child, the frame can be put on the ground, a table, a chair, or into a wheelchair.
DESIGN FOR AN ADAPTED CASTER CART (WHEEL BOARD)
Use the same suggestions for supports, guides, and straps.
Note: The child’s weight is over the large wheels. He can rock from one caster to the other. For travel over rough ground, he will learn to balance on the center wheel and barely touch down with the others.