DavisMade - Home of the Standing Dani

Functional head control is a crucial component for enabling a child to enjoy quality interactions with playmates. Optimal head control enhances eye contact, depth perception and eye/hand coordination. When combined with functional range of motion of the upper extremities the child is better able to manipulate objects in his/her physical environment. When independent mobility is added to the mix, the possibilities become endless. Good head control requires the head be balanced on a properly positioned stabilized trunk. The trunk must be supported by a properly positioned and stabilized pelvis. Because the pelvis is the foundation that supports the entire upper body, it becomes obvious that the pelvic girdle is the most crucial anatomical structure to position when placing a child in standing. The following explanations describe what components are utilized on the Standing Dani® Wheelstand and how they are positioned to correct postural irregularities while enhancing desirable activities.

PELVIS

The posterior pelvic stabilizer (pelvic saddle) on the Standing Dani® Wheelstand comfortably stabilizes the child’s pelvis in the most desirable position for standing, making it the most important positioning component on the Standing Dani® Wheelstand. The pelvic saddle is rigidly attached to the spine of the prone board (in the front of the child) via a curved steel tube called a gooseneck. (Think of the prone board as a vertical post that is anchored to the ground and is located in front of the child.) The gooseneck fits between the child’s legs at the knees. It is the prone board upon which all the positioning components are anchored, including the pelvic saddle which allows for various height and depth placement of the pelvic saddle. When properly positioned the pelvic saddle should be vertical and comfortably fit the contour of the child’s bottom.

On either side of the pelvic saddle are attached straps with quick release buckles laced on the ends. Receivers for the buckles are anchored to the prone board in front of the child on either side of the hips. The anchors are independently adjustable both laterally and vertically for optimal positioning. Once the saddle straps are engaged to the anchors, they should traverse directly over the child’s greater trocanter to minimize lateral shifting at the hips. If, for instance, the child exhibits a tendency to shift the hips to the right, you would move the anchor points for the strap buckle inward and leave the left anchor wide to allow the hips shifting to the left. Once the pelvis is properly positioned and secured it is wise to do a quick check of the upper body (arms, head, and neck) to make sure that nothing is being pinched and the upper extremities are not restrained before addressing the lower extremities.

ABDOMEN

An anterior abdominal pad may be helpful for children that exhibit pronounced anterior/posterior pelvic tilt and/or anterior posterior pelvic rotation. The abdominal pad comes in various shapes and sizes. Various height locations allow for proper placement and various spacers allow for controlled pressure upon the abdomen for comfort. Multiple pads can be installed to disperse pressure over an even larger area. Wedges can be added to either side of the abdominal pad to minimize pelvic rotation. Custom fabricated pads may be necessary for accommodating implants (Baclofen Pump) and/or feeding tubes.

FEET

Once the pelvis is properly positioned and supported, proper foot placement, ankle/knee flexion (contractures) even leg length discrepancies require attention. The feet should be planted squarely with the shoulders with even distribution of the weight throughout the heel and ball of the foot. The foot plates are independently adjustable up/down, in/out, fore/aft. The foot plates can be enlarged for bigger shoes, they can be moved laterally for a broader stance and they can be staggered for leg length discrepancies. As a general rule, if the foot plates are widened or offset the kneepads should be offset as well. If mild knee contractures persist, accommodations may be made with foot placement and knee pad depth. It is important to note that the more bending at the knee, the more pressure is applied to the patella. If pronounced knee contractures persist, it may be necessary to vertically position the pelvis and trunk behind the knees and feet. This allows you to accommodate ankle/knee, and hip contractures below the stabilized pelvis in such a way that you can properly stack the trunk vertically and balance the head. A properly stacked trunk also allows for enhanced range of motion throughout the trunk and arms.

KNEES

Optimal positioning of the knee is in the 5° or less range of flexion with the feet aligned squarely under the shoulders. The knee pads on the Standing Dani® Wheelstand come in three sizes and they are designed to wrap around the knee joint with the center of the pad cut out so as not to apply pressure directly on the patella which may be uncomfortable for the child. The knee pads are generously padded and mounted to the prone board via spring steel brackets with lots of give. A wide variety of spacers are available for determining the proper depth of the knee pad and height adjustment is also possible. The spring steel brackets offer dynamic resistance while the soft padding encapsulating the knee area offers comfort. The spring brackets have memory to return the knee to the proper position when the child relaxes. Straps may be attached to the knee pads that wrap behind the knee joint when hyperextension of the knee is a concern. AFO’s should be worn if prescribed by the doctor when the child is standing in the wheelstand.

TRUNK

There are many factors to consider when positioning the trunk. Does the child exhibit good head control? Is there a curvature of the spine; scoliosis; lordosis; kyphosis? Does the child exhibit high, low or fluxuating muscle tone? Is involuntary spasticity present and how frequent; how severe? Does the child have a tendency to seizure? For many children with medical conditions such as Muscular Dystrophy or Spinal Muscular Atrophy, low muscle tone prevails. For these children, positioning components must also support the body by holding it up. For children with conditions such as Cerebral Palsy or Traumatic Brain Injury, involuntary spasticity, high and/or fluxuating muscle tone render conditions such as hemiplegia, triplegia, pronounced back extensor thrusting or asymmetric tonic neck reflex. Functional head control is often difficult. With these extreme conditions the positioning components must have enough flexibility with built in resistance to minimize the severity of bad postural tendencies. All prone boards have a padded chest support of some type, so does the Standing Dani® Wheelstand. Our chest pads come in three sizes with various configurations available.

DavisMade, Inc. offers a wide variety of interchangeable components with endless precise configurations available. At DavisMade, Inc. we acknowledge the fact that the rib cage is not parallel with the spine and/or abdomen, therefore, a wide variety of spacers are available for determining the proper depth of the chest pad and for wedging the chest pad to address conditions such as kyphosis (wedged at the top) or persistent trunk rotation in one direction (wedged on only one side only). The various chest pads on the Standing Dani® Wheelstand have the corners cut away at the top so as not to interfere with the range-of-motion of the shoulder. This affords the child easy access to his/her physical environment (toys), the activity platform and drive wheels. We also offer a chest pad with cut-out relief’s for developing females as well as a chest pad with a built in chin rest for children that have difficulty holding their head up. When a child exhibits pronounced kyphosis it may be necessary to install the chest pad upside down so that the top corners are no longer cut-out. Pressure can now be applied directly at the shoulder to counteract rounding of the shoulders.

Most prone boards offer nothing more than an extended chest pad for supporting the abdomen. Not the Standing Dani® Wheelstand. We offer a variety of abdominal support components with the same degree of adjustability as the chest pad. Conditions such as lordosis can be addressed with the correct placement of the abdominal support in relation to the pelvic saddle.

Most prone boards have some sort of lateral trunk controls, so does the Standing Dani® Wheelstand. What makes our lateral trunk controls unique is the fact that each side is independently adjustable, not only in relation to each other but in relation to the chest and abdominal and posterior pelvic supports as well. It is most desirable to anchor the lateral supports symmetrical to maintain good mid-line positioning of the trunk. Often times it is necessary to stagger the lateral trunk controls when a child exhibits a tendency to lean prominently to one side.

For instance, if a child leans prominently to the left, we would move the lateral trunk control on the left side up and/or in to minimize the leftward learning. We would also move to the right pelvic strap anchor inward to minimize the tendency for the hip to shift to the right as the trunk leans to the left. Not only would we tighten up the left trunk/right hip controls, we would also loosen the right trunk, left hip controls to allow for desirable (seldom done) leaning to the right to take place. The lateral trunk controls on the Standing Dani® Wheelstand greatly enhances the child’s ability to comfortably maintain good head control. They also enhance the range of motion of the upper extremities as the child no longer feels the need to use one arm as a prop to compensate for the unnatural tendency to constantly lean to one side.

For children that simply lean rearward too much we offer a simple floating posterior thoracic panel that is placed across the child’s back via a strap that anchors to the lateral trunk controls on either side of the child’s chest cavity. The floating posterior thoracic panel is amply padded for comfort. By itself, the posterior thoracic panel offers sensory input, making the child aware that rearward leaning is occurring and to lean forward.

HEAD

The Standing Dani® Wheelstand offers a full compliment of head systems to assist with even the most severe head control issues. We offer the only prone board on the market capable of providing both an anterior and posterior exoskeleton support structures. It is upon the prone board (anterior) that all of the positioning components are ultimately anchored. You may recall that the (posterior) pelvic saddle is anchored to the prone board in front of the child. That same gooseneck provides the foundation upon which all of the posterior trunk supports are anchored.

Nominal head control issues can often be contained by simply incorporating anterior head support or full circumference head support collars while the child is standing. Companies such as Danmar Products offer a variety of size and configuration of head support collars. If mild extensor thrusting is a persistent condition it may be necessary to utilize our posterior thoracic panel with post combination. The post attaches to the gooseneck on the pelvic saddle and provides a means of stabilizing the posterior thoracic panel. It is upon the thoracic panel with post that the head rest is attached when needed. The posterior thoracic panel is used to anchor state of the art head positioning components offered by the Whitmeyer and Stealth companies.

The activity platform or tray is an additional and essential positioning component on the Standing Dani® Wheelstand. We offer trays of various sizes and configurations. A typical tray is square and the back corners cut at 45° to allow for unobstructed access to the drive wheels for self propelling and they have a lip around the edges to prevent things such as pencils or crayons from rolling off. The tray attaches to the prone board via pushbuttons. It is height adjustable to allow the child comfort and stability, making activities such as play or school work easy to accomplish. When properly positioned, the child is able to stabilize the upper torso by bearing weight through the forearms. This allows the child to stand up taller, thus, making it easier for the child to hold his head up. We also offer trays that have elbow supports for children that need extra support. An easel that attaches to the tray may be purchased to hold books or other reading material for the child.

ACCESSORIES

A pushbutton attached handle is available for caregivers to help the child get around. The pull handle allows the caregiver or playmate to pull the child as one does a wagon. The pull handle is handy for long distances, steep inclines, rough terrain or whenever the care giver wishes to assist the child in movement. It is telescopic and, while retracted, it may remain attached to the prone board as the child self-propels. A vent try for carrying a portable ventilator and/or means for attaching an oxygen tank holder or IV pole is also available when needed with the Standing Dani® Wheelstand.