Client Information: 5-year-old boy Height and Weight: 38 lbs. and 43" tall Diagnosis: Cerebral Palsy: Double Hemiparesis
Past Medical and Functional History:
- He lives with his father, mother and little brother
- He has difficulty with controlled movements in his extremities
- He has significant difficulty with head, neck and trunk control (very low tone)
- His tone fluctuates; his upper and lower extremities have higher tone while his trunk and neck have low tone
- His first seating system was a stroller with a custom seating system
- He required a custom mounted Whitmyer headrest and a cervical collar to support his head
- He was 3 years old when he was initially evaluated by the team
- The team originally met him for a communication evaluation
- The team worked with him on AAC and discovered his switch access was very accurate
- The team found that his family was waiting for power mobility because they thought he had to use his hands to control the power wheelchair
Cognition: He is a very intelligent and bright boy.
- Supine Evaluation:
- Checked pelvic motion, lower extremities, trunk, head and neck and upper extremities mobility. All were within functional limits.
- Sitting Evaluation:
- Balance was a major limitation for client. He could not sit without 100% support.
- Took proper anatomical measurements
- At the time of the evaluation he lived in a home that was not wheelchair accessible
- Getting the power wheelchair in and out of the house was going to be a challenge, but his family was up for it if he was more independent
- The family did not have a van to transport the wheelchair at the time of the evaluation
- The team trialed him in:
- A couple of mid-wheel drive power bases with a manual tilt feature
- A planar back rest with a small sacral support insert
- A Pediatric Stimulite Contoured seat cushion
- Curved lateral trunk supports
- A Whitmyer headrest then a Stealth I2I headrest with an anterior trunk support underneath the headrest for additional support
- A padded pelvic belt at a 45 degree angle to his body
Results of Simulation:
- The team trialed a joystick at his hand. Ruled it out.
- The team trialed a joystick at his foot. Tried left and right foot. Ruled it out.
- Based on his limited movement and control the team trialed a single switch at his hand and foot. Ruled it out.
Results of simulation:
- SUCCESS!!!!!!!!! Switch was mounted above his right knee where he could use hip flexion to access the switch.
- The team found that he picked up very quickly how to maneuver the power wheelchair around within all of his environments
- His mother reported she was amazed by his ability to drive the wheelchair
- He was all smiles while driving the power wheelchair
- We decided to go for funding and purchase of a new Q610 with proper seating
The List of Items Delivered at the Fitting:
- A Q610 with manual tilt-in-space, enhanced display, two egg switches, custom mounting brackets for the switches and custom straps for arms
- Seating system: a Stimlulite contoured seat cushion, an after-market planar back rest with sacral support, curved lateral trunk supports, a Stealth I2I headrest with temporal pads and swing-away components, anterior trunk support, pelvic belt (mounted at 45 degrees to his body) and a pair of lateral hip support pads
- He has been very successful with single switch driving; he can maneuver the power chair through very small tight spaces
- Since receiving the power wheelchair his family has built a new house with an open concept interior that benefits him significantly
- His family purchased a van for transportation
- He now has the capability to use two switches, one to drive and one for his communication device
- He has decided to no longer use footplates because he feels he has greater accuracy with switch use without the footrests
- He is starting to develop better control with his right foot and will eventually try a joystick with foot control
- Things his family and school team have noticed
- He is communicating more verbally and with his AAC device
- He is putting together words to form sentences
- His driving has become very accurate
- His mother has become creative giving him chores to do:
- He does recycling
- He helps with laundry
- His school team has adapted to his power wheelchair at school
- They play follow the leader with a jump rope attached to his chair
- He plays tag with the other kids; they run around with hula hoops and he touches the hula hoop with his foot
- He is using a computer now in addition to the communication device
- His mother said, "Power mobility has been wonderful for him and has made him very independent."
- She is just sorry they waited as long as they did to pursue power mobility
- They are also going to be putting a path in between their house and his cousin’s house next door so he can independently get to his cousin’s house.
- Found him to be an excellent driver
- He is capable of two switch driving but prefers 8-way scanning
- He now has the ability to participate more with computer use He has had an increase in communication since he started driving the wheelchair
- The team will try a joystick at his foot or other access methods when appropriate