Knowledge of orthotic and assistive devices is an important component of rehabilitation practice.
Having an understanding of normal upper and lower body movement is fundamental for appropriate recommendation and fabrication of an orthosis. Likewise, clinicians’ understanding of normal communication behaviors and language abilities is a prerequisite to the recommendation of an augmentative and alternative communication device.
An orthosis may be defined as any device, applied to the external surface of an extremity, that provides better positioning, immobilizes, prevents deformities, maintains correction, relieves pain, mobilizes joints, exercises parts, or assists or supports weakened or paralyzed parts (19). Orthotic devices may be classified as static or dynamic, depending on the functional need and ability of the extremity. A static orthosis is rigid and supports the affected area in a particular position, whereas a dynamic orthosis allows for some movement. They can be used to substitute for absent motor power, allow optimal function, assist motion, provide for an attachment of devices, and supply corrective forces to increase directional control (18). Several variations of upper and lower extremity orthoses are available that have been proven to increase function for the user.
Assistive technology includes “... products, devices or equipment, whether acquired commercially, modified or customized, that are used to maintain, increase or improve the functional capabilities of individuals with disabilities...,” according to the definition proposed in the Assistive Technology Act of 1998. These may include specialize augmentative and alternative communication equipment, such as speech-generating devices, off-the-shelf computer mouse alternatives (such as a trackball), or software that provides special features. Some features that were first used primarily by people with motor and keyboarding disabilities are now included in standard computer operating software (such as speech recognition software).
The key to identifying the most appropriate orthosis or augmentative communication device is being creative and having a proper understanding of the anatomical, biomechanical, and communication needs of the patient and being sensitive to the patient’s (or the parents’) preferences and desires.
The pediatric population adds a further challenge. Early development is heavily based on fine and gross motor skills. Infants and children use these skills to explore and manipulate their environment. Studies have indicated that the inability to master the environment independently may lead to decreased socialization, learned helplessness, and a delay in normal development (1,5). Therefore, an orthosis should allow for and assist in the growth of the child.
Several team members are involved in prescribing, fabricating, and fitting the orthosis, augmentative communication system, or computer-access option. The physician, often with input from the therapist, provides patient assessment and a prescription of the orthotic device (21). The therapist and/or orthotist are instrumental in its fabrication and fitting. A team including a speech-language pathologist, an occupational therapist, a special educator, and rehab engineering is often beneficial for augmentative and alternative communication device recommendations. Lastly, the patient and family play an important role in its acceptance and usage. If the device is cumbersome and difficult to manage, it will be rejected and find a home on the top shelf in the closet (3).