Improvement of children's work activities after using wheelchairs

Stephanie is a sociable, energetic girl, diagnosed with mixed ataxia / hypotonic cerebral palsy, attending a school in a children's rehabilitation hospital. She is beginning to want the independence that the average teenager pursues. Although Stephanie can't speak, she often smiles or cries. She can express her needs and expectations through her facial expressions and eyes.

Stephanie's core tension is low, while peripheral extensor tension increases from time to time. Stephanie had very little balance response and no functional protective response in a sitting position without support. The trunk is not well controlled, and the arms can not be used freely. Due to the strong stretching tension, Stephanie's hip and knee joints will be straightened, and the pelvis will tilt backward with compensatory hump. Because of the unstable tension of her lower limbs, she couldn't keep her feet on the ground all the time. Stephanie can keep her head in the middle to maintain visual contact with her environment, but she turns her head to one side, triggering atnr to initiate arm movements to retrieve objects. The other arm becomes shoulder abduction, scapula retraction and elbow bending. Stephanie can't make adjustable autonomous midline movements and functional gripping, although she can reach out and briefly touch a switch. Stephanie doesn't have the ability to move independently in space like her peers. She can roll and move for short distances like crawling through the sea.

Stephanie's communication and movement functions are enhanced by using the biomechanical reference frame of children's functional postures. A supporting seat system is provided for Stephanie, including a strong seat and back, abdominal girdle, body side support, hip baffle, chest band, a front knee block, and a foot pad or magic belt. With a knee table placed on her upper limbs, Stephanie has enough posture and head control. An electric wheelchair can be driven by using an air surface liquid (ASL) approach head rehearsal system. This is a semicircular headrest in which a sensor is embedded to read the relative position of the head without physical contact. After an occupational therapist trained to improve the adjustment of head and upper limb control, Stephanie has left shoulder control, can activate the restart switch in front of the knee table, and has enough head control to successfully control her wheelchair to move in the crowded school corridor. She also uses head control movements to use her communication aids, which are more effective than arm movements.

Despite these potentials, Stephanie still needs adults to monitor her actions in school. She cannot safely pass through the door frame. Stephanie's use of turning her head to trigger atnr to help initiate autonomous arm movements will make the ASL sensor unable to function accurately, and the opportunity for her eyes to see the space she needs to see will be reduced. Stephanie's arm needs external control to keep her head in the middle of the switch. To enhance Stephanie's safety and independence, occupational therapists created a system:

(1) Wrap Stephanie's arm in the accessories of the table on the knee (no arm restraint)

(2) Allow full sight to drive

(3) Strong enough to withstand Stephanie's extremely irregular tension

(4) It's something that family members and caregivers can handle

(5) Adjustments can be made in unpredictable situations

The therapist designed a knee table with two detachable Plexiglas on the side and padded front panels on both sides to prevent Stephanie's elbow from getting stuck between the back of the chair and the side of the table. In order to reduce the weight of the device. The side plates are oblique. When Stephanie's chair "grows bigger" with her height, the device of the lap table can also be adjusted. Of course, a larger lap table can be made in a few years' time. Although Stephanie's initial desk looks different from other people's, she feels depressed, but when she starts to like her independence in school and community, her hesitation soon disappears There is.

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