Assistive Devices:

Mobility, Orientation
and ADL
Suellen Concessio Fernandes
Overview
• 90% of persons with CP have mobility challenges.
• CP affects groups of muscles which include ligaments tendons and joints
• As part of the physical therapy plan, assistive devices play a vital role in the treatment of CP
• Assistive technology encompasses an array of items and equipment
• It is used to improve and maintain functional capabilities of the CP person
• Assistive, adaptive and augmentative devices help cerebral palsy patients achieve greater independence and self-confidence.
• Low-tech assistive devices make it easier for patients to grasp and manipulate items, or provide bracing support for weak joints.
• High-tech equipment includes state of the art mobility aids and computerized communication devices. A custom cerebral palsy treatment plan
may include the use of these aids and devices:
Orthotic Devices
Orthotic devices are braces worn externally, providing support and stability for individuals facing mobility challenges. The devices may
be used temporarily, to enhance a period of treatment and development, or utilized as lifelong aids for standing, walking and
positioning.
According to the needs of each patient, orthotics can be used to correct and prevent:
• Hip and knee dislocation
• Spastic movements
• Fallen arches
• High arches
• Inward (inversion) and outward (eversion) angled feet
Walkers
A walker serves as a sturdy frame a patient holds as he or she walks. The devices provide support and stability, giving CP patients greater independence and
confidence. Various walkers meet the needs of cerebral palsy patients, including these distinct types:
• Two-wheeled posture rest walker – Four posts stabilize the user – two fitted with wheels and the others capped with rubber tips. This style of walker helps
with pace and control while walking. It can also be equipped with a seat, giving users full-time access to a resting bench.
• Four-wheeled posture control walker – Four wheeled units help toddlers and young school children maintain their balance – without slowing them down.
• Chest-support walker – Chest-level support enhances balance and promotes standing and walking.
• Gait trainers – Designed with extra clearance for walking, gait trainers come in various sizes and can be modified and customized to accommodate evolving
mobility needs of children finding their stride.
• Suspension walker – Extra support helps a child with CP stand and carry his or her body weight. Suspension walkers keep children upright as they build
strength and coordination – before moving-on to gait trainers.
Walking Sticks and Canes
• Cerebral palsy patients find balance and stability.
• It is adjustable ands assist CP patients across a range of developmental stages.
• Folding cane – Split to fold down in two or three pieces, folders are portable and versatile for those needing
a cane part-time.
• Offset cane – Adding an extra bend to the shaft makes this cane more stable and adjustable. Ergonomic
handles add comfort and better grip for safety.
• Quad cane – Using four points of contact for the base, instead of a single shaft, creates a sturdy, stable
support structure. Quad cane bases are made in various sizes, accommodating children and adult CP
patients.
Crutches
Crutches help patients able to walk, but need extra support.
The versatile mobility aids come in two types:
• Underarm crutches – Like the crutches issued to patients with leg injuries, these familiar supports
tuck-in below the shoulder, giving the user a cushioned underarm lift. Crutches can be used singly or
in pairs.
• Forearm crutches – Shorter than underarm versions, these crutches incorporate a collar, which wraps
around the users forearm, below the elbow. They are easier to manipulate than full-length underarm
crutches, and the collar or strap keeps them attached to the arm – even when the user lets go of the
handle.
Standers
The mobility devices enable children with CP and other disorders to bear their own body weight, when physical limitations would otherwise prevent it.
Several types of standers are used in cerebral palsy therapy, including:
• Prone stander – This type of stander supports the user from the front, enabling a child with CP to lean forward for stability. The angle of support can be
adjusted, according to the patient’s level of strength and ability.
• Supine stander – Supine standers support patients from the back, holding the user upright or slightly angled to the rear. Trays and other accessories can be
added to make the devices more functional. Supine positioning is particularly helpful for cerebral palsy patients with limited head strength.
• Sit-to-stand stander – Versatile mobility aids enabling users to move between sitting and standing positions.
• Mobile stander – These adaptive mobility aids incorporate large wheels, empowering children to pull themselves along or propel themselves. The units are
most effective for patients with good head control and upper body strength.
Lifts
Lifts help cerebral palsy patients support their own weight and make transfers between devices or locations. Lifts also assist
caregivers with patient transfers and positioning. These lifts may be used to improve comfort, convenience and functionality:
• Stair lift – Installed on staircases to help patients move up and down, without the ability to walk.
• Transfer lift – Sometimes called Hoyer lifts, these multi-function units provide hydraulic assistance for moving patients in
various settings.
• Ceiling lift – Permanently installed track systems enabling patients with physical limitations to move independently.
• Sit-to-stand lifts – Moving from seated to standing position is made easier with the help of this device, designed for
cerebral palsy patients and others with muscle weakness in the lower extremities.
Wheelchairs
Wheelchairs are vital mobility aids for cerebral palsy patients with ambulatory issues. The essential devices are available as fully-
manual versions or powered, electric alternatives, which can be equipped with advanced features. Selecting the proper wheelchair
accounts for several variables, including the following concerns: Leg requirements, anticipated uses, cushioning preferences, patient’s
abilities, height, width and seat proportions, portability, price and accessories.
Electric wheelchairs are highly customizable, offering various configurations, battery options and drive specifications. Manual
wheelchairs typically fall into these classes:
• Rigid frame – These chairs do not collapse for transporting.
• Folding frame – Easier to transport than rigid models, folding wheelchairs can be broken-down and stowed in small spaces.
• Recliners – Reclining wheelchairs are equipped with adjustable back rests, typically extending higher than a standard chair.
Power Scooters and Driving assistance

There are numerous types of driving modifications available today, especially for people with cerebral palsy.
• Wheelchair Vans, Trucks and SUVs – If you would like to enter and exit your vehicle while sitting in a wheelchair, check out
a wheelchair accessible converted vehicle. These vehicles are converted so that a ramp or lift will allow PwCP to enter while
staying seated. Some wheelchair vehicles allow for the driver to stay in the wheelchair while driving.
• Driving Aids, Hand & Foot Controls, Accessible Steering Options
• Transfer Seats and Accessible Seating
• Wheelchair and Scooter Lifts
• Power scooters come in 3 or 4 wheeler options
Adaptive Seating for CP
• A floor seat – suited for persons to sit on the floor.
It provides support to the back and torso of the
child. If a child slips forward a wedge seat can be
added or a pommel based on the needs of the
child.
• A Box Seat - the floor seat can be raised off the
floor and used with wheels to ensure mobility. The
only extra measurement taken is the height from
the knee to the floor.
Adaptive Seating to keep children sitting

• Some Children who have tightness between their legs may require a
pommel which separates the legs. It also helps to sstop children slipping
forward in the chair.
• Children who tend to slip forward benefit from a ramp or wedge seat. The
wedge is fitted to the seat to prevent slipping. It is more comfortable than a
pommel and adequate enough to keep the child in his seat. If the child still
slips forward with a ramped seat then a pommel should be used.
• A pelvic strap gives added support and stability for children who tend to
slip forward. It is fixed at the back and below the level of the seat.
Tables and cut outs
• Floor table
• Cut out tray
ADL
Activities of Daily Living, also referred to as Self Care Skills, play a major role in a child's overall functional growth, confidence and independence.
Problems in this area may be due to an underlying problem, which may include impaired Sensory Integration or diminished Fine Motor or Upper
Body Coordination. Children may also exhibit poor motor planning which affects their ability to sequence, time and grade motor activities.
There are many variations on the definition of ADL's but most organizations agree there are five basic categories.
• Personal Hygiene such bathing, grooming and oral care
• Dressing including the ability to make appropriate clothing decisions
• Eating, the ability to feed oneself although not necessarily prepare food
• Maintaining Continence or the ability to use a restroom
• Transferring oneself from seated to standing and get in and out of bed
ADL
• Cerebral palsy patients face challenges completing everyday tasks. From dressing and eating to personal care, daily activities can pose difficulties. Various adaptive devices make routine tasks easier, empowering CP patients to enjoy independent lives. Assistive devices and equipment contribute in diverse settings:

• Bath –

• Custom toilet seats

• Safety bars

• Bathing benches

• Kitchen –

• Weighted eating utensils

• Non-slip plates and bowls

• Bedroom –

• Safety mats

• Pull-out tables

• Positioning devices

• Dressing aids

• Classroom –

• Adaptive scissors

• Writing and typing aids

• Specialized art supplies

• Adaptive sports equipment