Hesperian Health Guides

Precautions in Providing a Child with Aids, Equipment and Procedures

To make sure aids and equipment really meet the child’s needs, consider the following:

1. How necessary are the aids or equipment? Might it help the child more to learn to manage without them?
For example:
Elena has arthritis. Her thighs have become too weak to support her body weight. You can fit her with braces and crutches. But watch out! These aids will not make her thighs stronger. They may even make them weaker, since she could then walk without having to use her thigh muscles.
Girl using crutches.

A better solution might be exercise to strengthen her thighs. For example, walking in water will make it easier for her legs to support her weight.
Girl walking with cane.
Also, using a cane instead of crutches helps her to use and strengthen her thigh muscles.
Two hands helping girl walk with water to the waist.
2. As any child grows and develops, his needs keep changing. Frequent re-evaluation is necessary to find out if an aid should be changed or is no longer needed. Ask the child what he wants.
For example:
Misha has been slow to develop balance for sitting. At first, straps helped him sit in a stable, upright position.
Boy strapped upright in chair playing with dangling toy.
But as he continues to develop, keeping him strapped in a chair may keep him from improving his balance more or from learning to sit without help.
Boy sitting on log plays with a ball.
Misha might be helped more by a seat that gives support to his legs and hips but lets him balance the top part of his body without help (see "Sitting Aids").
3. A simple, low-cost aid that is designed and made to meet the needs of a particular child often works better than an expensive commercial one.
For example:
Commercial wheelchairs are often too big for children, and hard to adapt to their positioning needs. Repairs are difficult and expensive; replacement parts are hard to get.
Child in commercial wheelchair looking uncomfortable with hands and legs dangling.
A simple wood or plywood chair can be easily made to fit the child’s size and positioning needs. Repairs and replacements are easy because bicycle wheels and other standard parts are used.
Child in plywood chair with appropriate leg and arm supports.

4. Consider the economic limitations of the family and community. Growing children will frequently need larger sizes of aids such as leg braces, artificial limbs, and special seating. Use either aids that are cheap enough to replace often, or that can be easily made bigger.
For example:
Poor families sometimes spend as much as a year’s earnings on an expensive, modern brace with knee and ankle hinges and special shoes. When the child outgrows the brace, or it breaks, the family cannot afford to repair or replace it—so the child goes back to crawling, develops contractures and may never walk again.
Child with commercial elbow crutch and leg brace.
costly hinged brace with orthopedic boots
costly commercial elbow crutch
Child crawling with very curved spine, playing with walking doll.
A cheap brace without hinges will not let the child bend his knee to sit. But the brace can be cheaply replaced, so the child is able to stay on his feet. Up to 20 low-cost braces can be made for the price of one expensive one.
Child with crutches and leg braces at 3 different ages from younger to older.
bamboo elbow crutch
adjustable homemade elbow crutch
(See "Metal Braces" and "Crutches".)

5. Make use of the special opportunities in rural areas. Look for ways that a child can do her exercises as part of daily work and play with other people—not as a boring chore that keeps her separate and different.
For example:
If a child needs a special aid to strengthen her weak arm. Avoid making her do the exercises in a way that isolates her.
girl doing arm exercises with a weight system.
woman yelling at girl doing exercises while she works with her other children.
No, you can't help grind the rice. Now, do your exercises like a good girl!

Instead, find ways for her to do her exercises while taking part in activities with others.
arrows pointing to a weight attached to the handle side of the weight system.
If the grinder is too heavy to lift, you can put another weight here.
girl uses her arm exercises and her weight system attached to the grinder to help grind the rice.
Another child can help lower the grinder.
In places where people grind grain with a handmill, this can also be used for exercises. So can grinding grain on a stone dish. A mill can be adjusted from ‘easy’ to ‘hard’. (Also see Maricela's Story and "Ideas for Making Exercises Fun".)
girl using the handmill to do her exercises.

6. Whenever a choice can be made, keep orthopedic aids as light and unnoticeable as possible.
For example:
Tina is from a village where most children wear sandals. A rehabilitation center in the city fitted her with a heavy metal brace and boots like this. She hated them and refused to leave the house with them on.
girl with leg brace attached to bulky full boots.
Six months later, Tina’s father took her to a village rehabilitation center where they fitted her with a lightweight plastic brace. She could wear it under stockings, and still use her old sandals. She was happy to wear it anywhere.
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Note: In areas where children do not wear shoes and socks, a brace with a wood clog, leaving most of the foot open to the air, may be preferred (and may be cleaner).

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7. Try to adapt aids and equipment to the local culture and way of life. An example of adaptation to the local situation is the ‘Jaipur limb’ (see also Chapter 67):

In India, villagers squat a lot. They cook and eat at ground level. A person with a standard artificial leg cannot squat because the leg does not bend enough in the knee and ankle. Also, the standard leg is not made to be used when barefoot, or in water.
boy standing with a standard limb speaking to two boys cooking on the ground, one with a Jaipur limb.
I can't help!
I can!
The ‘Jaipur limb’ was designed for the needs of villagers in India. It has a knee with a joint that bends all the way. The foot piece is made mostly of rubber and is very flexible, allowing the person to squat. It is the color and shape (including toes) of a normal foot. It is waterproof, so that people can work in water or rice fields without harming it. The leg is low cost and quick to fit.
accurate looking rubber foot.
(See more information on the Jaipur limb.)

8. Make aids and equipment as attractive and enjoyable as possible. To test the attractiveness of an aid, find out:
  • Does the child take pleasure or pride in his aid?
  • Do the parents like it?
  • Do other children want to use it or play with it?
child riding aid equipment shaped like a horse amongst other children who would like to ride his equipment
Hey Tim! Let me ride your horse!
9. A common error is to provide children with more bracing than they need. Often a child will come to the rehabilitation center already fitted with big heavy braces that he never needed or no longer needs. They may actually slow him down. Always check to see what a child can do with and without his aids. Try smaller, lighter aids, or none at all. Above all, ask the child what he prefers.
unhappy boy with full leg braces on crutches standing next to the flower.
Walk from here to that flower as fast as you can.
25 seconds.
happy boy on crutches moving much faster towards the flower without any leg braces
Now do it again without your braces.
Only 17 seconds!
But your feet bend over some. Let's try with some below-knee plastic braces!
very happy boy moving fast on crutches towards the flower with his minimal leg braces.
Only 11 seconds!!
(for this child)
(See "Plastic Braces".)

This page was updated:27 May 2020