Rehabilitation Technology

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THE DREAMThe Reality
CPU tower with built-in coffee makersomewhat inscrutable - cup warmer plugs into USB port

Objectives:

  1. Understand and apply a developmental perspective to pediatric DME needs, and be able to explain the differences between children and adults related to growth, development, and systems of service.
  2. Be able to troubleshoot a problematic seating and mobility system and recommend appropriate corrections.
  3. Be able to prescribe and justify an appropriate seating and mobility system for a variety of adult and pediatric rehabilitation patients.
  4. Be aware of the existence of various seating components, ADL and comunications devices, gadgets, and techniques and their appropriate uses.
  5. Understand the roles and credentials of other professionals invovled in equipment provision.

Materials:

Pam Brown's wheelchair PowerPoint and pix, Vikki Stefans' updated version
Barbara Nemeth-King's talk may include information from these sites on DME vendor certification: More sites on seating and other Assistive Technology: A Quia quiz on Rehabilitation Equipment and Technology
Discussion Questions
Welcome to Seating Clinic (Troubleshoot This!)
The earliest Developmental, ADL, and Communication slideshow
Slightly newer DevelADLComm version, though not by much
Updated 2010 developmental mobility equipment and
Updated 2010 ADL and communication as a separate show

Diagrams and Outline Notes:

From Pam's original lecture:

getting correct center of gravity near center of rotation

Grade-Aids

posterior pelvic tilt produces shear and kyphosis

three point fixation to help correct scoliosissling seat offers no support or correction for scoliosis

Overly Complicated Chart from Dr. Stefans' lecture
("LUPUS" should probably be "MS")


3d seating grid

Slightly Less Complicated Chart

2d seating grid

Just remember the big three questions:
  1. Postural control
  2. Deformity - asymetrical vs symmetrical, correctable vs fixed
  3. Sensation - consider pressure relief cushions
...and that ONLY group 3 and a few group 2 with movement disorder need custom molded seating
(group 1 is planar, others contoured.)

Degrees of Postural Control

propped, hands needed, and independent sitting

Mechanisms of Symmetrical Slouch and its correction (usually Group 2):

symmetical slouch dues to bad hamstrings, with and without compensatory rigid kyphosis

BY THE WAY - What's wrong with this website and how would you fix it?


TROUBLESHOOTING GUIDE

Some items you should look up if you have not heard of:

Transportation Safety -

regular and adaptive car seats, other options for tie downs

MEDICAL JUSTIFICATION -

ADLs - useful gadgets vs human assistance

UE vs LE prosthetics

LE much more often successful because UE function requires more detailed sensory feedback

DEVELOPMENTAL EQUIPMENT

crawlers, floor-sitters, corner chairs, standers

ADULT NEEDS

driving, working, relationships

Adaptive Driving basics-

  1. get permit first
  2. specialized eval unless cerebral function and upper extremities intact
  3. medical safety issues - seziure control for 6-12 months depending on state, VOLUNTARY reporting preferred, diabetes and heart disease can pose greater risks
  4. hand controls - sufficient gross leg movements, fast enough and without looking at feet (check proprioception)
  5. advanced controls
  6. add-ons - switch a function from one side to the other

ADA issues and accessibility -

...is there really a disability backlash? If not, why don't the Paralympics get any decent coverage??

Relationships

classic book, Sexual Options for Paraplegics and Quadriplegics (SCI focus)

Communications

Sensory disability

Disability Etiquette and Language

why NONE of our patients are "wheelchair bound" or "suffering from..."

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Since my M.D. also stands for Messy Desk, please use my e-mail!
Write me anytime at:stefansvikkia@uams.edu