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Case Study: 5 year old male with cerebral palsy

Supplier: Pride Mobility Products
19 March, 2014

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.

Mat Evaluation:

  • 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

Environmental Factors:

  • 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

Simulation:

  • 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.

Trial Results:

  • 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

Follow Up:

  • 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

Family Report:

  • 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.

Review:

  • 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