Medical equipment use in children with disabilities: A descriptive survey.

OBJECTIVE: To investigate the use of medical equipment by children with disabilities, the reasons for use, and prescribers of equipment. METHODS: A convenience sample. SETTING: Referral clinic for children with developmental conditions. PARTICIPANTS: Caregivers of children with motor disabilities completed an interview survey for children 0-21 years. RESULTS: 108 parents/caregivers reported 467 (mean=4.3 per patient) pieces of owned equipment. The mean age of children was 7.1 years (± 5.0), and 49% were female. The most common diagnoses were cerebral palsy (45%), 'Other' diagnoses including intellectual disability (19%), genetic abnormality (13%), spina bifida (13%), and neuromuscular diseases (7%). Survey participants described use of the following types of equipment: orthotics (82%), bath chair (37%), seating device (34%), stander (19%), augmentative communication devices (17%), walker (14%), and gait trainer (10%). Reasons for "non-use" of equipment included: outgrown (19%), not useful (14%), and child refusal (15%). Physicians were the sole prescriber for 15% of families, whereas physical or occupational therapists most commonly recommended new equipment (76%). CONCLUSION: Based on parental report, children with neuromuscular disabilities use most equipment that is medically recommended. The majority of equipment needs are identified by therapists. Pediatricians can benefit from additional expertise in the provision of medical equipment for children.

The floppy infant: evaluation of hypotonia.

Hypotonia is characterized by reduced resistance to passive range of motion in joints versus weakness, which is a reduction in the maximum muscle power that can be generated. (Dubowitz, 1985; Crawford, 1992; Martin, 2005) Based on strong research evidence, central hypotonia accounts for 60% to 80% of cases of hypotonia, whereas peripheral hypotonia is the cause in about 15% to 30% of cases. Disorders causing hypotonia often are associated with a depressed level of consciousness, predominantly axial weakness, normal strength accompanying the hypotonia, and hyperactive or normal reflexes. (Martin, 2005; Igarashi, 2004; Richer, 2001; Miller, 1992; Crawford, 1992; Bergen, 1985; Dubowitz, 1985) Based on some research evidence, 50% of patients who have hypotonia are diagnosed by history and physical examination alone. (Paro-Panjan, 2004) Based on some research evidence, an appropriate medical and genetic evaluation of hypotonia in infants includes a karyotype, DNA-based diagnostic tests, and cranial imaging. (Battaglia, 2008; Laugel, 2008; Birdi, 2005; Paro-Panjan, 2004; Prasad, 2003; Richer, 2001; Dimario, 1989) Based on strong research evidence, infant botulism should be suspected in an acute or subacute presentation of hypotonia in an infant younger than 6 months of age who has signs and symptoms such as constipation, listlessness, poor feeding, weak cry, and a decreased gag reflex. (Francisco, 2007; Muensterer, 2000)