Leisure Activities, Modifying the Environment and Children with Disabilities

It can be a challenge at times to encourage children with physical disabilities to participate in leisure activities.  The Canadian Journal of Occupational Therapy published a small study to determine the effectiveness of environment-based interventions on participation of  6 adolescents with physical disabilities.  A 12-week intervention occurred with a focus on removing environmental barriers and coaching parents.   The Canadian Occupational
Performance Measure was used to establish performance on 17 goals that were set.  Occupational therapists delivered the intervention which included the following: (a) Review baseline participation goals; (b)  evaluate environment-based barriers/ facilitators to participation, including the setting in which these activities take place; (c) work together with the adolescent and parents to explore and implement strategies to modify environmental barriers and/or activity demands and (d) provide knowledge about useful strategies to search for information and advocate for the child’s inclusion.

Some strategies that were used included: adapted bicycles, educating instructors, pre-teaching, assisting with acquiring transportation and more.

The results indicated:

1.  clinically significant improvement in performance scores was observed across all 17 goals.
2.  statistically significant treatment effect was replicated in 13 goals (76%).

The researchers concluded that environment-based interventions are effective in promoting youth participation, but larger studies are required.

Reference:  Dana R. Anaby, Mary C. Law, Annette Majnemer, and Debbie Feldman
Opening doors to participation of youth with physical disabilities: An intervention study: Favoriser la participation des adolescents ayant des handicaps physiques : Étude d’intervention
Canadian Journal of Occupational Therapy April 2016 83: 83-90, first published on October 21, 2015 doi:10.1177/0008417415608653

Need to pre-teach ball skills?  Check out Teaching Catching, Throwing and Kicking Skills.  Help children learn how to catch, throw and kick with this packet full of information of age progression of skills, visual picture cards, tips, letter to parents and more!

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5 Follow Up Questions about Adaptive Equipment

Once a piece of adaptive equipment is put in place to use with a student, therapists need to follow up frequently.  Whether the adaptive equipment is a pencil grip or a tablet, on going assessment is needed.  Here are 5 follow up questions to answer after implementing adaptive equipment:

1.  Is it being used at all?  May sound ridiculous but we all have seen many pieces of adaptive equipment gather dust.  

2.  Is it being used when it was suggested for use?  For example, perhaps special adaptive seating was recommended for seat work but it is being used during floor time on the rug.   

3.  Is the tool suiting the needs of the student?  Once the equipment has been used, make sure is it helping the student to accomplish a functional goal.  

4.  Does the equipment need to be modified in any way?  If the tool is not accomplishing the task, can it be tweaked or does a different modification need to be put into place.  Children grow very quickly, always recheck for sizing.  

5.  Is the student comfortable using the equipment?  Check to make sure that the student agrees with using the equipment.  If the student is not on board with using it, the equipment will not be used.  Also, is it truly comfortable to use the equipment?  Check for fatigue, skin breakdown, pain level, etc. to ensure comfort and a pain free experience.   

Modifications and Interventions for School - Reporting Forms

This book, in printed or electronic format, provides pediatric therapists with over 60, reproducible reporting forms with hundreds of suggested modifications and interventions for students.  Track progress once modifications are put into action.

Find out more at http://yourtherapysource.com/modifications.html

24 Hour Positioning

School based therapists are frequently involved in monitoring sitting and standing postures in order for students to access the educational curriculum without compromising range of motion.  It is the pediatric therapists job to ensure that deformities are avoided through proper positioning.  Obviously, this can be monitored and followed during the school day.  But what happens when the student goes home.  If a student is positioned properly at school whether in a wheelchair or adaptive seating and then goes home to sit slumped on a couch not much will be accomplished.  Or perhaps a student goes home and remains seated or standing with appropriate posture but then goes to sleep for 10 hours in a misaligned position.  

Although school based therapists only work in the school, educational goals may not be met if a program is not also followed through at home.  Consider the following when creating a positioning program and offer suggestions to help supplement proper positioning at home:

1. Is the child positioned properly before school and during transport?
2. Is the child positioned properly in each classroom setting ie homeroom, library, music, art, etc?
3. Does the child have appropriate posture during meal times?
4. Is the child positioned properly after school?
5. Is the child positioned properly during sleep time? (here is an informative article on sleep positioning - http://www.atgrehab.com/clinician/articles/LOJSampleSleepPositioningEquipment.pdf )

 

Printing a Prosthetic Hand

How cool is this?  Using a 3D printer, there is the capability to make prosthetic hands.  Watch this video to see how it came to fruition and how they made it all happen.   The last few minutes of the video show some children in action using their robohands.

I happen to be highly interested in 3D printing.  Imagine the possibilities 3D printing has for all the children that we work with in terms of personalized adaptive equipment, prosthetics and orthotics!  I hypothesize that 3D printing will be the next great thing that hits our technology world.  What an amazing world we live in.

Curious to know is anyone using a 3D printer with any adaptive equipment, prosthetics or orthotics?  Would love to hear about your experiences. 

Tweaking Equipment

Pediatric therapists frequently modify or adapt equipment for children.  Whether it be a writing utensil or sports equipment, sometimes children don't need a specialized tool to participate in the activity but just small adjustment to the typical equipment.  Here is a simple example - perhaps a child would write more legibly with a shorter pencil versus a pencil with a grip on it.  Maybe a student could hit the ball further in gym class using a lighter bat.  When you are considering changes to equipment start with the most simple ideas and make little changes if possible. 

In general, you can ask yourself would the child be able to participate more independently or successfully if the equipment was:

• larger?
• smaller?
• brighter?
• softer?
• harder?
• different color or contrast?
• shorter?
• taller?
• closer?
• farther away?

Sometimes, we are quick to jump to an off the shelf product or a larger modification when all the equipment may need is a little tweak.  What would you add to the list of simple changes?
 

Adaptive Pretend Play

Recent research indicated that children with cerebral palsy displayed less affective expression and imagination when engaging in pretend play as compared to typically developing peers.  When the children with cerebral palsy played with adapted pretend play toys positive affective expression and imagination increased.

Pretend play is a learning experience for children that requires so many skills.  Pediatric therapists should provide consultation services to adapt toys and activities in the home, preschools and early elementary schools.  Here are some suggestions:

1.  Use a switch - is it possible to adapt the toy to provide switch access?  Some pretend play toys such as pretend kitchen sets have knobs to turn on/off.

2.  Use open ended, easily manipulated, pretend play objects - For example items such a play silks are light weight and can be adapted with a wrist cuff for a child to use.  Maybe large hats to represent role playing instead of having to put full costumes on.  Costumes with velcro or ones with easy closures may work better.

3.  Make sure toys are within reach - if a child can not reach the toy it is useless.  Shelving can be lowered,  place toys on the floor or put toys on an accessible table top for all the children to experience them.

4.  Adapt handles if necessary - If objects are hard to grab try to build up handles or knobs to make it easier to grasp.  For example, you could use foam around toy baby bottles to make it easier to hold.

5.  Try large, bright materials - For example if playing grocery store use regular size recycled boxes with adapted grips if necessary.  You could cut handles into cereal boxes making them easier to lift.  Limit visual stimulation in the background.

6.  Provide demonstrations - Not necessarily an adaptation but sometimes children may benefit from suggestions of how to use the toys for pretend play.

What ideas or suggestions do you have for adapting pretend play?

Need ideas to help teach pretend play?  Check out the Pretend Play School forms, Pretend Play Doctor and Hospital and Pretend Play Animals to help spark the imagination.

Reference:  Hsieh HC. Effectiveness of adaptive pretend play on affective expression and imagination of children with cerebral palsy. Res Dev Disabil. 2012 Jun 22;33(6):1975-1983. [Epub ahead of print

Plan an OT/PT Showcase

Have you ever considered hosting an occupational and physical therapy showcase at the school where you work?  You could invite parents, teachers and students to come check out all the assistive technology and adapted equipment that is available for students.  When therapists hop in and out of classrooms and homes they only see a slice of that child's life.  Parents and teachers are with the children many more hours in the day therefore offering the most insight.  When you stop to think about it, parents and teachers may not know what is even available especially along a continuum.  For example, perhaps a student is using some simple adaptive equipment like a slant board.  There are many different slant boards available along with many homemade versions.  Perhaps if a parent or teacher spots a certain feature of one versus another for a student, that will trigger an idea of what would work best.  Same could be said for other equipment including bigger equipment such a wheelchairs or standing frames.  Therapists tend to recommend equipment from a medically and educationally based perspective of what the child needs but don't always take into account the perspective of the parent or teacher.  If they are not on board than we all know the equipment usually does not get utilized (understandably so).

So here are some suggestions:

1.  Have an open house night where you exhibit any adaptive equipment or assistive technology and its uses.  Separate areas of the room perhaps by handwriting tools, technology tools, adaptive equipment and larger equipment.  Make sure information is available for what each tool is used for.

2.  Provide a demonstration of certain tools - explain why certain pencil grips are chosen, demonstrate word prediction programs, demonstrate different walkers, etc.

3.  If you have a loads of equipment to showcase break it up into different nights therefore parents/teachers can come on the nights they are interested in the topic.

4.  If you do not have time to host an actual showcase, how about create some poster presentations to leave by the room.  This will inform teachers and parents what is available as they walk by.  You could have different themes each month.

5.  Love the idea of a showcase?  Invite local vendors to bring wheelchairs, standing frames, orthotics, computer software, etc.  Advertise it well and you would get attendees from other communities including therapists.

6.  Take it one step further and make it a fund raiser.  Do you need money for an adapted bicycle, iPad or handwriting program?  Set up your showcase and charge a small admission fee.

Occupational and physical therapists have so much information to share that just can not occur during a 30 minute session.  Start thinking outside the box to provide educational insight for all members of the special education team.  

Adapting Books

Found this excellent resource on ideas to adapt books for children with disabilities from the North Carolina Assistive Technology Program. There are tips on simple low tech suggestions and more high tech suggestions. Worth a look if you interact with any individuals with disabilities. Read The A-Z of Adapting Books for Children with Disabilities.

Letters of Medical Justification

Need to get some ideas to write letters of medical justification for adaptive equipment? Check out some of these websites to spark your letter writing:

Rifton - How To Write Letters of Medical Necessity

Easystand - Offers a checklist of what to include in your letters.

LMN Builder - If you write many letters a year, this website is worth a look. It is free web tool for therapists to help write letters of medical necessity.

Many wheelchair vendors offer sample letters of medical necessity as well.

Adapted Musical Instruments

I have recently come across several interesting websites regarding adapting musical instruments. School based occupational and physical therapists are frequently adapting tools in the classroom. Here are several websites for suggested adaptations:

One Handed Woodwind Instruments

A Day's Work - This is a commercial website of items for sale. Although you can get some great ideas from the pictures of how you could adapt some instruments yourself.

Adaptive Music Wiki

Choosing a Musical Instrument

Curious to know how many of you get involved in the music room?

Homemade Assistive Devices

Workshop Solutions is jammed packed with information about homemade assistive devices for people with disabilities which I heard about from Barbara Boucher website Therextras. There is a full list of mobility and communication devices that two men have compiled. There are many photos to support the text which describes various pieces of mostly homemade equipment. Some of the photos and ideas are a little dated but the creativity and ingenuity is fun to view.

I did not look at every one but here are some of my unique favorites:

1. Toilet table - a table to encourage a child to sit on the toilet for longer.

2. Quick Knickers - adapted underwear

3. Swingboard - homemade platform swing

4. Customized walker - homemade tiny gait trainer

5. Mini wheelchair - great retro photos.

Make sure you have ample time to explore this website if you are interested in adapting equipment.