Adaptive Strollers

Transcript

6/12/2017 Adaptive Strollers Delia “Dee Dee” Freney, OTR/L, ATP NRRTS Webinar June 13, 2017 Learning Objectives 1. The participant will be able to define the adaptive stroller and how it differs from a wheelchair 2. The participant will be able to identify one feature that an adaptive stroller has and why a commercial stroller won’t meet the client’s seating needs 3. The participant will be able to describe how adaptive strollers will fit infants, children and adults. Greetings from California! Riley and Dee Dee from California 1 6/12/2017 DME Clinical Specialist with Kaiser Permanente  Began as a pediatric OT specializing in adaptive equipment from birth to 21 years in the California Children Services Medical Therapy Units  Became a provider for 6 years in complex rehab  Consultant and educational speaker working with manufacturers  High Mobility DME clinic evaluations including regional spina bifida clinics Developing countries; benefit from donated adaptive strollers In Peru with Eleanore’s Project What is a commercial stroller and how does it differ from adaptive stroller? 2 6/12/2017 Commercial Strollers  Most parents have commercial strollers for their babies and infants  Commercially available: strollers, prams, umbrella strollers at retail and online stores  New parents often receive commercial strollers as gifts  Many attractive strollers with cute animal or design prints  A variety of extra convenient features like parent cup holders Adaptive Strollers  Special needs children and clients need adaptive strollers that have seating support systems than a commercial stroller cannot provide  Necessary medical equipment such as suction machines may need to have its own platform on the adaptive stroller  Adaptive strollers are available online but a quality evaluation by an RTS/ATP and a therapist is recommended and required for most funding sources More Commercial vs Adaptive Stroller Comparisons  Commercial strollers have size and weight capacity; up to 50 – 70 lbs.  Commercial strollers have basic shoulder and seat belt  Some lightweight umbrella strollers can be opened with one hand  Adaptive strollers have growth capabilities and can support up to 200 lbs.  Adaptive strollers have positional supports including an independent headrest  Adaptive strollers are funded as medically necessary and may carry medical equipment 3 6/12/2017 Diagnoses          Cerebral Palsy Developmental Delay Down Syndrome Spinal Muscular Atrophy Spinal Cord Injury Traumatic Brain Injury Muscular Dystrophy Seizures Neurological and Orthopedic diagnoses Adaptive strollers come in all sizes to fit infants to adults  Adaptive strollers are dependent mobility devices  An end user will not be able to self propel sitting in the stroller  Base adaptive stroller is lighter than most wheelchairs  Many adaptive strollers “grow” in seat depth  Ability to adjust shoulder straps to accommodate back height of the end user  Sizes can accommodate infants to young adults Adaptive Strollers  Historically, strollers have not been funded  Funding agencies did not know the difference between commercial vs adaptive strollers  Creative justification was to call it a dependent mobility device (which it is!)  Tray and canopy are accessories unless ~  Medically justified as an anterior horizontal support  Canopy for sun sensitivity due to medication 4 6/12/2017 Poll Question How many of you are getting adaptive strollers funded? Who funded? Justification? History of Adaptive Strollers and Pediatric Wheelchairs; they didn’t exist!  Infants and children with special needs cannot be well supported in the commercial stroller  No pediatric wheelchairs available and narrow adult 14” wide strollers too big for most children “She’ll grow into it” First Versions of Adaptive Strollers  Mulholland, Safety Travel Chair  Tumbleform Carrie Seat has a stroller base/car seat  Snug seat with the shell for seating 5 6/12/2017 Kid Kart  Designed and developed by Wayne Hanson, Montana  Tilt, recline, complex seating supported system, could accommodate the Whitmeyer head supports  Cut out trays  Base folds like a stroller  Can face forward or rear facing to be able to see parent  “Cute upholstery” keeps it looking more like a stroller Aesthetics: why is it important?  Parents want and will use strollers that are cute and adaptive strollers should be no different  Parents of special needs children have many new issues to face; including special seating and mobility  Parents with their new little end users will more easily embrace attractive strollers than equipment that looks to “medical” like a wheelchair Kid Kart (early version) 6 6/12/2017 Kid Kart Sunrise Medical Front facing Rear Facing or Pram Style Ease of Use  One of the biggest benefit of stroller bases is that it is lightweight, folded in a configuration that is typically easier for a parent to use  Umbrella Strollers; no support but can fold with one hand Options: 3 and 4 wheel bases  Adaptive strollers have both 3 and 4 wheel base configurations.  3 wheel bases are also known as jogging strollers Kimba Neo Special Tomato 7 6/12/2017 Wheelchair vs Adaptive Strollers  Independent or dependent mobility  Wheelchair heavier  Offers complex seating  Tilt and recline  Folds side to side or rigid frame       Dependent mobility only Adaptive stroller lighter Offers complex seating Tilt and recline Base is foldable 3 wheel option Wheelchairs fold side to side or rigid frame Base folds differently from wheelchairs 8 6/12/2017 Strollers are not just for children  Many widths up to 18” wide  Seat depth; telescoping increase of seat depth  Weight capacity; up to 200 lbs. Advance Mobility Freedom Stroller Adaptive Stroller as a back up to a Power wheelchair Power wheelchairs are great for end users unable to self propel any manual wheelchair. However, parent and caregivers often prefer to have adaptive strollers as a convenient way to transport in cars Poll Question Who recommends adaptive strollers as a back up to a power wheelchair? ****** End users who drive power wheelchairs are not able to self propel. A manual wheelchair as a back up mobility device is an option but many parents and caregivers choose an adaptive stroller. 9 6/12/2017 Case Studies Kolbe  17 months old 2’5” 20 lbs.  Diagnoses: Encephalopathy, severe developmental delay, seizures, A commercial stroller did not offer enough support and with no head and trunk control it was difficult to hold him in midline Challenges  Kolbe has limited head and trunk control  Requires full support in sitting to be able to engage in activities  Visually impaired  G tube fed  Moves his arms only with a startle reflex  Lower extremities show minimal movement 10 6/12/2017 Solutions  Adaptive stroller with full seating support system that also allows parent to fully recline to horizontal to change his diapers while in the stroller.  Rear facing so mom can keep an eye on him as it gives her comfort to be able to watch him  Adaptive stroller need to hold suction machine and portable oxygen holder  Easy to fold mother has a compact car and often Grandmother is a passenger Angel         21 months old 2’8” 27 lbs. Diagnosis: cerebral palsy Spastic quad with no head or trunk control Full time nurse due to her medical needs Portable oxygen tank Ventilator suction machine Tube fed; nasal but soon to get a G tube Challenges  Has a commercial stroller from Target but she has outgrown it  Multiple medical support equipment that a commercial stroller cannot accommodate  Poor head and trunk control but spasticity is present requires moderate to maximum support in sitting  Needs specific head support  Secondary funding MediCal/MediCaid 11 6/12/2017 Solutions  Adaptive stroller with full seating support system that also allows parent to fully recline to horizontal to change his diapers while in the stroller.  Cervical head/neck support to keep Angel’s head supported especially important for suctioning  Adaptive stroller with growth features  Stroller needs to have vent tray, oxygen holder, suction machine One more challenge… funding  Evaluation was on 3/8/17  Quote was approved on 3/28/17 for 80%  Secondary funding of 20% has not been approved to date 6/10/17  Angel has grown 1 inch and gained 2 pounds while waiting for funding to be approved  Pediatric challenge of timely funding due to growth issues 12 6/12/2017 Skye  4 years old 3’3” no present weight  Diagnosis: encephalopathy, respiratory failure, developmental delay, congenital defect of bilateral feet  She does not ambulate due to her feet Challenges  Poor head control  Spasticity in all extremities with a hypotonic trunk  She required both supported seating and various angles to manage her severe spasticity and achieve the most optimum head control  Only a custom manual wheelchair was recommended  Non folding tilt in space custom manual wheelchair could not be transported in the family vehicle 13 6/12/2017 Solution  Adaptive stroller with a variety of supports including a headrest with multi axle adjustments  Family can get the adaptive stroller in their vehicle.  Compared to the custom manual wheelchair, they prefers the ease of use with the stroller base and its ability to fold  All the features on the custom manual wheelchair were duplicated on the adapted stroller Evan  32 years old 5’2” 124 lbs.  Diagnosis: had a stroke at 6 weeks old, grand mal seizures and presents with spastic hemiplegia, developmentally delayed  Unable to self propel wc but can crawl around the home  Non verbal; has receptive language  Self stimulates by rocking and shake things to make noise Challenges  Becomes agitated when unable to rock therefore prefers as little support restraints as possible  Attends a community day program and his manual tilt in space wheelchair is not WC-19 compliant  He is independently mobile crawling around the home  If school transportation is not available, mother cannot transport wc in her vehicle 14 6/12/2017 Solution  Young adult size adaptive stroller  Minimal supports; he has good head and trunk control  Adaptive stroller is WC-19 compliant to safely transport to Day Program in paratransit vehicle  After medical appointments, mom is able to take Evan to his Program using the foldable stroller  His stroller has some dynamic components to allow him to self stimulate without damage to the frame How about this Solution? 15 6/12/2017 Will share a story from Nicaragua Conclusion When commercial strollers can’t provide seating support and growth for the end user, consider Adaptive Strollers. An Adaptive Stroller is a good alternate device to non-folding manual wheelchairs for transportation Adaptive strollers can be considered as back up to a power wheelchairs Not only infants and children use adaptive strollers but young adults who are not able to self-propel can benefit from them as well. Questions? Dee Dee [email protected] m 16 6/12/2017 Acknowledgements Rusty Hallett, NSM Portia Lemmons, End user Charlotte Mann, OTR/L Steven Ortiz, NSM 17