Hesperian Health Guides
Chapter 62: Developmental Aids
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In this chapter we look at the design details of aids for lying, sitting, standing, balance, use of hands, and communication. Aids for walking are in Chapter 63.
Whether or not a particular child needs an aid, and what kind of aid she needs, must always be carefully and repeatedly evaluated. An aid that helps a child at one level of development may actually hold her back at another. When considering aids, we suggest you first read the chapters on child development, those covering the particular disability of the child, and Chapter 56.
Note: Many developmental aids have already been shown in PART 1 of this book, especially in Chapter 9 (cerebral palsy), and in Section C, on child development. Aids and equipment for play and exercise are in PART 2, Chapter 46 (Playgrounds). Wheelboards and wheelchairs are in Chapters 64, 65, and 66.
Lying aids
Lying face down is a good position for a child to begin to develop control of the head, shoulders, arms, and hands, and also to stretch muscles in the hips, knees, and shoulders. However, some children have difficulty in this position. For example:
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| Rosa cannot lift her shoulders. She has to bend her neck far back to lift her head. | Juan does not have enough control and balance to reach out his arms. | A firm pillow under the chest may help both these children to lift their heads better and to reach out. |
A wedge or slanting support is often helpful. The height depends on the needs of the particular child.
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 Letting feet hang down helps prevent tiptoe contractures. |  |
| Diana manages best on a wedge high enough so that she can lift herself up a little at arms length. (Height is the length from wrist to armpit.) | Cassio does better on a lower wedge, so he can lift up on his elbows. (Height is slightly less than length from elbow to armpit.) | Carmen and others with little or no arm or hand control do best when their arms can dangle. She can see them moving when she moves her shoulders. |
Wedges can be made with:
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| stiff foam plastic or layers of cardboard | a log and a board with a soft foam cover | a stick frame |
| If necessary, a leg separator can be added. | Or sides can be included for the child who needs to be positioned with supports or cushions. |
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 Design from Functional Aids for the Multiply Handicapped. |
Some children are able to control their shoulders, arms, and hands better when lying on one side.
A side-lying frame may be helpful for some children with severe cerebral palsy. Try cushions or padded blocks of different shapes until you find what works best. Use straps only if clearly needed to keep a good position.
Also see lying frames for straightening hip flexion contractures ("Positioning" and "Hip Contractures"), and lying frames with wheels.
ADJUSTABLE BEDS
This design from the Centre for the Rehabilitation of the Paralysed in Bangladesh adjusts easily from an upper position to a lower position.
| The upper position is right for moving to and from a regular wheelchair. | The lower position is right for moving to and from a low-level wheelchair or ‘trolley’, which many people use in their houses in Bangladesh. |
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These metal beds and wheelchairs are welded together by paraplegic workers. For the ‘coconut fiber’ mattresses they use, see "Padding and Cushions for Lying".
ADJUSTABLE BACK SUPPORT CLAMP
| Supporting a severely paralyzed person so he lies on his side can be difficult. Pillows easily move or slip. This simple clamp helps solve the problem. It was designed and made by disabled workers at the Centre for the Rehabilitation of the Paralysed, Dacca, Bangladesh. |  |
CAUTION! To prevent pressure sores, be sure the child changes position often (see Chapter 24). |