Wardrobe of Devices
Wallace Motloch, C.O.(C)
Many children with spina bifida, especially those with more severe involvements, may require not just one but rather a system of devices in order that they may engage in various activities contributing to normal development.
At the Ontario Crippled Children's Centre a system of modular aids has been developed in accordance with the philosophy expressed by Dr. G. E. Sharpies in a recent conference on The Child with an Orthopaedic Disability: His Orthotic Needs and How to Meet Them,5 and paraphrased below:
It was emphasized that experiences at every period of life have impact and long-range implications for development, i.e., that contributing experiences are not confined to a limited period of time, e.g., the first five years. The experiences encountered at different age levels are unique and all are necessary for total development.
Individuals who are seen as being different are challenged less intellectually and physically than are so-called normals. This reduced challenge is reflected in their own motivation and attitudes. If told that they should expect less of themselves, a reduction in goals occurs. If possible, skills should be acquired at the stage of development normally appropriate for those skills. If they are not, then attainment becomes more difficult because that particular stage of development has involved an abnormal experience.
Every effort should be made to maximize normalcy in the developing child even if later "falling back" is anticipated. There are too many dimensions of normal behavior to sacrifice development of any part. Therefore, if the patient can be "normalized" during any period by use of orthotic appliances, their application is justified even if he is not expected to use them effectively all of his life.
Part of our attempt to adhere to this philosophy is illustrated in Fig. 1 , A through D. The patient is 2 1/2 years of age and has difficulty sitting without hand support. His lower limbs are totally paralyzed. In order for him to function at a level close to that of his peers he needs help in a number of areas:1,2,4
- Stationary sitting. The trunk is balanced by a special sitting jacket with large anterior protrusions (Fig. 1-C). The hands are freed for bilateral functional activities and exploration rather than being used to balance the trunk.
- Exploration at floor level when he and his peers are in the crawling stage. The same sitting jacket is fitted into a wheeled base (caster cart), as shown in Fig. 2, to allow the child greater range (one floor of a house) for exploration. The caster cart is provided with a removable handle to help parents wheel the child to parks, supermarkets, etc. (Fig. 1-A).
- Exploration in standing (when his peers are upright). Because the child needs to be standing for various physical and psychological reasons, we introduced an upright "A" frame or standing brace (Fig. 1-B and Fig. 3 ) to which the sitting jacket is quickly attached for trunk support (Fig. 4 ). With a parallel walker (Fig. 1-D) the child can now explore the environment in a second dimension. If, for example, this same person had spine instability, the sitting jacket could be fabricated to serve also as a body jacket to support the collapsing spine. The spine should be supported in the sitting as well as in the standing position so a quick-detach unit is used on the back of the jacket to facilitate its attachment to the caster cart as well as to the standing brace.
This philosophy of orthotic assistance can be extended to numerous additional facets and ages of child development but always keeping in mind the admonition that: "Mechanical Aids for the disabled are often helpful, sometimes they are necessary, but at best they are only tools to do a job that cannot otherwise be done."3
Wallace Motloch is Supervisor, Spina Bifida Unit, Ontario Crippled Children's Centre, Toronto, Ontario, Canada
1. Carroll, N. C, Personal communication.
2. Hamilton, E., Personal communication.
3. J, Langford, G. K., Personal communication.
4. McLaurin, C. A., Personal communication.
5. Sharpies, G. E., pp. 14-15 in The Child with an Orthopaedic Disability: His Orthotic Needs and How to Meet Them. (Report of a conference-C. H. Epps, Jr., Chairman.) National Academy of Sciences, 1973.