Assistive Technology for Limited Mobility
There are numerous mobility aids, also called assistive technologies or assistive devices, to help with mobility limitations associated with cerebral palsy. Most assistive devices can be adjusted to fit a child’s height or can be specially made to fit their individual needs. Assistive devices greatly improve a child’s quality of life, as well as increase their independence.
Orthotic devices are braces worn externally that improve and strengthen mobility. There are two types of orthotic devices: accommodative orthotics and functional orthotics.
Accommodative orthotics are “over the counter” devices, which means they do not require a prescription or the approval of a doctor to be purchased. They are made in various sizes to fit anyone and can be bought in most pharmacies or sporting goods stores.Functional orthotics are specifically made for the individual.
An orthopedic surgeon, orthotist or physical/occupational therapist must evaluate a child’s condition to determine which functional orthotic device they need.
Functional orthotics are commonly used by those with cerebral palsy because they can be customized to fit the individual’s needs.
Orthotic devices come in hard, semi-soft or soft forms. There are many types of orthotic braces, including:
- Foot orthotics
- Ankle-foot orthotics
- Hip-knee-ankle-foot orthotics
- Knee-ankle orthotics
- Knee orthotics
- Spinal orthotics
- Trunk-hip-knee-ankle-foot orthotics
- Prophylactic braces (mostly used for knee injuries)
Walkers can assist children with cerebral palsy with their mobility issues, including problems with balance and posture. They also allow the child to bear weight on their legs, which increases bone strength and reduces the risk of fractures and osteoporosis.
There are several kinds of walkers available to help those with cerebral palsy, such as:
- Four-wheeled posture control walkers - These walkers have four posts with wheels on each. They can help children who have issues with balance and posture.
- Two-wheeled posture control walkers - These walkers also have four posts. The two posts in the front have wheels and the two posts in the back have rubber tips. The rubber tips on the rear posts allow for slower walking and more controlled movements, which is beneficial for those with severe balance impairments. These walkers also come with a built-in seat option to help with fatigue.
- Chest-support walkers - These walkers have four posts with wheels on each and a chest-support system to stabilize the trunk. They are ideal for children who do not have the ability to use their arms as needed for a traditional walker, but they can support their weight on their legs.
- Gait trainers - Gait trainers usually have four wheels and can help a child learn to walk properly, maintain momentum and build muscle skills. They have a built-in seat that allows the child to go from sitting to standing easily and often. They can come with a trunk component for those without the ability to support their own body weight while standing. They can also come with a harness to help improve posture, as well as head support attachments to improve head control.
- Suspension walkers - Suspension walkers are useful for those who have balance and posture issues and cannot support their full body weight while upright. These walkers have four posts with wheels on each and a suspension frame over head. A harness with a motorized lift attaches to the suspension frame, allowing the child to control how much weight they bear on their legs.
Walking Sticks and Canes
Walking sticks and canes are a cost effective option that provide extra balance and stability for those with milder forms of cerebral palsy. They are most helpful in patients with hemiplegia or monoplegia.
Canes and walking sticks can be adjusted to fit the child’s height. There are several types of canes, including:
- Non-folding canes
- Folding canes
- Quad or tripod base canes (these provide a better base for support)
- Folding seat canes (folds out to a seat to help with fatigue)
Crutches are often used by those with cerebral palsy who have the ability to ambulate, or walk, but need extra help with balance and stability. There are two types or crutches: underarm crutches and forearm, or elbow, crutches.
Underarm crutches are mostly used for short term disability, like a broken leg. Forearm crutches are used for long term or lifelong disabilities and more commonly used by cerebral palsy patients. These crutches attach to the forearms and help with balance, but are not meant to take on the user’s full weight.
Standers are devices that allow those with cerebral palsy to stand for short or extended periods of time. They help to support a person’s weight and provide stability while in the upright position.
There are many benefits of using a stander. Standers:
- Allow for weight bearing in the legs
- Facilitate bone and muscle development
- Reduce the risk of developing osteoporosis
- Encourage lower extremity use
- Allow for prolonged passive stretch of the hamstrings and hip flexors
- Improve bowel and bladder functions
- Allow the child to be at eye-level with peers, which helps them to connect mentally and emotionally with others
- Increase alertness
- Stimulate the development of motor coordination and head control
The following types of standers may be helpful to those with cerebral palsy:
- Sit-to-stand standers - As the name suggests, these standers allow children to move from sitting to standing and vice versa. These standers require some head and trunk control.
- Prone, supine and multi-position standers - These standers are commonly used by children with cerebral palsy. Prone standers position the child up right on their belly, while supine standers position them on their back. Standers that allow for both the prone and supine positioning are called multi-position standers.
- Mobile standers - Mobile standers allow children to stand upright and propel themselves forward. They come in a sit-to-stand option with pulleys to propel movement, a motorized option and a prone stander option with large wheels on each side. Some head control and upper body strength are required to use these standers.
- Active standers - These standers are relatively new and are similar to mobile standers. They come in a sit-to-stand option and either the arms, legs or a combination of the two can be used to move the device. This stander also requires some head control and upper body strength for independent use.
There are a number of lift options to help those who have difficulty transferring positions and supporting their body weight. Some lifts that are helpful with cerebral palsy include:
- Stair lifts - These carry patients up and down the stairs and are installed into the staircase to ensure safety.
- Ceiling lifts - These lifts run on a track system that is installed in the ceiling of the patient’s home. They help to transfer patients from device to device within a room or from room to room.
- Patient/pediatric transfer lifts - These lifts help to transfer patients from moving from one position or device to another. These lifts have numerous uses, like helping a patient out of bed and into a wheelchair or out of a wheelchair and into a car.
- Floor lifts - Floor lifts are also very versatile and can help with a number of lifting needs, like moving a child from room to room. They come in manual or power options.
- Sit-to-stand lifts - These lifts help patients move from a sitting position to an upright standing position. They are very useful for transfers and for toileting.
Wheelchairs are common mobility aids for non-ambulatory cerebral palsy patients. There are numerous design options and features to choose from, but there are two basic types: manual wheelchairs and power, or electric, wheelchairs.
Manual wheelchairs must be propelled by the user or pushed by another person, while power wheelchairs are motorized.
Manual wheelchairs are a more cost effective option, but they do require upper body strength to move them. There are several types of manual wheelchairs, including:
- Rigid frame wheelchairs - These chairs do not fold and take up more space. However, they are often lighter than other chairs and require less maintenance.
- Folding frame wheelchairs - Folding frame wheelchairs fold to save space and for storage purposes. These models are often heavier than rigid frame wheelchairs and are not as customizable to fit the patient’s specific needs.
- Reclining wheelchairs - As the name suggests, these wheelchairs recline to allow for more comfort. These chairs are similar in frame to folding frame wheelchairs, but these chairs usually require more maintenance.
Power wheelchairs are more expensive, but are more convenient for those who do not have the ability to propel a manual wheelchair. They’re also well suited for those who maintain an active lifestyle. These chairs come with many different features and options. They’re also very customizable to an individual’s needs. Electric wheelchairs come in rear wheel, front wheel or mid wheel drive and have a variety of different battery options.
It’s important to consider the following when buying a wheelchair:
- Type of wheelchair (manual or power) needed
- Where the wheelchair will be used (indoor, outdoor or both)
- Weight of the wheelchair
- How the wheelchair will be used (daily activities, outdoor activities, sport, etc.)
- How the wheelchair will be transported (a large vehicle and transport lift may be needed for heavier power models, whereas a folding frame chair fits easily in most cars)
- Seat width and height
- Seat cushioning
- Armrest preference (some are adjustable or removable)
- Leg and foot rest requirements
- Type of battery (if buying an electric wheelchair)
- Size and type of tire
- Cost and financing
Power scooters are an alternative to wheelchairs and are often cheaper than power wheelchairs. They’re great for use outdoors and for those who do not have the upper body strength to operate a manual wheelchair.
While power scooters are more compact than power wheelchairs, they’re more difficult to maneuver because of their longer design. They’re also not as customizable for day-to-day activities and can be difficult to transport because of their heavy weight.
Where to Buy Mobility Aids
In most cases, children with CP who have mobility limitations must first be evaluated by a qualified professional to determine which device fits their needs. The following professionals can help with choosing the proper mobility aids:
- Physical therapists
- Occupational therapists
- Orthopedic surgeons
- Assistive technology experts (orthotists, prosthetists, seating practitioners, etc.)
Most assistive devices can be purchased in stores or online through specialty retailers. Many orthotic devices and other mobility aids that must be customized may need to be specially ordered or fitted by a doctor, therapist or assistive technology expert.
To learn more about mobility aids, try downloading our free Cerebral Palsy Guide, which includes over 12 pages of in-depth information for children and parents of a child with CP.