Assistive Devices for Cerebral Palsy

Introduction

The information on this page has developed for you from the expert work of Roelie Wolting alongside the Enablement Cerebral Palsy Project and Handicap International Group.

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Introduction to Assistive Devices

Many children with Cerebral Palsy can be more independent with the help of (simple) equipment. Some children with Cerebral Palsy need (simple) equipment in order to prevent contractures and deformities.

Some Principles:

  • There is no one size which fits all
  • So: you will not find all the answers here. Be creative and find different ideas.
  • Discuss with the child and the family first: do not give people equipment because you think it is needed. Make sure the family wants to use it.
  • Children grow, so the equipment should grow with them.

Below are some photos of assistive devices that are not necessarily correct for the child:

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Wheelchair is far too big for him, but the grandmother, who is taking care of him is very happy with it, because she does not need to carry him
The chair does not support him enough: not helping to keep his head up, the knees are “falling” side-wards, the arms are turned inwards.
This is a very floppy boy; and reflects the reality. This picture was taken when trying to find a better chair and sitting position for him
Does not look as if she needs this much support;
This girl could sit independently; just needed a chair so she could put her feet on the floor; no need for a special chair.

Case Study

Roelie Wolting, our Cerebral Palsy expert, has reported on a Doctors Review of Assistive Chairs for children with Cerebral Palsy:

A doctor was doing research on the causes of disability in children. He was meeting a lot of children with Cerebral Palsy and their families. The children were usually lying on a mattress and did not have any assistive devices. The doctors wrote a project proposal for an Embassy in order to be able to provide all these children with special chairs specifically designed for Cerebral Palsy. He was granted the money and had the chairs made by a local carpenter. He then gave the chairs to the families and asked them to have the child sit in the chair because that is much better for the development of the child. After three years the doctor wanted to know what had been the impact of these chairs on the development of the children and their families so he visited all families again. He found that 95% of the chairs were not being used.

Here are some of the reason why they were not used:

  • The children could not sit comfortably in the chairs because they were not ‘custom made’. If a chair is not comfortable, nobody wants to sit on such a chair for hours.
  • The chairs were often too big for the small family rooms.
  • The doctor thought this would help the family but he did not discuss with the family about their needs and their priorities.
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Here is a picture of assistive chairs being distributed, a 'one size fits all.' This is still done in many countries today.

Assistive Devices for Children with Cerebral Palsy

You can find many ideas for assistive devices for children with cerebral palsy. One of the books to get ideas from is: Disabled Village Children Some of the chapters are listed below in additional resources.

The most important things to remember when looking at providing an assistive device for a child with cerebral palsy are:

  • That it fits the needs of the child and the family and,
  • It is made to measure for the child / it fits the child

Here are some ideas of different assistive devices from eating to walking. 

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Deep bowls can make it easier to get food onto a spoon Cups with cut outs can allow for easier drinking as the child does not have to extend their neck as much. Adaptive cutulrey makes it easier to hold and use. Cups with handles and lids make it easier to handle and avoid spilages if there is difficulty with motor control.
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Spoon with hand strap can help if there is difficulty with fine motor control and the child cannot grip efficiently Some form of rubber around the handle of the spoon can assist with grip. Non-slip mats under the plate can prevent the plate from moving around if there is difficulty with motor control.  Wedges under a child may help promote cervical extension and use their arms for play


Walkers

There are two types of walkers for paediatric use: anterior walker and the posterior or reverse walker.
The posterior walker in the majority of children with CP is the most appropriate as it provides the best gait pattern and is less energy consuming. Standard anterior walkers lead to increased weight bearing on the walker and increased hip flexion during gait. Choose them only in cases where extensor spasticity predominates. Children with spastic diplegia have problems with posterior balance and tend to fall backwards. In this case, prescribe a walker. The child who walks very slowly in a high guard position and falls backwards after a few steps will benefit from a posterior walker as an aid to improve his balance.

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Posterior Walker Anterior Walker

Conclusion

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Additional Resources

References