Term
| Define positioning equipment |
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Definition
• device used to promote function or mobility or a device that provides the external stability needed to
maintain postural alignment for a child who lacks independent postural control
• often used to compliment direct treatment
• reinforces movement and positions that are encouraged during treatment |
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Term
Discuss the purpose of positioning equipment in relation to what is should and should not be
expected to provide |
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Definition
• should
• help to prevent or reduce contractures and deformities
• promote normal alignment
• inhibit abnormal movements or tone
• facilitate normal movement
• increase comfort
• provide mobility and promote exploration of environment
• encourage emerging motor and cognitive skills
• increase independence in ADLs and self-help skills
• improve social and educational interaction
• assist the child to control his/her environment
• improve physiological functioning
• enhance QOL
• should not
• provide total support
• substitute for treatment
• inhibit functional skills
• place a burden on caregiver in terms of financial cost, time required to position child, or physically for
moving the equipment |
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Term
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Definition
• will it decrease the influence of abnormal tone?
• can it maintain or increase ROM?
• can it increase function by providing external stability?
• it the equipment static? can it adjust as child moves?
• does is contribute to immobility and orthopedic problems 2* being static?
• does it reinforce abnormal alignment? (especially in trunk) |
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Term
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Definition
• does equipment provide external support to allow child to direct energy to other activities?
• does equipment provide mobility to allow child to explore environment? |
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Term
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Definition
• does it increase function to help increase self-esteem and facilitate social interaction?
• does it help normalize child’s appearance? (not ugly or overwhelming) |
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Term
| Recognize the practical considerations associated with positioning equipment |
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Definition
• transportation of equipment
• ease of transitioning child in and out of equipment
• safety of child and caregiver
• family acceptance, cosmetic appearance, ease of use
• cost - rent or purchase, source of funding, temporary or permanent
• appropriate size - growth capability, modified
• comfort
• manufacturer - warranty, support services |
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Term
| Describe the various types of positioning equipment available |
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Definition
• supine positioning devices
• wedges, half rolls, boppy pillow
• used to promote symmetry and reaching forward in space
• prone wedges
• wedge, foam rolls, boppy pillow
• used to promote child in prone and promote UE weight bearing and use
• sidelyer
• provides firm support and helps child maintain sidelying
• generally used for a more severely involved child with hypertonicity or spasticity that requires more
total body support or one who demonstrates asymmetric postures in prone or supine
• corner seat
• useful for children who require support for sitting and need facilitation of scapular protraction and
midline orientation
• adapted chairs
• provide additional support pieces for head, trunk, and extremities
• used for children who require upright positioning but lack sufficient postural control or endurance to
sit in regular seats and chairs
• bolster chair
• used to prevent adduction/IR/extensor synergy of LEs
• standers
• provide support needed for assisted standing in semi-prone, semi-supine or fully upright positions
• scooter boards
• used to promote mobility
• benches
• used for short-sitting, stepping, climbing, cruising or as a table top
• balls & bolsters
• provide a mobile surface and can be used to facilitate automatic reactions
• tilt board & equilibrium boards
• provides displacement in anterior/posterior or medial/lateral directions
• postural control or reverse walkers
• promotes a more upright posture |
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Term
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Definition
• used to
• prevent extensor thrusting - head should be maintained in neutral or slight flexion
• dissociate the LE - extend lowermost leg, flex uppermost leg
• tilt the pelvis - may have lumbar support to promote APT
• promote midline orientation and midline play, hand regard and hand function
• disadvantage
• gives abnormal visual perception of environment
• considerations
• head should be supported on pillow or pad in alignment with trunk
• support legs in dissociation - don’t allow uppermost leg to fall into IR or adduction
• alternate lying on each side
• toys should be placed at chest level or lower to discourage head/neck hyperextension and to
facilitate eye-hand regard
• arms should be placed in scapular protraction and shoulder flexion to promote play
• provide support at the anterior trunk to help maintain correct alignment and prevent child
from rolling forward, also provides tactile input to abdominals |
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Term
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Definition
• used to
• facilitates development of head control and head righting
• development of head/neck and upper thoracic extension
• modified long sitting to accommodate hamstring tightness or to promote APT and increased
trunk extension
• supports upper trunk to allow work on head control and frees UEs
• disadvantage
• requires adequate use of flexors to counterbalance the extensors and prevent
hyperextension
• considerations
• monitor for head/neck hyperextension, hyperextension of lumbar spine
• monitor for excessive thoracic rounding - indicates child doesn’t have enough support
• monitor LE positioning - prevent hip IR/adduction & excessive foot plantarflexion |
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Term
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Definition
• used to
• provide support for symmetrical posture and midline control of the head and trunk and
improved respiration for children with low trunk tone
• promotes the development of head control by supporting the trunk
• prevents scapular and shoulder retraction promoting forward reach and midline hand use
• in children with spasticity hips can be positioned in 90* flexion to decrease extension
• disadvantage
• need belt or strap across pelvis to stabilize pelvic position in children with extensor thrusting
• child needs adequate hamstring length to be able to long sit, otherwise will be pulled into
PPT
• considerations
• abductor pommel to promote hip abduction
• tray for UE support or as a work surface
• elevated seat to accommodate tight hamstrings |
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Term
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Definition
• used to
• provide support for children who require upright positioning but lack sufficient postural control
or endurance to sit well in regular child-sized seats and chairs
• disadvantages
• look at depth of seat - don’t allow impingement of popliteal fossa
• look at height of arm rests - if too high will promote elevation of shoulders and head/neck
hyperextension
• considerations
• if child has poor head control
• recline chair as a unit
• add wings or lateral supports to headrest
• may use foam collar for head support
• options
• lateral trunk support
• promotes trunk symmetry
• anterior trunk support
• shoulder straps should be inserted at shoulder level or slightly below and pulled down
behind to promote shoulder depression, retraction and placement of head in midline,
upright position
• H harness - frontal support with straps going up and over shoulders and one across
chest
• medial thigh support
• assists in maintaining hips in neutral
• must be used with pelvic positioning strap
• lateral thigh support
• assists in maintaining hips in neutral
• head support
• for child with decreased head control
• may be necessary in transport for child with fairly good head control
• support generally posterior & lateral, may have anterior head band
• reverse wedges
• creates more acute angle at hip joint to decrease tendency of pushing into extension
• cushion
• prevent skin breakdown and increases comfort
• changes back height and arm rest height
• tray
• UE support or work surface
• mounting computers or communication devices |
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Term
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Definition
• used to
• prevent adduciton/IR/extensor synergy of LEs
• provide long stretch to tight adductors
• allow pelvic to be positioned more vertically
• disadvantage
• child needs good head control
• considerations
• height should allow feet to be on floor, hips flexed 95-105*, knees flexed 90*
• if UEs in high guard or scapula are retracted
• add wings to promote scap protraction
• if child has tendency toward extensor thrusting
• add belt at pelvic or lumbar roll to facilitate APT
• if child has increased kyphosis and rounded shoulders
• add H-harness or alter the child’s head position from hyperextension to neutral |
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Term
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Definition
• used to
• facilitate active movement of head/neck and upper trunk flexors
• provide WB through heels
• promote LE alignment
• decrease development of LE contractures
• allow upright interaction with peers and/or environment
• provide physiological benefits (increased depth of respiration, B&B, etc)
• disadvantage
• if child has hip/knee flexion contractures may not be able to get appropriate WB through feet
• may promote extensor tone, especially if child has persistent tonic labyrinthine reflex
• may stimulate child with persistent moro reflex
• may promote strong extensor thrusting or positive support reaction
• considerations
• feet should be strapped or blocked in place
• straps are placed across the front of knees to maintain knee extension
• trunk alignment is maintained with a strap across the mid-trunk with lateral trunk supports
• abductor pommel may be added to decrease hip adduction
• can be placed at various angles from vertical to horizontal to adjust for amount of head
control and WB through legs |
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Term
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Definition
• used to
• maintain stretch through gastroc-soleus muscles
• acilitate active movement of head/neck and upper trunk flexors
• provide WB through heels
• promote LE alignment
• decrease development of LE contractures
• allow upright interaction with peers and/or environment
• provide physiological benefits (increased depth of respiration, B&B, etc)
• disadvantage
• may promote WB through toes
• if child is not appropriate for prone stander will slump into kyphosis or have increased tone
with retracted scapula and head/neck hyperextension
• considerations
• feet should be strapped or blocked in place
• strap or pelvic stabilizer block provides pressure across buttocks to maintain hip extension
• need upper thoracic extension and head control that child can maintain
• angle of incline can be adjusted based on child’s ability
• need dorsiflexion range in ankles - get maintained stretch on heelcords
• good for spasticity reduction in gastroc-soleus muscles |
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