Page 18 - Mobility Management, May 2017

clinically speaking By Jeff Auter, ATP, CRTS
A PEDIATRIC CASE STUDY:
Meeting Multiple Needs, Including Aesthetic Ones
Ireceived a call from Heather, a physical therapist working with the Birth-to-3 program for one of the
counties in Wisconsin.
She told me of a child, Bianka,
born Dec. 4, 2014. At the time I received that call from Heather, Bianka was just over 2 years old and already had a very significant medical history.
Bianka’s Story So Far
Bianka was born full term, but was transferred to a hospital shortly after birth. There were concerns with her temperature, blood sugar levels, head size and eating.
A brain MRI indicated a
A front view of Bianka in her color-coordinated Little Wave Flip wheelchair.
18 MAY2017|MOBILITYMANAGEMENT
malformation, ventrioulomegaly (abnormal enlargement of brain ventricles), hydrocephalus, and septo-optic dysplasia (a brain devel- opment disorder that can include underdevelopment of the optic nerve, dysfunction of the pituitary gland and/or an absent septum pellucidum in the brain).
Bianka was then transferred to a children’s hospital and remained
in its neonatal intensive care
unit for five weeks. She had a gastronomy tube placed and a Nissen procedure (to prevent reflux) on Dec. 30, 2014.
Today, Bianka is quite large for her age. She began to have infantile spasms and seizures in late 2015. These spasms can be quite hard and fast. Her mother and her occu- pational therapist have reported that Bianka has lost a lot of function since the spasms started, and her vision is very limited.
Bianka has significant motor impairments and prefers supine or supported positions. Her tolerance of prone and ability in prone are fair. Bianka requires maximum assis- tance to floor sit, and she avoids taking weight through her upper extremities. She will not take weight through her upper extremities when held in a stance.
At the time I met Bianka, she sat in a commercially available highchair with props, a Rifton adaptive chair (on loan) and a commercially avail- able stroller. While seated, her pelvis is posteriorly tilted, and her bottom is scooted forward to the edge of the seat. She demonstrates poor posture in her stroller.
A side view shows Bianka’s improved positioning in her new system.
Nothing That “Looks” Like
a Wheelchair
Heather informed me that the family was looking for an adaptive stroller, something that did not look like a wheelchair.
(I have been doing specialized wheelchairs for 43 years, and I still wonder what a wheelchair “looks like” or doesn’t look like in the mind of the parents. When the word wheelchair is mentioned, we all get a different image in our brain of what that looks like.)
The issue with traditional adaptive strollers is that they are very wide and do not come into the home very easily. Many units have the seating tilt and recline located between the push handle tubes. This causes the
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