Today I wanted to discuss adaptive equipment and its use in the school environment! What is adaptive equipment? By definition, adaptive equipment is any tool, device or machine that helps an individual perform a task or function associated with their daily living. Thus, there are several different categories and many different types of adaptive equipment which can assist a person. The 3 categories in which adaptive equipment can fall under is: mobility, basic activities of daily living (BADLs), and instrumental activities of daily living (IADLs). For more information on Activities of Daily Living (ADLs) see this blog. Adaptive equipment can range from simple to really complex and can be created or purchased. For our purposes, we will discuss only those relevant to PT in the school environment!
- Wheelchairs – Wheelchairs are a primary form of mobility for many children & adolescents with physical disabilities. Wheelchairs can be manual (meaning the child or caregiver propels the chair with their own physical effort & ability) or power (meaning the chair runs off a rechargeable battery & the child can drive it using a joystick, head array and/or eye gaze configuration). Again, as wheelchairs serve as many children’s primary means of mobility, they spend a majority of time in their wheelchairs and do all sorts of activities in them. Thus, school based PTs must ensure that children are able to negotiate & navigate their school environment safely & efficiently in their wheelchairs.
- Walkers – Walkers can also be a primary form of mobility for children & adolescents with physical disabilities. Walkers benefit children & adolescents who can already stand & bear weight through their legs but need a little bit of extra support with balance & stability while walking. Walkers can be oriented anteriorly (in front of) or posteriorly (behind) depending on which orientation best suits the child. School-based PTs work to ensure kids are able to negotiate their school environment with their walker safely & efficiently.
- Gait Trainers – Gait trainers are more supportive and are designed to provide assistance to kids who have not developed the strength to bear weight through their legs or the ability to walk. Gait trainers often come with accessories that can be added or removed to increase or decrease the level of assistance a child needs to walk. Furthermore, they are typically used more for short distances and to practice walking in the classroom, gym, or in therapy sessions.
Activities of Daily Living:
- Standers – The purpose of a stander is to maintain a child who is unable to stand on their own in an upright standing position, bearing weight through their legs. Standers support bone health & bone density, gastrointestinal function & motility (including managing salivary secretions), and breathing & breath support. However, standers provide more than physiological benefits and can be used with the tray attachment to practice specific fine motor activities, perform classroom tabletop work and/or work on basic activities of daily living (BADLs) such as brushing hair, brushing teeth, washing their face, etc.
- Activity Chairs – An activity chair is a chair utilized for positioning to assist children who are unable to maintain sitting & sitting balance on their own. An activity chair is typically used as an alternative seating device to a child’s wheelchair and can be used to provide optimal positioning in the classroom for tabletop work or BADLs (such as feeding, grooming, etc.).
- Transfer Board – A transfer board (also known as a sliding board) is a small rectangular piece of wood or plastic used by individuals to transfer from one surface to another (i.e. wheelchair to/from toilet, wheelchair to/from activity chair, etc.) while in a seated position. Typically, transfer boards are used by people with good sitting balance and core control who can assist with the transfer or who can perform the transfer independently with use of the transfer board. Transfer boards can increase access to a student’s school environment as well as increase their participation in BADLs such as toileting.
- Mechanical Lift – A mechanical lift can be used in situations to transfer more physically involved students who are unable to assist from one location to another or one surface to another. There are a couple different types of mechanical lifts: a Hoyer lift and ceiling lifts. The Hoyer lift is a portable lift which can be moved from room to room. Ceiling lifts can be free standing or attached directly to the ceiling. Ceiling lifts can be used for transfers within a room such as a bathroom or if set up appropriately can be used to transfer between rooms. School staff must be trained by the school PT to utilize these lifts appropriately & safely to ensure student safety.
It is pretty common for these pieces of equipment to undergo some wear & tear. Thus, it is extremely important to ensure that a child’s adaptive equipment fits well and is in safe, good working order. School-based PTs (often in collaboration with a child’s outpatient/private physical therapist) monitor a child’s growth to ensure that their adaptive equipment is a good fit and work with Assistive Technology Professionals (ATPs), equipment experts, in situations where new pieces of equipment or new parts must be ordered and/or in situations where the child’s current equipment requires adjustments.
Adaptive equipment is so important and serves such a meaningful purpose in many individual’s lives (especially children & adolescents). Improving function and access to their environment, adaptive equipment can greatly impact a child’s performance & participation at school. I hope this post finds you all well and sheds some light on adaptive equipment, its role in the school environment, and the role PT’s play with adaptive equipment.
Until next time!
Catherine C. Skelton, PT, DPT
Pediatric Physical Therapist