Assistive Technology Devices for Children with Disabilities

Abstract

Optimizing home and community participation of children with disabilities is an important outcome for pediatric rehabilitation. The literature demonstrates that assistive technology (AT) can produce beneficial outcomes for the children and the caregivers, but it also shows that the use of AT devices is far from always being successful. One key factor for success seems to be the active involvement of the child and the family throughout the AT intervention processes.

Assistive devices might widen the gate to everyday activities and participation for children with various impairments.

Appendices

The Case Study

Keywords

Assistive technology devices, cerebral palsy, children’s view, school

Introduction

The theme of this case study concerns the complexity of assistive technology device (ATD) use and provision within a school context. The case is based on a recently completed research project exploring participation opportunities in children with cerebral palsy (CP) when they started primary school.

The students’ task include:

• 1. Finding evidence for use of ATD to enhance occupational performance and participation in children with disabilities

• 2. Identifying facilitators and barriers for effective use of ATD

• 3. Reflecting on how to involve the child in implementation of ATD in their everyday life

As a starting point, the students should use the following references to gather background information:

Bernd T, De Witte LP (2009) Existing models and instruments for the selection of assistive technology in rehabilitation practice. Scand J Occup Ther 16(3):146–158. doi:10.1080/11038120802449362

Eliasson A, Krumlinde-Sundholm L, Rösblad B, Beckung E, Arner M, Ohrvall A, Rosenbaum P (2006) The manual ability classification system (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol 48(7):549–554

Hidecker MJ, Paneth N, Rosenbaum PL, Kent RD, Lillie J, Eulenberg JB, Taylor K et al (2011) Developing and validating the communication function classification system for individuals with cerebral palsy. Dev Med Child Neurol 53(8):704–710. doi:10.1111/j.1469–8749.2011.03996.x

Judge S (2002) Family-centered assistive technology assessment and intervention practices for early intervention. Infants Young Child 15(1):60–68

Nicolson A, Moir L, Millsteed J (2012) Impact of assistive technology on family caregivers of children with physical disabilities: a systematic review. Disabil Rehabil Assist Technol 7(5):345–349. doi:10.3109/17483107.2012.667194

Østensjø S, Carlberg EB, Vøllestad NK (2005) The use and impact of assistive devices and other environmental modifications on everyday activities and care in young children with cerebral palsy. Disabil Rehabil 27(14):849–861

Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39(4):214–223

Overview of the Content

The major goal of assistive technology (AT) intervention in a school context is to support the student’s performance and participation in pedagogical and social activities.

The learning objects are to:

• Increase the student’s knowledge about the role and effectiveness of ATD’s in children with disabilities

• Be aware of the importance of a user-centered approach to AT provision

The Background History of the Clinical Case Study

Eve goes to an ordinary primary school. The family is supported by an interprofessional team and she has an Individual Education Plan (IEP). The use of ATD is not incorporated in the IEP.

Eve is diagnosed with dyskinesia CP with four-limb involvement. She has speech problems not producing intelligible speech. Her gross motor function was classified according to Gross Motor Function Classification System (GMFCS) level III (Palisano et al. 1997). She maintains floor sitting by using a “W-sitting” (sitting between flexed and internally rotated hips and knees). When sitting in a chair, she requires pelvic support to maximize hand function . She is unable to walk without a device. With respect to hand function, she has abilities to handle a limited selection of easily managed objects in adapted situations (Manual Ability Classification System, MACS, level IV; Eliasson et al. 2006). Her communication abilities was classified according to level III by the Communication Function Classification System (CFCS; Hidecker et al. 2011), which implies that she is communicating effectively with familiar partners, but not with unfamiliar.

The school assistant is waiting for Eve when she arrives in a taxi, and helps her into the posterior walker called crocodile. In the wardrobe, she assists her in taking off the jacket and into the powered wheelchair. Eve moves to the classroom; on her way to her desk, she has a small talk with Ida, her best friend from kindergarten. The assistant supports her into the height-adjustable working chair and fastens the seat belt (Fig. 21.1). She puts on a dynamic Lycra glove on her right arm to enhance hand function, which was a prioritized goal of the parents (“improve grasp function”) and the teacher (“improve pencil grasp”) and the child herself (“learn to put on a necklace”).

Fig. 21.1

Eve sitting in her height-adjustable working chair doing schoolwork

It is time for break and outdoor play. The assistant asks: “Do you want the crocodile or the Petra?” (running bike). “The crocodile,” Eve answers and hurries out, in the direction of a little ice pond in the end of the school yard (Fig. 21.2). Throughout the break, she slices on the pond along with some other students (Fig. 21.3).

Fig. 21.2

Eve in the “crocodile” on her way to the ice pond

Fig. 21.3

Eve skating in her “crocodile” on the ice pond

Looking at the photo where she is sliding, Eve tells, “I do skating” (articulation unclear, Ida, her friend helps to translate). “How did you do it?” (10 s pauses). “Run, slide, jump, and slide.” “Have you done this before?” “No, (6 s pauses) I love it, it is fun, fun to slide.”

As the students were going to start eating lunch, Eve began to cry. The assistant was not near; the teacher came up to her, but Eve did not succeed in communicating that the dynamic Lycra suit has to be opened. A RollTalk, with speech synthesis, recommended by the OT, had been mounted on her powered wheelchair 1 month ago to support communication, but was not operative.

In the English class, later in the afternoon, all the students were sitting on benches, with the exception of Eve who was standing in her moveable stander (Fig. 21.4). When she looked at the photograph of this situation, she spontaneously says, “It hurts to stand with the orthoses.” “It hurts, but how was it when you were sitting on the floor, as you did throughout ‘The student’s choices activities’?” “It hurts too.” “Is there any time when the orthoses do not trouble you?” “When I sit in the chair.”

Fig. 21.4

Eve standing in her moveable stander in the English class

The Student’s Report

The following guiding questions have been identified in developing possible solutions to management and follow-up of ATD in a school context. These questions are generated from the available literature references and our clinical experiences:

Questions:

• 1. What functions might be affected in children with CP according to the ICF framework?

• 2. What are important goals for use of ATD in a school context?

• 3. What is the evidence for effective use of ATD?

• 4. How can the ICF framework be used as a guide for AT interventions?

• 5. How can an ATD be an enabler to social participation?

• 6. How can OTs work with school staff to make communication more effective for children with problems in producing intelligible speech?

• 7. How to involve the child in the implementation of preventive and supportive ATD in school life?

• 8. What are the key messages about AT interventions in children with disabilities from this case study?