Miscellaneous Aids for Physically Handicapped Children
NIGEL D. RING
All hospitals and therapy units have many gadgets for solving particular problems in daily living. In Great Britain such aids are reported in an excellent publication, Equipment for the Disabled. However, we feel that the more publicity given to these items the better. Accordingly, this report lists a number of devices, with brief descriptions and sketches, which have proved useful at Chailey. We would welcome any comments on these aids from readers and would be pleased to receive any other ideas which might be of help to us. The fact that we are listing these aids does not necessarily represent a claim for originality, but merely that we have found them useful!
There is a full-time carpenter on our staff and many pieces of equipment have been made by him.
This little trolley ( Fig. 1 ) has received wide acceptance internationally, and is on the list of scheduled items in the British National Health Service. It is particularly suitable for children up to about four years of age, although larger versions have been made for older children. For the spina bifida child it helps to develop the trunk and arm muscles, while protecting the back and legs. For the child with severe limb deficiencies a version with canted wheels has also proved useful ( Fig. 2 ).
A useful refinement of the go-cart has been a brake/clutch system which was incorporated in one case ( Fig. 3 ). A jockey wheel on a lever can be pushed out of the way for free-running, be pushed forward to act as a one-way clutch for use on hills, or pressed hard forward to act as a running brake.
For the child with high calipers, a standing-chair ( Fig. 4 ) allows him to relax without having to operate his hip and knee locks. By standing on the footboard he can recline into the chair without any risk of falling. This device has proved most useful in the classroom, and also has value in assisting kidney drainage. It can also be used as a dressing aid by adding hooks and so on as required.
This piece of furniture ( Fig. 5 ) is also suitable for a child in high calipers. Although the table is not novel in itself, one or two unusual features have been incorporated. First, the door is locked shut with a lever Fig. 6 ) which can be operated only by adult-length fingers. Second, the tabletop can be adjusted for height by locating the lop in grooves spaced at equal intervals. Such a semipermanent adjustment is more suitable than, say, friction adjustment where the adjustment is only made infrequently to allow for a child's growth.
The idea of a mobile axilla-bearing walking-aid is not new. However, one that has been made at Chailey ( Fig. 7 ) can be adjusted in both height and diameter to allow for growth of the child.
Mounted on a baseboard we have found that a vertical strut with a slide groove forms a useful basis for a dressing-aid ( Fig. 8 ). Suitable hooks, bars, and other aids can be attached to this strut and adjusted to the child's requirements. For instance, a crossbar with two swinging arms has proved most useful. The arms can be "dressed" with the clothes so that a child with little natural arm movement can easily put them on.
Miscellaneous Aids to Daily Living
Eating. A number of eating aids have been produced at different times. The Cerebral Palsy Eating-Aid ( Fig. 9 ) for use with a head stick has been particularly useful for one child with severe athetosis. By shovelling food onto the spoon, and pressing the spoon back to engage in a ratchet, a child is able to feed himself. The Ontario Crippled Children's Centre, Canada, has further developed this idea, and now has a very elegant version. Similar head sticks have also been used for typing and for controlling an electrically powered wheelchair.
For flail upper limbs, or cases of arthrogryposis, a rocker forearm support is useful ( Fig. 10 ). The forearm is supported in a trough and can then rock on a "spherical" base using body movement. Cutlery can either be held in the hand or attached to the device.
For limb-deficient patients with reasonable arm stumps, cuffs have proved successful. In the case of a young child with a short below-elbow stump, a socket and harness combination was made with a bolt incorporated into the distal end ( Fig. 11 ). Cutlery could be attached with a wing-nut. A simple "Terry-clip" was also used for holding rattles and other articles.
Dressing and Toilet. A simple G-clamp, to which short lengths of tube have been welded and cross-drilled to lake a wing-bolt, provides the basis for a range of useful aids such as a hairbrush holder ( Fig. 12 ). The holder can be clamped to a convenient table or chair back, and the rod bent to a suitable shape. This is one of many aids which can be given a professional-looking finish with a polythene coating. To achieve this finish the parts should be heated in an oven to about 150 deg. C and dipped in polythene powder contained in a lank (say, an old oil drum) which has a false bottom of cloth, or, better, a porous tile or porous plastic ( Fig. 13 ). Air is passed through the powder by a blower (e.g., the blower from a vacuum cleaner) to fluidize it. After dipping, the heated part is put back into the oven for a few moments (suspended by thin wire) so that the polythene melts to form a skin.
A buttonhook ( Fig. 14 ) is another simple device which, with the addition of cross-struts, can be used by many patients with weak fingers or short arms (such as some of the thalidomide-damaged children).
A dressing stick with some form of simple clasp is often useful. Two types have been used at Chailey ( Fig. 15 ). One has a ball or roller which clamps the waistband of a skirt, say, by rolling down a ramp, and is released by being moved sideways. The other has a remotely operated cam. Both are suitable for pulling up socks, trousers, and soon.
Various modified sticks have been used as toilet aids. For pushing/pulling zip-fasteners a double hook in combination with a key ring on the zip is a simple aid ( Fig. 16 ). For boys a further simple aid can be a ring or gutter on the end of a stick to hold the penis ( Fig. 16 ).
To assist limb-deficient girls with micturition, a modified plastic funnel and bottle ( Fig. 17 ) have proved most useful since they may be used by standing astride the funnel without removing the leg prostheses.
A conical spring on a stick provides a simple toothbrush extension ( Fig. 18 ).
Scissors can be used without hands, or with individual finger movement, by means of spring-loaded scissors ( Fig. 19 ). By attaching a stabilizing plate and biassing the scissors open, they may be used by exerting only downward pressure.
Various simple pencil holders ( Fig. 20 ) may be used for different disabilities. For mouth users a piece of drilled and moulded perspex is useful. For hands with poor grasp an indoor tennis ball provides a satisfactory solution, while the severe athetoid may have more success with an especially made "dumbbell."
Several Patient-Operated Selector-Mechanism (P.O.S.M.) typewriters are used here and a number of splints incorporating microswitches have been made. A selection is shown in Fig. 21 and Fig. 22 . (I would like here to express my gratitude once again to Barbara Pitchford who has typed this report at approximately 40 w.p.m. using an 8-input P.O.S.M. typewriter.)
There are a number of items which do not readily fall into the above categories. Several crash-hats have been made where head protection has been required (e.g., for children with four deficient limbs, and those with hydrocephalus). A handsplint with elastic "tendons" has been used successfully to aid finger extension in one case of hand spasticity. For deaf children, simple hearing-aid stabilizers have been made using two lightweight bands over the top and behind the head. These are readily concealed by the hair.
To assist one child with head support, a skullcap and elastic suspension from an overhead gantry attached to a chair were used.
The above items have all proved useful at some time or other. It is hoped that these simple descriptions will both stimulate others to circulate their ideas and, more important, help to improve the quality of life of some disabled patients in other parts of the world. If further information on these or other aids is required, we should be pleased to try to provide it.