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Nothing About Us Without Us
Developing Innovative Technologies
For, By and With Disabled Persons

Part One
Freedom and Development, Not Confinement



Paper-Based Aids:

Seating and Standing Aids for Cruz and Kim, and a Helmet for Edgar

This stool can support 3 people.

This stool, made only of paper and cardboard, can support 3 people. The photo is from the APT manual mentioned on page 73.

This stool can support 3 people.

This stool, made only of paper and cardboard, can support 3 people. The photo is from the APT manual mentioned on page 73.


Most of the special seats described in this book have been made, at a fairly low cost, with wood or plywood. But for many families, even local wood is too expensive or difficult to obtain. For this reason, in Zimbabwe, Africa many years ago, an elderly man named Bevill Packer began to make special seating and other assistive devices out of waste paper and cardboard. In this Appropriate Paper-Based Technology (APT), layers of paper and/or cardboard are glued together with a paste made from flour and water. Paste can be made from maize flour or even with left-over "sadza," a wheat-flour baby food widely used in Africa. Well-made paper-based seating aids and other devices can be unbelievably strong.

Apart from being low-cost (in terms of materials), paper-based technology has other advantages. It is:

  • Easy and fun to make. Children love to help make this equipment. (However, care with technique is needed for the results to be strong and durable.)
  • Adaptable to personal needs. Seat-backs and supports can be molded to meet individual needs. Adjustments can easily be made, hollows scooped out, or lumps or wedges added where needed, for greater comfort, protection, or support.
  • Gentle to the touch. The finished seat or device has a surface that is somewhat flexible, especially when made of corrugated cardboard (from "thick wall" cardboard boxes). This provides a softer, giving, personal touch and is gentler where it comes in contact with knees, butt bones, and other bony areas. It tends to be more comfortable and protective (against pressure sores) than wood, plastic, or metal.

During the last few years, the art of Paper-Based Technology has spread over much of Africa, and is now being discovered in other continents, including the Americas and Europe.

For years, PROJIMO and Project Piaxtla in Mexico have made limited use of paper-based technology for things such as paper-maché puppets, learning aids, and wheelchair cushions. (A cardboard cushion to prevent pressure sores is shown on page 157.) PROJIMO has only recently begun to experiment with using APT for special seating, standing boards, and other assistive devices. The aids in this chapter are among PROJIMO's first experiments.

A donkey with a head of paper.

This donkey, with a head of paper maché, was made by Piaxtla health workers and used in a farm worker theater skit to awaken villagers to their constitutional land rights.

Paper frog

To make a paper-maché frog, strips of newspaper several layers thick are pasted over a balloon.

A child plays at feeding a frog

A child with developmental delay plays at feeding a frog by putting small stones into its mouth.


Cruz learns to sit.

Cruz learns to sit, with the help of sandbags on his legs and behind his hips (see page 46).

CRUZ is a 2 year old boy with cerebral palsy that is in part floppy (low muscle tone) and in part spastic (uncontrolled tightening of muscles). His mother devotes a lot of time to helping him develop his body, mind, and spirit to their best potential. Cruz's brothers and sisters play with him, talk to him, and help him with activities.

Cruz and his family.

Thanks to this loving family effort, Cruz has gained fairly good head control and, with effort, he manages to open his hands to wave hello and goodbye. He also tries very hard to speak. His words are difficult to understand, but his family has learned to interpret them, and they encourage him to speak as much as possible. The boy thrives on all the hugging, handling, and encouragement he receives.

Cruz hated his wooden seat.

A wooden Seat the child hated. Cruz's mother brought him to PROJIMO from a nearby village. She understood his condition so well that the rehabilitation workers learned as many practical developmental activities from her as they were able to teach her. It was agreed that Cruz might benefit from a special seat. Juan designed and built a handsome plywood seat for him with a removable backrest.

But for some reason, Cruz hated his wooden seat. Usually a cheerful child, no sooner was he placed in the seat than he began to scream and wail. His mother was sure he would get used to it, but after two months he still refused to accept it.

Cruz was all laughs and smiles with his cardboard seat.

A cardboard seat that he liked. PROJIMO had been experimenting with paper-based technology. So they tried sitting Cruz in a still-unfinished seat made of laminated cardboard (layers of cardboard from old cartons, glued together). To everyone's surprise, Cruz was all laughs and smiles. His mother was amazed at the difference.

We are not sure why Cruz, who had such a strong dislike for the plywood seat, took such an instant liking to the cardboard one. The positioning and support provided by each was much the same. We suspect that the cardboard seat - with its thick, rounded, relatively soft, yielding structures - was somehow friendlier and more similar to human touch. By contrast, the plywood seat, even with its cushioned lining, was more rigid and unyielding. Despite the smiling rabbits painted on its sides, the wooden seat was not as child-friendly.


A Cardboard Seat Built for Cruz

The seat was designed with many special features. A removable post, or pommel, was placed between the boy's thighs to keep him from slipping forward. A table-top fits around his waist to help stabilize his lower body. A removable, U-shaped hip support fit into the seat to stabilize his hips. It held him slightly forward from the seat-back so that when he wanted to, he could sit up without leaning against the seat-back. (This idea came from watching Cruz's mother place sand bags around his hips to help him sit upright.)

To make the seat, large sheets of cardboard were bent to form the sides and back. After gluing, they were sewn with string to hold them as the paste dried. Village children helped to build the cardboard seat.

All of the seat parts, including the table top, the pommel, and the U-shaped hip support, were made by pasting together (laminating) layers of corrugated cardboard cut from old cartons.

On his first try, Cruz sat fairly well in the seat. But there were problems that required some modifications:

Cruz's legs stiffened and his tense body pushed backward. A removable foot separator.

  1. When Cruz was excited, his legs stiffened and his tense body pushed backward.
    So a removable ankle bar was added to keep his feet on the foot-rest. The bar was made of cardboard, reinforced by a flat metal rod, bent to help position his feet. A removable foot separator of layered cardboard was added to help him position his feet well.
  2. Although the U-shaped hip-support at times seemed to help Cruz sit upright, often he would slump or push back against the seat back.

So a 2-piece low-back support was made of layered cardboard. It could be easily removed as he gained better hip and back control.

U-shaped hip support made of laminated cardboard. An additional support for higher stabilization of hips. The 2 hip supports can be used together or singly. Both hip supports plus groin pommel stabilize hips well.


Addition of an adjustable tilt to the seat. On experimenting with the angle of the seat, it was found that sometimes Cruz sat more upright when the seat tilted forward. (See discussion of positive seating in Chapter 4, page 48.) So a mechanism to change the seat angle was added.

A thin cloth strap was attached to the back edge of the seat-board. By pulling the strap the seat could be positioned at different angles. Three small wooden hooks were made, with posts that fit tightly into holes drilled into the back side of the cardboard seat-back.

Hooking the strap on the 2 lowest hooks gives the seat a steep tilt. When Cruz sits on the forward sloping seat, he sits more erect, with more trunk control.
WOOD HOOK: By hooking the cloth strap on one or more of these hooks, the seat could be adjusted to 7 different angles.

The forward tip of the seat seemed to help Cruz sit in a more upright position. The tilt caused him to push downward with his legs to keep from slipping forward. This increased the muscle tone in his back. But since the foot-bar kept his knees bent, he avoided spastic arching backwards.

All of these adaptations and additions were simple and fun to make because the cardboard frame and attachments were so easy to cut, drill, and modify. Almost the only tool needed was a knife. Removable pieces molded from cardboard could be firmly attached by pressing them (or the pegs attached to them) through grooves or holes cut into the frame. The thickness and texture of the cardboard frame provided a firm grip for the inserted posts and attachments.

The different pieces and attachments to Cruz's seat are almost all removable and many are easily adjustable. The final version of the seat with its removable parts is shown here.

The final version of the seat with its removable parts

An instruction sheet for making cardboard seats is on page 72.


A Cardboard Standing-Frame for Cruz

Village children paste together sheets of cardboard to make a standing-frame.
Tip-toe position

Cruz's mother, brothers, and sister often held him upright, and Cruz did his best to stand. At first his legs stiffened in a tip-toe position. But, if he was held quietly for a while, the spastic muscles would gradually relax and his feet would flatten on the ground. Cruz's mother had bought him new, high-top shoes, which seemed to help him position his feet better.

The PROJIMO team felt Cruz might be ready for a standing-frame. Again, they decided to use mainly corrugated cardboard. The cardboard was reinforced with wooden struts, and had a wooden base-board.

In a preliminary trial of the standing frame, Cruz stood fairly well on it. His feet rested flat on the base-board and were held apart by the foot-holes in the vertical frame. The boy seemed delighted with being able to stand by himself.

His knees angled inwardly.

However, his knees angled inwardly as he stood.


He needed something that would hold his legs straight and apart. So a leg-separator was made by re-shaping and gluing together 2 cardboard boxes to form a long, thin triangle.

A big advantage of a standing-frame made of cardboard is its smooth, soft surface, and its capacity to bend or sink in slightly, under pressure. The cardboard, therefore, provides more gentle support for bony areas such as Cruz's knees.

A standing-frame made of cardboard provides more gentle support for bony areas such as Cruz's knees.

In conclusion: PROJIMO's early trials with cardboard assistive devices show great promise. The PROJIMO team still needs to improve its technique, to create smoother and cleaner products. But the results are working remarkably well. Cardboard provides a number of advantages over other materials: especially its low cost, and the ease with which the structures can be modified and adapted to meet individual changing needs.

Go back to the CONTENTS

Nothing About Us Without Us
Developing Innovative Technologies
For, By and With Disabled Persons
by David Werner

Published by
Workgroup for People's Health and Rights
Post Office Box 1344
Palo Alto, CA 94302, USA