Physical Access, Seating and Positioning

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Physical Access, Seating and Positioning

• Kim Ho, PhD CCC-SLP

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Overview

• Questions about Symbols lecture
• Quiz Two
• Mobility and Positioning lecture
• Wheelchair positioning and handling activity
• Lifting and Handling
• Transferring activity
• Alternative Access Lecture

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Educational Implications Mobility Positioning

• Wheelchairs pads, cushions, straps to keep
  student in midline position
• Ankles, knees, and hips bent at 90
• Supports placed correctly
• Headrest (if needed)
• Tray--may restrict movement
• Other mobility aids Walkers, crutches, adapted
  bicycles, scooters

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Wheelchair Positioning

• Hips and Pelvis Midline position hips bent 90
  Pelvis in back of seat
• Trunk Midline position maintain normal curve of
  spine
• Shoulders and arms Shoulders at midline and
  neutral position Elbows flexed about 90
• Head and Neck Midline position face forward
• Legs Thighs and knees slightly apart knees bent
  at 90 Feet facing forward and directly below or
  slightly behind knees ball and heel flat on
  footrest.

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Wheelchair Handling

• Foot rest removal
• Managing curbs
• Transferring to and from w/c
• Collapsing
• Safety speed, wheelies

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General Principles of Lifting and Handling

• Have child bear weight and assist
• Determine how many people needed to lift safely
• Provide broad base of support
• Never bend at waist to pick child up
• Do not bend at the back when placing child in
  wheelchair
• Use arm and leg muscles to lift
• Hold child close when carrying to maintain
  balance
• Never twist back when holding child
• Never use arms or legs as handles

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One-Person Lift

• Bring wheelchair close to child and lock brakes
• Kneel on one leg next to child
• Bring child into sitting position
• Place one arm under childs thigh and other
  around childs back
• Lift child up close to you
• Come to standing position
• Slowly carry child to wheelchair and lower in
• Properly position child and adjust equipment

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Two-Person Lift Side-to-Side Method

• Bring wheelchair close to child and lock brakes
• Two adults kneel on either side of child
• Bring child into sitting position
• One person brings one arm under thigh and other
  around back. Second person does same
• One person counts 1..2..3
• Lift child straight up (on 3)
• Carry child to wheelchair
• Lower child into wheelchair
• Properly position child and adjust equipment

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Tow-Person Lift Top-Bottom Method

• Bring wheelchair close to child and lock brakes
• One adult kneels at top of child, other at side
  (near childs legs)
• Bring child into sitting position
• Top person brings arms under childs arms and
  around to front
• Bottom person holds both thighs
• One person counts 1..2..3
• Lift child straight up (on 3)
• Carry child to wheelchair
• Lower child into wheelchair
• Properly position child and adjust equipment

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Transferring Activity

• Form groups of 3-5. Each individual in the group
  will practice being transferred and being the one
  who transfers at least once. Other group members
  will observe and assist.
• Write names down on a piece of paper
• Include comments/questions

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Weight-Bearing Transfer

• Tell individual what you are going to do (each
  step) provide a touch cue as needed
• Lock w/c breaks
• Position chair approximately 90 degrees from w/c
• Remove/swing away w/c foot rests
• Take off safety straps, seat belt, etc

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Transfer Contd

• Move individuals hips forward so that feet are
  flat on the ground
• Keep a wide base of support, bend your knees and
  keep your back straight, as you hold individual
  around their chest, under their arms
• Encourage weight bearing (if authorized) as you
  pivot individual to other chair
• If the individual is well balanced, place one
  hand on the chair arm or nearby table before
  seating her/him

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Transfer Contd

• Hold individual around hips, and encourage
  her/him to bend at the waist and sit down on the
  chair
• Position individual on the chair following
  positioning guidelines from the lecture.
• Include comments/questions to hand in

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Gross-Motor Terminology

• Flexion
• Dorsiflexion
• Extension
• Decubiti tissue breakdown/death
• Contractures permanent muscular contraction
  joints
• Tone tension present in resting muscles
  support against gravity
• ROM range of motion

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Gross-Motor Contd

• Spasticity velocity-dependent resistance to
  passive stretch
• Paresis - weakness
• Rigidity consistent resistance to passive ROM
• Hypotonicity too little activity
• Tremors involuntary trembling
• Initiation/cerebellar voluntary movement
• Passive/resting tremor during rest

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Gross-Motor Contd

• Apraxia impairment in executing purposeful
  movements
• Ataxia inability to coordinate muscles in
  voluntary movement
• Supine on back
• Prone on stomach
• Side-lying

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Positioning Devices

• Devices used during functional or academic
  activities to promote movement, alignment, and
  bone growth, and to provide stability
• Wedges
• Sidelyer
• Corner Chair
• Supine/prone standers

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Placement of Material

• Determine optimal placement of materials based
  on
• Students range of motion
• Students visual field

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Alternative Access

• Selection set
• Physical characteristics of displays
• Number of items
• Determined by number of messages
• Symbols
• Codes
• Commands

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Size of Display

• Individual item and overall display
• Visual displays, symbol size depends on
• Visual capabilities
• Motor access technique
• Type of symbol
• Number of items

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Size of Display Contd

• Overall size involves compromise
• Number of items
• Size of individual items
• Spacing of items
• Mounting and portability factors
• AAC users physical capabilities
• Auditory displays, depends on
• Memory
• Ability to retain the organizational scheme of
  the display

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Types of Displays

• Fixed symbols and items fixed
• Dynamic two types
• Changes the selection set when activated
• Informs the user which items in the selection set
  are available for activation

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Selection Technique

• Way the AAC user selects items from selection set
  
• Direct Selection
• AAC user indicates desired item directly
• Typing, natural speech, gestures, finger
  pointing/touching
• Light pointer, headstick, eye gaze
• Scanning
• Choose items indirectly from selection set

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Direct Selection

• Physical pressure/depression
• Physical contact
• Pointing (no contact)
• Voice recognition

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Scanning

• Lack of motor control
• Scanning Patterns
• Circular Scanning
• Linear Scanning
• Group-item Scanning

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Selection Control Techniques

• Directed (Inverse) Scanning
• Indicator/cursor begins with activation
• Selection is made when switch is released
• Automatic (Regular or Interrupted) Scanning
• Movement of cursor is automatic and continuous
• Make a selection by closing the switch
• Step Scanning
• Cursor moves one step at a time per activation
• Make a selection by pausing or second switch

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Feedback

• Activation Feedback
• Lets user know that an item has been selected
• Not what symbol/message has been selected
• Message Feedback
• Tells user what symbol/message has been
  formulated
• May be useful to communication partner

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Message Output

• Synthesized Speech
• Rule-generated speech using complex algorithms
• Digitized Speech
• Natural speech recorded, stored and reproduced