音声ブラウザご使用の方向け: SKIP NAVI GOTO NAVI

Disabled Village Children
A guide for community health workers,
rehabilitation workers, and families

PART 3
WORKING IN THE SHOP:
Rehabilitation Aids and Procedures

571

CHAPTER 62

Developmental Aids

In this chapter we look at the design details of aids for lying, sitting, standing, balance, use of hands, and communication. Aids for walking are in Chapter 63.

Whether or not a particular child needs an aid, and what kind of aid she needs, must always be carefully and repeatedly evaluated. An aid that helps a child at one level of development may actually hold her back at another. When considering aids, we suggest you first read the chapters on child development, those covering the particular disability of the child, and Chapter 56.

Note: Many developmental aids have already been shown in PART 1 of this book, especially in Chapter 9 (cerebral palsy), and in Section C, on child development. Aids and equipment for play and exercise are in PART 2, Chapter 46 (Playgrounds). Wheelboards and wheelchairs are in Chapters 64, 65, and 66.

Lying aids

Lying face down is a good position for a child to begin to develop control of the head, shoulders, arms, and hands, and also to stretch muscles in the hips, knees, and shoulders. However, some children have difficulty in this position. For example:

CP

Rosa cannot lift her shoulders

Rosa cannot lift her shoulders. She has to bend her neck far back to lift her head.

Juan does not have enough control and balance.

Juan does not have enough control and balance to reach out his arms.

A firm pillow under the chest.

A firm pillow under the chest may help both these children to lift their heads better and to reach out.

A 'wedge' or slanting support is often helpful. The height depends on the needs of the particular child.

Diana manages best on a wedge high.

Diana manages best on a wedge high enough so that she can lift herself up a little at arms length. (Height is the length from wrist to armpit.)

Lifting up on elbows.

Cassio does better on a lower wedge, so he can lift up on his elbows. (Height is slightly less than length from elbow to armpit.)

The children who have little or no arm or hand control do best when their arms can dangle.

Carmen and others with little or no arm or hand control do best when their arms can dangle. She can see them moving when she moves her shoulders.


Wedges can be made with:

Stiff foam plastic or layers of cardboard. A log and board with a soft foam cover. A stick frame.


572

CP

If necessary, a leg separator can be added (see Page 81).

A child who is lying with his leg separated.

Or sides can be included for the child who needs to be positioned with supports or cushions.

Sides can be included for the child who needs to be positioned with supports or cushions.

Some children are able to control their shoulders, arms, and hands better when lying on one side.

CP

A side-lying frame.

A side-lying frame may be helpful for some children with severe cerebral palsy. Try cushions or padded blocks of different shapes until you find what works best. Use straps only if clearly needed to keep a good position.

Also see lying frames for straightening hip flexion contractures (Page 81 and 86), and lying frames with wheels (Page 618 and 619).

ADJUSTABLE BEDS

This design from the Centre for the Rehabilitation of the Paralysed in Bangladesh adjusts easily from an upper position to a lower position.

The upper position.

The lower position.

See Page 590

These metal beds and wheelchairs are welded together by paraplegic workers. For the 'coconut fiber' mattresses they use, see Page 199.

ADJUSTABLE BACK SUPPORT CLAMP

adjustable bacck support clamp.

Supporting a severely paralyzed person so he lies on his side can be difficult. Pillows easily move or slip. This simple clamp helps solve the problem. It was designed and made by disabled workers at the Centre for the Rehabilitation of the Paralysed, Dacca, Bangladesh (see Page 518).

CAUTION: To prevent pressure sores, be sure the child changes position often (see Chapter 24).


573

Sitting Aids

CP

A wide variety of early sitting aids are included in the chapter on cerebral palsy (see Page 97 and 98). Special seating adaptations for chairs and wheelchairs are in Chapter 65. Here we include a few more ideas:

Holes for straps.

See Page 5

Tire seat or swing bends head.

See Page 421

A log or roll seat.

A log or roll seat helps the child with spasticity or poor balance sit more securely with legs spread. Log should be as high as the knees. Leave a little room between the cut-out circle in the table and the child's belly.

Seats for a child with spasticity.

seat for a child with spasticity whose body stiffens backward.

Design from Handling the Young Cerebral Palsied Child at Home (see Page 638).

OTHER IDEAS FOR HOLDING LEGS APART

from Don Caston and AHRTAG

Other ideas for holding legs apart (from Don Caston and AHRTAG)

from other parts of this book

From other parts (p.5, 416). Page 5, 416

From other parts (p.5). Page 5

From other parts (p. 7). Page 7

From other parts (p.81,97). Page 81, 97

From other parts (p.98). Page 98

From other parts (p. 609) Page 609

From other parts (p.329). Page 329

A seat and table in the form of a fish on the ocean makes sitting in a special seat fun. The seat can be used for straight leg.

For more ideas on adapted seating, see Chapters 9, 35,and 65. Also, see scooters and walkers with roll seats, Page 98.

574

Standing aids (See also Page 99, 312, and 500.)

CP

Many children who have problems with balance or control for standing may benefit from standing or playing in a 'standing aid'. Even for the child who may never stand or walk on her own, being held in a standing position with weight on her legs helps circulation and bone growth and strength.


STANDING BOARD

Sometimes a child who does not have enough control or strength to hold his head up when lying.

can hold his head up better when sitting or standing.

A child who does not have enough control or strength. Hip straps.

A simple standing board can help hold the child in a stable position. This one leans against a table.

A simple standing board.

LEANING BOARD

Leaning board.

See Page 642.

Leaning board-1
Leaning board-2

BACK-BOARD

This can be used to gradually bring a child to a standing position. It is especially useful for older children who get dizzy if stood up straight too quickly. This can happen after a spinal cord injury or a long, severe illness. The child can be stood up gradually and for longer each day.

BACK-BOARD


STAND-IN TABLE

STAND-IN TABLE


OTHER IDEAS

Standing aids - other ideas


575

STANDING FRAMES

Adjustable model

These are mainly for a child with contractures or painful joints who has difficulty standing straight. The child can gradually be straightened up.

Movable model

Simple fixed model


STANDING-AND-WALKING FRAME

This is a useful aid to begin standing and walking, for children paralyzed or severely affected below the waist (paraplegia, Spina bifida, diplegic cerebral palsy).

Standing frame.

Walking frame.


STANDING-WALKING BRACE

Design that does not allow sitting.

Design with hip and knee hinges to allow sitting.

This has the same use as the standing-walking frame above, but is especially useful for children who need to learn how to walk before they are fitted for braces with a hip band or body brace.

576

Aids for balancing and body control

CP

An old drum or barrel .

Activities for improving balance are discussed on Page 105, 311, and 312. Here we bring together a few of the aids for balancing that are shown in different parts of this book, together with a few new ones.


BALANCE BOARDS

A balance board rocks less smoothly. A wide rocker.

Padding to avoid injury.


BALANCE BEAMS

Fallen tree

Logs

Balance beam

See Page 642.

Adjustable wide or narrow balance beam.

The child's ankles that bend in.

For the child whose ankles bend in,

Walking on a log.

walking on a log helps bend the ankles outward.

The child can walk on slanting boards.

Or the child can walk on slanting boards, like this.

The child's ankles that bend outward.

For the child whose ankles bend outward,


To improve baWalking on a boards.

walking on boards like this helps bend the ankles inward.

lance also see swings, rocking horses and merry-go-rounds.

Swings

Page 420 and 421

Rocking horse

Page 422

Merry-go-rounds.

Page 425


577

Other aids

Many aids not yet described in PART 3 have been described in other parts of this book. Here is a brief summary of some of these to give you basic ideas and tell you where to look. We also give a few ideas of aids not shown before.

EATING AND DRINKING AIDS

Eating and drinking aids (p. 112).

Page 112

Eating and drinking aids (p. 189).

Page 189

Eating and drinking aids (p. 223).

Page 223

Eating and drinking aids (p. 230).

Page 230

Eating and drinking aids (p. 326).

Page 326

p. 330

Page 330

Eating and drinking aids (p. 331)

Page 331

Eating and drinking aids (p. 332)

Page 332

Eating and drinking aids (p. 431).

Page 431

TOILETING AIDS

Toileting aids (p. 189)

Page 189

Toileting aids (p. 342)

Page 342

Toileting aids (p. 343)

Page 343

Toileting aids (p. 343)

Page 343

Toileting aids(p. 343)

Page 343

Toileting aids (p. 344)

Page 344

Toileting aids(p. 344)

Page 344

   


HOLDING AND REACHING AIDS (Also see Page 6, 223, 230, 335, 336, 431, and 507.)

Key holder

key holder

Wash cloth mitten for washing dishes.

wash cloth mitten for washing dishes (or self)

Button fastener.

button fastener

Aids for working with feet.

aids for working with feet

   

SPIRAL HOLDING AID

Cut a piece of heavy rubber tube.

Bolt it to a piece of plastic pipe or bamboo.

Bolt heavy rubber tube to a piece of plastic pipe.

Use it like this.

Use a piece of heavy rubber tube.

Spiral attached to washstand.

Spiral holding aid

Note: For larger objects such as a knife or ruler, the spiral can be made of garden hose.

 


REACHING TOOL

Reaching tool

ALL-PURPOSE TOOL

All-purpose tool.


WRITING AIDS (Also see Page 189, 223, 230, and 501.)

Pencil in a large gum eraser.

Loop oof car inner tube.

Leather or thick cloth (Velcro)

Bamboo or tube or hose. Rubber or plastic tubing.  

578

COMMUNICATION AIDS (Also see "Blindness" Page 253 to 254 and "Deafness" Page 259 to 275.)

Page turner.

Page 288 and 501.

Aids for painting, writing, or pointing.

Sitting in wheelchair.

Communication board

See Page 641.

PHYSICAL EXAMINATION, MEASURING AND RECORDING AIDS

INSTRUMENT FOR LEVELING HIPS

Instrument for leveling hips.

Cut 2 pieces of thin plywood like this. Fasten them together so that they slide back and forth.

Close instrument around child's waist.

To use, close instrument around child's waist and push down against hip bones. Then raise or lower shorter leg until the instrument is level.

Aid for measuring leg length difference.

aid for measuring leg length difference (Page 34 and 549)

'Flexikins' for measuring contractures and deformities.

'flexikins' for measuring contractures and deformities (Page 43 to 50)

Other methods for measuring contractures.

other methods for measuring contractures (Page 43 and 79)

Rib-hump angle measurer.

rib-hump angle measurer (Page 163)

Aids for hearing examination

aids for hearing examination (Page 450)

Aids for seeing examination.

aids for seeing examination (Page 452 and 453)

 


FOOT CONTRACTURE PREVENTION AIDS

Also see Chapter 59, "Correcting Joint Contractures," and Chapter 58, ''Braces".

Foot contracture prevention aids in p.81.

Page 81

 
Foot contracture prevention aids in p.81.

Page 81

Foot contracture prevention aids in p.81.

Page 81

Foot contracture prevention aids in p.81.

Page 81

Foot contracture prevention aids in p.184.

Page 184

EXERCISE AIDS

Exercise aids in p. 5.

Page 5

Exercise aids in p. 71.

Page 71

Exercise aids in p. 141.

Page 141

Exercise aids in p. 145.

Page 145

Exercise aids in p. 146. Page 146 Exercise aids in p. 149. Page 149

Exercise aids in p. 186.

Page 186

Exercise aids in p. 229.

Page 229

Exercise aids in p. 373.

Page 373

Exercise aids in p. 388.

Page 388

Exercise aids in p. 392.

Page 392

Exercise aids in p. 528.

Page 528

Go back to the CONTENTS


Disabled Village Children
A guide for community health workers,
rehabilitation workers, and families

by David Werner

Published by
The Hesperian Foundation
P.O. Box 11577
Berkeley, CA 94712-2577