The matching of Assistive Tecnology in deveopmental age.

12/16/2016

Maria Teresa Agati, president C.S.R.

October 16th , 2015 - BeijngThe matching of Assistive Technology in developmental age.

Rehabilitation in Developmental Age: an holistic perspective.

Seminary

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残疾人辅助器具残疾人辅助器具残疾人辅助器具残疾人辅助器具

• 为了达到尽可能的最佳为了达到尽可能的最佳为了达到尽可能的最佳为了达到尽可能的最佳舒适度舒适度舒适度舒适度

• 为了提高自尊为了提高自尊为了提高自尊为了提高自尊• 为了尽可能的独立自主为了尽可能的独立自主为了尽可能的独立自主为了尽可能的独立自主• 为了方便护理者的护理为了方便护理者的护理为了方便护理者的护理为了方便护理者的护理• 为了防止二次伤害为了防止二次伤害为了防止二次伤害为了防止二次伤害

The matching of Assistive Tecnology in deveopmental age.

3

残疾人辅助器具残疾人辅助器具残疾人辅助器具残疾人辅助器具

• 为了达到尽可能的最佳为了达到尽可能的最佳为了达到尽可能的最佳为了达到尽可能的最佳舒适度舒适度舒适度舒适度

• 为了提高自尊为了提高自尊为了提高自尊为了提高自尊• 为了尽可能的独立自主为了尽可能的独立自主为了尽可能的独立自主为了尽可能的独立自主• 为了方便护理者的护理为了方便护理者的护理为了方便护理者的护理为了方便护理者的护理• 为了防止二次伤害为了防止二次伤害为了防止二次伤害为了防止二次伤害

The disability is the result of a complex relation between person and environment factors. An environment with barriers and without facilators limits the person’s performances;appropriate assistive technologies favour the best performances of the disabled person. The society may hinders the person’s performances both making barriers (e.g. inaccessible buildings) and not supplying facilitators(suitable technical aids ).

The suitable aid is a facilitator ; using the proper aid the profile ICF changes positively.

The matching of Assistive Tecnology in deveopmental age.

The main aim of a rehabilitative or assistive project is the achievment of autonomy or at least the maximum possibleautonomy of the person or of the family system where the personlives.Within the project it is necessary to define a program that identifies, from the beginning, interventions and essential assistivetechnologies for achieving the desidered goals.

The Italian Law says that the prescription of assistive technology is a fundamental part of the «prevention, care and rehabilitation programof persons with disabilities».

Aids facilitate the development of autonomy .

From the beginning the evaluation must address both impairments(mobility problems, cognitive impaiment)… and the degree of change of the individual profile of disability to define realistic and meaningful functional goals for the child and his family.

In the definition of the rehabilitation program, the assessment of the reachable autonomy level allows the choice of aids and orthesis notonly useful to compensate deficits, but uppermost to strenghten the remaining abilities .

Thus the aid will be perceived as facilitator of a sequence of positive results.

In developemental age the early use of proper aid facilitates the positive development of the person.

The matching of Assistive Tecnology in deveopmental age.

The Italian system identified the types of essential aids for rehabilitation and care of persons with disabilities. The National Health System provides the aids free of charge. TheMinistery of Health determines the list of aids to include in the Essential Care Level and these are provided to all disabled persons on prescription and under supervision of medical specialist of the National Health System (public). Other non-essential technologies are freely obtained by the disabled and the State gives some benefits (contributions, purchase tax reduction, etc.)

In Italy aids are part of the

essential levels of care

Different types of aids, specific for the developmental age, are included in the list of aids that the State provides for free, for eachmain function•Sitting to performe activities;•Moving or being transferred while sitting;•standing;•Walking;•Carrying out coordinated actions handling objectsthis allows to choose, for each function, the most suitable aid for each child, depending on the specific stage of development.

In developmental age the rehabilitative aids are the essencial ones that allow the main active functions .

The matching of Assistive Tecnology in deveopmental age.

In the Italian system the supplied aid can be replaced free of charge with another one more suitable at all times, either because the child has new sizes and because his skills changed . The doctor in charge for the Individual Rehabilitation Project just needs to evaluate and state the reasons for the required replacement.

To be effective the aids must accompany the changes in developmental age .

The aid is selected within anIndividual Rehabilitation Project.

Do not assess what a child cannot do, but what he could do, if he had a suitable facilitator (technical support) requires precise rehabilitationskills. It’s necessary: •Define a “Rehabilitation Project ” evaluating impairments and each child’s potentialities;•Identify the needed technical aids set , over time , to overcome the impairments and achive the best possible perfomances. The aids for each function must change to enable the adaptation to the morphologicalevolution and to comply with the functional improvement resulting from learning a sequenceof mobility strategies.

The matching of Assistive Tecnology in deveopmental age.

The term Childhood Cerebral PalsyIl (PCI) includes a group of non- progressive syndromescharacterized by motor disorders and posture, resulting from various diseases that affect the central nervous system (SNC) during the early stages of its development. The rehabilitation project is based on letting the child to follow the normal motor milestone development. This requires the preparation of postural and movement patterns of each position and walking for the next steps.

Aids must change to support the functional improvements resulting from learning a sequence of mobility strategies.

In Childhood Cerebral Palsy aids must CHANGE to accompany and comply improvement .

The distrophies are characterized by progressive degeneration of muscles, that creates a widespread muscle weakness. It appears in early childhood with walking problems that progresses to loss of autonomy .

The rehabilitation project considers the progressive use of orthesis and stabilizers for passive standing to counter the retractions, first simply walkers and then with trunk support up to the ultra-light wheelchair with postural system and the power wheelchair. A suitable aid equipment allows to mantain autonomy and emotional envolvement for long time,

In distrophies it is necessary to CHANGE the aids to extend the autonomy .

The matching of Assistive Tecnology in deveopmental age.

132/16/2016

The matching of Assistive Technology in developmental age.

Aids for motor disability, essentialfor a rehabilitation actionthat meets the different children’sneeds.

The free care assistance in the Italian system.

In the Italian system the assistive aids in the developmental age must have some mandatory features that make them

particularly adaptable .

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The matching of Assistive Tecnology in deveopmental age.

1) Simple systems , for activity with the upper limbs in sitting position. Suitable for schools, for less serious disabilities. With accessories to customize the aids according to the child’s need.

2) Adjustable postural systems to accompany the child’s growthand different requirements.

Necessary for a correct postural sitting, for children with severe motor disabilities. They must gradually fit dimensions and support necessities. They must be adjustable and completed with accessories:seat adjustable in depth and, backrest adjustable in height; thorax supports adjustable in

height and on the side; adjustable pelvis supports; headrests in different shapes; footrest adjustable in height, inclination, with whole or separated footrest: differentkind of belts……

Two kind of frames: indoor and outdoor. Purpose: grant a comfortable position; prevent muscolo modification skeletal.

For the sitting posture, two kind of aids.

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Simple systems, for activity with the upper limbs in sitting position.

The matching of Assistive Tecnology in deveopmental age.

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Adjustable postural systems to accompany the child’s growth and different requirements

1) Stabilizers for static in supine posture, to upright posture;2) Stabilizers for static in prone posture without support on the lower

limbs; 1) Stabilizers for static in prone posture, to upright posture;2)Stabilizers for static in prone posture, with indipendent adjustmentof the legs abduction;3)Moving stabilizers in upright posture.

Each type must be customizable with accessories to suit the individual needs.

For the passive standing posture…

Stabilizers for static in prone posture without support on the lower limbs

The matching of Assistive Tecnology in deveopmental age.

Stabilizers

1) Simple walking frame;2) Posterior walking aid;3) Stabilizer walking frame.

Each type must be customizable with accessories to suit the individual needs

In the child's life it is very frequent to begin the transition with a walker stabilizer and once the child acquires sufficient motor skills to move to a simple walker.On the contrary, the reverse path is necessary in case of a progressive disability.

For walking.

The matching of Assistive Tecnology in deveopmental age.

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walking aid

1) Postural stroller. The backrest should be adjustable; the foot rest adjustable in height; It must provide the supports and belts suitable to maintain a stable position.

1) Wheelchair.The choice must be made between different models. We should provide a tiltingwheelchair when he needs stability or an ultralight wheelchair when maximumautonomy and self-propelled possibilities must be favored.

3) Power wheelchair. To provide as early as possible, when the child has a cognitive ability that allowshim to drive safely. Stimulates autonomy and builds a strong and independentpersonality. In cases of progressive disability, it allows to extend the autonomy.

Transfers in sitting position.

The matching of Assistive Tecnology in deveopmental age.

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Transfers in sitting position

To know the child: what can he do today , what can he do tomorrow .

Knowing the requirements of each type of aid available, to choose the one that the child can use today, in view of what he can do tomorrow.

The matchingof Assistive Technology in developmental age.

The matching of Assistive Tecnology in deveopmental age.

In order to accompany properly all rehabilitation stages, you must have at least one model, in at least two sizes each, for each typ e of aid , complete with all accessories.

Important requirements:Adjustable dimensions , to suit the different children’s morphologies.Several accessories , to meet the different needs;Possibility to change upholstery and coverings to renew the look without high costs.

Group of necessary aids in a rehabilitation center for children in the developmental age.

AIDS FOR SITTING POSITION

Chair for activities 2 small and big size

Postural system 2small and big size , indoor and outdoor frame

AIDS FOR UPRIGHT POSTURE

Stabilizers for prone e supine posture

2Small and big size, complete of accessories

Adjustable stabilizers for prone posture

2Small and big size, complete of accessories

Stabilizers for prone posture with independentlegs abduction

1 Small size26

Aids for a developmental age rehabilitation center.

The matching of Assistive Tecnology in deveopmental age.

AIDS FOR WALKING

Simple walking frame 2 Small and big size

Rear walking frame 2 Small and big size

Walker 1 Adjustable single size

StabilizerWalking frame

2 Small and big size

AIDS FOR TRANSFERS

Postural buggy 1 Single size

Adjustable wheelchair 2Small and big size, complete of accessories

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Aids for a developmental age rehabilitation center.

Systems for the prone position without support on the lower limbs.

Soft supports for sitting and lying.

Mats and any other objects that support a comfortable and relaxing position for facilitate the movement.

Additional useful aids in a rehabilitation center f or developmental age.

The matching of Assistive Tecnology in deveopmental age.

The matchingof Assistive Technology in developmental age.

To know the child:

what can he do today , what can he do

tomorrow .

Thank you!

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