Rehabilitation Therapist Role Rehabilitation Therapist Role Includes occupational

Rehabilitation Therapist Role

Rehabilitation Therapist Role • • • Includes occupational therapists and physical therapists Assess a child’s physical capabilities and determine ways to improve a child’s interaction with their environment Often work with children who have involved positioning needs

Rehabilitation Therapist Role • • Individualized positioning guidelines if questions arise regarding how to position a child in a restraint for transportation Most rehab therapists are not CPSTs but important to involve them when working with children with complex positioning needs

Rehabilitation Therapist Role • • Primary goal of CPST rehab therapist is to provide family centered care to enhance participation in everyday activities by providing safe transportation options Safe transportation can be achieved through the use of conventional or adaptive/specialized restraints

Rehabilitation Therapist Role • Patient and family interview • Positioning assessment and intervention • Recommendations • Order equipment • Deliver equipment

Patient and Family Interview Occupational therapist interviewing patient and family

Patient and Family Interview The interview documents: • Diagnoses • Weight, height, and age • Positioning assessment • Number and location of passengers in vehicle • Current child restraint system • Type and year of vehicle • Installation information • Recommended equipment Interview form developed by OTs at Riley Hospital for Children and adapted to include necessary OT evaluation information

Positioning Assessment • High muscle tone • • Muscles are contracting more than normal, and muscles may feel very tight Low muscle tone • Muscles are contracting less than normal, and muscles may feel very loose

Positioning Assessment: Head Control Decreased head control • Head can fall forward, to the side, or back

Intervention: Decreased Head Control • • • Head pads Soft cervical collar or towel rolls (if allowed by manufacturer) Choose a seat that offers head support system

Positioning Assessment: Trunk Control Decreased trunk control • • Rounded back Falls side to side

Intervention: Decreased Trunk Control • • Towel rolls on both sides or one side of trunk Consider adaptive car seat with lateral positioning pads or supports

Positioning Assessment / Intervention • High muscle tone in lower extremities • • Legs can scissor, or cross Intervention • Foam abductor or towel roll between legs

Positioning Assessment / Intervention • Low muscle tone in lower extremities • • Legs can abduct (spread far apart) Intervention • • Towel rolls on side of hips Restraint with higher seat sides

Positioning Assessment / Intervention • • • Scoliosis • Harness may be looser on one side • May be an empty space behind child More padding on one side compared to the other for optimal support Choose a seat that offers increased positioning options or adjustments Roosevelt harness adjusts at hips to accommodate for asymmetry

Positioning Assessment / Intervention • Anterior/posterior pelvic tilt • • Towel rolls under knees to help keep pelvis positioned back in seat Transfer child into seat in an already flexed position to inhibit tone

Recommendations Trial various adaptive / specialty seats • Meets child’s needs • Meets family’s needs

Recommendations Take measurements • • Head circumference • • Leg length (seat depth) Chest circumference Seated waist circumference Hip to shoulder height (seated torso height) Shoulder width

Ordering Equipment • Determine is child restraint will fit in vehicle with other passengers, additional child restraints, etc. • Order equipment • Obtain referral/order from MD (prior to appointment) • Write letter of medical necessity (LMN) • Agree upon vendor/supplier with family input • Vendor receives funding approval and orders child restraint system

Delivering Equipment • • • Fit and adjust restraint system Train patient and family Assist with installation of child restraint in family vehicle • • May need to arrange for heavy duty tether installation Family return demonstration of installation Mobility specialists installing heavy duty tether anchors

Questions?